key: cord-0006142-x9drxbhk authors: nan title: ECTES Abstracts 2016 date: 2016-04-04 journal: Eur J Trauma Emerg Surg DOI: 10.1007/s00068-016-0658-5 sha: 29d5e0a8748ca68d10f3de29c64c017e7568f368 doc_id: 6142 cord_uid: x9drxbhk nan It is a great honor to welcome you to the 17 th European Congress of Trauma and Emergency Surgery from April 24-26, 2016 in Vienna, Austria. is the leading theme of this congress. Colleagues of all national ESTES member societies in Europe as well as from other continents will share their knowledge and experience during these three days. Instructional lecture courses, keynote sessions, mini-battles, case presentations and poster sessions will present the state of the art in emergency and trauma surgery. Distinguished speakers will share their personal experiences in invited lectures at noon. Also, in order to intensify the cooperation and understanding within the ESTES community we have prepared several sessions involving more than one section, e.g. • Mangled extremity in war, disaster and civil • Interface between trauma and emergencies • Cross border rescue • Interface: prehospital & inhospital • Nightmare session … and many more For the first time, an EBSQ trauma exam will be held in Vienna on April, 23rd, 2016. Furthermore, a Modular Ultra Sound Estes Course (MUSEC) will be offered. The 17th European congress of Trauma and Emergency Surgery (ECTES) is organised by the European Society for Trauma and Emergency Surgery (ESTES) in close cooperation with the Austrian Trauma Society. Vienna -I am sure you know our keywords like Schönbrunn, Mozart, Apfelstrudel and the Opera. But, you may be certain, Vienna offers much more and will fascinate you with culture, lifestyle, hundreds of restaurants and lovely places to relax. ''Vienna waits for you'' -as Billy Joel sang in 1977… I am glad to be a part of this congress and it will be my pleasure to welcome you to my hometown Vienna! Prof. Dr. Richard Kdolsky Congress president S11 Introduction: Recent literature provides only few prospective studies addressing the pain component when performing SLAP repairs, although it is well known that patients complain of pain especially after refixation of the biceps tendon anchor. The aim was to prospectively evaluate the chronological sequence of function and pain after arthroscopic isolated type II SLAP repair. Material and methods: Outcome measures were assessed using the Individual Relative Constant Score (CS indiv ), the American Shoulder and Elbow Surgeons (ASES) Score, the Visual Analogue Scale (VAS), and the Short Form 36 . Data was collected preoperatively as well as 3, 6, 12 and [24 months postoperatively. Results: Twelve patients with an average age of 33.9 years (range 22.8 to 56.6 years) underwent arthroscopic repair of isolated type II SLAP lesions. The mean follow-up was 41.9 months (range 36.1 to 48.4 months). Six months after surgery, there was a statistically significant improvement of function according to the CS indiv (p = 0.004), the ASES Score (p = 0.006), and the SF-36 subscale ''physical functioning'' (p = 0.014) and a statistically significant decrease of pain according to the VAS (p = 0.007) and the S12 Introduction: During open reduction and internal fixation of a midshaft clavicle fracture it is not uncommon that the osteosynthesis plate has to be bent perioperatively to fit the curvature of the clavicle. This takes time and is suboptimal in the sterile environment. To avoid the need for bending the plate we developed a method where the plate is preoperatively bent according the curvature of a plastic replica of the fractured clavicle, created using rapid prototyping. The aim of this study was to test this method. The hypothesis was that this will shorten plate handling time and improve surgical workflow. Material and methods: A non-blinded, prospective cohort study was performed. The control group received conventional operative treatment using standard precontoured clavicle locking plates. The intervention group received operative treatment by means of described method. In both groups four specific proceedings were timed. Results: Eight subjects were included in the control group and seven in the intervention group. A plate handling time reduction of 2:04 minutes (p:0.563) was measured, however this time reduction was associated with a lengthened average surgery time of 9:22 minutes (p:0.132). A good integration of the method in the workflow of the surgical team was accomplished. Conclusion: It is possible to implement this rapid prototyping method in fracture treatment. No significant time reduction can be stated, 1 1st Unit General Surgery Department of Emergency, Papa Giovanni XXIII, Bergamo, Italy, 2 Papa Giovanni XXIII Hospital, Bergamo, Italy Introduction: Clinical Pathways (CP) have been demonstrated to improve patient management as well health resources. Material and methods: the CP, based on EBM, has been developed according to the Institutional rules. The analysis has been done by measuring the result indicators provided before the release of the CP. When comparable, the results were matched to pre-CP observation. TG13 diagnostic criteria for ACC were used. A questionnaire to test the acceptance of the CP was administered to surgeons Results: 134 patients with biliary disease were observed mean age 60. 3 yo, 64.4 % males; 65 patients (48.5 %) reached the diagnosis of ACC: 48 (73.9 %) were admitted at the first presentation, 12 were discharged home but 5 (41.6 %) required a second ED into 72 h and 3 (25 %) were admitted. Among admitted patients (n 51), 29 (57 %) were operated on at the index admission while the remnant were discharged home: the 85 % because high risk patients and 15 % for refusal of the operation. Admission to Surgical Unit correlates with a higher rate of operation (58.5 %). Among surgical patients we observed 1 readmission for abdominal pain requiring observation (IVB Clavien complication). The comparison to pre-CP on ACC shows significant decrease in the rate of delayed operation for patient admitted to the Surgical Unit, a significant decrease in the rate of controversies among surgeons on preoperative biliary tree clearance and on surgical timing Conclusion: Despite some positive results, in our hospital, there is a strong need for continuous sharing the ACC CP in order to improve all the aspects of the ACC patient treatment Introduction: The introduction of the major trauma network in England 2012 has resulted in a 63 % improvement in probability of survival from trauma [1] . However orthoplastic services at major trauma centers were found to be inadequate by the national peer review [2] . The impact of the major trauma network on plastic surgery operative workload has not been quantified. Such information is essential to help guide workforce provision and postgraduate training. Material and methods: A prospective, multicentre study was performed. All major trauma patients, as defined by the Trauma and Audit Research Network (TARN), presenting to eleven major trauma centers (MTCs) in England over a set three-month period were identified. Operative data were recorded for those requiring plastic surgery. Results: A total of 2,056 patients were admitted to 11 MTCs within the study period. 53 % required surgical intervention, of which 242 (22 %) required plastic a surgery procedure. A total of 902 plastic surgical procedures were performed. Wound debridement accounted for 27 % and free-flaps for 4 %. The most frequently operated on body regions were the upper (17 %) and lower (27 %) extremities. Consultant plastic surgeons performed 26 % of the procedures. Conclusion: Major trauma is a significant yet often unrecognised aspect of the plastic surgeon's workload. This data demonstrates that the plastic surgery skill set is required in this patient population. To ensure on going quality care, enable workforce planning, and specialist training needs the important role which plastic surgery plays in the management of major trauma patients must be acknowledged. On behalf of POW-MTC collaboration. (1) . Injury scores have been developed to facilitate trauma stratification, clinical decision-making and research. Trauma registries in LMIC depend on adapted trauma scores that do not rely on investigations that require unavailable material or human resources. We sought to review and assess the existing trauma scores used in pediatric patients. Our objective is to determine their validity, setting of use, outcome measures and criticisms. We believe there is a need for further development of a truly adapted trauma score for pediatric patients in low resource settings. Material and methods: A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. We constructed a peer-reviewed search strategy in collaboration with a senior hospital librarian. Multiple databases were searched, including sources of gray literature. Articles were selected based on predefined inclusion criteria by 2 reviewers and underwent qualitative analysis. Results: All scores identified are suboptimal for use in Pediatric patients in low-resource settings based on various factors. An ideal score should be easy to calculate using point-of care data that is readily available in resource limited settings, and can be easily adapted to the specific physiologic variations of different age groups. Conclusion: There appears, therefore, to exist a gap in our ability to simply and reliably estimate injury severity in pediatric patients and understand their probability of poor outcome References: 1. Mock C, Abantanga F, Goosen J, Joshipura M, Juillard C. Strengthening care of injured children globally. Bulletin of the World Health Organization. 2009; 87(5) :382-9. Disclosure: No significant relationships. Surgery, College of Medicine, UAE University, Al-Ain, United Arab Emirates, 2 Surgery, Fujairah Hospital, Fujairah, United Arab Emirates Introduction: ATLS is one of the most common courses taught worldwide. We aim to present the lessons we learned over a decade from teaching ATLS courses in the United Arab Emirates in educational, clinical, research, and international collaboration areas. Material and methods: We have started teaching ATLS in 2004. More than 2000 doctors have been trained in three centres. More than 85 % were residents and specialists (1) . They stand in the first line of managing multiple trauma patients. Results: Teaching ATLS in UAE was helpful in increasing the knowledge of our doctors and develop and update their management plans. It was made obligatory for all doctors who manage trauma patients in most of our major hospitals to attend this course. Our ATLS training had a major impact on other countries in our region as it helped to start ATLS training in Egypt, Syria, India, and Iran. Furthermore, it helped us to perform high level educational research and its value using evidence based approach (2) . Conclusion: ATLS courses are very useful for doctors who treat multiple trauma patients although they may not alone improve trauma death rates and disability. Our experience supports its use and spread worldwide. of older patients treated was higher in Level III (38.4 %) than in higher ranked trauma centers. Injury severity (ISS 17.7 Level III vs. 23.4 Level I) and the rate of severe head injuries (AIS-Head C3: 30.0 % in Level III vs. 60.7 % in Level I) increased accordingly. Independent of the supply stage, the observed mortality matches the expected according to RISCII (Level III 18.5 %vs. 17.5 %; Level I 30.7 %vs. 28.1 %) . Conclusion: The allocation of elderly patients to the different levels of care follows predominantly the entity and severity of injury. However, patients [65 years are mostly treated in local and regional centers compared to younger patients. Nevertheless, the standardized mortality ratio indicates a good quality of care in all health care levels. References: Disclosure: No significant relationships. Introduction: The elderly patients complicated with polytrauma and severe pelvic fractures are presumed to present with extremely severe conditions [1] [2] [3] [4] . The aims of this study are to describe the clinical features of these patients in comparison with younger adult patients. Material and methods: This is a retrospective cohort study at a single institution. Patients with pelvic AIS score of 3 or more, and with at least 2 body lesions of AIS score of 3 or more were included. Fifteen patients older than 65 years (group G) and 13 of younger adults (group A) were identified. We compared the data of two groups and evaluated factors related to severity that is defined as receiving massive transfusion (MT) and/or death. Results: Mean age was 75 ± 7/38 ± 11 (group G/A). Mean injury severity score was similar in two groups. Differences among two groups in systolic blood pressure, heart rate, shock index, Hb level, PT-INR, and base deficit were not significant. Two patients in group G and 1 in group A died. Over two third of group G demanded MT. The number of patients receiving MT was significantly greater in the group G. In group G, hypotension, anemia, coagulopathy, base deficit [ 2, extravasation on CT scan were predictors for severity. In group A, shock index [1 showed relationship with severity. Conclusion: Two-thirds of geriatric polytrauma patients with pelvic fractures demanded MT, and it showed a significant difference from younger adult patients. The severity of these patients could be predicted by hypotension, abnormality in a blood test, and extravasation on CT scan. Trauma and Orthopaedics, Sandwell General Hospital, West Bromwich, UK Introduction: Diabetes has become an increasingly common comorbidity [1] . Orthogeriatric neck of femur fracture patients more commonly present with this co-morbidity. Diabetic patients are thought to pose a higher risk of post-operative mortality and morbidity due to diabetic control. There is little previous literature detailing this [2] . We aimed to assess relative mortality of all operated orthogeriatric diabetic neck of femur fracture patients for an orthopaedic centre in Birmingham, UK. Material and methods: 6 months of operations identified 43 diabetic patients (mean age 78.9). Diabetic control (HbA1 c ) and comorbidities (generally classified to cardiovascular, respiratory, vascular, neurology, gastrointestinal, renal, ophthalmological, and malignancies) were recorded. Mortality from the operation was recorded at 30 days, 3, 6 and 12 months. Results: 30-day mortality rates were equal between non-diabetic and diabetic patients (9.3 %), but above national average (8.2 %) [3] . 1-year mortality was higher in the non-diabetic population (30. 2 % vs. 11.6 %) . No significant difference between number of co-morbidities or age of patients. There was a significant difference in renal function (creatinine) between diabetic and non-diabetic deaths (mean non-diabetic 88, diabetic 115, p = 0.007). Type of prosthesis had no impact. Diabetic patients who died had a significantly higher age than those who survived (mean alive 76.2, dead 91.3, p = 0.027). There was no significant difference in co-morbidities (p = 0.656), HbA1 c (p = 0.123), or renal function (p = 0.193). Conclusion: We evaluated the perception that diabetes increases post-operative mortality in an orthogeriatric neck of femur fracture population. Diabetic patients are not at higher risk of mortality, but elderly diabetics have a higher mortality risk than their younger diabetic counterparts. References: 1. Diabetes: Facts and Stats May 2015, Diabetes UK, https://www.diabetes.org.uk/Documents/Position%20statements/Facts %20and%20stats%20June%202015.pdf. 2. 'Mortality after hip fracture in diabetic patients ', 2011, Karakaya J, Exp Clin Endocrinol Diabetes, 119 (7) Especially in the subgroup of geriatric trauma victims, little is known about the drivers for infectious complications. The objective of this study was to characterize the burden of all-cause infections in the severely injured elderly. Material and methods: Cohort study of consecutive geriatric trauma patients. Setting: Level-I Trauma Center. Elderly trauma victims ([60 yrs) with ICU admission following resuscitation were included. Data collection (1-12/2013 ) included patient demographics, comorbidities, injury mechanisms/characteristics (AIS; ISS, NISS), baseline physiology, objective score systems (e.g. SAPS II) and therapeutic interventions (e.g. vasopressor use, antibiotic coverage, organ replacement therapy). Infections loci were documented according to CDC/ACS: Bacteremia, respiratory, urinary tract, vascular catheter line, wound and surgical site infection. Furthermore, microbiological findings and resistograms were evaluated. Statistical analyses were performed with SPSS statistics (IBM, Version 21). Results: There were no significant differences in age (mean 75.6 ± 9.2 years; p = 0.12), sex, injury severity (mean ISS 23.9 ± 9.3; p = 0.33) and objective scores (SAPSII) between patients who developed infection (39 %, n = 14) and those who did not (61 %, 22). There were 9 respiratory, 5 bloodstream, 2 SSI, and 2 urinary tract infections. A high number of ''exotic'' or resistant pathogens, and polybacterial infections (mean 3.0 ± 1.7) were identified. ICU stay was prolonged in septic patients (5 vs. 17 .5 days, p = 0.001). Regression analysis identified hemodynamic instability at ER admission as major independent risk factor for infectious complications (OR 20.8, . Conclusion: Infectious complications occur frequently in elderly trauma patients and must be considered as major burden for patients and society. Introduction: Increasing number of orthogeriatric patients with proximal femur fracture makes co-managed care more important for the outcome than fracture treatment alone. Source of major complications are infections associated with diminished immune response system in geriatric population. Infections are associated with in-hospital delirium. One of the most frequent is urinary tract infection. Do we have to wait and treat urinary tract infection or is it better to treat bacteriuria during the perioperative period? Material and methods: 20 consecutive patients with proximal femur fracture were included in the study. At the time of admission urine was taken for analysis. If there were nitrates, leukocytes or bacteria in basic urine analysis, urine was sent for further microbiological analysis and immediate treatment with Sulfametoksazol/Trimetoprim was initiated. Incidence of further delirium and infections was analyzed. Results: 10 % of patients had no bacteriuria at the time of the admission. With 25 % of patients there were nitrites and numerus bacteria present at the time of admission. Later microbiological testing was positive with these patients. In 65 % of patients there was either small amount of bacteria or leucocytes present in these microbiology was positive in 54 %. Post-operative delirium developed in 15 % of patients. Urosepsis developed in one patient without bacteriuria at the time of admission. No surgical site infections or symptomatic infection was present where antibiotic treatment was initiated. Conclusion: Early treatment of bacteriuria and urinary tract infection may reduce the level of post-operative delirium. New guidelines for treatment of bacteriuria with orthogeriatric patients may be needed to reduce post-operative delirium and infection-rate. reperfusion. Blood samples were taken at baseline, end of resuscitation (EOR), 24 and 48 h after shock and survival was followed for 28 days. Results: APOSEC treatment modulated the immune response reflected in IL-10 (decrease by 26 % at EOR) compared to vehicle group (p \ 0.01). Changes in IL-6 and MCP-1 were not different between groups. APOSEC attenuated apoptosis reflected by plasma histone release up to 24 h (p \ 0.003). Cell injury assessed by lactate dehydrogenase was 40 % decreased by APOSEC treatment 24 h post shock (p \ 0.05). HTS-induced liver injury determined by plasma alanine aminotransferase was 1.6 and 1.5 fold higher in vehicle compared to APOSEC group at EOR and 24 h respectively. The 28-day mortality (25 %) was prevented by APOSEC treatment (100 % survival). Conclusion: Here we show for the first time that APOSEC supplemented resuscitation ameliorates the TH-related inflammation, apoptosis, cell and organ injury, and prevents TH-induced long term mortality in rats. Introduction: Humans are able to compensate for significant blood loss with little change in traditional vital signs, limiting early detection and intervention. We hypothesized that an algorithm, which monitors subtle compensatory changes in pulse oximetry waveforms (PPG) caused by acute changes in central volume, would accurately differentiate asymptomatic and symptomatic humans who are bled. Material and methods: Men/women, 18-55 years, underwent stepwise (*333 ml aliquot) removal of 20 % blood volume (males 15 ml/kg; females 13 ml/kg). PPG waveforms were processed in realtime by a computational algorithm that calculated each subject's compensatory reserve index (CRI). CRI is a physiological measure of compensation related to changes in central volume. A CRI of ''1'' represents supine normovolemia and ''0'' represents the circulatory volume at which hemodynamic decompensation will occur; values between 1 and 0 are estimates of the proportion of reserve remaining (e.g. CRI = 0.5 implies 50 % compensatory reserve remaining before decompensation). Withdrawn blood was re-infused at the end of each experiment. Results: 42 subjects (24 men/18 women). 3 had corrupted data. 32 subjects achieved maximum blood loss volume and were never symptomatic: baseline CRI = 0.9 +/-0.07 and lowest CRI = 0.6 +/-0.17 at maximum blood loss. 7 subjects became symptomatic and collapsed (SBP \80): baseline CRI = 0.9 +/-0.08 and lowest CRI = 0.15 +/-0.08 at maximum blood loss. The symptomatic subjects were rescued with saline/stored blood. Statistics (alpha 0.05 range) for CRI sampled in asymptomatic versus symptomatic subjects at baseline and maximum blood loss. Conclusion: The Compensatory Reserve Index (CRI) exploits information present in the PPG waveform to trend individual-specific, real-time compensatory changes associated with acute blood loss from normovolemia to collapse. References: 1. VA Convertino, J Mulligan, GZ Grudic, SL Moulton. J Appl Phys 2013; 115 (8) Introduction: Severe injuries are associated with profound systemic implications on the immune response, which increases susceptibility to acute respiratory distress syndrome and infections. The interleukin-1 receptor family member soluble ST2 (sST2) is secreted by lung tissue and binds to interleukin-33 (IL-33), thereby acting as a ''decoy receptor'' counteracting its pro-inflammatory potential. With this study we sought to investigate the potential involvement of this pathway in immunosuppression and pulmonary complications observed after severe injuries. Material and methods: Therefore, we included polytraumatized patients admitted to our level I trauma center in this study. Blood withdrawals were performed at admission and 24 to 48 hours later and levels of IL-33 and sST2 were evaluated using ELISA technique. Results: Our study population consists of 130 patients with a mean injury severity score (ISS) of 32. ARDS was present in 42 patients (32.1 %), while pulmonary infections manifested in 41 patients (31.3 %). ARDS was associated with higher IL-33 serum levels on both time points (1:5.65 vs. 8 .15 pg/ml, p \ 0.01; 2:3.38 vs. 5.42 p \ 0.01). In patients suffering from pulmonary infections plasma levels of sST2 were significantly increased at the 2 nd measurement (2083.38 vs. 4569.78, p \ 0.01). Soluble ST2 was elevated at the follow-up measurement (2580.51 vs. 16015.21 pg/ml, p \ 0.05) in non-surviving patients. Conclusion: Our data suggest involvement of the IL-33/ST2-pathway in pulmonary complications commonly seen after severe injuries. Here presented results indicate the potential utility of IL-33 and sST2 as a biomarker for mortality and pulmonary complications in these patients. References: Disclosure: No significant relationships. A. El-Menyar 1 , H. Al-Thani 2 , H. Abdelrahman 2 , R. Peralta 2 , M. Ellabib 2 Introduction: We aimed to study the implications of serum Troponin and outcomes in traumatic brain injury (TBI) patients in the absence of cardiac injury. Material and methods: A retrospective analysis was conducted for TBI patients admitted between [2010] [2011] [2012] [2013] [2014] . Patients were divided into 2 groups according to the serum Troponin (Group 1; negative vs Group 2; positive). Results: Over the study period, we identified 805 TBI patients with a median age of 28 years. MVCs were the main injury mechanism in group 2 (51.8 % vs 38 %, p = 0.01). Ejection from the car was frequent in group 2 (p = 0.005). Age and chest AIS were comparable in the 2 groups. Admission blood pressure and GCS were lesser in group 2 (p = 0.001). Mean ISS (28 ± 10 vs 21 ± 9), head AIS (4.04 ± 1.1 vs 3.7 ± 1.0) were greater in group 2(p = 0.001). Skull fracture, brain edema and diffuse axonal injury were significantly more prevalent in group 2. Brain contusion, and subdural and extradural hematoma, subarachnoid and interventricular hemorrhage were comparable in the 2 groups. Pneumonia and sepsis rates were higher in group 2 (p = 0.001). Median ventilatory days, hospital and ICU length of stay were prolonged in group 2 (p = 0.001 for all). Overall mortality was 24 % with a higher proportion in group 2 (36 % vs 11 %, p = 0.001). On multivariate analysis, positive troponin was independent predictor for mortality (OR 2.71; after adjusting for ISS, GCS and head AIS. Conclusion: TBI patients with positive serum troponin has a 3-fold increase in mortality and prolonged hospitalization in the absence of traumatic cardiac injury. The implications of positive troponin among TBI need further assessment. References: Salim A, Hadjizacharia P, Brown C, et Systemic IL-6 levels during the first 10 post-injury days were determined. P-value \ 0.05 was considered statistically significant. Results: Eighty-six female and 257 male TP comparable in age and ISS were included. Abbreviated Injury Scale (AIS) C3 of chest and abdominal body regions were significantly more prevalent in male vs. female TP (Chest: 51.02 % vs. 36.05 %, Abdomen: 19.84 % vs. 10 .47 %, p \ 0.05). Female TP had significantly lower SIRS and sepsis rates (SIRS: 53.31 % vs. 40.70 %, p \ 0.05; Sepsis: 19.46 % vs. 6 .98 %, p \ 0.05). On post-injury days 1 and 2 IL-6 was significantly increased in male TP (d1: 363.9 ± 72.58 vs. 163.7 ± 25.98 pg/ml; d2: 194.3 ± 31.38 vs. 114.3 ± 17 .81 pg/ml, p \ 0.05). There were no further significant gender-based differences in IL-6 levels during the later post-injury course. Conclusion: This study indicates that early increased systemic IL-6 levels may contribute to higher susceptibility for SIRS and sepsis development in male compared to female TP. References: Disclosure: No significant relationships. Introduction: 10 % of multiple injured develop sepsis during their hospital stay, 18.2 % of them die. The objective of our study was to evaluate the impact of exogenous leptin, related to the presence of IL-6, in an animal model that simulated the processes referring to trauma patients. Material and methods: Following the same scheme 69 wild type and 63 IL-6-/-mice were evaluated separately in three models each subdivided into three groups, the 2Hit-model (first hit: standardized closed fracture using a blunt guillotine, hemorrhage by orbital plexus puncturing; second hit: cecal ligitation and puncture two days later), the 1Hit-model (first hit and laparotomy) and the Sham-model (laparotomy). In the three models equivalent tests series were performed, applying recombinant leptin in two different doses to the Leptin2-groups (5 lg/g body weight) and the Leptin1-groups (2.5 lg/ g body weight), respectively, whereas a saline solution was administered to the Vehicle-groups. All animals were exsanguinated by direct cardiac puncture six days after the test started. Results: Our test series revealed a dose-dependent immunomodulatory effect of exogenous leptin by influencing the immunologic pathways corresponding to patient's medical condition. Whereas the lethality rate of sepsis significantly decreased in wild type mice (2HitVehicle-group: 36.4 %, 2HitLeptin1-group: 25 %, 2HitLeptin2group: 0 %), it increased in IL-6 knockout mice (53.8 %, 83.4 %, 100 %). Conclusion: Preventive leptin administration to trauma patients seems to have no negative impact on their medical condition. Leptin might be a therapeutic agent for the prevention or treatment of sepsis after initial trauma. References: Disclosure: No significant relationships. Introduction: Tension pneumothorax (TPT) is a significant cause of potentially-preventable mortality following trauma, occurring in up to 5.4 % of pre-hospital trauma patients [1] . Decompression by needle thoracostomy (DNT) remains widely-advocated, most notably by the most recent ATLS guidelines [2] , but is associated with iatrogenic morbidity and a reported failure rate of 38 % [3] . Given its controversial role, we performed a systematic review of the published literature relevant to DNT for TPT. Material and methods: We searched CENTRAL, MEDLINE, EMBASE, and trial registries from inception to August 2015, including any randomised controlled trials(RCTs) or observational studies in which the effectiveness and safety of DNT to treat tension or simple pneumothorax was evaluated or compared with any other intervention. Study selection, qualitative assessment using GRADE methodology [4] and extraction of relevant data were performed independently by the review authors, with disagreements resolved by an additional review author. Results: 47 papers were included in this review -7 case series, 32 cohort studies, 8 case reports and no RCTs. Overall, the quality of evidence was low, ranging from moderate to very low. The quoted effectiveness of DNT ranged from 40.7 % -85.3 %. The existing literature describes several complications following DNT, including failure to reach the pleural space, catheter dislodgement, lumen obstruction, and tissue/vessel injury. Conclusion: Evidence quality is poor with regard to the effectiveness of DNT. Continued use of this procedure as a first-line intervention may delay definitive treatment and lead to increased patient mortality. In the absence of prospective RCTs reporting adverse events, expert consensus is needed in this field. Introduction: Resuscitative endovascular occlusion of the aorta (REBOA) is expected as an alternative to aortic cross clamp (ACC) in recent years, however clinical evidences have largely lacked [1] . Material and methods: This study included adult torso trauma subjects who underwent surgery after undergoing REBOA or ACC from subjects of the Japan Trauma Databank. Subjects with out-ofhospital cardiac arrest or subjects who underwent both procedures were excluded. A linear regression analysis adjusted for the probability of death based on the Trauma Injury Severity Score estimated differences in mortality between subjects with REBOA or ACC. Twostage least square (2SLS) of instrumental variable method [2] which enabled to adjust for even unmeasured confounders demonstrated sensitivity analysis for the result of adjusted linear regression analysis. Results: Out of a total of 644 subjects eligible to the selection criteria, 279 (60.8 %) of 459 subjects underwent REBOA and 152 (82.2 %) of 185 subjects underwent ACC died during hospitalization, respectively. An adjusted linear regression analysis estimated that difference in in-hospital mortality was lower in subjects with REBOA S26 ], P \ 0.001). We found that number Introduction: Flail chest injuries after blunt trauma to the thorax Show a high morbidity and mortality rate. Especially when serial rib fractures are combined with fractures of the ipsilateral clavicula a good functional outcome might be endangered . In this special case the framework of the shoulder and the chest lost its stability so muscular imbalance and a loss of function can occur. Material and methods: 10 patients with flail chest injury combined with a fracture of the clavicula, were surgical stabilized by addressing the ribs and the Clavicula. Locked plate Fixation was performed through limited surgical approaches to the ribs under general anaesthesia. Patients were followed up after 2, 6 and 12 weeks. Results: All patients showed severe chest wall deformity due to severely displaced fractures of the ribs and the clavicle. They were suffering from pain and restriction of respiratory movements. The chest wall could be restored to normal shape in all cases. The healing was uneventful in all cases. Plates showed a high patients convenience. Fractures of the clavicle and the second rib were managed through an innovative clavipectoral approach. Fractures involving the anterolateral chest wall were managed through an anterolateral Approach and those involving posterior ribs through an interspinoscapular Approach. Since the limited approaches were performed in muscle sparing technique there was no loss of muscular function of the shoulder. Conclusion: Stabilizing of combined costoclavicular fractures restores the function and the shape of the chest wall and the shoulder. It reduces the morbidity after complex flail chest injuries. Conservative Treatment of severely displaced fractures may not be a sufficient strategy, References: Disclosure: The Senior author has Consultant Agreement with DePuySynthes. He also joins the Thoracic expert Group of the AO Foundation. The other authors are not involved in any COI O043 SURGICAL TREATMENT OF ASSOCIATED THORACIC TRAUMA AND SHOULDER GIRDLE FRACTURES pain impulses and development of severe respiratory failure. Treatment of each injury is very difficult due to multiple associated trauma. Because of respiratory complications fractures are treated conservatively with poor outcomes. Material and methods: This study included 139 patients with multiple injuries treated in clinic of surgery from 2011 to 2015. Injuries of the rib cage were combined with traumatic brain injury, abdominal trauma, fractures of the long bones and pelvis. Multiple fractures of the shoulder girdle were observed in 49 patients and 12 had fractures of the thoracic vertebrae. Results: Fractures of the clavicle, scapula with unilateral multiple ribs injuries formed a pronounced deformation of the chest wall, with retraction of the dome and the ''floating shoulder''. If significant displacement of fragments of ribs, sternum was present after unsuccessfully orthopedic treatment, open reduction and intramedullary fixation of ribs was performed, retrosternal hematoma was evacuated. All patients after surgery completed treatment successfully. Conclusion: The stabilization of fractures of the shoulder girdle and the floating ribs valve in patients with favorable and uncertain outlook reduces the treatment time. Mininvasive osteosynthesis of bones of the shoulder girdle in victims with stable hemodynamics is made urgently. In patients with unstable hemodynamics it is necessary to use a pneumatic fixation of the rib and mini invasive osteosynthesis made after stabilization of vital functions in the delayed order before transferring a patient from mechanical ventilation to spontaneous respiration. References: Disclosure: No significant relationships. Emergency General Surgical Unit, Aintree University Hospital, Liverpool, UK Introduction: It has been established that rib fractures in the trauma patient are associated with significant morbidity due to hypoventilation, atelectasis and pneumonia [1, 2] . Early effective analgesia is a core component in reducing these risks. We aim to show how the use of different analgesia modalities may affect patient morbidity and pain scores. Material and methods: A prospective audit was undertaken to evaluate the management of pain in patients with thoracic trauma admitted between May and September 2015 at Aintree University Hospital. Patients were split into 4 groups: those receiving oral analgesia only, those with patient controlled analgesia (PCA), those who received paravertebral blocks (PVB) and those who received epidural infusions (EDI) as part of their analgesia. The Rib Fracture Score, pain score on moving on admission, pain score on moving on discharge was well was morbidity were recorded. Results: Out of 66 patients, 44 received oral analgesia only. of these 3 suffered from a pneumonia, the mean Rib Fracture Pain score was 6.24. There was a mean improvement of 2.24 between first recorded and discharge pain score. Patients given PCA, PVB or EDIs as part of their management numbered 30, 8 and 3 respectively with Rib Fracture Scores of 8.56, 8.5 and 6.5 respectively and a mean improvement of pain scores of 3.8, 2.9 and 6.4 respectively. Conclusion: The use of PCA and invasive analgesia is associated with a lower incidence of morbidity and a greater improvement in perception of pain on discharge when compared to oral analgesia in the context of thoracic trauma. References: 1. Easter, A. (2001) Management of patients with multiple rib fractures. American Journal of Critical Care. 10 (5) p. 320-327. 2. Carrier, F. M. et al (2009) Introduction: Blunt diaphragmatic injury (DI) is an uncommon injury and one which is difficult to diagnose. The objective of this study was to identify features associated with this injury based on a large data registry. Material and methods: This was a retrospective study based on records of 354,307 blunt trauma victims treated between 1998 and 2013 collected by the Israeli National Trauma Registry. Results: Blunt DI was reported in 231 (0.065 %) patients. Motor vehicle accidents were responsible for 86.2 % of the injuries: 97 (42.0 %) were reported as drivers; 54 (23.4 %) were reported as passengers; 34 (14.7 %) were pedestrians hit by cars; and 10 (4.3 %) were injured while riding a motorbike. Males outnumbered females 2.5:1 (p \ 0.0001). Blunt DI was more common in patients aged 15-29 years (p \ 0.0001) and 30-44 years (p \ 0.0001). ISS was 9-14 in 5.2 %, 16-24 in 16.9 %, 25-75 in 77.9 %. Urgent surgery was performed in 67.5 % of the patients and 79.7 % were operated within the first day. Overall mortality was 26.8 %. Though over 40 % of patients with blunt DI had associated rib, pelvic and/or extremity injuries, less than 1 % of patients with these injuries had associated diaphragmatic injury. Conclusion: 1. Blunt DI is most common following motor vehicle accidents, in males, and in those aged 15-44 years of age. 2. Most patients suffering from DI have severe associated injuries resulting in high ISS and need for urgent surgery. 3. Inability to rule out missed cases in patients not diagnosed during their index hospitalization is a major limitation of this study. References: Disclosure: No significant relationships. 1 Department. Abdominal pathology was the main diagnosis (62.8 %), of those, 45.0 % with peritonitis, 18.3 % in occlusion and 12.7 % with incisional hernia. The most frequent reason for surgery was related to 30 day elective surgery complications (52.2 %). The 30-day mortality for these patients was 31.6 %. Conclusion: Any cancer patient can experience emergencies that require surgical consultation and possible surgical treatment. The Surgical Oncology Department should be ready to deal with a great variety of surgical emergencies, inside and outside the department, in a multidisciplinary setting. References: Disclosure: No significant relationships. Introduction: Colorectal cancer is still the main cause of large bowel obstruction. Surgical resection is the gold standard treatment and the latest international guidelines recommend to sample at least 12 lymph nodes to obtain an adequate staging. This study is comparative evaluation of the lymph node clearance obtained in emergency and elective colorectal surgery. Material and methods: Data were obtained from prospective registry of emergency and elective colorectal surgery. We selected patients with colorectal cancer underwent R0 resection, and the two groups were compared using the Propensity Score Method (PSM) using the following variables: gender, age, location and stage of disease. Results in terms of lymph node clearance were assessed using lymph -node harvest (NHL), number of positive lymph nodes in the surgical specimen and lymph -node ratio (LNR). Results: From 2006 to 2012, 87 patients were operated for colorectal cancer in emergency with an R0 resection. The most frequent localization was the one left colic (52.8 %). The majority of patients (42.5 %) underwent surgery for Stage III tumor. The NHL average in this group was 18.6, with an average of positive lymph nodes of 3.1 and an average 0.18 LNR. Conclusion: The preliminary analysis conducted so far has documented how the nodal clearance obtained in patients operated in emergency has to be considered adequate and higher than recommended in international guidelines (average 18 vs. 12 nodes). No difference were obtained between the two groups in terms of linfonode clearance General Surgery, Istanbul Medical Faculty, Istanbul, Turkey, 2 Pathology, Istanbul Medical Faculty, Istanbul, Turkey, 3 Infectious Disease, Istanbul Medical Faculty, Istanbul, Turkey Introduction: Actinomycosis is a rare, progressive granulomatous disease. Here, we present a patient who had a mass both in the proximal part and in the distal part of transverse colon due to Actinomyces infection. Material and methods: A case report. Results: A 47-years-old woman was admitted to emergency unit with abdominal pain and fever. She had a history of abdominal pain for four days. She has been with an intrauterin device for 10 years. On her physical examination, her abdomen was distended and tenderness was found on the right upper quadrant. Contrast-enhanced computed tomography revealed 17 mm wall thickness compatible with tumor growth in the 6 cm segment of the proximal part of the transverse colon and 2 nodular lesions which are compatible with implants and 5.5 9 4 cm another tumoral lesion in the distal part of transverse colon. Colonoscopy revealed edema and induration at the long segment of the colon wall. Biopsies taken at colonoscopy was resulted as actinomyces like microorganism colonies. Computerized tomography guided trucut biopsy was taken from the lesion which was thought implant and the microscopic examination of the specimen revealed a granulation tissue rich from polymorphic nuclear leukocyte. Upon receiving the pathology report, she treated with systemic intravenous penicillin for 14 days. Intrauterin device was removed. She saved from the nontherapeutic laparotomy. She was discharged on 24th day with complementary treatment using oral antibiotics. 3 months later after treatment, lesions totally disappeared in the control computed tomography. Conclusion: This case demonstrates that development of inflammatory mass mimicking colon tumor secondary to actinomycosis is difficult to predict in the preoperative period and unnecessary surgery can be performed. Introduction: Despite therapeutic advancements, amputation rate due to chronic osteitis or severe soft tissue infection is still estimated between 4-10 % [1] [2] [3] . Many factors are believed to influence the development of infectious complications, but a risk assessment model has not yet been established. The aim of this study is to provide an overview of described risk factors for infections after open fractures. Material and methods: A comprehensive search in all literature of the last 30 years was performed to identify described risk. Studies were included when infectious complications were assessed in light of one or more risk factors. A meta-analysis was performed using review manager 5.3. Risk Ratios and 95 % confidence intervals were calculated. Results: A total of 101 articles were included. Eight patient related, six trauma related, and six treatment related risk factors were described. Male gender (RR 1.55), lower extremity fractures (RR 2.04), Gustilo-anderson grade III fractures (RR 2.41), contaminated fractures (RR 7.85) and polytrauma patients (RR 2.05) were identified as significant risk factors for the development of infectious complications. None of the treatment related risk factors showed statistical significance, but selection bias was highly suspected. Clinical Emergency Hospital, University of Medicine and Pharmacy, Bucharest, Romania, 2 Clinical Emergency Hospital, Bucharest, Romania, 3 Zetta Clinic, Bucharest, Romania Introduction: Bone infections require complex treatment, starting with debridement and sequestrectomy; consequently, a bone defect results, thus necessitating complex procedures in order to graft it. This paper analyses the type of surgery required to completely heal a bone infection in order to establish a potential algorithm for treating these complications Material and methods: Authors retrospectively analyze 12 patients with segmental bone infections operated between 01.01.2009-01.06.2014, regarding: age, gender, type of fracture -closed or open, initial treatment, microbiology, type of injuries time from trauma to surgical treatment, number and type of surgical procedures, mean time of hospitalization, local and systemic complications Results: Mean age was 34 yrs. (14-62 yrs.); high energy trauma were responsible for the fracture in 10 cases.; there were 8 open fractures, 1 case type I, 1 type II, 1 type III A, 4 cases III B, 1 case IIIC, The medium value of the number of surgical procedures was 5, and bone defects were 6-20 cm long. External fixation was used in all the cases; Local procedures (peroneum pro tibia) was used in 4 cases and vascularised peroneal graft for the rest. In all the cases, the alternative in case of failure would have been amputation Conclusion: Our experience with microvascular transfer of fibular grafts has shown that, with negligible donor site morbidity, massive autogenous bone grafting with an intact vascular pedicle can provide healing in bone infection, when debridement generated a defect larger than 6 cm. Introduction: The management of fracture nonunion poses a significant clinical challenge for musculoskeletal trauma surgeons and has an important socio-economic impact. The incidence of nonunion varies among different studies. Recent large retrospective series showed nonunion rates higher than 10 % in lower extremity fractures. This study evaluated our experience in treating patients with nonunions or defect fractures using the RIA (Reamer/Irrigator/Aspirator) technique for bone graft harvesting. Material and methods: We retrospectively evaluated patients with nonunions or defect fractures, who were treated with bone graft harvested using the RIA technique between June 2008 and March 2015. Our primary outcome was clinical and radiographical bone healing. Results: We included 75 patients who underwent a RIA procedure for bone graft harvesting. Indications for the RIA procedure were defect fractures (12 %), and septic or aseptic nonunions (17 %, respectively 71 %). In total 57.3 % of the patients were classified as having a clinical and radiographical union after treatment with bone graft harvested with the RIA technique. Conclusion: In recent years, the RIA technique has emerged as an alternative in harvesting autologous bone graft. Several studies previously published positive results with high rates of union after the use of this graft material. The preliminary results of our study show less promising results in a large patient cohort, with healing rates up to 57 %. Although we believe that this technique has its place in the treatment algorithm of these complex lesions, future randomised trials are necessary to evaluate the specific indications for its use. Disclosure: The department of Trauma Surgery of the University Hospitals Leuven receives an unrestricted research grant from DepuySynthes and is a training centre for DepuySynthes. Serbia, 3 Orthopaedic & Traumatology Clinic, Clinical Centre of Nis, Nis, Serbia, 4 Orthopaedic & Traumatology Clinic, Clinical Center Nis, Nis, Serbia Introduction: Axial dynamization is recognized as method which encourages bone union. Because of that many doctors routinely remove one screw from interlocking nail, two months after primary operation to provide axial dynamization. Dynamization is happened in about 20-25 %, according to the literature. Material and methods: We analyzed series of 849 patients with 871 fractures treated by the use of extramedullary nail, one selfdynamizable internal fixator for proximal, diaphyseal and distal femur fractures treatment. Results: The average operative time was 44 minutes (23-119), average fluoroscopy time was 12 seconds while average blood loss of 90 milliliters (60 to 250 milliliters) when minimally invasive technique used. None of the patients developed complications during the intraoperative period. Healing time was 3.9 months (3) (4) (5) (6) (7) (8) (9) . Healing was achieved in 99.1 %. Superficial infection developed after 7 fixations (0.9 %) while deep infection developed in 8 patients (1.0 %). The screw breaking occurred 6-18 weeks after 19 fixations (2.6 %) . Cut out phenomenon happened in 24 cases. Spontaneous axial dynamization was observed in seventy-one patient (23.8 %), 5 millimeters on average (2 to 12 millimeters). Conclusion: Extramedullary nail, as a selfdynamisable internal fixator, is one effective method and device for the treatment of femoral fractures but at the same time can be regarded as one suitable tool to define the need for axial dynamisation. Introduction: The primary aim of this study was to evaluate the number of complications and re-operations following dynamic locking plate fixation of intracapsular proximal femoral fractures (AO 31 B1-3). The secondary aim was to identify risk factors for these complications. Material and methods: Single-centre retrospective case series of 55 consecutive patients with proximal femoral fractures (AO 31 B1-3), treated with the Targon Ò FN (B. Braun Melsungen AG) between 2010 and 2014. Setting: Level 1 trauma center. Demographic data and data on postoperative complications and reoperations were collected. Fractures were classified according to the AO and Garden classification and postoperative x-rays were reviewed. Statistical analysis was performed to reveal factors influencing patient outcome. Results: During a median follow-up of 12 months, 20 complications were encountered in 55 patients (36 %). Complications were: tractus irritation (55 %), avascular necrosis of the femoral head (15 %), screw perforation into the joint (10 %), secondary loss of reduction (10 %), implant failure (5 %) , infection (5 %) . Twenty-seven re-operations were performed in 20 patients. Out of these 20 patients implants had to be removed in eleven cases due to tractus irritation. A secondary joint replacement was required in four patients after an average of three months. Patients age, type of reduction (open versus closed), number of telescoping screws and postoperative caput-collum-diaphyseal (CCD) angle were significantly different between patients with and without a second operation. Conclusion: The use of Targon Ò FN for intracapsular proximal femoral fractures was associated with a high number of re-operations. Patients age and predominantly surgery related factors (reduction, number of screws and CCD angle) did impact patient outcome significantly. References: Disclosure: No significant relationships. Introduction: Combined orthopaedic and plastic surgery of severe open tibial fractures has been widely studied. Evidence regarding optimum management of severe tibial plafond fractures is however scarce. Unplanned plastic surgery due to wound complications is common among these patients. The goal of our study was to review our results with the combined orthopaedic and plastic surgical treatment of these fractures Material and methods: We reviewed all tibial plafond fractures (AO 43) surgically treated at our centre over 6 years, with a minimum 1-year follow-up. 86 cases in 76 patients were available for follow-up. of these, 16 were treated with a free tissue flap in addition to surgical fixation of the fracture. Results: of the 16 cases, 8 were initially closed fractures. Bridging negative pressure wound therapy was used in half of the cases. The free tissue flaps used were gracillis in 6 cases, anterolateral thigh in 5 cases and latissimus dorsi in 5 cases. Seven patients suffered complications of the free tissue transfer: 4 of the 16 flaps failed, and one patient required below the knee amputation. Fourteen patients suffered some type of orthopaedic complication: wound infection (50 %), wound dehiscence (37.5 %), delayed union (47.8 %), and skin necrosis (12.5 %). Overall, time to union was 9.25 ± 3.6 months and AOFAS scores averaged 65.3 ± 16.8 points. Traumasurgery, Radboudumc, Nijmegen, The Netherlands, 2 Traumasurgery, Gelderse Vallei, Ede, The Netherlands, 3 Surgery, Erasmus MC, Rotterdam, The Netherlands Introduction: Chronic knee pain is a common complaint after tibial nailing. Injury or entrapment of the infrapatellar nerve is a possible explanation for this persisting post-operative knee pain. The purpose of this randomized, placebo-controlled, double blind crossover trial was to compare changes in knee pain after an infrapatellar nerve block with lidocaine or placebo. Material and methods: Patients with chronic anterior knee pain after tibial nailing were randomized to an infrapatellar nerve block with a subcutaneous injection of lidocaine or placebo after which they were supervised in performing eight activities. Before and after these activities, pain was recorded using a numeric rating scale. Hereafter patients crossed over to the alternate group. Primary endpoint was the change in pain intensity during kneeling after each infrapatellar nerve block. Secondary outcomes were changes in pain intensity during rest, walking, running, jumping, squatting, climbing stairs and sitting with flexed knees. Results: 28 patients aged 18 -62 years (mean, 41 years ± 13) were equally randomized. A significant reduction of the NRS for kneeling pain with an infrapatellar nerve block with lidocaine was found compared with placebo (median [range], -4 [-10 -+1] vs -1 [-11 -+8] ; P = 0.022. There were no differences between the treatments for the NRS values for the secondary outcomes. Conclusion: Compared with placebo, an infrapatellar nerve block with lidocaine was more effective in reducing pain during kneeling in patients with chronic knee pain after tibial nailing. Data from the present study support the contention that kneeling pain after tibial nailing is a peripheral nerve-related problem. References: Disclosure: No significant relationships. Introduction: The consequence and utility of standardised postoperative radiographs after having obtained an intraoperative C-arm control remains under debate. The purpose of this study was to evaluate the frequency of changes in treatment plan due to standardised postoperative radiographs. Material and methods: Single centre retrospective case series of 167 consecutive patients, operated with ORIF for distal radius or ankle fractures in 2014. Fractures were classified according to the AO classification. Intra-operative radiographs were not standardised. Postoperative files were evaluated if the postoperative radiographs did lead to a change in treatment protocol. Changes in treatment protocol were defined as additional CT-imaging, reoperation or other changes as defined in the postoperative orders. Results: In 7.2 % (12/167) of the patients, a change in the treatment plan was recorded after the postoperative radiographs. Ten patients (6 %) were reoperated (three without additional imaging, seven after additional imaging with CT). of these 10, 8 required a reosteosynthesis. Two patients had additional imaging (CT) without further consequences. There was no statistical difference between changes in the treatment plan depending on night or daytime surgery or if the surgeon was a resident or consultant and also independent of the fracture classification. Conclusion: Standardised postoperative radiographs led to over 7 % changes in the postoperative treatment protocol. Moreover, 6 % of the patients required a second operation. These numbers are high and suggest that standardised postoperative radiographs do add to the quality of fracture care. In the future, standardised intra-operative radiographs will be defined at our institution in order to prevent the need of postoperative radiographs. References: Chakravarthy, J. Postoperative radiographs following hip fracture surgery. Do they influence patient management? Int J Clin Pract, Cooney, A. D. Do check X-rays influence the management of patients who have undergone hip fracture fixation using image intensifier guidance? Injury, Harish, S. Routine radiography following ankle fracture fixation: a case for limiting its use. Injury, Stone, J. D. Utility and cost analysis of radiographs taken 2 weeks following plate fixation of distal radius fractures. J Hand Surg Am, Tarallo, L. Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events. J Orthop Trauma, Disclosure: No significant relationships. Introduction: The current trend in treatment of displaced distal radius fractures favours volar plating. However, recent studies question both the clinical advantage and the cost effectiveness of this treatment modality. An alarming number of complications ranging from 5 to 30 % have been reported in the literature. The aim of the study was to estimate the complication rate of volar plating of distal radius fractures in correlation to surgeon experience, type of plate (VariAx Ò and Acu-Loc Ò ) and AO-fracture type. Material and methods: We reviewed all cases operated with a volar locking plate at Aarhus University Hospital between February 2009 and June 2013. Surgeon experience was categorized as orthopaedic consultant, 2 nd -5 th -year resident, or 1 st -year resident. Correlation coefficients between complications, surgeon's experience, type of volar plate and type of fracture (AO) were estimated. Results: 576 patients (median age 63, 78 % females) presenting with distal radius fractures were operated with a volar plate by 21 consultants, 27 2 nd -5 th -year residents and 16 1 st -year residents. Within the mean observation time of 3.2 years (min = 1.0; max 5.4) 69 reoperations were performed including 44 plate removals. We observed 30 nerve complications, 4 flexor tendon ruptures, 12 extensor tendon ruptures, 3 cases of complex regional pain syndrome, 5 disturbances of the distal radius ulna joint or scapholunar dissociations and 2 deep S33 infections. No correlation was found between complication rates and type of plate or surgeon experience. We observed significantly more intraarticular fractures in the complication-than in the no-complication group (p \ 0.01). Conclusion: The reoperation rate was 12 %. Only type of fracture was related to complications. Introduction: Trauma outcomes in the published literature are often limited to mortality. No validated tools for the assessment of posttraumatic morbidity exist. We describe initial experience with the ''Adapted Clavien-Dindo for Trauma'' method (ACT)-a derivative of an established tool [1] for grading elective surgical complications. This new tool accounts for patients both managed surgically and by selective non operative management (SNOM). Material and methods: This is an observational, prospective pilot study tested the ACT scoring system in patients admitted to critical care at a UK Major Trauma Centre. Demographics, mechanisms of injury, critical care and hospital lengths of stay, organ dysfunction and 30-day mortality were compared between patients with and without complications. Results: Fifty-one patients were included. Median age was 37. 5 (26.6 -53.2) years, and 76.5 % were male. Median ISS was 16 (11. 5 -24.5) . Median Sequential Organ Failure Assessment scores on Days 1 and 4 were 4 (2 -7) and 1 (0 -5.5) respectively. 30-day mortality was 11.8 %. 15/51 (29 %) patients suffered complications. ACT grades were successfully assigned to all of these. Patients with complications had longer critical care stays than patients without (10 (7 -18) days vs. 3.5 (2 -8) days; p = 0.009), and had higher SOFA scores on day 4 (5 (2 -9) vs. 0 (0 -3.25); p = 0.023). Conclusion: This initial exploration suggests that the ACT scoring system may be both feasible and useful for grading post-traumatic complications. It is the first tool to assess trauma patients following both surgery and SNOM. Further prospective multi-centre validation is required. References: 1. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992; 111(5) :518-26. Disclosure: No significant relationships. Unfall-, Hand-Und Wiederherstellungschirurgie, Uniklinik Frankfurt, Frankfurt, Germany Introduction: Delayed diagnosis of an injury of the intestine increases the risk of sepsis, multiple organ failure and mortality. The Intestinal fatty acid binding protein (I-FABP) is a protein solely expressed in the intestine and is released extracellular after tissue damage. This study evaluates the value of I-FABP as an early biomarker in particular to detect an injury to the intestine. Material and methods: Prospective matched pair-analysis of 20 patients with an abdominal injury, of which 10 patients suffered from an intestinal injury. Every patient with an intestinal injury was matched with an abdominal injury but without an intestinal injury (no int. injury) using the Injury Severity Score (ISS) and the abdominal Abbreviated Injury Scale score (AIS abdomen). Twenty healthy volunteers served as controls. Plasma I-FABP levels were measured at admission to the emergency room (ER) and up to ten days daily (d1-d10). Results: Median I-FABP levels were significantly higher in the ''int. injury '' group (2101 '' group ( .0 pg/ml [IQR = 1248 ]) compared to the ''no int. injury ), p \ 0.05. Furthermore I-FABP levels of both patient groups were significantly higher compared to the control group (127.2 pg/ml ), p \ 0.05. The time course of I-FABP levels showed a peak on the day of admission and a decline to the control levels in the further post-traumatic course. Conclusion: This study confirmed our previous findings that I-FABP might be used as an early biomarker for the detection of abdominal injuries. In addition, the results indicate that I-FABP might be an even more specific and promising parameter in the diagnosis of intestinal injuries. Disclosure: No significant relationships. Orthopedic Trauma, RWTH Aachen University Hospital, Aachen, Germany, 2 Institute for Laboratory Animal Science & Experimental Surgery, RWTH Aachen University Hospital, Aachen, Germany Introduction: Soft tissues are known to be of importance for local and systemic inflammation and bone healing. However, studies dealing with local changes after trauma are rare. In this study we have analysed changes of microcirculation in soft tissues associated with haemorrhagic shock and surgical strategy after femoral fracture. Material and methods: Male pigs (german land race, 30 kg) were used. Combined trauma consisted of lung contusion, femoral fracture, liver laceration and controlled haemorrhage (HS) (MAP 40 ± 5 mmHg) for 90 minutes. O2C (oxygen to see) device was used to measure a blood flow (Flow), the oxygen saturation (SO2) and relative Haemoglobin amount (rHb). Microcirculation was measures on healthy muscle. Femoral fracture was treated either with intramedullary nailing or with external fixation. Microcirculation was measures daily in fracture site of this animals. The observation period of this study was 3 days. Results: During HS (n = 6) we have found a significant increase of blood flow (Flow) and elevated local SO2 and rHb. All these parameters indicate a presence of hyperaemia in soft tissues after haemorrhage. Moreover, the analysis of microcirculation after fracture fixation has shown a significant reduced circulation in musculature on a day 2 and 3 after fracture treatment with external fixation. After intramedullary nailing no differences of Blood Flow, SO2 and rHb was observed in comparison to the non-injured site. Conclusion: We have observed increased microcirculation in soft tissues after HS. This might be if importance in development of local and systemic inflammation. Moreover, External fixation led to reduced microcirculation in musculature. References: Disclosure: No significant relationships. Introduction: The treatment of distal tibial fractures requires a stable fixation while preserving the soft tissues. The experimental Retrograde Tibial Nail (RTN) is currently under investigation as a minimally invasive alternative to angle stable plating and antegrade intramedullary nailing. The purpose of this study was to evaluate the surgical feasibility in a cadaver model for all types of distal tibial fracture types considered treatable by nailing. Material and methods: Five different fracture types (AO/OTA 43-A1/A2/A3 and 43-C1/C2) were created on separate cadaveric limbs. In simple fracture types primary nailing was performed. In fractures with intraarticular involvement reduction of the articular block and lag screw fixation was performed before nailing. Intraoperative complications, quality of reduction, fluoroscopy duration and operative time were evaluated. Results: Retrograde intramedullary nailing was possible in simple fracture types by closed manual reduction and percutaneous reduction forceps. Retrograde nailing is also feasible in fractures with simple intraarticular involvement after primary lag screw fixation. Postoperative evaluation of alignment showed an excellent reconstruction of the normal anatomy. The varus-valgus axis deviation was between 0°t o 4°varus. The distance from the joint line to achieve triple distal interlocking was between 26 and 29 mm. The duration of surgery ranged from 40 to 62 min. No major complications occurred. Conclusion: The minimally invasive retrograde nail combines a minimally invasive local osteosynthesis with the ability to adequately fix extraarticular and simple intraarticular distal tibial fractures. The results suggests that retrograde tibia nailing is a promising new concept for the treatment of distal tibia fractures. Introduction: The Short Musculoskeletal Function Assessment (SMFA) is a widely used patient reported outcome, designed to assess physical functioning. The aim of this study was to evaluate the structural validity of the SMFA in a broad range of trauma patients and hence to evaluate which factor structure (e.g. scoring model) fitted best. Material and methods: Trauma patients, treated at the University Medical Center Groningen (The Netherlands), completed the SMFA at 6 weeks post injury. A Confirmatory Factor Analysis was performed on a total of 6 factor structures and their corresponding bifactor structure, in which a general factor is hypothesized. Reliability of subscales was analyzed with Cronbach's a and x parameters. Statistical power was retrospectively evaluated with a Monte Carlo simulation. Results: A total of 491 patients participated (response rate: 74 %). The correlated 4-factor (RMSEA = 0.061, CFI = 0.961, TLI = 0.959) and corresponding bifactor model (RMSEA = 0.063, CFI = 0.960, TLI = 0.956) fitted best. The correlated 4-factor model showed high factor loadings and scale reliability(a C 0.81, x T = 0.98). The bifactor model showed high loadings and reliability on the general factor (General Physical Functioning, x H = 0.90) and the Upper Extremity factor(x s = 0.85), substantial reliability and loadings on the factors Lower Extremity Dysfunction(x s = 0.34) and Mental and Emotional Problems(x s = 0.44), but low reliability and loadings on the Daily Activities factor(x s = 0.02). Other models, including the original 2-index structure, had a mediocre or unacceptable fit. Statistical power was estimated [99 %. Conclusion: The four factor model showed best structural validity and high scale reliability. The SMFA is best scored and interpreted conform the 4-factor structure, including a newly introduced total score (General Physical Function). References: Disclosure: No significant relationships. Material and methods: The study was carried out on porcine cadaver knees from large animals (50-60 kg). All the knee joints were dissected, and the ACL was the only ligament that we kept intact. Furthermore bony structures were stabilized by the use of Technovit. All samples were subjected to a uniaxial tensile test and load-extension characteristics were registered. Moreover, cyclic tests (10.0009) were performed to test the impact of cyclic loading on biomechanical characteristics of the porcine ACL. Results: Median maximal load (N = 8) of the pigs ACL was 374 N and varied between 421 N und 363 N. Load-displacement curves showed comparable patterns in all animals. We observed a bimodal peak was at 370 N und 240 N and this represents the sequential rupture of the anteromedial and posterolateral bundle of the ACL. Furthermore, porcine ACL Stiffness was significantly decreased after cyclic loading. Conclusion: Maximal load and stiffness measurements of the porcine anterior cruciate ligament showed homogenous data. Furthermore the pattern of sequential rupture of ACL-bundles is comparable to the human ACL. Moreover, the impact of cyclic stress on biomechanical properties of the ACL makes the pig model suitable for proof-of principle studies for novel treatment modalities for the ruptured ACL. Introduction: The American Society of Anesthesiologists (ASA) physical status (ASA-PS) is used worldwide and has also been incorporated into various prediction rules [1, 2] . However, concerns have been raised regarding inter-rater agreement [3] . Furthermore, a reliability study has not yet been conducted in the field of emergency gastrointestinal surgery. Therefore, the aim of the present study was to investigate the inter-rater reliability of ASA-PS for emergency gastrointestinal surgery. Material and methods: Three sets of scenarios were generated for each ASA-PS class (2E, 3E, and 4E) in emergency gastrointestinal surgery, resulting in 9 scenarios. These scenarios described the preoperative profiles of patients who underwent emergency gastrointestinal surgery in one hospital. Two or 3 anaesthesiologists from 18 other hospitals provided scores for ASA-PS for each scenario. We measured the reliability of ASA-PS ratings assigned by anaesthesiologists using Fleiss' kappa statistics (F-j) and intraclass correlations (ICC). Results: Fifty anaesthesiologists scored the ASA-PS class. Thirtythree (66 %) to 45 (90 %) of these anaesthesiologists assigned the same ratings as the reference ratings for the individual scenarios. Inter-rater reliability was assessed as F-j (95 % CI) of 0.55 (0.54-0.56, p \ 0.001) and ICC (95 % CI) of 0.79 (0.63-0.93, p \ 0.001). The absence of significant differences in the ratings between the hospitals was verified by the Kruskal-Wallis one-way analysis of variance test. Conclusion: The results of the present study revealed the consistency of ASA-PS ratings between anaesthesiologists for emergency gastrointestinal surgery. ASA-PS may serve as a reliable variable in the prediction rules for this field. Introduction: Posterior stabilization of the spine can lead to muscle damage. The aim of our study was to visualize muscularly changes after posterior stabilization of thoracolumbar spine fractures and to investigate if these changes are related to the clinical outcome. Material and methods: Study performance between 05/2012 and 10/2014. Including criteria: Bisegmental stabilization and isolated traumatic thoracolumbar fracture without neurological deficit (T11-L2). Muscularly size and activity of the lumbar multifidus and the abdominal muscles were examined by a standardized ultrasound protocol one year after surgery. Furthermore standardized questionnaires (VAS-Spine-Score; ODI; SF-36) were subjected. A healthy control group was matched regarding age, BMI and gender distribution. Data were analyzed using SPSS (Version 20) . Statistical significance was defined as p \ 0.05. Results: Twenty-five patients and 23 control probands could be incorporated into the study. Fifteen patients were treated by open surgery while ten were treated percutaneously.The patients showed a diminished muscularly function of the lumbar multifidus one year after surgery compared to the control group (p \ 0.05). The abdominal muscles showed no differences between both groups (p [ 0.05). No difference between patients treated by open or percutaneous surgery were found. The questionnaires showed worse results in all categories for the patients compared to the control group. A correlation between muscle activity and clinical outcome could not been demonstrated (rs [ 0.07; NS). Conclusion: Muscularly deficits of the lumbar multifidus still occur one year after surgery. Results of patients treated by open or percutaneous surgery were comparable. Furthermore no correlation between the muscularly deficit and the clinical outcome was found. References: Disclosure: No significant relationships. Introduction: Chloride is important to maintain acid-base balance, muscular activity, and osmosis. Several studies have been showed the association of hyperchloremia with hospital mortality in critically ill septic patients. However, there are no studies about trauma patients. The purpose of our study was to identify the association of serum chloride (Cl) levels with 30-day mortality in major trauma patients. Material and methods: This study was enrolled 243 major trauma patients by retrospective chart review, from January 2011 to August 2015. Patients were over 16 years of age, and major trauma were defined as injury severity score (ISS) being greater than 15. Serum chloride levels were measured after 24 hours from initial evaluation, and Cl [ 110 mEq/L was defined as hyperchloremia. Clinical and laboratory parameters were compared in between the two groups (hyperchloremic group and non-hyperchloremic group). Survival curves were constructed using a Kaplan-Meier survival analysis with comparisons between the curves based on a log-rank v 2 statistic. A multivariate Cox regression model was applied to assess the association between serum chloride levels and 30-day mortality. Results: 30-day mortality of total patients was 8.6 % and 51 patients (21 %) showed hyperchloremia on hospital day 1(HOD-1). The significant difference in survival between hyperchloremic group and non-hyperchloremic group was shown in the Kaplan-Meier survival curve (p = 0.001). In multivariate Cox regression model, hyperchloremia (Odds ratio, 5.549; 95 % confidence interval, 1.800 -17.110 ; p = 0.003) was independent predictive factor for 30-day mortality in major trauma patients. Conclusion: Hyperchloremia on HOD-1 was associated with 30-day mortality in major trauma patients. Introduction: The care of severely injured patients is an interdisciplinary task. A large proportion of medical students will be involved in the care of seriously injured patients later in their medical career. The current medical curriculum does not adequately teach the technical and non-technical skills necessary for an adequate patient care. Material and methods: We developed a new ''blended learning'' curriculum, made up of four learning modules, each consisting of a eLearning unit of 1-2 h self-study and a 3 h long skills and simulation training. They are accompanying the 4-week rotation in traumatology. The overall design was influenced by the CanMEDS (particularly the roles ''Professional '', ''Communicator'' and ''Collaborator'') and in light of the recently adopted National Competency-based Objective Catalogue for Medicine. The learning modules take place in small groups of max. 8 students with 2 instructors with a clinical background in trauma surgery, anaesthesia and radiology. Results: 2 Pilot courses were instructed in the fall of 2015. Results derived for self and objective assessment showed that final year medical students can achieve the theoretic, practical and non-technical skills to perform as an effective team member in polytrauma care. Conclusion: New teaching strategies should be implemented in order to advance the knowledge and skills of medical school graduates. Introduction: In the last 10 years we have used Locking plates for proximal humerus fractures, we have identified various problems. Our indications for fixation have changed from fixation of nearly all fractures to a much more conservative approach with and increased number of arthroplasty cases. The loss of the medial calcar has become an important part of the decision making process and this is an aspect of the proximal humerus fracture that is extremely difficult to manage well, especially in the younger patient. Material and methods: We have evaluated 80 proximal humerus fixations that have been done at Tygerberg hospital. The fixation was done using the Proximal humerus plates from ITS Ò , the older plate and in some cases the new plate. The x-rays where reviewed and the reduction was evaluated. The humerus neck shaft angle was measured in each case as well as the lateral angulation. Results: Neck shaft angles where restored in [90 % of the cases and the lateral angulation is within 10°in more than 95 % of cases. Plate Breakage in 6 cases with concurrent non union with the old plate system. The new plate system had 3 screw problems that resulted from technical issues during surgery. Conclusion: The proximal humerus fixation in patients with severe proximal humerus fractures are difficult to treat and can lead to nonunion. The proximal fixation of the head remains an important aspect of fixation as well as plate strength for medial calcar fractures. The other aspect is how much of the head is held by the locking plate. With many plates the so called multiple axis fixation does not allow more fixation into the head due to a narrow plate design. We will present a review of the popular plate designs and how they have changed over the last 10 years. We will also present the volume of the head that each plate can hold. The important aspect of this is that the more head you can hold with a plate the easier it is to place your plate. References: Complications that occur in proximal humerus fractures are more common than we would like to admit. We will also present an extensive review of all our complications and options on how to deal with these severe problems. Disclosure: No significant relationships. Introduction: Acute total hip replacement (THR) has become popular as a treatment for older patients with acetabular fractures as it enables earlier return to good function. When THR is used for posttraumatic hip osteoarthritis, the procedure can be more difficult and there is an interval of pain, stiffness and poor function for the patient. Controversies for acute surgery involve higher complication rates including infection, loosening and revision surgery. Material and methods: This prospective study reports the functional outcome and complications experienced by 50 consecutive patients over 55 who sustained an acetabular fracture and underwent open reduction and internal fixation (ORIF) plus acute THR or ORIF alone. Merle D'aubigne and SF36 scores were analysed. Results: A total of 26 patients were treated with acute ORIF and THR with a mean age of 76.4 years. The majority of patients were independent ambulators at most recent follow-up. Two patients were transferred to our institution with periprosthetic fractures sustained at the time of primary THR. Both developed periprosthetic infection and underwent subsequent debridement with retention of implants. One patient experienced a dislocation of the total hip replacement. One patient underwent revision surgery for secondary cup migration. Conclusion: Acute ORIF and THR is an effective treatment method for older patients who have sustained an acetabular fracture. Operative principles include sufficient lateralisation of the centre of rotation, maximal bony contact with the acetabular implant, maximal fixation of implant to bone and restoration of stability. The cases illustrate that at least one of these principles was compromised in the patients with complications. References: Disclosure: Paul Culpan has a consulting contract with ITS. a period of 13 years we treated 18 patients with Pipkin fractures dislocations. They were distributed according to classification of Pipkin: Type I-4, Type II-5, Type IIIA-1, Type IIIB-3 and Type IV-6. 3 patients were treated nonoperatively. Smith-Peterson approach was used for 7 fractures Pipkin I, II, for fractures Pipkin IV was chosen Kocher -Langebeck (5 cases) and 1 with ''Flip osteotomy''. Watson-Jones and Hardinge approaches was used for Pipkin IIIA (1 case) and Pipkin IIIB (2 cases). 3 fractures were treated by primary THA, 2 fragments from the femoral head were excised and 11 fractures were reduced and fixed. Results: All patients were followed up. From 18 patients with 19 fractures of the femoral head assessed by HHS, we obtained 10 excellent and good, 5 fair and 4 poor results. The distribution of the results is as follows: Pipkin I -2 excellent, 1 good and 1 fair, Pipkin II-2 excellent,1 good, 1 fair and 1 poor, Pipkin IIIA -1 excellent, Pipkin IIIB-2 excellent, 1 poor, and Pipkin IV-1 excellent, 3 fair and 2 poor. With iatrogenic temporary nerve dysfunction (n. Introduction: Current treatment of fractures around femoral stems is invasive, expensive, and result with high complication and reoperation rates. Aim of our study was to design a technique of less invasive intramedullary fixation in periprosthetic fractures and deformities of the femur to provide primary stability of the stem and the femur. Material and methods: Fixator-assisted internal fixation with a slotted nail connecting to the stem was used in the treatment of 71 consecutive femoral periprosthetic fractures. Vancouver B1 -23 cases (8 cemented), Vancouver B2 -24 (2 cemented), B3 -17 (3 cemented), C-7 (2 cemented). In 29 of 41 B2/B3 fractures femoral stems were subsided 10 mm and more. Results: Frame application allowed to restore length and alignment of the segment in all 30/71 cases of stable stems (B1 and C). With fixator-assisted nailing it appeared attainable to reduce stem position in all cases of subsided stems. 64 patients (90 %) were available for follow up in 1 year. 62 healed (4 after secondary procedures). There were no signs of stem loosening revealed in all cases (24) of subsided non-cemented stems that were reduced. Conclusion: In case of loose subsided stems the presented approach provides not only strong primary fixation but also correction of the stem position along. In patients with uncemented loose stems secondary stem stabilization can be expected so formal revision with S38 stem replacement renders unnecessary. The current approach with plating in stable stems and revision in loose ones can be replaced by the introduced approach in vast majority of cases. Introduction: The standard treatment of displaced acetabular fractures is open reduction and internal fixation (ORIF). Since patients age is a relevant factor in combination with comorbidities, ORIF may not be the best option. Primary total hip arthroplasty (THA) including an antiprotrusion cage and autologous bone grafting, for selected acetabular fractures may provide several advantages in elderly osteoporotic patients. In our retrospective study we aimed to delineate the special indications for THA. Material and methods: Our clinical retrospective study was carried out between 2010 and 2015. We analyzed 19 patients with THA and 21 after ORIF including 22 males and 16 females with an average age of 69 years. The fractures were classified using Letournel and Judet classification. Basic operative parameters, complications, heterotopic ossification after the radiologically based Brooker Classification, length of hospital stay (LOS), return to mobility, and clinical outcome assessed with the Harris hip score and the Merle d'Aubigne score were evaluated. Results: THA provides primary stability and immediate pain relief, permits graded weight-bearing and early pain-free mobilization, and may also treat hip arthritis, if it exists. Conclusion: In selected acetabular fracture types, we believe that a primary THA may provide several advantages including quick weight bearing with a lower rate of complications and a lower 5-year mortality rate. Material and methods: A two step method applying first an external fixateur and in a second operative stage the hindfoot nailing of Lexer can prove a useful solution to this problem. The external fixateur is a simple large pin frame with a 'kickstand' extension that suspends the heel to prevent skin breakdown during the intensive care stage of the patient's care. The second stage is performed about a week later and is a nailing across the subtalar and tibiotalar joints. Four representative cases show the phases of this treatment program. Results: Patients can be mobilized to a standing position after a few days. There has been rapid consolidation of fractures and no delay in rehabilitation. Longterm the nail can be removed with some return of tibiotalar function in appropriate cases. Conclusion: Salvage of mangled ankle joints with transarticular nailing is a useful treatment pattern in seriously injured patients or patients with special care problems. As severe open injuries are more and more frequent in modern traumatology, threatening not only the integrity of the affected limb, but even the life of the patients, new methods desired to cope with the consequences of these trauma were described. Vacuum therapy is one such method which has been described as enhancing healing in trauma with extensive soft-tissue injuries, included those with septic complications Material and methods: Authors prospectively analyse 15 patients with severe lower limb trauma with MESS less than 6, with considerable soft tissue loss following initial debridement and fracture fixation. The patients needed serial debridements and vacuum therapy was applied after delayed healing due to initial severity of the trauma, for an average period of 12 days (7 -23 days).In 7 cases vacuum therapy was applied for septic complications Results: Within the study group, there were no local complications; secondary debridements were performed for all the patients and vacuum system was re-installed after these debridements. No amputations were needed. Medical records were reviewed in order to compare the outcome of the patients: the hospital stay, anti-microbial therapy, time to healing of the bone and soft tissues (there is no standard group to be compared with) and the result shoed considerable improvements in the outcome of the patients. Conclusion: Vacuum therapy improves healing of the soft tissues, including those infected; hospital stay and the number of secondary necessary procedures are reduced, therefore it is considered a valuable support in treating trauma of the limbs with severe soft tissue injuries. Introduction: There is consensus in treatment of compartment syndrome, however there is no data about fasciotomy closure nor complications related to them published from Finland to date. Therefore, we conducted this study to find out the amount of tibia fractures treated with tibia nailing and compartment syndromes associated to them in Finnish patient cohort between years 2007 and 2015. We also wanted to know the fasciotomy closure method used and if it had any influence to patient recovery. An additional goal was to discover if there was a relation between fasciotomies and deep infections. Introduction: Septic risk after Open Fractures (OF) is unanimously recognised but the factors influencing its onset have not been yet clearly quantified. The authors intend to check in this paper the hypothesis that time form trauma to initial complete surgical debridement influences the onset of infection after OF. Material and methods: A retrospective study was performed in a Level 1 Trauma Center regarding OF operated with at least 18 months follow-up. From 588 open injuries, only 362 completed the follow-up regarding the time from trauma to the first antibiotic dose and time from trauma to surgical debridement. The outcome was the incidence of infection within the first 18 months after trauma. Results: Following Gustillo Classification, there were 172 type I, 101 type II and 90 type III open fractures. The mean time from trauma to first antibiotic dose was 2.8 hrs (0.5-6 hours),mean time from trauma to initial debridement was 3 hrs (42 min-48 hrs). The incidence of infection was 6.9 %; time between trauma and antibiotic treatment significantly increased the incidence of sepsis from 4.8 % (antibiotics before 3 hrs) to 7.8 % (after 3 hrs), while time from trauma to debridement increased the risk from 3.8 % (debridement before 6 hrs) to 7.6 % -after 6 hrs. Conclusion: The current study suggests that, more than time from trauma to antibiotics, time from trauma to surgical debridement is essential for the incidence of infection. Introduction: The use of modern high-energy weapons in modern wars is a cause of multifactorial injury of the extremities. The projectile creates a zone of necrosis that leads to the extensive tissue loss. Material and methods: Between April 2013 and April 2015, four patients with gunshot wounds of the upper extremities, complicated by extensive loss of bone substance, were operated with free composite fibular graft. Three patients were injured at the shoulders. One injured had forearm wound. The wounded in the forearm had a gunshot fracture of both bones of the forearm, mainly affecting the diaphysis of the radius. Preoperatively there were routinely performed angiography of the injured extremity and the donor lower leg. Fixation of the bone part of the graft on the shoulder was carried out with spanning plate in all cases. Bone stabilization with rigid nail fixation was applied for reconstruction of the radius. Results: One flap transferred on forearm healed completely. Fasciocutaneous part of the graft had partial necrosis in two cases. Last patient had thrombosis varicose changed veins of the flap in the early postoperative period that caused the total necrosis of the fasciocutaneous skin paddle of the graft. Despite this complication, the bone portion of the flap healed successfully. Healing took no more than 6 months in all cases. Conclusion: The experience of treating patients with gunshot tissue loss of the upper extremities showed that free composite osteocutaneous fibular flap allows replace complex gunshot defects of the upper extremities simultaneously with minimal functional and cosmetic loss of the donor segment. References: Disclosure: No significant relationships. Orthopaedic and Traumatology Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina Introduction: A full 20 years after the war research is being conducted on the most adequate therapeutic approach for chronic osteomyelitis of long bones caused by high kinetic energy projectiles. Material and methods: This study shows 60 patients who were treated by the classic surgical method and 60 patients who were treated in accordance with the suggested original surgical protocol. Patient selection was random. Selection of patients was done on the basis of clinical and radiologic examination which included RTG and CT scanning. Osteomyeltises were selected in line with the McCollis classification and the dictated by the physiologic class of patients ABC. Results: The combined original suggested protocol showed superior comparative advantages statistically defined as significant. Introduction: Gastroduodenal perforation is one of most common surgical emergency. Immediate surgical intervention is usually necessary. Under some rare condition, the perforation is related to gastric adenocarcinoma. Material and methods: In Chang Gung Memorial Hospital, Linkou, there were 2738 patients diagnosed with ICD 9 codes of gastrointestinal perforation while 6864 patients with ICD codes of malignancy of stomach from 1997 to 2013. There were 50 patients with both groups of ICD codes and only 29 were diagnosed with gastric adenocarcinoma related gastric perforation. Results: The mean age for the series of 29 patients is 77 year-old, male dominant (n = 19), and most of patients with chronic underlying diseases (n = 25). There were 15 patients with preoperatively diagnosed gastric adenocarcinoma while 14 patients were diagnosed intra-operatively or postoperatively. The surgical procedures (15 patients were treated radically), locations of perforation, and TNM stage (25 patients with stage III or more advanced) were all evaluated. For survival analysis, we compared this series with a cohort of 232 patients with non-malignant gastroduodenal perforation. Hospital mortality for these patients was significantly higher for malignant perforation (24.1 % vs. 8.9 %). Conclusion: Gastric adenocarcinoma related gastric perforation is a condition of surgical emergency. According to our study, these patients were with relative advanced stages and radical surgery can not usually be done. In addition, clinical outcome is dismal. Introduction: The open abdomen management (OAM) has been utilized for the patients who received the damage control surgery. It was usually decided intra-operatively just based on physicians' clinical judgment and experience. In current study, the risk factors of the patients who required the OAM were discussed. Material and methods: The patients who received the damage control surgery were enrolled. The OAM was performed according to clinical requirement. The patients' demographics, method of surgery, amount of blood transfusion and operation time were recorded. The factors which may result in the difficulties of the closure of abdominal wound were analyzed in the subgroup of trauma and non-trauma patients. Results: There were 266 patients received the damage control surgery, and 32.7 % (N = 87) required the OAM. There were 58 patients received such management due to intra-abdominal trauma, the other 29 OAMs were originated from non-trauma disease. Compared with the patients who did not require the OAM, there were significantly more patients received the surgery due to intra-abdominal trauma in the patients required the OAM (66.7 % vs. 29.1 %,p \ 0.001).The patients who received the OAM had significantly more amount of blood transfusion(trauma: 2355.6 vs 877. 6 Introduction: To evaluate the usefulness of ERCP in the diagnosis and treatment of pancreatic trauma patients. Material and methods: We reviewed the medical records of 72 pancreas trauma patients who were evaluated by endoscopic retrograde cholangiopancreatography (ERCP) for the suspicion of pancreatic duct injury. Patient demographics, mechanism of injury, initial CT findings, endoscopic intervention, methods of surgical treatment and outcomes were evaluated. Results: From February 1988 to June 2015, 57 men and 15 women with a mean age of 35.51 ± 15.1 years were underwent ERCP at Wonju Serverance Christian Hospital for suspected pancreatic duct injury. Blunt abdominal trauma was the injury mechanism in all cases. Pancreatic duct injury was confirmed with ERCP in 34 patients. 12 patients were found to have duct injury which was not found in pre-ERCP CT image. The initial treatment modalities of pancreatic duct injury patients were surgery in 15 patients, conservative management in 8, endoscopic stent insertion without further surgical intervention in 11. There were two failed treatment cases in endoscopic treatment group. One patient underwent percutaneous drainage procedure, the other underwent Roux-en-Y pancreaticojejunostomy. Endoscopic treatment group had no generalized peritoneal irritation sign in pre-ERCP physical examination. There were 2 pancreas related mortality (13.3 %) in surgical treatment group, 1 pancreas related mortality(9.0 %) in endoscopic treatment group. Conclusion: ERCP is necessary for the accurate diagnosis of duct injury in pancreas trauma patients. In regard to treatment of pancreatic duct injury patients, it can be an effective treatment modality equal to surgery in patients without generalized peritonitis. Introduction: True pancreaticoduodenal artery (PDA) aneurysm is a rare, but potentially fatal disease, accounting for \2 % of all visceral aneurysms. Open surgical repair, endovascular or a combination of these two technique have been used for treating ruptured PDA aneurysms. Very few cases of successful endovascular treatment of ruptured PDA aneurysm have been reported in the literature. Material and methods: A 62-year-old man was admitted to our hospital for a 2-day history of epigastric pain. Contrast-enhanced CT identified a large retroperitoneal hematoma around pancreatic head and a 1,5 cm posterior inferior pancreaticoduodenal artery aneurysm. At angiography selective catheterization of the superior mesenteric artery and then sub-selective catheterization of the branches feeding the aneurysm sac has been performed: both inflow and outflow of the aneurysm has been embolized with microcoils. Postoperative course was uneventful, patient was discharged in 6 th postoperative day. Results: PDA aneurysms could occur following trauma, surgery, pancreatitis, but more often association with stenosis of the celiac artery due to arteriosclerosis or compression by median arcuate ligament has been described. The development of PDA aneurysms may be related to increased retrograde blood flow through the pancreaticoduodenal arcades. The incidence of PDA aneurysm rupture is up to 65 %, and the risk of rupture appears to be unrelated to the size of the aneurysm. In case of rupture treatment is challenging and mortality has been reported in literature up to 50 %. Conclusion: Endovascular treatment of ruptured PDA aneurysms is less invasive than surgical resection and should be attempted first if possible in the management of these patients. Introduction: Pseudoaneurysms of visceral arteries are an infrequent complication after invasive procedures or surgeries, specially of the biliary tract. In the last years, we have seen an increase of this pathology. We present our experience of 12 cases of pseudoaneurysms after surgery, including manifestation, treatment and outcomes. Material and methods: We perform a retrospective study of all pseudoaneurysm diagnosed after abdominal surgery in our hospital between 2008 and 2014. Results: 12 patients were included, 8 men and 4 women. All patients presented surgery of biliary tract. 75 % of cases had post-operative complication as intraabdominal infection, bile or pancreatic fistula. Clinical manifestations were observed in 9 patients, 6 as gastrointestinal bleeding, 3 as hemoperitoneum. All patients except one were treated with embolization or stenting. One of the total needed surgery despite previous embolization, to control the bleeding. A small percentage of patients, 4 out of the total, had unceasing bleeding and died. Conclusion: Pseudoaneurysms of visceral arteries are an unusual postoperative complication; they are also increasingly seen as a complication in procedures involving bile tract manipulation. Different hypothesis are accepted as it is described in literature: direct vascular injury at clipping, electrocautery erosions, bile leakage or postoperative infection. The most frequent clinical manifestation is acute bleeding, well as hemobilia, or as hemoperitoneum. The diagnosis is made with CT scan and angiography establishes the definitive diagnosis. A high index of suspicion is needed, because it may produce massive bleeding. Therapeutic option includes angiographic embolization, solving the problem the most of the times. Introduction: Although conservative treatment of acute diverticulitis is successful in the majority of cases, recurrences are often and complains like persisting abdominal pain or bloating common after conservative treatment. Material and methods: Follow up study that included patients that underwent successful conservative treatment for acute diverticulitis. Results: During the last 30 months, 156 patients were admitted in Bucharest Emergency Hospital with acute diverticulitis. Among these, 116 patients with staged Hinchey Ia, Ib and II and III acute diverticulitis, underwent successful medical treatment, the rest of the patients requiring surgical intervention either as first intention or following failure of medical treatment. We contacted a sample of 30 patients randomly selected from this group and realised a quality of life (QOL) assessment using a EuroQol-like classification that was completed by a health care professional over the phone. From these patients we managed to get a full questionnaire in only 20 cases, the rest of the selected patients either refused to answer or could not be reached. Recurrences of diverticular disease were seldom and only a few patients required readmission for surgery. Conclusion: Successful outcome of medical treatment of acute diverticulitis should be assessed not only on short term evaluation but also on long term for an exact evaluation the benefits and risks of this approach References: Disclosure: No significant relationships. A. Barkalaia 1 , N. Tskhvedadze 2 , Z. Chkhaidze 3 1 Introduction: Diverticulitis is a common problem, and although most cases will respond to conservative measures, surgeons will frequently need to treat patients requiring emergency surgery. Surgical management has progressed over the past 30 years, with a change in practice from routine drainage and proximal diversion (necessitating two further major procedures) to primary resection and anastomosis in selected cases. Material and methods: Although substantial progress has been made in the conservative management of sigmoid diverticulitis, a significant number of patients require operative management emergently or urgently after presentation. Most patients with sigmoid diverticulitis present with the classic triad of signs: left lower quadrant tenderness, fever, and leukocytosis. 25 patient Clinica Lancet'' Georgia + Da Vinci hospital. BKR Methods: US, CT, colonoscopy. Results: Several case series have demonstrated the safety of primary anastomosis without diversion for the treatment of acute diverticulitis and have found that the morbidity and mortality of primary anastomosis compared favorably to patients treated with the Hartmann procedure. When evaluating the results of such case series, it is important to note that patients selected for the Hartmann procedure likely differed substantially from those selected for primary anastomosis in ways Conclusion: Prior to closure, the abdomen should be copiously irrigated with saline. If there is an established abscess cavity, drainage should be considered, otherwise routine drainage is unnecessary. The fascia should be closed as per usual routine, but in the case of Hinchey Stage IV or in the immunocompromised patient, consideration of internal retention sutures should be given. Introduction: Restoration of bowel continuity after Hartmann's resection is technically challenging. High morbidity and mortality have been reported: respectively 15-50 % and 5-10 %. Laparoscopic approach have been reported to decrease perioperative complications, but until now very few papers have been published about singleincision laparoscopic surgery. Material and methods: We retrospectively analyzed data of 14 patients who underwent laparoscopic Hartmann's resection for acute diverticulitis (10 Hinchey Stage III and 4 Hinchey Stage IV). Results: There were 9 men and 5 women and the mean age was 63 years (range 42 -83 years). Laparoscopic Hartmann's resection was performed at first cutting both, inferior mesenteric artery and vein at their origin, than mobilizing left splenic flexure and detaching colon-epiploic ligament before to sew the stoma. There were no conversions. The mean time to the reversal procedure was 6 months (range 2-13 months): single-port laparoscopic operations (SILS) were successfully performed in 100 % of patients through the pre-existing stoma site. The detachment of colon-epiploic ligament done during the first procedure greatly facilitated the SILS reversal operation facilitating the colorectal anastomosis: a colon-rectal mechanical anastomosis (with EEA28) was performed. No intraoperative complications were noted and no blood transfusion were required. The median operative time and postoperative length of stay were 120 min (range, 90-150 min) and 7 days (range, 5-18 days), respectively. There were 3 postoperative complications (21.4 %): 1 (7.2 %), wound infection, 1 (7.2 %) urine retention and 1 (7.2 %) atrial fibrillation. Introduction: Though Hartmann's procedure is a common operation for colorectal perforation, abdominal contamination often leads to surgical site infection (SSI). Laparoscopic Hartmann's procedure (LH) was less invasive and was expected as an alternative to conventional Hartmann's procedure (CH) for mildly or moderately contaminated colorectal perforation, however, lacked clinical evidence. Material and methods: This retrospective observational study included all patients who underwent CH or LH after colorectal perforation, from April 2007 to October 2015. Exclusion criteria were severe contamination categorized by CT, systolic blood pressure of \ 90 mmHg, white blood cell count of \ 4000/lL, age of [80 y, subjects with malignancy or subjects previously underwent surgery on lower abdomen.[AS1] Descriptive statistics of baseline characteristics and outcome after CH or LH were assessed. Results: A total of 13 subjects out of 55 consecutive patients with colorectal perforation was included. The median age was higher in subjects with CH than LH (60 vs 54 y). The median operation time of the subjects with LH was longer than those with CH (253 vs 210 minutes). SSI did not occur in subjects in LH (0/3) whereas occurred in a half of subjects with CH (5/10) and needed longer median hospital stay in comparison with CH subjects without SSI (21 days versus 13 days). Median hospital stay was 10 days (9-12) in subjects with LH and 18 days (10-75) in subjects with CH. No patients in both groups have died during hospitalization. Conclusion: In our first experience, LH was feasible for in terms of SSI incidence and length of hospital stay. References: Disclosure: No significant relationships. Introduction: The surgical treatment of generalized peritonitis due to colonic perforation has been a matter of debate. The aims of the study was to analyze the outcomes of patients presenting with peritonitis due to colonic perforation, in order to highlight patient-related and surgery-related prognostic factors which concur to determine the patients' short-term prognosis. Material and methods: Data were collected concerning 205 patients, who underwent surgery for generalized peritonitis due to colonic perforation at San Gerardo Hospital in Monza (Italy), between January 2002 and September 2014. Results: Hartmann's procedure was performed in 108 patients (52.7 %), while resection with primary anastomosis was performed in 59 patients (28.8 %); the remaining 38 patients (18.5 %) underwent either primary suture of perforation or diverting stoma creation. The overall mortality rate was 26.3 %. Non connection was found to exist between in-hospital mortality and the choice of surgical treatment. Factors such as the presence of severe sepsis at admittance, major peritoneal contamination, advanced age and comorbidities appeared to strongly affect short-term outcomes. Major post-operative complications (i.e. Clavien-Dindo stages IIIb to IV) occurred in 38 patients (18.54 %) and were mostly due to the presence of septic shock. Conclusion: The short-term prognosis of patients presenting with generalized peritonitis due to colonic perforation is mainly determined by patient-related factors, and particularly by the presence of deranged physiology at admittance and of previous comorbid conditions. Since no differences were noticed in outcomes of patients who underwent resection with primary anastomosis, this procedure appears to be acceptable and should be considered an alternative to Hartmann's procedure in stercoral peritonitis. Introduction: To date, laparoscopy is emerging as a feasible alternative to the standard open procedures in several cases of complicated diverticulitis. We report our early experience with minimally invasive surgery for the treatment of complicated diverticulitis. Material and methods: Between 2011 and 2015, 55 patients with diagnosis of acute diverticulitis, graded according to the Hinchey Classification, were laparoscopically operated on at our Center. 15 patients (mean age 57y -r.35-88), 4 H2 and 11 H3, underwent laparoscopic peritoneal lavage (LPL) and 40 patients were operated on laparoscopic sigmoid resection: 22 (mean age 63y-r.39-85), 7 H2, 10 H3 and 5 H4, underwent laparoscopic Hartmann's intervention (LH) and 18 (mean age 59y-r.32-76) 6 H2, 8 H3 and 4 H4, underwent resection with primary anastomosis (PA). Results: In LPL group post-operative complications have been recorded in 3 H2 and in 1 H3 (p \ 0.05). 2 H2 were re-operated on and underwent open Hartmann's procedure because of persistent fistula and recurrence of perforation on 45th post-operative day. In LH group 1 patient died for pulmonary edema and myocardic infarction. In AP group 1 patient was complicated by pelvic abscess on 7th post-operative day, treated by percutaneous drainage, and 1 patient developed a low output fistula, managed conservatively. Conclusion: Laparoscopy can be feasible as safe and effective in properly selected cases after early onset of symptoms. Careful patient selection is mandatory before attempting LPL, since it is suitable only in cases of purulent peritonitis (H3). If a perforation is identified (H4), resection with or without primary anastomosis is still required. 3 Surgery, Medical Center Haaglanden, Den Haag, The Netherlands Introduction: An important factor within the military medical logistical chain is the capability of expeditious evacuation from point of injury, through an MTF, to the country of residence where highest level of care can be provided. To investigate possibilities for improvement in this domain, it is necessary to analyze the relationship between duration of evacuation and long-term functional outcome and QoL of injured repatriated Dutch service members. Material and methods: Repatriated service members were invited to participate in a survey concerning functional outcome and QoL. LEFS, SF-36 and EuroQol-6D questionnaires were used. A possible association between functional outcome and QoL in respect to duration of medical evacuation from point of injury to arrival in the Netherlands was analyzed with dichotomization of evacuation within, and after 72 hours. Results: Sixty percent (28/47) of BCs arrived in the Netherlands within 72 h and 40 % (19/47) past 72 h. For the DNBI-injury cohort this distribution was 30 % (7/23) within, and 70 % (16/23) after 72 h. Within the DNBI-illness group 19 % (5/27) was evacuated in 72 h or less and 81 % (22/27) in more than 72 h. No significant independent associations between interval duration and measured outcomes were found. Conclusion: Significant difference in functional outcome and QoL between the two groups was not found. Specialized tactical evacuation and enroute care capability during strategic evacuation, developed and matured in Afghanistan. This trend combined with our results could implicate that the medical evacuation paradigm has shifted from the best care as soon as possible towards delivery of the right care to the right patient at the right time. Introduction: Ziv Medical Center in Israel (the closest hospital to the Israel-Syria border) has treated 500 civil war-wounded since 2013. The majority of the wounded have suffered blast and/or gun shots. A cohort of patients presented with challenging perineal injuries. We report their presentation, management and outcome. Material and methods: With institutional ethics committee approval, electronic and paper case notes of all 500 Syrian patients were retrieved. of 500 patients, 11 were found to have perineal injuries. Results: of the 11 patients with perineal injuries, 4 had isolated perineal injuries, 4 had perineal injuries extending into the abdomen, 1 had perineal injuries extending down to the thigh, 1 had perineal injuries extending to the back and 1 had pelvic and perineal injuries. Six patients had gunshot wounds only, 4 patients had combined gunshot and shrapnel injuries and in one patient the mechanism of injury remains unknown (most likely blast injury). There were no vascular injuries, 1 pelvic fracture, 1 colonic injury, 3 small bowel injuries, 1 ureteric injury and 1 complex rectal injury. Introduction: Penetrating cardiac injuries pose great challenge in diagnosis as well as management. Military weaponry shrapnel injuries are rare and seldom reported. Material and methods: Methods: To review our experience in managing penetrating shrapnel to the heart due to combat injuries Retrospective review of medical records of all the injured admitted with penetrating shrapnel chest injuries due to combat injuries. Only wounded with cardiac injuries were included. Results: Over a two year period (August 2013-October 2015) 8 patients were identified with penetrating shrapnel injuries to the pericardium and/ or the heart resulting from combat etiology. All the patients were male but one female, mean age was 26.6 years (Range 13 -47 years). Associated injuries were common. Five patients were awake and alert and three were mechanically ventilated. All had FAST, CT and Echocardiography studies. Five had positive FAST for the pericardial fluid. CTS demonstrated the shrapnel location. In 5 patients shrapnel into the pericardial space and 2 patients with shrapnel into the myocardium were identified and one patient with shrapnel into the Right Atrium. One patient underwent percutaneous pericardiocentesis. The Female patient was operated due to her intracardiac shrapnel. Six patients were treated non-operatively. One patient in the non-operative group died (14 %) due to severe head injury. Introduction: Japan and the Osaka prefectural government has publicized the estimation of the damage caused by the Nankai Trough quake, whose probability of recurrence in the next 30 years is 70 %. Osaka prefecture is preparing for the disaster by establishing ''disaster coping'' hospitals: 7 disaster base hospitals, 2 municipal disaster coping hospitals, and 92 ''disaster cooperative'' hospitals in Osaka City. Studies have not fully examined whether the medical care system will be able to manage the high number of casualties. This study assesses the manageability of the disaster medical care system in Osaka City by integrating the data on damage estimation and those on disaster coping hospitals using a GIS (geographic information system). Material and methods: The following geographic spatial data was used: height of the tsunami, distribution of seismic intensity, percentage of roadblocks, and distribution of casualties and disaster S46 coping hospitals. These data were expanded on GIS using ARCGIS software. Results: A water level of more than 30 cm, which prevents the movement of EMS vehicles, was found around 35 hospitals largely along the coast of Osaka Bay. The percentage of roadblocks caused by the collapse of buildings was high in the outskirts of Osaka City, where a higher number of casualties was found as well. A large number of casualties are estimated to be concentrated in 5 disaster base hospitals at the center of Osaka City. Conclusion: The uneven distribution of medical resources and medical requirements in Osaka City becomes apparent in a simulation of a Nankai Trough quake. Introduction: Since February 2013, 500 Syrian civil-war wounded patients have been treated in Ziv Medical Center, the closest hospital in Israel to the border with Syria. In spite of the destruction of Syrian health facilities, some patients arrived after initial treatment in Syria. Material and methods: With institutional ethics committee approval, the files of all 500 Syrian patients were reviewed. Results: Fifty three had received treatment in Syria prior to their arrival in Israel. On arrival in Ziv Medical Center a protocol for the management of stable patients who had undergone previous surgery evolved as it emerged that treatment, though life-saving, had been partial and other injuries remained that required attention, for example, ureteric injury, bowel perforation and limb ischaemia. All patients were assessed in the Trauma Room along ATLS guidelines. Stable patients routinely underwent whole body CT scan with intravenous contrast. All patients with previous laparotomy underwent repeat laparotomy. Intercostal drains were removed and new drains inserted. Patients received vancomycin and amikacin antibiotic therapy until culture and sensitivity results were obtained. Conclusion: The destruction of health facilities in conflict zones is a source of great concern. Initial care, even though improvised and partial was, most likely, life-saving for these patients. Introduction: The burden of trauma is large and neglected in low income developing countries as compare to discussion about communicable diseases. The socioeconomic impact of injury related disability is magnified in low income countries, where there are often poorly developed trauma care and rehabilitation centers. Injuries contribute to poverty and economic, social costs have an impact on individuals and society. Sometimes simple fractures like colles fracture are not treated with standard recommendations. Non availability of fluoroscope and portable radiographic machines at many hospitals of developing countries leads to difficult situation in managing simple fractures. The orthopaedic surgeons are left with choice but clinical judgment after reduction of colles fracture and later on radiographs done in radiology department. Material and methods: Study conducted at Fazle Omar Hospital Chenab Nagar on 50 patients with non intra articular colles fractures and reduction was done without using the fluoroscope. The reduction was assessed by clinical assessment like shape of the wrist and clinical palpitation of radial styloid and POP back slab applied and later on post reduction check radiographs in radiology department. Results: The post reduction radiographs were assessed for reduction if meets acceptable criteria, patients were discharged otherwise again attempt is made. Thirty patients post reduction radiographs meet acceptable criteria. Introduction: Calcaneal fractures are known to cause a considerable long-term disability. Little is known about outcome differences between different levels of trauma care. This study describes the demographic patterns and outcomes of patients with a calcaneal fracture in a regional trauma system. Material and methods: This is a retrospective regional cohort study including all patients aged 16 years or older with a calcaneal fracture admitted in a level I or II hospital from 2010 to 2012. All demographics and patient and fracture characteristics data were collected. The outcome was measured with a questionnaire, consisting of the EQ-6D, patient-specific characteristics, satisfaction on appearance of foot and wearable range of shoes, complications, and the capability to work. Results: In total 66 (level I) and 219 (level II) were admitted. The level I population was significantly younger, sustained a more severe injury and had more concomitant injuries. 30 (level I) and 96 (level II) patients filled out the questionnaire. The median EQ-5D index value of the level I population was significantly lower compared to the level II population (0.72 vs. 0.83, p = 0.022). Furthermore, these patients returned less often to work, 72 % versus 90 % (p = 0.022). Complications, satisfaction with wearable range of shoes or appearance of foot did not differ. Conclusion: There is a substantial difference between the patient and injury characteristics and outcome of patients with a calcaneal fracture in level I and level II hospitals. Therefore, trauma centers with different level of care should account for this in the management of these patients. Introduction: The high risk of shortening and reduction of the hight of the calcaneus is related with comminuted fractures. Displaced fractures are need at some type of the operative treatment. CRIF is difficult, especially reduction and stabile fixation of the upper subtallar joint surface. ORIF is usually relate with wound complication and is contraindicated in diabetes, heavy smokers etc. The authors present sinus tarsi approach and nailing of the calcaneal fractures. Material and methods: The 176 patients with 196 fractures of the calcaneus was treated by sinus tarsi approach and nailing during last 3 years. Standard preop procedure was performed. One shot of antibiotics in the close fractures case, open fractures were excluded. The sinus tarsi approach was made, the reduction of the upper subtalar surface, lenght and hight of the calcaneus and stabilisation with one or two cannulated screws which fixed subtalar fragments. Definitive fixation we make by calcaneal nail (C-nail by Medin). Results: We treated 176 patients during last 3 years by this. The aftertreatment was without the cast, simple movement from the first postop day, half weight bearing after 6-8 weeks. All fractures was healed during 10 weeks after surgery without the wound complications. The full weight bearing was possible 3 month after procedure. Conclusion: This method provide anatomical reduction and fixation of the upper subtalar joint, no wound healing problem and good stability without lose of the reduction in this type of fixation. We can recommend this approach and stabilisation by nailing. Our experiences shows that the definitive fixation with the nail (C-nail Traumacenter, Regional Hospital Liberec, Liberec, Czech Republic, 2 Regional Hospital Liberec, Liberec, Czech Republic Introduction: The aims of the operative treatment of intraarticular fractures of os calcis are the anatomic reduction of articular surfaces and the restoration of the shape of calcaneus. The extensile surgical approaches are associated with high risk of serious wound healing problems. The authors present their experience with less invasive treatment of intraartricular calcaneal fractures using C-nail. Material and methods: Nineteen patients with twenty intraarticular calcaneal fractures type II and III according to Sanders classification were treated with C-nail in years 2014 and 2015. The follow-up period was at least 6 month. The operation time, wound healing, bone healing, stability of osteosynthesis (talocalcaneal height and Böhler angle changes) and clinical results (AOFAS scoring system) were analyzed. Results: No wound healing problems were observed and all fractures healed successfully. We noticed only a minimal loss of talocalcaneal high and Böhler angle during follow-up. Clinical score in all patients was between 81-100 points (good to excellent result). Conclusion: Intramedullary nailing of less severe intraarticular calcaneal fractures using C-nail seems to be a good alternative to plate osteosynthesis. Clinical and radiological results are very satisfactory with a low rate of complications Introduction: External fixation using Ilizarov frames provides good outcomes for severe comminuted fractures, however, a safe angle of insertion has not yet been examined when applying hind foot frames for these fractures. This study investigated the risk to the posterior tibial neurovasculature (PTN) when anteromedial wires were inserted into the calcaneus. Material and methods: Twenty cadaveric limbs had 5 wires inserted into the calcaneus. In Group A, wires were inserted 1/3 of the distance from the posterior tip of the heel to the tip of the lateral malleolus (n = 50). In Group B, wires were inserted halfway between these landmarks (n = 50). Angle of insertion was varied between -10°and 50°in both groups. Vernier calipers were used to measure the distance between the wires and the PTN. Results: In Group A, no wires pierced the PTN. At an increased angle of insertion ([ 30°) there was greater risk to the PTN (Pearson's correlations coefficient r = -0.785, p \ 0.001). In Group B, 11 wires pierced the posterior tibial neurovascular bundle and 3 passed within 1 mm of it. Wires in Group B were significantly closer than in Group A (t = 6.852, df = 93.73, two-tailed p \ 0.01). With an increased angle of insertion there was greater risk to the PTN (r = -0.801; p \ 0.01). Conclusion: Based on these results, a maximum angle of 25°is recommended for insertion of calcaneal wires at 1/3 from the heel. If greater bone purchase is required, a halfway insertion point may be used, with a maximum angle of insertion \ 10°decreasing risk to the PTN. References: Calori, G.M., Tibial pilon fractures: Which method of treatment? Injury, 2010. Nayagam, S., Safe corridors in external fixation: the lower leg (tibia, fibula, hindfoot and forefoot). Stratagies in Limb Reconstruction, 2007. Catagani, M., V. Malvez, and A. Kirienko, Advances in Ilizarov Apparatus Assembly, ed. A. Bianchi Maiocchi. 1999 Traumatology, UZ Gasthuisberg, Leuven, Belgium Introduction: Calcaneal fracture is rare and difficult to treat. His treatment remains controversial, but the gold standard treatment is to operate in case of displaced intra-articular fracture. The main goal of surgery is the repair of the posterior subtalar joint (PSJ) facet. At our hospital we developed a 3D model analysis to assess the fractured bone and the bone after osteosynthesis. Both are compared to the uninjured side. Results of this technique are presented. Material and methods: 16 patients with unilateral calcaneal displaced intra-articular fractures were operatively treated at our Hospital. Pre-op, post-op, and contralateral uninjured foot CT images were segmented with Mimics Ò software(Materialise Ò ), and analyzed with a homemade program based on MeVisLab Ò technologies. Results: 16 patients were operatively treated. 9 presented an improvement of the distance between talus and calcaneus, 6 presented an improvement of the orientation of the PSJ calcaneal facet. Three had a significant remaining subsidence of the PSJ calcaneal facet, without clinical significance. Conclusion: The calcaneal anatomy is very complex and 3D reconstruction imaging gives a clear overview of the fracture pattern and of the osteosynthesis. It helps to plan the surgical technique and to assess the postop result. Several measurements are available: the distance from the calcaneus to the talus, the surface of the joint facet and the orientation of the joint facet. Orthopaedic, Evagelismos Hospital, Athens, Greece Introduction: The fracture of the calcaneus accounts for about 1 % of all fractures. The majority of these fractures are intra-articular. Surgical intervention is an accepted way of treatment of these fractures Material and methods: In a period of nineteen years 47 patients ages between 19-77 years old, were treated surgically using the lateral extensile approach. Follow-up ranged from 1-19 years. The evaluation was based on x-ray appearance (calcaneal morphology, Bohler's angle, Gissane's angle), active ROM, footwear problems, time off work. The SF-36 health status survey was used for outcome assessment. Results: All fractures have been healed in an average time of 15.3 weeks. The outcome was excellent for 24 cases, good for 17 cases and poor for 10 cases. Complications were malposition of fixation in 8 cases, superficial wound slough in 5 cases, reflex S49 sympathetic dystrophy in 6 cases and deep infection in one case which cleared up with antibiotics and metalwork removal following union of the fracture. Two patients who had late reconstruction resulted in malunion which was corrected with an osteotomy. Conclusion: ORIF is an effective method of treatment for these fractures provided that restoration of calcaneal height and talocalcaneal relationship is achieved. Based on these results, if severe posttraumatic subtalar arthritis does not occur, long-term (10-20 years) functional results with mild pain, minimal alterations in activities of daily living or work, and normal shoe wear can be expected from a properly performed ORIF. Patients must be counseled regarding difficulty with uneven ground and an inability to return to vigorous sports activities. Introduction: There is evidence that both incomplete treatment and malreduction of injuries to the syndesmosis can lead to poor clinical outcomes. This study's aim is to compare the ability of two reconstructive techniques to restore anatomic positioning of the syndesmosis. Material and methods: Fourteen paired, fresh-frozen human cadaveric limbs were mounted in a weight-bearing simulation jig. CT scans were obtained in the simulated foot-flat loading (75 N) and in single-legged stance (700 N), in five foot positions: neutral, external rotation, internal rotation, dorsiflexion, and plantar flexion. The elements of the syndesmosis and deltoid ligament were sequentially sectioned and rescanned following each resection. One of each pair was then reconstructed via two methods: Achilles autograft and peroneus longus ligamentoplasty. Results: Multiple measurements were made to define the position of the fibula in the incisura. The deformity at the incisura was consistent with clinical injury, and the degree of displacement in all ligament states was dependent on the foot position. Statistically significant differences between the intact and reconstructed states were found with all measurements, specifically when the foot was in external rotation and dorsiflexion, p \ 0.05. There was no significant difference with direct comparison of the reconstructions. Conclusion: This study has detailed the motion of the fibula in the incisura and its variation with foot position. Neither reconstruction was clearly superior, and both techniques had difficulty in the externally rotated and dorsiflexed positions. This study design can serve as a model for future ex-vivo testing of reconstructive techniques. Introduction: In unstable ankle fractures many authors found a better outcome after surgical management. Plate osteosynthesis is the standard procedure today. However soft tissue problems due to trauma, arterial or venous problems and diabetes can cause severe soft tissue problems. The screw fixation in osteoporotic bone and in comminuted fractures can be insufficient . After ankle osteosynthesis Zaghloul reported in over 60 year old patients a rate of infection of 2 % but 21,5 % of the patients had complications and 10.8 % where major requiring operative revisions. The XS nail a straight 4.5 mm intramedullary implant which can be locked every 9 mm with threaded wires showed significant lower deformation and higher bearing capacity as plate osteosynthesis in experimental tests and avoids soft tissue problems. Material and methods: From December 1999 to march 2001 214 patients with a ankle fracture were treated consecutively with a XS nail in all ankle fractures except patients having a medullar canal too thin for nail insertion. All patient data pre, intra and postoperative data where recorded prospectively and clinical and radiological reexamination 6-18 months after operation was performed and evaluated according to the Olerud score. A long time follow up was also performed. Results: Olerud score n Exzellent 71,4 % n Good 24,3 % n Satisfactory 1,2 % n Bad 2,2 % (bad results in 4 patients with regional pain syndrome, Parkinson, reosteosynthesis after plate, complete joint dislocation) Conclusion: The XS nail allows a stable fixation also in comminuted and osteoporotic fractures. The soft tissue problems are rare and because of the intraosseous implant position their management is simple. There were no infections and low complication rate References: J. Gehr, W. Neber, F. Hilsenbeck, W. Friedl New concepts in the treatment of ankle joint fractures The IP-XS (XSL) and IP-XXS (XXSL) nail in the treatment of ankle joint fractures Arch Orthop. Trauma Surg. (2004) Introduction: Acute Mesenteric Ischemia (AMI) has not changed mortality rates in the past 50 years. Such poor outcome is influenced by treatment delay due to diagnostic difficulties. After an observational retrospective analysis at Humanitas Research Hospital Analysis of patients with AMI a diagnostic algorithm was designed to shorten presentation to treatment time. Material and methods: We retrospectively analyzed 36 patients with postoperative diagnosis of AMI; medical history, clinical features, laboratory, imaging, time to treatment, in-hospital complications and mortality were considered. Mann-Whitney non parametric test and Fisher's exact test were considered for statistical analysis. All CT scan were reviewed by a single radiologist according to the Furukawa criteria. AMI were classified in Embolic, Thrombotic, Non Occlusive and Venous AMI. Results: Medical history, risk factors, clinical features at presentation seemed to have no influence to identify patients with worst outcome except tachycardia that is associated with severe complications (p = 0.006); no laboratory test was statistically significant in order to obtain early diagnosis. Systematic CT reviewing according to Furukawa criteria identified many radiologic features not reported before surgery. Mortality was strictly related to time to treatment: (\6 hrs: 30 %, 6 to 12 hrs: 36,4 %, [12 hrs: 53,3 %). Conclusion: Our study confirmed the difficulties to achieve an early diagnosis and underlined the necessity to treat these patients within 6 hours; therefore we introduced in our clinical practice an algorithm to guide emergency physicians to a faster assessment of patients with suspected AMI. Further analysis after the introduction of the algorithm need to be performed in the future to evaluate its efficacy. Introduction: Free fluid is a common finding in many abdominal acute diseases. Interpretation of the nature of the fluid could be critical for the management. We prospectively evaluate the impact of the systematic use of US-guided Diagnostic Peritoneal Aspiration (US-DPA) in the decision making of abdominal emergencies. Material and methods: US-DPA was systematically performed in all patients with acute abdominal problems (no trauma) submitted to US and/or CT when free fluid was detected, whenever uncertainty remained on the final diagnosis and right clinical decision. Analysis of the fluid was performed only every time the gross appearance was not considered enough for decision. The following data were analyzed: DPA feasibility, time to clinical decision (surgery, observation, new investigation), rate of decisions definitely changed by DPA. US-DPA was performed bedside, with 19/21 G needle, preferably by an inplane technique. Results: Seventy nine patients underwent DPA for the following conditions or suspicions: 17 SBO, 15 NSAP, 25 postoperative complications, Introduction: Blunt abdominal trauma patients are prone to hemodynamic deterioration once laparotomy abolishes the hemostat effect of the abdominal wall. In such situation time factor is crucial and procedure results demands essentially a highly skilled exploring surgeon. This study is trying to minimize the skill difference factor among trauma surgeons through proposing a methodology standard plan to apply in abdominal trauma exploration. . Material and methods: This is a multi-center clinical trial on multiorgan blunt abdominal trauma patients. Between March 2012 and August 2015 the study recruited 78 isolated blunt abdominal trauma patients with more than one solid organ injury whom needed surgical exploration. Computerised tomographic scan is the basis of organ injury assessment and plan designation. The proposed protocol gave priority criteria of management as follows: Priority is given to the highest grade of organ injury, then the highest organ blood perfusion found injured and lastly the least time needed to manage the organ. Also priority is given to control haemorrhage over definitive procedure per organ. Results: Patients' data regarding clinical status progression is tabulated. Protocol violation points and related deviation of results are all recorded. Procedure time, haemoglobin status and number of blood transfusion units, hemodynamic progression and the final outcome of procedure are all documented. Collective data processing in horizontal and vertical directions achieved to extract maximal information. Conclusion: The applied protocol proved, less demand regarding patients' hemodynamic support, procedure time saving and showed promising and less moribund outcome. The proposed protocol needs to be verified on wider scale studies. Introduction: Small and large bowel volvulus (S/LBV) are rare surgical conditions. We aimed to assess all adult S/LBV in our center to look for its presentation, management and outcomes. Material and methods: A retrospective analysis included all S/LBV adult patients between 1990 and 2014. Results: There were 58 BV patients (males = 71 %) with mean age of 47 ± 19 yrs. Among SBV patients (n = 17), the affected segments were jejunum, ileum, and jejunum plus ileum (2, 6 and 9 respectively). Seven patients had bowel gangrene, and 1 died subsequent to surgery. Nine patients had resection and primary anastomosis, 6 had simple derotation and 1 had reduction of hernia and repair. Postoperatively, 2 patients developed sepsis and none had anastomotic leak. Median hospital length of stay (HLOS) was 9 days (5-52) and the overall mortality was 6 %. In LBV (n = 41), sigmoid was the most frequently involved segment (95 %), followed by cecal (2.4 %) and transverse colon (2.4 %) . Thirteen patients underwent endoscopy and 8 had surgery alone. Ten had endoscopic deflation followed by elective surgery. In 4 cases, endoscopic deflation failed which required emergency surgery, 1 patient required laparotomy, adhesiolysis, simple derotation and deflation through cecostomy and 1 underwent laparoscopy converted to open sigmoidectomy. Post-S52 operatively, 1 patient had anastomotic leak and 1 developed wound infection. Median HLOS was 10.5 Introduction: In the evaluation of stab wounds of the anterior abdomen (ASW), CT has been said to be not helpful. Material and methods: One hundred sixty patients with ASW in the past 30 years were studied (68 % male, mean age of 44-years-old, self-inflicted of 76 %, shock state in 30 %, having evisceration in 22 %). The period was divided into three groups: the first 8 years (G1) without CT scan; the next 5 years (G2) with occasional scan when a chief doctor judge it necessary; and recent 17 years (G3) with routine scanning for all patients being hemodynamically stable after resuscitation. The results were evaluated by whether the management was proper (necessary laparotomy and successful NOM) or improper (unnecessary laparotomy and NOM failure). Furthermore, CT effectiveness was also assessed in total. Chi-square test was used for the statistical analysis. Results: CT was applied in 39 % in G2 and 83 % in G3. The management was judged proper in 67 %, 86 %, 91 % in G1, G2, G3, respectively (p = 0.0008 between G1/G3). In total, the rate of proper management was 93 % when the patients underwent CT and 76 % without CT (p = 0.002). The reason for choosing NOM in G2 (21 %) was simply no significant abnormality on CT, but patients of NOM in G3 (46 %) included hepatic injury, large hematoma of the abdominal wall, etc. Conclusion: CT make the management more proper: widening the application of NOM and reducing the unnecessary laparotomy rate. The CT information was advantageous not merely for choosing the management way but also for preoperative planning of surgical procedure. Introduction: Hollows viscus injury (HVI) is a rare occurrence and represents a clinical challenge because of its subtle and nonspecific clinical findings. The specific aims of this study were to determine the overall frequency of HVI in blunt trauma patients occurring in large urban area, the relative frequency of various hollow organ injuries, and the outcomes of such injuries Material and methods: A retrospective trauma registry review was performed by analysing data from the University Hospital Sant' andrea in Rome and data from the Emergency Surgery and Trauma Care Unit of S. Filippo Neri Hospital in Rome The clinical records of all blunt abdominal trauma observed between January 2006 and December 2014 were blind analysed. Variables considered for analysis were: sex, age, time/type of trauma, associated injuries, timing/ characteristics of operative treatment, ISS, AIS, length of hospital stay, morbidity and mortality. Results: Seventy-one, 7.5 % of all abdominal trauma recorded, were coded having 89 HVI. The overall morbidity and mortality rates were 29.6 % (n = 21/71) and 19.7 % (n = 14/71) respectively. Multivariate analysis indicated that only WBC (p = 0.007) was significant independent predictor of morbidity whereas preoperative transfusion (p = 0.010) and ISS (p \ 0.001) were significant risk factors for mortality. Conclusion: HVI is rarely found in patients with blunt abdominal trauma and it can be fatal and life-threatening, particularly in patients for whom a pertinent diagnosis is delayed. It appears clearly that during an ER evaluation of a blunt abdominal trauma an HIV has nowadays always to be considered to reach a quick diagnosis and prompt surgical intervention. Introduction: Proximal femoral fractures are common in the elderly and are associated with a high rate of mortality and morbidity. Many of these patients are under oral anticoagulation by vitamin K antagonists (VKA) [1] . The purpose of this study was to examine the current practice of perioperative management of anticoagulation in proximal femoral fractures and to get data about the use of vitamin K and PCC, which may allow early surgery in this delicate patient group. Material and methods: Data from patients with proximal femoral fractures were recorded retrospectively. PCC together with vitamin K was compared to the use of vitamin K alone. Time to surgery, bleeding, hospital stay and complications were analyzed. Results: A total of 678 patients were analyzed. 110 (16 %) patients received VKA prior to the fracture. In patients treated by osteosynthesis, PCC significantly reduced the time to surgery, compared to vitamin K alone (6.5 vs. 82.7 hours) . Total hospital stay could be reduced by PCC and there were no differences in hemoglobin drop or need for packed red blood cells or revision rates. Conclusion: The administration of PCC together with vitamin K prior to surgery in patients with proximal femoral fractures on VKA therapy who need surgery by osteosynthesis leads to shorter time to surgery than the administration of vitamin K alone without increasing bleeding risk. Patients under anticoagulation by VKA who need arthroplasty due to femoral neck fractures could also benefit from the use of PCC for faster VKA reversal and a shorter time to surgery. References: Ahmed I, Khan MA, Nayak V, Mohsen A. An evidencebased warfarin management protocol reduces surgical delay in hip fracture patients. Journal of orthopaedics and traumatology: official journal of the Italian Society of Orthopaedics and Traumatology 2014; 15 (1) Introduction: Hip surgery, both elective and trauma, is associated with major bleeding. Mortality is increased five-fold in patients suffering from anaemia, but blood transfusion is not without risks. Tranexamic acid is an antifibrinolytic agent that can be used in the prevention and treatment of haemorrhage; the leading cause of preventable death in trauma. Material and methods: We included patients undergoing hip arthroplasty over a three-month period, and measured pre-and postoperative haemoglobin, transfusion rates, and side effects following tranexamic acid. We retrospectively investigated these same outcomes in patients who had not received tranexamic acid. Results: Forty patients given 1 g of tranexamic acid pre-operatively were audited, and the results compared with forty patients who had not received treatment. 7/40 in our control group required a postoperative transfusion. The mean pre-op haemoglobin in this group was 130 g/L, and post-operatively 98 g/L. One patient suffered an early transfusion reaction. None treated required a transfusion, and the mean haemoglobin dropped from 132 g/L to 116 g/L postoperatively. Conclusion: Tranexamic acid is an inexpensive anti-fibrinolytic agent, with 1 g costing £3.00 [1] . In comparison a single unit of red blood cells has an estimated cost of £120 [2] . In our study, none of the patients who received tranexamic acid required a blood transfusion, compared to almost 20 % in our control group. In addition, those who were treated saw an average drop in haemoglobin of 16 g/L; a value doubled in our control group. The authors conclude tranexamic acid is an effective way to prevent post-operative anaemia, as well as eliminate the risks and costs associated with transfusion. References: 1. British National Formulary: Tranexamic Acid. Accessed 20th October 2015. http://www.evidence.nhs.uk/formulary/ bnf/current/2-cardiovascular-system/211-antifibrinolytic-drugs-andhaemostatics/tranexamic-acid. Introduction: Hip fractures mainly occur in the elderly population. This group is fragile and has a high risk for perioperative complications such as delirium. Mainly opioids are used for pain management in this population and have frequently proven to be inadequate. Use of opioids and inadequate pain management is believed to increase the risk of developing delirium. This study therefore evaluates the effect on incidence of delirium of the fascia iliaca blockade (FICB) in hip fractures. Material and methods: In a 2 year prospective cohort setting two groups were defined. Patients aged 60 years and older with a hip fracture were included on admission. In the first period conventional pain management was applied. In the second cohort patients received an ultrasound guided FICB on admission. The primary outcome variable was perioperative delirium, diagnosed by a geriatric specialist. Results: Demographics, mean ASA classification, comorbidities, anesthetic and operative procedures were comparable in both groups. However the intervention group showed a higher incidence of mental dysfunction (dementia or Parkinson) on admission (20.0 % vs. 3.9 %). Delirium occurred in 28 (22.8 %) of the 123 included patients. Incidence of perioperative delirium in the FICB group was 50.0 % (10/20), significantly different compared to 17.5 % in the control cohort (18/103). Conclusion: Patients who received a FICB showed a significant increase of delirium incidence. This could be due to the higher presence of mental dysfunction or the so far limited sample size of the intervention group. More data is needed to state a conclusion about the effect of FICB on the incidence of delirium. Surgery, VUmc, Amsterdam, The Netherlands, 2 Surgery, Spaarne Gasthuis, Haarlem, The Netherlands, 3 Surgery, Medisch Centrum Alkmaar, Alkmaar, The Netherlands Introduction: Femoral neck fractures are common but can be challenging injuries with high re-operation rates after internal fixation. The Dynamic Hip Screw (DHS) is a frequently used internal fixation device. To prevent rotation of the femoral head, an anti-rotation screw is sometimes added to the DHS. Although proven in small biomechanical studies, its additional value in clinical studies remains controversial. The aim of this study is to assess the difference in reoperation rates after a DHS with and after a DHS without anti-rotation screw. Material and methods: We reviewed all patients operated with a DHS for intra-capsular fractures between January 2010 and December 2013. Minimal follow-up was 1 year. The participating hospitals were one academic and two teaching hospitals in the Netherlands. Results: 368 patients after a DHS were included: of which 50 with and 318 without additional anti-rotation screw. Mean age was 70 years (median 70), 58 % was female and mean ASA classification was 1.86 (median 2). In total there were 91 failures of osteosynthesis (34 with avascular necrosis of the head, 25 with pain related to the osteosynthesis, 10 non-unions, 10 displacements, and 12 due to other causes). There were 85 reoperations: 70 (22.0 %) in the group without anti-rotation screw and 15 (30.0 %) in the group with anti-rotation screw. This was non-significant. Conclusion: This study did not reveal a significant difference in reoperation rates between a DHS with and a DHS without additional anti-rotation screw. Further analysis will be performed, using additional patient characteristics (Garden Classification, Pauwels classification and quality of reduction Introduction: The high risk of secondary, contralateral hip fractures and the associated, significantly increased mortality [1, 2] underline the need for prophylactic reinforcement to avoid these injuries in case of a low energy fall. Invasive, internal augmentation approaches show high potential [3, 4] , but there is no ideal methodology available yet. Computer models can aid the development of optimized reinforcement strategies. Material and methods: A previously validated, non-linear finite element (FE) analysis framework was applied to predict the fracture load of fifteen proximal femora in sideways fall based on high resolution CT images. Various augmentation strategies using bone cement or metal implants were developed and virtually performed on the bone models. The relative strengthening compared to the nonaugmented state was evaluated using case-specific FE analyses. Results: For the cement-based strategies, strengthening was linearly proportional to cement volume and was significantly affected by cement location. With an optimized location and 12 ml cement, 64 ± 33 % and 156 ± 126 % increase in yield load and energy was reached, respectively. With 19 ml, these were 87 ± 42 % and 209 ± 187 %, and not significantly different from those achieved using metal implants. However, for metal implants, higher risk of subcapital fractures was indicated. Weaker bones were strengthened exponentially more for all augmentation strategies. Conclusion: Despite the encouraging results of this study, further development is required to identify the ideal, clinically relevant augmentation strategy that can deliver sufficient strengthening and avoid inducing damage within important regions of the femur. This numerical analysis technique helps to screen the potential mechanical S55 benefit of various augmentation approaches and highlight promising candidates for experimental evaluation. Introduction: Early hip surgery is acknowledged as a quality indicator. Guidelines recommend surgery within 24 to 48 hours from admission for emergent hip fractures, however, the effect of operative delay on morbidity and mortality remains controversial. The objective was to determine whether early surgery affects postoperative outcomes. Material and methods: Early surgery was defined as surgery within the next calendar day from admission. This case-control observational study, including 242 patients aged 60 years and above, compares 123 patients in 2014 after 'early surgery' was implemented with 119 patients in 2013. Primary endpoint was mortality and secondary endpoints were demographics, complication rate, and length of stay (LOS). Results: Median age was 84 yo (IQR 77-88). Early surgery was achieved in 88.6 % vs. 50.4 % of the patients in 2014 and 2013, respectively (p \ 0.001). Despite a tendency to lower mortality in 2014, six and twelve month mortality did not significantly differ between 2014 and 2013 (respectively, 9.8 % vs. 13.4 %, 2014 vs. 2013, p = 0.370, 6 months; 12.2 % vs. 14.3 %, 2014 vs. 2013, p = 0.667, 12 months) . Also complication rate did not significantly differ between 2014 and 2013 (73.2 % vs. 65.5 %, p = 0.198) . Except for less thromboembolic complications (p = 0.020), subanalyses showed no significant differences for pneumonia, wound infection, mechanical failure, delirium, and bladder infection. LOS was significantly lower in 2014 as compared to 2013 (12 vs. 16 days, p = 0.016). Conclusion: We successfully implemented early surgery for hip fractures. As a consequence of early surgery, we hospitalized shorter and had less thromboembolic events. However, there was no significant reduction in six and twelve month mortality. References: L. Moja, et al., ''Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A metaanalysis and meta-regression of over 190,000 patients,'' PLoS One, vol. 7, p. e46175, 2012. J. Librero, et al., '' Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System,' ' BMC Health Serv Res, vol. 12, p. 15, 2012. C. Ventura, et al., ''Impact of multidisciplinary hip fracture program on timing of surgery in elderly patients, '' Osteoporos Int, vol. 25, pp. 2591 -7, Nov 2014 Surgery, VUmc, Amsterdam, The Netherlands, 2 Surgery, Spaarne Gasthuis, Haarlem, The Netherlands, 3 Surgery, Medisch Centrum Alkmaar, Alkmaar, The Netherlands Introduction: Annually some 18.000 hip fracture patients are admitted to Dutch hospitals. Older people are at a higher risk of hip fracture being accompanied by additional injury. This study aims to explore this increased risk in the elderly. Material and methods: All hip fractures that occurred between January 2010 and December 2013 were extracted from the trauma records of one academic hospital and two teaching hospitals in the Netherlands. All patients over 70 were included. The exclusion criterion was an Injury Severity Score of 16 or higher (multi-trauma). Using the Abbreviated Injury Scale, the types of accompanying injury following hip fracture were identified. Results: 2,402 patients could be included, and 14 were excluded because of multi trauma. 279 (11.6 %) suffered a total of 319 accompanying injuries: 225 patients (9.4 %) had one accompanying injury and 54 patients (2.2 %) had two or more accompanying injuries. The most common injury involved the upper extremity (44.8 % of all the accompanying injuries), followed by head injuries (31.0 %). The principal upper extremity injuries were wrist fracture (N = 54), skin cuts and abrasions (N = 29) and humerus fractures (N = 26). Head injury mostly involved skin cuts and abrasions. Conclusion: Some 10 % of elderly hip fracture patients suffer one or more accompanying injuries that also require treatment. Therefore it is important to perform a full-body examination in case of hip fracture. The accompanying injury occurring most frequently is related to the upper extremity. immobilization in combination with stress-inducing events such as trauma and operative treatment may result in further loss of muscle mass, possibly increasing the risk of adverse outcomes. However, it is unclear to what degree loss of muscle mass occurs during hospitalization in this patient group. Material and methods: Hip fracture patients (C 65 y) were included in the study at hospital admission. A single-slice CT-scan of the nonfractured upper leg was performed at time of admission and prior to discharge. The muscle cross-sectional area (CSA) of the whole upper leg and the quadriceps muscle were measured using ImageJ software. We used Wilcoxon-Signed Rank tests in combination with data-imputation models to compare the data between time-points. Results: So far, 11 elderly hip fracture patients (age: 82.3 ± 2.1 y) were included in the study. The mean period between two measurements was 7.3 ± 0.4 days. The whole thigh muscle CSA significantly declined with an average of 4.7 ± 2.1 % (9148 ± 633 vs 7827 ± 493 mm 2 at admission and end of hospital stay, respectively, P = 0.013). In accordance, quadriceps muscle CSA was on average 5.3 % lower at the end of hospital stay (3845 ± 291 mm 2 ) when compared to the CSA at admission (4302 ± 385 mm 2 , P = 0.058). Conclusion: Elderly hip fracture patients lose a substantial amount of muscle mass during hospital admission. Effective interventional strategies are needed to preserve muscle mass and strength during hospitalisation of hip fracture patients. Introduction: Road traffic injury (RTI) is a significant worldwide cause of pediatric morbidity and mortality, with a disproportionate number occurring in low-and middle-income countries. Whether children are at increased risk of RTI on weekends has not previously been investigated. This study sought to assess weekend patterns in pediatric RTIs using hospital-based data in Cape Town, South Africa. Material and methods: Data was analyzed from Childsafe South Africa's prospectively collected trauma surveillance registry for injured children aged \ 13-years, presenting to a tertiary pediatric Trauma Department between 2004-2013. Results: A total of 71,180 patients presented with traumatic injuries, of which 8,815 (12.4 %) resulted from RTIs. RTI patient median age was 4.5-years, and were predominantly males and pedestrians. RTIs were more common on weekends than on weekdays (2.98 vs. 2.19 patients/day; 15.5 % vs. 11 .2 %, p \ 0.001). Moreover, injuries sustained by RTI patients on weekends were more severe than on weekdays, and when compared to weekend all-cause trauma patients (injury score 1.66 vs. 1.46 and 1.43, p \ 0.001). RTI patients were more likely to require admission to the trauma ward (1.14 vs. 0.79 patients/day, p \ 0.001) and ICU (0.10 vs. 0.07 patients/day, p \ 0.05) on weekends than on weekdays. There were most weekend RTIs during the last annual quarter, and these also more frequently required admission to the trauma ward and ICU. Weekend Trauma Department mortality secondary to RTI was rare. Conclusion: Pediatric RTI patients are more frequently brought to hospital and require admission during weekends, with particular risk during the last annual quarter. These findings indicate potential for targeted community prevention strategies. References: Disclosure: No significant relationships. Material and methods: This study was performed as a retrospective data analysis including patients aged \16 and ISS C16 who were treated between August 1992 und June 2013 at our Department. Statistical analysis focused on injury mechanism, GCS, ISS, AIS, GOS and clinical outcome of all patients. Results: 100 patients with a mean age of 9.5 years ± 5.0 were available for retrospective follow up (64 male, 36 female). The injury pattern was in 50 % caused by traffic accidents, in 41 % by a fall and other reasons in the remaining 9 %. With an initial GCS of 7.2 and ISS of 32.7 patients were taken to our clinic. Injured organs were; 73, head (mean AIS 3.9), 78 thorax (mean AIS 3.4), 43, abdomen (mean AIS 3.4), 70, extremities (mean AIS 2.5), two, skin (mean AIS 1.5) and four, neck (mean AIS 4). 28 patients died with a mean ISS of 41.5. 62 % of the patients reached a GOS of five after treatment. Conclusion: The polytrauma in children is a very rare disease mostly with severe injuries with a high morbidity and mortality. Caused by better security reasons polytrauma in children decreased over the last decades, nevertheless it is necessary to treat such patients in a specialised centre to secure good clinical outcome. Disclosure: No significant relationships. Introduction: The aim of the present paper was to present cases of occipital condyle fractures treated at our Department, review the literature, and stress the importance of MRI studies in the diagnostic work-up of these injuries Material and methods: Our retrospective study involved a group of 3 female patients (mean age was 16.3 years) with occipital condyle fractures diagnosed/treated .We assessed the cause and type of fracture, additional damage, available classification systems, treatment methods, outcomes and complications. Results: Mean follow-up period was 18 (10-24) months. We achieved good clinical outcomes (NDI scores) in all the patients. In one patient, a follow-up MRI scan revealed the presence of a clinically silent posttraumatic epidural meningeal cyst at the C2-C6 level, anterior to the spinal cord. Conclusion: 1. The choice of an appropriate treatment method is decisively based on the assessment of the morphology and stability of the fracture in a CT/MRI scan rather than on the fracture type alone. 2. There is no noticeable difference between the usefulness of the classification system developed by anderson and Montesano and that according to Tuli et al. 3 A 3- year old child presented as a Level 1 Trauma with a traumatic posterior hip dislocation and acetabular fracture after being struck by a vehicle on a bicycle. The patient was neurovascularly intact. Imaging revealed a posterior dislocation of the left hip. The patient was taken to the operating room for closed reduction under anesthesia with radiographic guidance. The patient was stabilized and discharged with instructions for partial weight bearing. A review of the literature was performed to discuss the incidence, management, complications and outcome of pediatric traumatic hip dislocation. Material and methods: Literature review was performed using OvidMD, Cochrane, and Pubmed using the following keywords: ''pediatric hip dislocation'', ''traumatic pediatric hip dislocations,'' ''traumatic hip dislocation,'' and ''hip dislocation.'' Results: Literature search revealed 15 relevant articles with 115 patients sustaining hip dislocation. Average age was 9.5 years; 70 % were boys, 103 were posterior dislocations, 8 were anterior dislocations, 3 were central/obturator dislocations, and one was unknown. Conclusion: The management of traumatic hip dislocation in the pediatric population is divisive. Some advocate for reduction in the emergency room, while others for reduction in the operating room under general anesthesia. Diagnosis is multimodal and related to the patient's age. Initial diagnosis is made by the history and physical examination, followed by radiography. Hip dislocations require emergent reduction due to a number of sequelae. Multiple studies describe treatment options with differences in outcome. Generally, pediatric hip dislocations have a good prognosis. Long-term follow up into adulthood has not been documented. Further studies are needed to investigate long-term sequelae. References: Introduction: In case of blunt pancreatic trauma, the diagnostic of the main pancreatic duct injury and its location is essential to guide the management. The aim of this study was to evaluate the use of endoscopy in blunt pancreatic trauma and analyze the short-term results concerning its success or failure. Material and methods: Multicentric retrospective cohort of 16 patients having a blunt abdominal and pancreatic trauma and an ERCP (endoscopic retrograde cholangio-pancreatography), between 1998 and 2014. Each patient had an abdominal CT-scan at time of admission. NISS, AAST grade, delay between endoscopy and initial trauma, types of lesion noted, treatment applied, hospital stay, and follow up have been determined. Failure of endoscopic procedure was defined by the incapacity to perform the ERCP or echo-endoscopy, the persistence of a fistula, stenosis or pseudocyst. Results: Only 13 patients had an endoscopic treatment: 10 stenting of the main pancreatic duct, 4 cystogastrostomy and 1 sphincterotomy. Overall success rate of endoscopic management was 62.5 %. After 21 days post-trauma, it was about 85.7 %. Among grade I, II, III and IV of AAST classification, the success rate of endoscopic procedure was respectively 100 %, 66.7 %, 20 % and 50 %. Pseudocysts have all been treated successfully. Stenting was efficient in the treatment of 2 stenosis, 2 fistulae and adding to a cystogastrostomy. The mean follow-up after endoscopy was 7.5 months. There was no death. Conclusion: Recent literature confirms that in case of partial or complete pancreatic injury, concerning the pancreatic duct, and a cephalic or isthmic location, early and prolonged stenting provides good results. Introduction: Isolated sternal fracture is a benign condition that usually is cured with conservative treatment. The indications for surgical repair include severe pain, aesthetic problems, malunion, disunity and compression of the heart. The best way to repair is controversial. The results of a new system of sternal osteosynthesis using titanium staples, designed specifically for the treatment of sternal fractures, are presented. Material and methods: Between 2013 and 2014, 12 patients with sternal fracture were surgically treated. 9 were women with an average age of 65 years. All injuries were due to traffic accidents. It was used for sternal osteosynthesis titanium clips specifically designed for this purpose by MedXpert GmbH. Different sizes of 3D clips were used depending on the width of the sternum. A film with surgical technique is shown. Results: There were no postoperative complications. The average operating time was 45 minutes. The mean postoperative hospital stay was 48 hours. All patients were discharged with oral analgesia. Outpatient follow-up at 1, 6, 12 and 18 months were performed. All patients were satisfied with the operation, had no pain and performed a normal life. There were observed no breakage 3D clip osteosynthesis. Conclusion: Based on our study, we believe that sternal 3D clip osteosynthesis screwless system is a simple method for setting the sternal fracture, surgical technique is not associated with complications and allows the sternal stability, pain management and recovery functional patients Disclosure: This Study has been supported by Medxpert (germany) Grant. Surgery, ASUR Marche Area Vasta 5, ascoli piceno, Italy Introduction: The author herewith shows the results obtained in diaphyseal as well as distal and proximal epiphyso-metaphyseal femoral fracture treatment by means of the DIF innovative system. Such system belongs to the so-called ''internal fixators'' category, i.e. angular stability plates which have been modified so as to become dynamic, when required. Within the action limit of the external fixators, this system, therefore, allows modulating the need to increase compression. The biomechanics osteo-implant system theory is discussed and the clinical and radiographic results obtained in fractures and pseudoarthrosis treatment are shown Material and methods: The DIF was applied to 10 patients with different femural fracture with patterns at risk of pseudoarthrosis. In all these patients the system was dynamized at a period between the 40th and the 60th day after the implantation. Xrays were taken every 30 days. The follow up was for all the 10 patients carried on until the radiographic evidence of bone repair. Results: In all the patients we observed a fast bone recovery and no case of implant failure. Conclusion: We think that DIF allows the possibility of increasing fractur site compression when charging during the healing process. Furthermore, the possibility of a plate-sliding system discharges the angular flexion pressure (flexing movement) becoming a sliding movement and thus an axial compression. Introduction: The use of plates for the fixation of posterior column or wall fractures is well described. However, small posterior wall fragments can be difficult to secure and comminuted wall fragments may not be adequately captured by conventional plates. Our aim is to report early findings of an anatomical plating system for posterior wall and column acetabular fractures. Material and methods: Over 12 months, 14 consecutive fractures were treated with PRS (RX) posterior plates (ITS). Outcome measures included SF36, Merle D'Aubigne and VAS. X-rays were independently assessed for loss of reduction. Secondary outcomes included infection, VTE, nerve injury and reoperation. Results: Mean age was 51.7 (range 24-84). Two patients were lost to follow-up. There were no cases of infection, VTE, iatrogenic nerve palsy or re-operation. Mean Merle D'Aubigne score was 11.2/18. Mean VAS was 0.4/10 at rest (0-2) and 2.2 on mobilisation (3) (4) (5) . There were no cases of loss of radiological reduction or early joint incongruence. Conclusion: Our early results of anatomically contoured pelvic plates are promising, with no early failures. Perceived surgical benefits of the plates include the ease of application, the ability to put screws through the plate and posterior wall fragment, superior containment of both comminuted and very marginal posterior wall fragments and the multiple hole options anteriorly reduce the need for gluteal retraction Introduction: Acetabular fracture patterns involving anterior and medial displacement can be technically challenging, particularly in older patients. Medial migration/loss of reduction is reported in 10-15 % cases, which rises to 30-45 % in patients over 65. Aims: To report the early findings of an anatomic plating system for anterior acetabular fractures and to describe our concept of injury to 'the middle column' in acetabular fractures in the elderly population. Material and methods: Over 12 months, 16 consecutive fractures were treated with PRS (RX) medial 'bird-foot' plates (ITS) through an anterior intra-pelvic (Stoppa) approach. Extent of middle column involvement was quantified pre-operatively. Outcome measures included SF36, Merle D'Aubigne and VAS. X-rays were independently assessed for loss of reduction. Secondary outcomes included infection, VTE, nerve injury and reoperation. Results: Mean age was 58.8 (28-91), two were lost to follow-up and mean follow-up was 29.9 weeks . Five of 16 (31.2 %) were planned for fixation in two stages -anterior fixation, followed by THR within 1-2 weeks. Mean Merle D'Aubigne score was 12. 6/18 (8-18) ; mean VAS was 0.3/10 at rest (0-2) and 2.0 on mobilisation (0-5). Conclusion: Early results of anatomically contoured intra-pelvic plates are promising. Perceived surgical benefits of the plates include ease of application, broad foot-print over the quadrilateral surface and screw fixation within the sciatic buttress. We propose an algorithm for assessing middle column damage, as an indication for early THR Introduction: The purpose of this study was to investigate the possibility of reconstruction and biological stimulation with chipping technique for femoral non-unions, especially ones with malalignment. Material and methods: A total of 21 femoral non-unions were treated with chipping procedure and re-fixation. 15 femoral nonunions associated with mal-alignment such as angulations, rotations, and limb length discrepancy. These deformities were simultaneously corrected by a combination of chipping and temporal external fixator. The median age of patients were 41 years (range, 19 -73 years). The median time from injury or the final surgery to the initial chipping procedure was 24 months (range: 9 -240 months). The non-unions were classified as hypertrophic in 9, oligotrophic in 5 and atrophic in 7. Clinical and radiological assessment was performed. Results: All femoral non-union clinically and radiographically healed with one (19 cases) or two (2 cases) chipping procedures without bone grafting. Pre-existing angular deformity was corrected from 148 to 28, mal-external rotation 278 to 38, and limb length discrepancy 16 mm to 7 mm. There were no major complications, although swelling of thigh and anemia was common after surgery. Introduction: Patients with Injury Severity Scores 25 or greater are at risk for missed or delayed diagnosis of fractures. In this study the incidence of missed diagnoses is measured and the morbidity associated with the initial failure to find these injuries is assessed. Material and methods: Three hundred and ninety patient records of admissions with Injury Severity Scores (ISS) of 25 or greater to our Trauma Center were reviewed for skeletal injuries not identified within twenty-four hours of admission. The missed injuries were catalogued by body region, severity, and method of eventual treatment. The missed injury group and the group without missed injuries were compared using statistical tests for significance. Results: Sixty-two patients (16 % of 390) had a total of 97 missed orthopedic injuries. The average time to diagnosis of these missed injuries was 5 days (range 1-38.) Most of the injuries were in the lower extremities (50 of 97.) The most common reasons for missed injury were lack of findings on physical examination, late radiographs, and injuries not seen on plain x-ray but found on CT scanning. There were significant differences for the group with missed in contrast to the group without missed injuries. These differences included greater length of stay, more ICU days, higher ISS scores, and more ventilator days for the group with missed injuries. Conclusion: Delayed diagnosis of lower extremity injuries in polytrauma patients is associated with longer hospitalizations, ICU stays and ventilator times. The routine use of total body CT scanning (man scan) decreases the incidence of this problem. Introduction: Adult humeral shaft fractures occur with an incidence of 3 % of all long-bone fractures. They are associated with primary radial nerve palsy in 2 %-18 %. Both, ORIF or intramedullary nailing are well-established treatment methods. However in case of primary radial nerve palsy, a decision whether or not an additional early exploration is indicated has to be made. Therefore the purpose of this study was to assess the influence surgical treatment on recovery in patients with primary radial nerve palsy following traumatic humeral shaft fractures. Material and methods: A retrospective analysis of prospectively collected data for all patients treated with humeral shaft fracture and accompanying primary radial nerve palsy at our level-I trauma center was performed. Trauma mechanism, fracture type, type of treatment as well as time of onset of recovery and time to full recovery were evaluated. Results: A total of 35 patients were treated with ORIF using dynamic compression plate-or angular stable plate-fixation. Twenty patients underwent treatment with closed reduction and interlocking intramedullary nails. In the ORIF and intramedullary group mean time of onset of recovery was 10.5 weeks, whereas the time of full recovery or significant improvement was 27.5 weeks and 24.5 weeks respectively. Introduction: Amputation injuries often lead to a restricted hand function and job loss. In the late 19 th century Nicoladoni performed the first toe-to-hand transfer. Through better microsurgical technics the toe-to-hand transfer has been revolutionized and in 1969 Cobbett performed the first toe-to-thumb transfer. Since then toe-to-hand transfers have been undertaken with increased frequency, not only for post-traumatic indications, but also in congenital defects and tumors. Especially in amputation injuries, affecting all three-membered fingers, the toe-to-hand transfer offers a good possibility to restore hand function. Material and methods: Three patients, one woman and two men, with toe-to-hand transfers after amputation injuries with a mean longterm follow up of 11 years have been retrospective reviewed clinically and radiologically. The mean age was 27 years. In all cases a transfer from the second toe of both feet's to the hand has been performed. For analyses of functional outcome the DASH-Score, Michigan Hand Questionnaire and Patient-Rated Wrist Evaluation Score were used. As well range of motion and VAS was measured. Results: All toe-to-hand transfers healed without any complications. Mean DASH Score was 24/100 points and PRWE Score 16/100 points. The mean Michigan Hand Questionnaire was 74 %. In all cases a complete restoration of the sensitivity in the Semmes-Weinstein test has been reported and a reintegration in the working process was possible. Conclusion: The toe to hand transfer offers a good possibility for reconstruction after amputation injuries of all three-membered fingers with a good clinical and functional outcome. It leads to an improvement of hand function and increased work ability. Introduction: Generally there is a high rate of missed perilunate (fracture) dislocations (PD). Especially in severe injured or polytrauma patients the focus of diagnosis and treatment is restoring vital functions. Thus the aim of this study was to analyze the diagnosis, S67 management and outcome of PD in polytrauma in our level I trauma center. Material and methods: All PD in polytrauma between 10/1994 and 06/2011 were included in this study. All eight patients with a mean age of 37.3 years (range: 17.2-60.9) were male. Diagnosis:Most cases (6) were initially diagnosed by conventional x-ray. A CT scan was performed additionally in 6 patients within two weeks. Treatment: In two cases closed reduction and immobilisation was performed, in two additional k-wire stabilization was used. In two cases the scaphoid fracture was stabilized by screw fixation + k-wires and plasterimmobilization. Only one patient was treated by open reduction and direct ligament repair. One greater arc lesion was diagnosed immediately, but was not treated, because of lethal complications. Results: The mechanism of injury included falls from [3 meter in five patients and traffic accidents in three cases. The mean ISS was 40 (range: 25-75). We found two persistent carpal instabilities, one compression of the median nerve. All scaphoid fractures healed uneventfully. Most wrists (6) Introduction: According to increased security measures severe hand injuries got rare but if they occur they are still challenging. Every effort is made to preserve or salvage the thumb, the most important digit from a functional standpoint for the hand. But severe damage to fingers and thumb may necessitate amputation or prevent replantation. Material and methods: Pollicization of index fingers and ray amputations after severe hand trauma are presented from time of trauma and first operation to reconstructive intervention and accompanied to present long term results up to 10 years. Operation techniques are briefly explained and alternatives such as subcapital amputation of the proximal phalanx discussed. Results: Ray amputation is most frequently undertaken as an elective procedure but in some cases a good choice for a single stage procedure. It shows a good cosmetic and functional outcome when preservation of a functional digit is unattainable. The loss of grip and pinch strength after ray amputation compared to amputation at the proximal phalangeal level is discussed controversial in literature. However, the better cosmetic look and similar function result in improved patient satisfaction. Pollicization of an index finger is a good procedure to recreate a new thumb and increase hand function after traumatic loss of the thumb. Introduction: External skeletal fixation has already became on the end of last century as routine temporarily method of fracture bone fixation, especially in the light of polytrauma and damage control. External skeletal fixation (especially hybrid devices) has also been accepted in many developed countries as important method in the treatment of complex articular fractures (knee, ankle, elbow). In some indication external skeletal fixation is recognized as definitive treatment methods. In this paper, it is also presented possibility of using of already applied external fixator as accurate reduction device before internal fixation or if used as a definitive treatment method. Material and methods: One week after external fixation, external fixator device, if need, was used as accurate reduction device on the new and simple method. Once, desirable fracture reduction achieved, internal fixation is very easy and we do no need prolonged fluoroscopy control for reduction. Genaral and Emergency Surgery, Usl Valle D'Aosta, Aosta, Italy, 2 Usl Valle D'Aosta, Aosta, Italy, 3 Usl valle d'Aosta, Aosta, Italy Introduction: Open abdomen refers to a solution in which the abdominal contents is left deliberately exposed under a temporary cover. Since 1970 the method has gained widespread acclaim in the treatment of severe intra-abdominal infections. In the 80 s the concept has been adopted for trauma surgery. Material and methods: Technique was first used as damage control in trauma. Subsequently we start to the treat septic complications and even as prevention of abdominal hypertension. Between 2002 and 7/2015 we have treated 119 patients. In 24 cases the disease was traumatic, in the remaining cases was inflammatory. Results: At the beginning of the experience we completed 4 drainage of the abdominal cavity according to Mickulizt, 5 laparotomy with mesh, 18 Bogota bag. These techniques have been abandoned in favor of the negative pressure therapy with Barker vacuum pack (36 cases), VAC (Vacuum Assisted Closure) AB Thera KCI Ò (32 patients) and CNP Suprasorb Ò of Lohmann & Raucher (24 patients). This is our choice in case of massive intestinal edema, risk/treatment of compartment syndrome, lethal triad (hypothermia, acidosis and coagulopathy), rapid conclusion in the case of damage control, need for multiple abdomen explorations and massive peritonitis. Negative Pressure guarantees removal of infected material, reduces intra-abdominal pressure, removes and quantifies the peritoneal fluid, promotes healing and protects the surgical wound. Introduction: Blunt traumatic injuries to small bowel (SB) and its mesentery could be misdiagnosed. Specific symptoms due to perforation and/or ischaemia may develop hours after trauma. Associated abdominal injuries may represent a confounding factor but also mandate surgery through an early diagnosis of SB trauma is cleared. Aim of this study was to detect if a delayed diagnosis of SB blunt trauma may worsen the surgical outcome. Material and methods: We reviewed 43 patients undergone surgery for SB and mesenteric blunt trauma. Two groups were identified. Group A included 35 patients (69 %) in which SB/mesenteric injuries were recognized and fixed within 12 hrs from admission. of these, 19 pts had immediate laparotomy for hemoperitoneum and shock due to severe multiple abdominal injuries and SB injuries were diagnosed occasionally. Group B included 8 patients (31 %) with isolated SB injuries in which diagnosis and surgery was accomplished more than 12 hrs from admission. Results: Group A patients presented with higher OIS grades. Among these 19 patients had multiple abdominal injuries and 16 of them had isolated SB injuries. Morbidity (34 % group A; 25 % group B, p [ 0.01) and mortality (14 % group A, nihil group B, p \ 0.01) were lower in Group B. However, no fatality was related to the SB trauma itself. Conclusion: In blunt abdominal trauma, the presence of multiple severe abdominal injuries requiring laparotomy makes possible a prompt diagnosis of SB/mesenteric lesions. When injuries are isolated, a delay in diagnosis and surgery could be expected. In these circumstances however late surgery does not seem to affect the outcome. References: Disclosure: No significant relationships. Introduction: Our Lady of Lourdes (OLOL) Hospital is a regional trauma centre with an established sepsis-screening pathway. If two or more SIRS criteria are positive then the Sepsis Six regimen must be completed including: 1. Blood culture (BC); 2. Full blood count (FBC); and 3. Serum lactate (SL). Material and methods: Microbiology, Haematology and Biochemistry exported data from January to June comprising: 2,204 BC, 51,720 FBC and 563 SL. All data cleaning, joining and analysis was performed in R. Results: BC requests are split equally by gender (Female: 50.9 %; Male: 49.1 %) but skewed towards fertile Females (median: 62 yr) and elderly Males (median: 67 yr). Almost 2/5 (37.3 %) of all BC requests were sent by ED. Abnormal (high or low) WCC was not correlated with positive blood culture. 2 However little is known regarding leukocyte kinetics in this specific patient group. So the aim of this study was to determine the feasibility of peripheral blood leukocyte numbers to predict infectious complications in patients with penetrating splenic injury (PSI). Material and methods: We included patients with a minimum age of 14 years and treated for PSI in two level-one trauma centers. Blood was sampled 4 times during the first day of hospital stay and after 24 hours on a daily basis. We compared leukocyte kinetics between patients who developed sepsis and those without sepsis. Results: A total of 103 patients with a median age of 27 and a median ISS of 25 (iqr; 18-34) were included. A total of eight patients were diagnosed with sepsis. All patients had leucocytosis 4 hours after hospital admission: 19.0 (iqr; 13.3-23.9) cells/ml. After 10 hours there was a more prominent decrease of absolute leukocytes in blood of patients who later developed sepsis (9.9(iqr; 4.4-13.3) vs. 3.8(2.3-6.4) , p \ 0.05). Thereafter white blood cell counts remained higher in the non-sepsis group compared with the sepsis group at all time points. Conclusion: Absolute leukocyte numbers in patients developing sepsis show a different pattern in peripheral blood than patients without sepsis and therefore white blood cell count level potentially have additional predictive value in this patient group. Introduction: Fluids administered during acute haemorrhage are causing dilutional coagulopathy that deteriorate bleeding control. In this study, the preclinical volume administration was simulated in vitro and different fibrinogen sources were supplemented to compare the haemocoagulative potential by using a thromboelastometric approach (ROTEM). Material and methods: A haemodilution model was prepared by diluting whole blood of six healthy volunteers with 33 % crystalloid fluid. Seven emergency therapies were simulated to normalize coagulation. Coagulation-promoting agents such as fibrinogen in both regular and high dosage with and without factor XIII (FXIII), fresh frozen plasma (FFP) and cryoprecipitate were supplemented. Full blood count and coagulation factors were measured as well as the haemostatic potential via ROTEM assay. Results: Substituting blood by crystalloid fluid resulted in reduced blood cell quantity and haemoglobin level. The adjunct of fibrinogen concentrates elevated fibrinogen level and high dosage improved the extrinsic clot formation time (CFT), a-angle and the EXTEM and FIBTEM maximum. Low-dose fibrinogen adjunct enhanced the early FIBTEM clot amplitude (A5), irrespective of FXIII, while the combination of both increased extrinsic A5 and MCF. The supplementation of FFP and cryoprecipitate did not result in a significant fibrinogen increase and had only minor effects on clot initiation and stability. Conclusion: Haemodilution-induced changes in blood clotting were improved after fibrinogen supplementation at which high dosage was highly efficient in enhancing clot dynamics and clot stability. The combination of fibrinogen and FXIII seems to be promising for increasing FIBTEM MCF, but only in high-dose fibrinogen adjunct. Unexpectedly, FFP and cryoprecipitate had a comparatively low efficacy in improving clotting. References: Disclosure: No significant relationships. Introduction: Fibrinolytic activation (FA), a vital feature of traumainduced coagulopathy, is initiated by the vascular release of tissue plasminogen activator (tPA) from ischemic tissue. Hyperfibrinolysis, a severe manifestation of FA, is associated with a poor outcome and is historically diagnosed with a maximum lysis (ML) [15 % in viscoelastic tests. Hypothermia, acidosis and hemodilution are considered key factors in the amplification of FA but the isolated impact of ischemia on ML has not been investigated. We aimed to study whether ischemia and reperfusion could induce hyperfibrinolysis in rats in the absence of hemodilution, hypothermia and severe tissue trauma. Material and methods: Nine rats were subjected to a unilateral hindlimb ischemia by applying a tourniquet under deep anaesthesia. After three hours, the tourniquet was released and the extremity was reperfused for one hour. At baseline (BL), end of ischemia (EOI) and during reperfusion (REP 5, 30 and 60 mins) systemic blood was drawn from a catheter in the jugular vein and viscoelastic tests (ROTEM), as well as blood cell counts and blood gas analysis were performed. During the entire procedure, animals were kept on a warming pad to prevent hypothermia. Results: Surgical intervention, ischemia and reperfusion resulted in elevated leukocyte counts and increased lactate levels. However, at none of the time points observed, ML exceeded 15 %. Conclusion: We conclude that severe ischemia of one large extremity is insufficient to induce hyperfibrinolysis in this rat model. We assume that hemodilution and the depletion of coagulation factors and endogenous antibrinolytic mediators are crucial for the manifestation of hyperfibrinolysis. Introduction: Prothrombin complex concentrate (PCC) and fibrinogen concentrate (FC) are used in some trauma centers as haemostatic agents in severe bleeding patients based on a goal directed treatment algorithm [1] . In hypovolaemic patients venous access is sometimes limited, especially in case of severe haemorrhage, and intraosseous access is recommended in some trauma guidelines as an alternative route for fluid and drug administration [2] . We investigated in vivo whether intraosseous administration of PCC ± FC results in the same systemic coagulation test values as compared to intravenous administration. Material and methods: Twenty-four pigs were enrolled into this study. Following controlled blood loss (35 ml/kg) and fluid replacement with a balanced crystalloid, intraosseous (IO, proximal tibia) administration of PCC (25 IU/kg bodyweight) alone or in combination with FC (80 mg/kg) was compared to intravenous (IV) administration. Results: All tested laboratory parameters (blood cell count, standard coagulations tests PT, PTT, Clauss plasma fibrinogen and thromboelastometry) were not different between the IO and IV group at baseline, haemodilution, and 30 min after PCC ± FC administration. Three pigs receiving PCC intraosseously developed a livid extremity after administration. Traumasurgery, University Medical Center RWTH Aachen, Aachen, Germany, 2 University Medical Center Utrecht, Utrecht, The Netherlands, 3 Surgery, UMC Utrecht, Utrecht, The Netherlands Introduction: Activation and migration of polymorphonuclear neutrophils are key mechanisms in the development of severe complications such as ARDS and MODS. Recently, different neutrophils phenotypes were identified in acute systemic inflammation. The spleen is the largest lymphoid organ and seems to play a modulatory role in the immune response to trauma. Therefore the aim of this study was to determine characteristics of different neutrophil phenotypes in the spleen in response to trauma and hypovolemic shock. Material and methods: We utilized a mice (C57BL/6) model of hemorrhagic shock/resuscitation (HS/R) combined with a unilateral femur fracture. Blood and spleen neutrophil subtypes were studied 2 and 6 hours after reperfusion. Neutrophil membrane receptor expression profiles were assessed by flow cytometry and compared between intervention groups, sham and control animals. Results: Trauma with HS/R results in increased numbers of splenic neutrophils after both 2 and 6 hours (P \ 0.05). We identified 4 neutrophil subtypes based on differences in the receptor expression of CD11b (Mac-1) and CD62L (L-selectin). Interestingly not all these subtypes were present in peripheral blood as well. Furthermore, morphological differences were observed between the blood and splenic neutrophil population in response to trauma. Conclusion: Trauma with hypovolemic shock results in evident changes in the splenic neutrophil pool. Splenic neutrophil numbers increase and we were the first to identify splenic neutrophil subtypes characterised by different membrane expression patterns of CD11b and CD62L. In order to identify novel treatment modalities for inflammatory complications after trauma, the exact role and function of these subtypes should be studied in more detail. References: Disclosure: No significant relationships. Introduction: In humans and mice, severe polytrauma affects the immune system, often triggering strong immunological deregulation, which predisposes subjects for secondary complications. Yet not all body compartments are equally responsive to development of immunosuppression. We investigated early immune responses evolving in the blood/bone marrow compartment in a severe murine model of polytrauma. Material and methods: 3-month old, female, balb/c mice (n = 35) underwent polytrauma (TSH) including unilateral femur fracture, splenectomy and hemorrhagic shock (30 % blood loss). Whole blood (WB) and bone marrow (BM) were collected at baseline and 24 h or 48 h. In WB and BM, mean fluorescence intensity (MFI) of total MHC-2 expression, and leukocyte populations (CD11b/LY6G) were assessed. In WB, CD4+, CD8+, CD4+ CD25+ CD127-T-cells, and phagocytic capacity of leukocytes were evaluated by flow cytometry and complement component C5a by ELISA. Results: At 48 h, TSH induced neutrophilia and lymphocytosis and a 2-fold increase of C5a (p \ 0.05). In BM, at 48 h a 20 % decrease in S72 granulocytes (CD11b+ Ly6G+) MFI occurred (p \ 0.05). MHC-2 on BM cells decreased by 3-fold, while a contrasting trend occurred in circulation. Within 48 h of TSH, there was a relative decline of CD4+ and CD8+ T-lymphocytes (by 25 % and 30 %; p \ 0.05), while regulatory T-cells (CD4+ CD25+ CD127-) increased by 1.5-fold (p \ 0.05). Phagocytic capacity of WB cells did not decline; it gradually increased until 48 h post-TSH. Conclusion: The analysis of immune responses in the blood/bone marrow compartment shows a simultaneous activation and impairment of the murine innate and adaptive immunity post-TSH. Therefore, assessment of any single compartment is insufficient to characterize the magnitude of the developing immunosuppression after polytrauma. Introduction: Thermal injuries are a frequent and serious threat to patients and often require surgical treatment. The cell-free secretome of peripheral blood mononuclear cells (PBMCs) -comprising all secreted factors over 24 hours -has been shown to improve wound healing in previous in vivo and in vitro studies. We used the PBMC secretome in an in vivo model in pigs that resembles the clinical setting to investigate its potential to improve the quality of regenerating skin, increase angiogenesis, and reduce scar formation after burn injury and skin grafting. Material and methods: PBMC secretomes were harvested after 24 hours under standard cell culture conditions. Gamma irradiation was used to induce apoptosis and create an additional stimulus. Standardized full-thickness burn injuries were created on the back of female pigs. After 24 hours, the necrotic areas were excised and the wounds were covered with split-thickness mesh skin grafts. Wounds were then treated repeatedly with either the secretome of cultured PBMCs (Sec PBMC ), apoptotic PBMCs (Apo-Sec PBMC ), or controls. Wounds were analysed and wound biopsies were taken on days 2, 5, and 10. Results: The wounds treated with PBMC secretomes had an increased epidermal thickness, higher number of rete ridges, and more advanced epidermal differentiation than controls. The samples treated with Apo-Sec PBMC had a two-fold increase in CD31+ cells, indicating more angiogenesis. The parameters of early scarring were improved in secretome-treated wounds. Conclusion: These data suggest that repeated application of PBMC secretomes significantly improves wound healing, skin quality, and scar formation in a porcine model of burn injury and skin grafting. Introduction: Large bone defects are a major problem in orthopedic surgery. Application of long term cultured stem cells combined with a scaffold lead to significant improvement of bone healing but is strongly restricted by EU-law. Bone marrow mononuclear cells (BMC), can be isolated, reintroduced within hours and were effective in experimental models of bone healing. The efficacy of BMC supported therapy might be influenced by the scaffold type. We compared three different scaffolds as carrier for BMC in a rat femoral critical size defect with regard to the osteogenic activity in the defect zone. Material and methods: Human demineralized bone matrix (DBM), bovine cancellous bone (BS), or b-TCP were seeded with human BMC and implanted into a critically sized bone defect of male athymic nude rats (n = 6 per scaffold and time point). Autologous bone served as control. Gene expression was measured after one week, histological (e.g. osteocalcin, vascularization) and radiological evaluation of bone formation was performed after 8 weeks. p \ 0.05 is significant. Additional we evaluated the flexural stiffness after 8 weeks. Results: Generally, regenerative gene expression (BMP2, RUNX2, VEGF, SDF-1, RANKL) as well as bony bridging, flexural stiffness and callus formation was highest in defects filled with autologous bone, followed in descending order by DBM, b-TCP and BS. Conclusion: DBM was superior to b-TCP and BS in most aspects of bone regeneration analysed, but the level of autologous bone was not reached. Hereby, we provide evidence the scaffold is critical for the regenerative response in the defect zone during BMC supported therapy of large bone defects. Introduction: Diabetic foot ulcer displays a severe complication of diabetes [2] , however, no sufficient therapeutic option exists. APOSEC, the supernatant of apoptotic PBMCs, has displayed beneficial effects in tissue regeneration and wound healing in previous studies [3] [4] [5] [6] [7] [8] , however, has not been tested in diabetic wound healing. Material and methods: We used genetically diabetic db/db mice in our study. 12 mice were assigned per group. We used a common fullthickness wound model. APOSEC or control were topically administered to the wound site for the following ten days. To determine if the effect of APOSEC is dose dependent three concentrations were applied. Wound size was measured at day 0, 3, 7, 11, 14, 18 and 25 by tracing the wound on an acrylic foil for planimetry and using a stereoscopic camera for 3D wound measurement (circumference, surface, average depth). Results: In this study we showed that local administration of APOSEC enhances wound healing in diabetic mice. Wound circumference, size of wound surface and wound size assessed planimetrically at day 18 was significantly reduced in mice treated with APOSEC. A significant dose dependency of the treatment with APOSEC could be shown for the wound circumference and planimetry. Conclusion: We could demonstrate that topical application of APOSEC in diabetic mice significantly enhances wound healing. Chronic diabetic ulcers display a severe burden. Hitherto no adequate therapy to address this problem exists. PBMCs are a side-product of blood donations and are usually discarded. Utilising this regenerative potential of a yet side product could provide an inexpensive possibility to address this burden in the future. References: 1 WHO. Diabetes. Data and statistics.,http://www.euro. who.int/en/health-topics/noncommunicable-diseases/diabetes/data-andstatistics (accesedon 22/10/2015). Introduction: Collagen-type-II is the key marker for differentiated hyaline cartilage and widely applied in osteoarthritis and cartilage regeneration studies. The current study aimed to define antibodies for immunolabelling, not only to detect collagen-type-II in general, but to identify newly synthesized and degraded collagen. Material and methods: Articular cartilage of healthy patents, either directly harvested or cultivated under different conditions, as well as osteoarthritic cartilage and tissue engineered constructs were embedded for paraffin-and resin-histology and stained with three different antibodies binding to specific regions of the collagen molecule: the triple helix, C-termini of freshly cleaved collagen and cross linked C-telopeptides of degraded collagen. Results: The collagen-type-II antibody binding to the triple helix stained the whole matrix of healthy and osteoarthritic cartilage and the hyaline regions in tissue engineered cartilage. C-termini binding antibody was restricted to the close surrounding of chondrocytes depending on the sample type and cultivation protocol. Cross linked C-telopeptide was only present around specific regions in the osteoarthritic cartilage samples. The triple helix binding antibody staining the total collagen type II matrix could also be used in resin sections, enabling high resolution images, even in combination with polarisation microscopy. Conclusion: The results of this methodical studies showed that the use of determined antibodies, specific for different regions in the collagen molecule, enable detailed analysis of newly synthesized, freshly degraded as well as the general collagen type II. A defined application of the different antibodies may increase the scientific information of the development as well as degradation of hyaline cartilage matrix. References: Disclosure: No significant relationships. Introduction: Multiple trauma remains to be the leading cause of death in the younger population. Research is limited due to a lack of models that adequately mimic the clinical situation. Therefore we aimed on development and implementation of a standardized large animal model of combined trauma that extends previous published observation periods. Material and methods: Male pigs (sus scrofa; 30 ± 5 Kg) were used. Combined trauma consisted of femur fracture, unilateral lung contusion, liver laceration, and controlled hemorrhage (Injury Severity Score: 27). Animals were treated according to established trauma guidelines, mechanically ventilated and under ICU-treatment for 72 h. Vital parameters were monitored, blood and urine sample were collected. Necropsy was performed at the end of observation period. Results: Induction of trauma resulted in a significant increase of heart rate and mean arterial pressure reduction. Furthermore blood gas analysis showed significant deranged shock parameters (lactate, pH S74 and BE). Full blood count detected early signs of organ damage and necropsy revealed macroscopic and histopathologic signs of organ injury. Posttraumatic immunologic deterioration was observed by increase of pro-inflammatory parameters (IL-6). Conclusion: The presented model successfully combines a relevant trauma severity and a long-term observation period of 72 h. Thus, relevant shortcomings of previous models were determined. A useful long-term large animal model was established that will allow to investigate physiologic changes, organ injury as well as systemic and local inflammation in the multiple injured organism. References: Shock. 2013 Oct;40 (4) Introduction: Chevron osteotomy is a well-accepted technique, providing the greatest exposure of the distal humerus articular for treating type C fractures. The sigmoid notch of the proximal ulna were separated to two articular facets by the bare area. Ideally, the osteotomy should enter the joint at the bare area while ensuring the saw itself does not enter the joint, where it can damage the joint cartilage. The purpose of this study was to define the bare area of proximal ulna anatomy and design the chevron shape for olecranon osteotomy. Material and methods: Thirty-eight cadaver elbows were dissected. The anatomic data of the bare area were measured, and the chevron shape osteotomy were designed. Results: The bare area was present in all specimens. The mean width of the bare area (lacking articular cartilage) was 0.4 cm (range, 0.10-0.86 cm), The coronal width corresponding to the bare area was the narrowest portion in the proximal ulna, the mean width was 1.90 cm (range, 1.69-2.38 cm). The mean distance from the triceps insertion to the corresponding area of the bare spot on the dorsal cortex was 1.95 cm (range, 1.65-2.30 cm), the bilateral part corresponding to the bare area were also devoid of cartilage. 34.21 % specimens(13/38) were devoid of the cortical notch, bilateral cortical notchs were present in 21.05 % specimens(8/38), 36.84 % specimens(14/38) were only existed in the medial side, while 7.9 % specimens (3/38) for only existed in the medial side. The bare area was analogous to arc through the lateral view, the mean distance from the triceps insertion to osteotomy apex was 2.25 cm (range, 1.82-2.42 cm), the mean angle between the osteotomy surface and the vertical plane corresponding to the tangent plane was 20°(range, 10-25°). The mean angle of the V shape was 140°(range, 130-150°). Conclusion: The bare area lies at the narrowest part of the proximal ulna, the lateral or medial narrowest edge where lack of cortical notch can be used for position mark of the bare area. In 84 % specimens, the designed chevron osteotomy could enter the joint at the bare area. Introduction: The incidence of fractures of the acetabulum is going to increase in the next decades due to a dramatically increase of fragility fractures. Beside the final functional and subjective result the acute and late complications of our therapy whether operatively vs. conservatively is of extreme importance. We made a retrospective study comparing two time periods and looking for the different outcome including complications. Material and methods: Clinical data of 411 patients with acetabular fractures from 01/2000 to 12/2012 were analysed. There were 283 males and 127 females aged from 14 to 96 years. Patients were divided into two age groups. First group with patients until 60 years (n = 238.57.9 %) and second group with people older then 60 years (n = 173.42.1 %).Initially treated by operation were 275(67.2 %) in total, 134 patients (32.8 %) were treated nonsurgically. We analysed the development of our therapy by dividing the total time into two periods (01/2000-04/2005; 05/2005-12/2012). Results: The number of acetabular fractures increased by 164.7 %.During the two periods the part of elderly people increased from 30.9 % to 46.2 %.The average age rose by 10 years. Among the younger patients the fracture of the dorsal column is most common(22.7 %).Among the elderly patients the fracture of the ventral column is the most common(20.2 %) in front of 2 column fracture(18.5 %).All patients were mainly treated operatively (67.2 %).Comparing the two time frames there is a significant increase of primary operatively treated elderly patients. The complication rate of operative and conservative treated patients was 29.7 %in total. Conclusion: The most important result was the fact that although the rate of operatively treated patients over 60 years increased (+12.6 %), we could reduce our complication rate of the elderly patients significantly. Furthermore there was no significant difference in the prevalence of secondary coxarthrosis between younger and elderly patients. References: Disclosure: No significant relationships. Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan Introduction: Pelvic fractures can result in life-threatening hemorrhage or other associated injuries. The computed tomography (CT) scan plays a key role in the management of the patients with pelvic fracture. We tried to evaluate the role of CT scan in the era of advanced technology. The significance of the pelvic stability was also analyzed. Material and methods: In our institution, the PXR was used as a primary tool to screen the pelvic fractures, and the pelvic stabilities were evaluated accordingly. The CT scan was performed in the patients suspected associated intra-abdominal injuries (IAI) or other conditions which decided by physicians' clinical judgment. The clinical features of patients with stable and unstable pelvic fractures were compared. The patients with stable pelvic fractures were analyzed to determine the characteristics of patients who had associated retroperitoneal hemorrhage or IAIs. Results: A total of 1433 patients were enrolled in the current study. There were 1066(74.4 %) patients with stable pelvic fractures of these patients, there were 133(12.5 %) and 101(9.5 %) patients with associated retroperitoneal hemorrhage and IAI respectively. There was no significant difference between the patients with associated retroperitoneal hemorrhage in their results of primary evaluation(vital sign, amount of blood transfusion, level of hemoglobin).Similarly, the demographics and the results of primary evaluation(symptoms, coma scale, level of WBC) in the patients with associated IAIs were also not significant different from the patients without associated IAIs. Conclusion: The role of the pelvic stability is not significant in the evaluation of the associated retroperitoneal hemorrhage or IAI. The routine CT scan was suggested for the patients with pelvic fracture because of the rapid scanning time and sufficient information. Introduction: Unstable pelvic ring fractures usually occur in polytrauma patients and are associated with high rates of morbidity and mortality [1, 4] . Operative treatment has been shown to reduce morbidity and mortality [2] . Ilio-sacral fixation was first described by Routt and can be placed percutaneously if a satisfactory closed reduction can be obtained [3, 5] . Our objective is to report the clinical results of the patients treated with sacro-iliac screws for unstable pelvic ring injuries. Material and methods: We included in our study group the patients operated with sacro-iliac screws (SIS) for unstable pelvic injuries between 01.03.2009-01.12.2014. We assessed the following parameters: trauma cause, associated lesions, type of the fracture, method of treatment, complications. Results: Study group: 95 patients (p)-61 male (64 %) and 34 female (36 %), mean age 40 years. The car accidents were the most frequent trauma cause-53 %. The average ISS: 32 and the most frequent associated injuries were skeletal-58 % and thorax lesions-44 %. According to Tile classification we had 63p-typeC and 32p-typeB and open fractures in 2p. The SIS were placed in S1-74p and S2-21p. 17p needed bilateral screw fixation and for 46p additional anterior fixation was used. Complications: misplaced screws-3p, nerve injury-3p, infection-1p, loss of reduction-2p, screw loosening-5p. The last two were noticed in type C lesions without anterior fixation. 12 deaths occured in our group (13 %) due to severe associated lesions, all these patients having an ISS [40. Conclusion: Closed reduction and SIS fixation is a fast and safe method for treating unstable pelvic ring injuries. In polytrauma situations it can play a double role: definitive fixation and damagecontrol procedure. Introduction: Alternatively to the modified Stoppa approach, the Pararectus approach is used clinically for treatment of acetabular fractures. This study assessed the surgical exposure and the options for instrumentation using both of these approaches. Material and methods: Dissections were conducted on five human cadavers (male, mean age 88 years (82 to 97)) using modified Stoppa and Pararectus approach (same skin incision length 10 cm). Distal boundaries of the exposed surfaces were marked using a chisel, softtissues removed and distances from the boundaries in the false and true pelvis were measured (reference: pelvic brim). Exposed bone was coloured, calibrated digital images of each inner hemipelvis were taken. The amount of exposed surface using both approaches was assessed and represented as a percentage of the total bony surface of each hemipelvis. For instrumentation, a suprapectineal plate was used. Screw lengths were documented, screw trajectories were S76 assessed by three-dimensional CT. Wilcoxon's signed rank test for paired groups was used (level of significance: p \ 0.05). Results: Percentage (mean ± SD) of exposed bone accessible after utilizing the Pararectus approach was 42 ± 8 % versus 29 ± 6 % using the modified Stoppa (p = 0.011). By use of the Pararectus approach, screws placed for posterior fixation and as a posterior column screw were longer by factor 1.8 and 2.1, respectively (p \ 0.05), could be placed more posteromedial towards the posterior inferior iliac spine or the ischial tuberosity. Conclusion: Compared to the modified Stoppa, the Pararectus approach facilitates a greater surgical access in the false pelvis, provides versatility for fracture fixation in the posterior pelvic ring and allows for the option to extend the approach without a new incision. Disclosure: No significant relationships. Introduction: For nearly a half-century the open osteosynthesis of acetabulum fractures has for the most part been achieved with the posterior approach of Kocher and Langenbeck and the anterior approach of Judet and LeTournel. With improvement in Emergency and Trauma Care patients with more complex injuries involving the hip socket survive and require internal fixation. The exposure of the Anterior Column with access to the pelvic brim from Stoppa's approach using special retractors provides a new alternative for fixation of difficult acetabulum fractures. Material and methods: The first five cases of anterior intrapelvic surgery were reviewed to determine fracture types, surgical times, blood loss, results and complications. Since this is an preliminary experience in a trauma center there was a definite learning experience in applying the approach and fixation. Results: All five patients had complex fracture patterns which were transverse with associated anterior or posterior column comminution or both column fractures. Operative times and blood loss was similar to the classic approaches. Fracture reduction was good. One case was complicated by entrapment of the femoral head in the pelvis with an attempt to percutaneously fix the posterior column by flexing the hip. In another patient, dissection of the pelvis was particularly difficult because of a prior C-section. Clinical results were good. Introduction: Objectives: Magnetic resonance imaging (MRI) is one of the most sensitive diagnostic modalities for fragility fractures of the pelvis (FFPs). We hypothesized that MRI could affect the treatment strategy for FFPs by detecting fractures that could not be detected using CT. Material and methods: Design: Retrospective observational study. Patients: Ninety-six consecutive patients with a mean age of 83.1 years were treated for FFPs in our center. Sixty-two of 96 underwent both diagnostic CT and MRI. Outcome Measures: The number of cases wherein the MRI findings resulted in a diagnosis different from that based on the CT findings, the MRI-based diagnosis resulted in a different treatment strategy and the patient was indicated for operative treatment and/or teriparatide therapy, and overall union rates. Results: of these 62 patients, MRI findings resulted in a diagnosis different from that based on the CT findings in 23. MRI resulted in a different treatment strategy in 5 of the 62 patients. Three of the 62 patients needed operative treatment, but the MRI-based diagnosis did not influence the treatment strategy in these cases. We also found that 17 of the 62 patients required teriparatide therapy, and the MRI findings influenced the treatment strategy in 2 of these cases. The fractures heeled in 57 cases; there were 2 non-unions and 3 cases of death early after injury without union. Conclusion: MRI efficiently yielded an accurate diagnosis of FFP, but in very few cases was the treatment strategy affected. The findings from the present study thus question the utility of routine use of MRI for the diagnosis of FFPs Introduction: Femoral neck nonunion (FNN) is a potential complication in patients with displaced femoral neck fractures, occurring in 33 %. This may lead to early hip dysfunction or arthroplasty. Combination of modified free vascularized fibular grafting (FVFG) and a reverse LISS may provide a reasonable means to salvage a painless, functional and native hip. Material and methods: Between August 2010 and August 2012, sixteen patients with femoral neck nonunion were treated with a combined procedure involving modified free vascularized fibular grafting and a reverse LISS. The average age of them is 20.3 years (range, 12.0-28.0 years). After removing old implants, the nonunion S77 site was debrided, reduced and fixed with a LISS. The fibular grafts were compacted into a trough in the femoral neck. The Harris Hip score system was used to assess hip function and anteroposterior and frog-lateral hip roentgenograms were used to evaluate bone healing. Results: All femoral neck nonunion healed without severe complications. The mean follow-up time was 32.9 months (range, 23.0-47.0 months) and the average union time was 7.6 months (range, 5.0-10.0 months). All coxa vara deformities and retroversions of the femoral head were corrected. The Harris hip scores (HHS) were improved 36.6 points on average (59.6 points preoperatively to 96.2 points postoperatively). No incidences of osteonecrosis of the femoral head were observed. Conclusion: The combined modified FVFG and reverse LISS plating is a suitable procedure for the management of femoral neck nonunion in patients younger than 30 years, especially for those patients with a revision history. References: Disclosure: No significant relationships. Department For Traumatic Injuries and Problems of Osteosynthesis, SI ''The Institute for Traumatology and Orthopaedics'' by the NAMSU, Kyiv, UKRAINE, 2 Traumatology Department, Poltava Regional Hospital, Poltava, UKRAINE Introduction: Fractures of proximal femur worsen reasonably the quality of life and decrease average index of human life duration in 12-15 %. Treatment of such fractures is a difficult task, because general health status, age, structural and functional conditions of bone tissue of the patient, character of fracture and many other matters in the field of traumatology and orthopaedics, gerontology and vascular pathology, anaesthesiology and rehabilitation should be taken into consideration. Material and methods: 103 cases of trochanteric femoral fractures treatment by proximal femoral nailing has been analyzed and on the grounds of biomechanical simulation optimal type of intramedullary implant fixation has been developed depending on type of trochanteric fracture. Results: After application of the developed algorithm, bone consolidation was observed in all cases; average Harris hip score in 4 weeks: 57.2; in 4 months: 64.3; in 1 year: 73.4. Due to specific health conditions of the patients we have encountered with local (superficial wound infection -4 cases, hematoma -4 cases) and general (cardiovascular -8 cases, pulmonary -2 cases, blood pressure -3 cases) complications, however eliminated. Introduction: Osteoporosis and unstable fractures increase the cutout rate in implants with gliding lagscrews. Therefore, an additional lagscrew U-Blade for the gamma3 nail was introduced to provide monoaxial rotational stability of the femoral head/neck fragment. The purpose of this study is to evaluate wether the additional use of the U-Blade is associated with a reduced cutout rate. Material and methods: 751 patients with pertrochanteric femur fractures were treated with a gamma3 nail between 2009-2014 at our institution. Out of this sample 199 patients received an antirotation U-blade lagscrew. A total of 135 patients (117 female, 18 male) with standard lagscrew (group A) were matched equally regarding age, sex, fracture type and location to 135 patients with U-blade lagscrew (group B). Within a 6-12 month follow-up we assessed the cutout rate, the Parker's ratio, lateralization, lagscrew position and migration. Furthermore we recorded all complications, hospital instay and duration of surgery retrospectively. Results: The most common fractures among group B with a cutout of the lagscrew were AO/OTA 2.3 and 3.2 whereas in group A 2.1, 2.2 and 2.3. There was no significant reduction of the cutout rate in group B 2.2 % (n = 3) compared to group A 3.7 % (n = 5). The duration of surgery was significantly shorter in group A (p \ 0.001). There was no significant difference in lagscrew placement, lateralization, the Parker's ratio and hospital instay. Conclusion: The antirotation U-Blade lagscrew did not reduce the cutout rate in treatment of pertrochanteric femur fractures. Considering higher costs and longer duration of implantation of the U-Blade, its use is questionable. nowadays the role of surgery is debated with increasing evidences toward the conservative treatment. The aim of our work was to describe the epidemiology of acute appendicitis and its treatment in a large population study. Material and methods: A retrospective analysis was performed from 1997 to 2013. All cases of acute appendicitis were selected from the administrative database of Bergamo district health system. Demographic data, surgical interventions and further hospital admissions due to appendicitis and bowel obstructions were recorded Results: During the study period 16544 acute appendicitis were recorded with an estimated incidence of 89/100.000 per year. Mean age was 24.51 (±16.17) and 54.7 % of patients were male. Appendectomy was performed in 94.7 % of cases, with laparoscopic technique in 47 %. Conservative treatment was performed in only 5.3 % of cases, with a mean length of stay of 3.98 days versus 5.98 of operated patients. (p \ 0.0001). 1.3 % of operated patients required further hospitalizations due to bowel obstruction after a mean time of 30 (±41) months; 57 % of them required surgery. Among conservatively treated patients a relapse rate of 23.1 % was recorded after a mean time of 6.5 (±15) months; 90 % of them were operated. Cumulative hospital stay was similar between the groups (5.2 vs 5.5 days, p = 0.02). Conclusion: Acute appendicitis is a common surgical emergency; conservative treatment is still offered to a very small percentage of the population with a relapse rate of 23 % and similar results to operative treatment. Introduction: Complicated acute appendicitis is one of the most common emergencies worldwide needing an urgent surgical approach. To date there is no clear data about real advantages of the laparoscopic appendectomy(LA) vs open appendectomy(OA).In particular, evidence is lacking for the subgroup of old people, which is characterized by a frail clinical condition. Material and methods: This retrospective study includes all the patients undergoing appendectomy for complicated acute appendicitis(with an intra surgery evidence of peritonitis),operated in our surgical department from September 2013 to June 2015. The choose of the surgical technique was left to operator's discretion. To evaluate patients' outcome we analyzed the post surgical days of hospitalization, the duration of antibiotic therapy, the number of deaths and a composite endpoint of post-surgical complications. Results: We analyzed 206 patients, with a mean age of 31 ± 19 years. OA patients were 63;143 for LA. There was no significant difference between the groups for BMI, for white blood cell count, and imaging evidence of abscess or perforation. The mean hospitalization time was 4.6 ± 2.6 days in OA group and 4.4 ± 2.2 in LA group. The mean duration of antibiotic therapy was 2.3 ± 2.1 days in OA and 2.6 ± 2.3 days in LA. Post surgical complications were recorded in 5/63 OA patients vs 15/143 for LA. In detail, a trend towards an higher incidence of postsurgical abscess was observed in AL group. For elderly patients (age [65 years, n = 24) no significant difference was observed in the duration of hospital stay (6.2 ± 3.6 vs 6.2 ± 4.0 days p = ns),of antibiotic therapy (3 ± 2.9 vs 2.8 ± 2.3 days)and the composite endpoint of post surgical complications (2 vs 3) Conclusion: In our experience, laparoscopic appendicectomy proved to be safe and effective but didn't show significant advantages compared to open approach in elderly patients as well as in overall population References: Bhangu Introduction: Evaluate the necessity of interval appendectomy in patients who had treatment with diagnosis of appendiceal mass Material and methods: Between 01 January 2010 -31 December 2014, 43 patients who had diagnosed as Appendiceal mass were analyzed retrospectively regarding age, genre, time between the onset of symptoms and admission to the hospital, duration of hospitalization and follow-up. Results: 25 of patients were male (% 58.2) and 18 of patients were female (% 41.8). Mean age was 47.7 (range 19-87). Mean time between the onset of symptoms and admission to the hospital was 9.1 (7-12) days for first diagnosis. At the second hospitalization with diagnosis of appendiceal mass, mean time between the onset of symptoms and admission to the hospital was 2.7 (1-4) days. 2 patients underwent diagnostic laparoscopy, 5 patients underwent diagnostic laparotomy and drainage. 2 patients underwent right hemicolectomy, one of it is because of the suspicion of malignancy and the other one is because of iatrogenic caecum injury. Malignancy was detected in two patients during routine colonoscopy after 1 month from discharge. 2 patients with malignancy underwent right hemicolectomy. 3 patients with periappendicular abscess underwent percutaneous drainage. Mean hospitalization duration was 8.7 (5-12) days. 1 patient required rehospitalization at 26. month and 30. Month because of appendicular disease and appendectomy was performed in third administration. No signs of recurrence was determined in other patients. Conclusion: In patients diagnosed as appendiceal mass who treated conservatively and after discharge with colonoscopy the ileocecal pathologies was ostracised, the follow-up without perform interval appendectomy is a suitable option. Introduction: In 3-12 % of cases, appendicitis manifests as palpable mass or localized abscess. Conservative treatment, with antibiotics and percutaneous puncture, has been gaining strength because of high incidence of complications arising from surgery in the acute phase. Interval appendicectomy is not consensus on the follow-up of these patients. Objectives: observe incidence of appendiceal tumor in patients with complicated appendicitis with palpable mass or localized abscess. Material and methods: Retrospective review of patients with palpable mass or localized abscess from December 2013 to May 2015, in Hospital das Clínicas, São Paulo University, Brazil. After conservative treatment, patients were subjected to laparoscopic appendectomy, according to our institutional protocol. Incidence of appendiceal tumor was registered. Results: Twelve patients were admitted with appendiceal abscess and treated with percutaneous drainage and antibiotics. Two (18 %) were lost to follow-up. The remaining were submitted to interval appendectomy after four weeks to ten months. In three patients (27.2 %) appendiceal cancer was diagnosed. Conclusion: Patients with complicated appendicitis with a palpable mass or localized abscess must be operated on after conservative treatment, because of the high incidence of cancer in this population. References: • JZ Lugo, DV Avgerinos, AJ Lefkowitz, ME. Motor vehicle crashes (MVCs) were the main mechanism of injury (70 %) followed by fall (19 %). On admission, 10 % had SBP \90 mmHg and 19 % had GCS \8. Majority of BSI were associated with chest (45 %), head injuries (25 %) and solid organ injuries (20 %). Injury severity scores (ISS) ranged from 20 in Grade I to 30 in Grade V. Initial and follow-up CT scan were done in 173 and 29 cases respectively. Pseudoaneurysm was found in 3 follow-up CT scan cases who then underwent angioembolization. Majority of cases had Grade II and III BSI (36 % and 30 %, respectively). Around 146 patients (76 %) underwent conservative management while splenectomy was done in 24 % mainly for Grade IV and V, and only one case had splenorrhaphy. overall mortality was 7.9 % (13 adults and 2 children) and most of deaths were related to polytrauma and severe traumatic brain injury. Adults had longer ICU stay compared to pediatric group. Rate of failure of conservative treatment was 0 and 0.6 % in pediatric and adult groups, respectively. Introduction: Analysis of the influence of anthropo-morphometry and 3D splenic variability on the severity of splenic injury in blunt abdominal trauma. Material and methods: Seventy-seven patients with a blunt splenic trauma had a tomodensitometry at admission. A severe splenic lesion was defined by the presence of: grade 4 or 5 according to AAST classification, lesion of the entire parenchyma, or lesion corresponding to a fracture or burst fracture. Splenic segmentation permitted to calculate splenic volume, orientation in space (colatitude, azimuth), morphometry, morphology and degree of span of the hilar vessels. Relationships between spleen stomach, liver and 10th left rib, were detailed. Results: In univariate analysis, splenic parameters for a severer lesion were: orientation of the hilar side turned towards the vertebral column (azimuth, p = 0.047), a spread conformation of the hilar vessels (p = 0.10) and a high splenic volume (p = 0.059). The more the patient was young, the more the splenic lesion was severe (p = 0.073). A full stomach and a left liver overflowing in the left hypochondrium were associated with a low gravity splenic lesion, p = 0.024 and p = 0.027, respectively. In multivariate analysis, injured patients whom hilar area was vertically oriented, were more at risk of a severe splenic lesion (OR = 0.92 (0.85-0.99). p = 0.021). Finally, an abdominal-shape liver were associated with a low gravity splenic lesion (OR = 0.13. (0.02-0.93). p = 0.042). Conclusion: Using this analysis with studying the biomechanical behaviour of the splenic tissue in case of trauma, will permit to create a numerical model of this organ, and integrate it to Virtual Human scientific application of modern traumatology Introduction: There are no definitive criteria to determine which patients with splenic trauma are better candidates for nonoperative management (NOM). Current risk factors for failure include contrast blush on the CT, advanced age and higher grade of injury. The first two factors can be determined with certainty, but the severity of injury is more difficult to assess. We used a new method of volume measurement for more precise determination of the degree of injury and in turn the likelihood of successful NOM. Material and methods: We collected data prospectively for two years from all our patients with splenic injuries and made volumetric measurements of the injured and healthy areas of the spleen based on conventional assessment of CT images and images processed with the new Vitrea software. Data collected included injury severity score (ISS), age, and degrees of splenic injury according to both conventional CT and Vitrea. A statistical outcome analysis was performed for the three treatment groups: NOM, surgical splenic preservation or splenectomy. Results: We saw 140 patients with splenic injuries. Ninety-one were chosen for NOM, which was successful in 82 cases and failed in 9. Sixteen patients had surgical splenic preservation and 33, splenectomy. Vitrea was more accurate than conventional CT in determining the degree of injury and so allows better prediction of the likelihood of successful NOM. The preliminary results indicate that this new CT analysis software shows promise for better assessment of the degree of injury and for better selection of patients for nonoperative management of splenic injuries. References: Disclosure: No significant relationships. Introduction: Non operative management (NOM) of blunt splenic injuries has been widely accepted, and the splenic angio-embolization (SAE) has been more and more becoming an effective tool in haemodynamically stable patients with all AAST grade splenic injuries. Overall complication rate of SAE is 6-8 %. Aim of this study was to analyze complications that may occur after SAE Material and methods: We reviewed 24 consecutive patients with blunt splenic trauma admitted to our Unit who underwent SAE. All these patients were managed in according to a diagnostical-therapeutic algorithm taken from international guidelines. Indications for SAE included evidence of spleen contrast extravasation/blush, pseudoaneurysm and/or AAST grade III-V splenic injury. SAE included 15 distal, 3 proximal and 6 combined arterial embolizations. The complications occured after SAE procedure have been analysed Results: Major complications occurred in 5 SAE-treated patients (20.8 %). 4 patients developed post-procedure bleeding and underwent early splenectomy. One patient developed an abscess in a total infarcted spleen and underwent late splenectomy. Minor complications, not requiring a surgical operation, occurred in 24 % patients and included fever and pleural effusion with an average hospital stay meanly longer than 7 days. Conclusion: Major and minor SAE complications could jeopardize the conservative management of blunt spleen injuries. A strict clinical and radiological follow up must be taken into account after a SAE procedure. SAE major complication rate could be considered acceptable for the effectiveness of the procedure, but it is likely that the other minor ones could be related to an increased cost of hospitalization and a longer mean hospital stay. References: Disclosure: No significant relationships. Introduction: The spleen is one of the most frequently injured organs in blunt abdominal trauma. There has been a shift towards non-operative management (NOM), provided the patient is hemodynamically stable and without peritonitis. Angioembolisation may be of use in higher grade splenic injury but emergent splenectomy remains a life-saving approach for many patients. We aimed to review the current practice for the evaluation, diagnosis and management of blunt splenic trauma in our hospital. Material and methods: Cohort of patients admitted in our institution with blunt splenic trauma, from January 2010 to December 2014. We analyzed demographic, clinical and imagiologic characteristics of these patients and compared outcomes according to their management. Results: 35 patients were admitted with blunt splenic trauma (12 females, 23 males; median age 52 years), 7 with grade I lesions, 6 with grade II, 12 with grade III and 10 with grade IV. The most common associated injury was hepatic trauma, retroperitoneal hematoma, renal trauma and diaphragm rupture. We performed emergent or urgent splenectomy in 45.7 % patients and NOM in 54 % with a failure rate of 31 %. 57 % were admitted in Intensive Care Unit. Total in-hospital time was longer in the group of patients submitted to surgical treatment. 1 of the patients died of refractory hemorrhagic shock. Conclusion: Due to evolving imaging techniques, the current approach to splenic trauma aims to avoid unnecessary surgery. However, in our hospital, NOM rates are below expected. The lack of availability of Radiology and Interventional Radiology can be a limiting factor in both diagnosis and management. Introduction: Conservative management of blunt trauma to the spleen is now a standard for hemodynamically stable patients. Acute embolization of splenic artery seems to be a suitable method of nonoperative treatment. Material and methods: This retrospective review was performed to evaluate the outcome and complications of patients with blunt trauma to spleen treated with embolization in Level I trauma center between January 2008 and December 2014. There were 21 patients. We analyze the demographic data of these patients, grade of splenic injury according to AAST, concomitant injuries, duration of hospitalization and frequency and severity of complications. Results: The group consisted of 8 female and 13 male with a mean average 41.7 years and with average grade of spleen injury to be 2.9 according to AAST. All patients underwent distal embolization and there were no necessity to convert patients to surgical treatment. Average duration of hospitalization was 15 days but this item was significantly affected by other concomitant trauma. We noticed one severe complication: renal failure after contrast administration with the need for subsequent dialysis Minor complications consisted of fever, fluidothorax and one splenic artery dissection by coil. Conclusion: Acute splenic embolization of hemodynamically stable patients with blunt trauma to spleen seems to be a safe and effective technique of non-surgical therapy. Complications related to this methods can manifest but these are mainly minor, however Introduction: The acute care surgery (ACS) model was developed to acknowledge the complexity of a traditionally fractured population of emergency general surgery patients. The purpose of this study was to prospectively examine the case mix of an ACS service at a tertiary center to identify the frequency and distribution of both operatively and non-operatively managed emergency general surgery conditions. Material and methods: This prospective cohort study evaluated consecutive patients assessed by the ACS team at a large Canadian tertiary care center over 2 months. This included all consults, as well as outside hospital transfers. Diagnoses, demographics, and co-morbidities were captured as were intervention(s) performed, complications, re-admissions, and in-hospital mortality. Results: The ACS team was involved in the care of 359 patients, 175 (49 %) of whom were admitted under the direct care of the ACS S83 team. No operative management was required in 47 % of ACS admission and 81 % of in-patient consults. Bowel obstruction (21 %) was the most common reason for admission, followed by skin and soft tissue infections (14 %), appendiceal (13 %) and biliary (13 %) pathology. The majority of in-patients consults were from trauma (36 %), medicine (28 %), and oncology (15 %). Thirty-day return to ER and re-admission rates were 17 % and 9 % respectively, and inhospital mortality was 2 %. Conclusion: Acute care surgery teams care for a wide breadth of disease, a considerable amount of which is managed non-operatively. This study is one of the first to describe the burden of non-operative care provided by an ACS team for patients admitted to both surgical and non-surgical services. Introduction: To ensure safety and emergency medical assistance to a major football match requires a multidisciplinary approach, which implies collaboration between the different entities involved in event security, including security forces, fire department and medical emergency services. Sensitive to this issue, the FCPorto, has created in 2004 a dedicated team of emergency medical assistance to the Dragon Stadium. It is the responsibility of this team to coordinate medical emergency services of the stadium and its perimeter, ensuring that both the more than fifty thousand supporters and all agents involved in the game receive the best medical care, timely. The aim of this study is to review the emergency medical apparatus of the Stadium in the match setting. Introduction: Primary study showed that the application of standardized rescue and treatment improved the prognosis of severe trauma patients; decreased the lethality and the rate of disability. Rescue and treatment of trauma was limited by rescue time and the regional area. Material and methods: In this study, Pilot areas were selected in several provinces and cities in China. Regional trauma rescue systems were established according to the population and the area of the regions and also combined with the local medical resource. Severe trauma patients were treated under this rescue system. We tried to explore a regional severe trauma rescue system suitable for China's national conditions and the local characteristics. Results: 32 hospitals which were selected in the different regions of China were set up as regional trauma centers. Several smaller hospitals were set up as the trauma stations in each region to form 2 level trauma rescue system. In the system, the evaluation and transfer rules of severe trauma patients were established; the information exchange and warning system were installed; Severe trauma patients' databases were set up; The pre-hospital and in hospital medical workers were trained. Severe trauma patients were rescued and treated under the improved regional rescue system. Introduction: Centralisation of trauma services occurred in the England in 2012, with the development of major trauma networks with a specialist trauma centre receiving patients from significant geographical distances. We aim to compare the change in the trauma demographic and patient outcomes post reconfiguration. Material and methods: Data was analysed from a prospectively maintained database located at a major trauma centre in Liverpool, England, from Jan 2012 to Jun 2014. Demographic details included age of patients, mechanism of injury and injury severity scores (ISS). Primary outcomes were interventions/operation and mortality rates pre and post centralisation. Results: There are two modes of trauma care in Shanghai. The first one is emergency trauma center, the other one is the emergency department first-diagnosis system. The first one is better than the second one in equipment, trauma score and trauma professional team. Low proportion of using of trauma database was a severe problem in the two modes. (1). The aim of this study was to evaluate mortality rates with weekend admissions in comparison to mortality rates during the rest of the week. Material and methods: This study was conducted at Queen's Hospital, London over a 12-month period from Sept 2014 -Aug 2015. All surgical admissions during this period were included in the study. Ethical approval was not deemed necessary as it was an evaluation of routine practice and the study was registered with the audit department of the trust. Results: There were 89 surgical mortalities during the study period, which included 40 men and 49 women. The mean age of the patients was 79. There was higher mortality rate on Saturdays. Patients admitted on Thursdays had a higher risk of dying. Patients admitted on Sundays tend to stay longer before death. Conclusion: Patients admitted just before the weekends are at a higher risk of dying with higher mortality rate at the weekend. A lower senior surgical input, with reduced medical cover and poor access to investigations at the weekends might explain a higher mortality rate for these patients. The data does support a case for expanded seven-day services, with implications for health care providers Material and methods: Eight patients treated with percutaneous TITS screws in S1 and/or S2 using image-fusion navigation were included in this study. 3.2 mm guide pin passed the safety corridors in S1 or S2 vertebral body using navigation, then 6.5 mm diameter cannulated fully threaded screws were inserted percutaneously. We evaluated injury types, number of screws in S1 and S2, screw positions by postoperative CT scan and complications. Results: Acute seven patients had sacral fracture; two cases to zone 1, four to zone 2 and one to zone 3 in Denis classification. In OTA classification, there were five cases to 61-B1 and two to B2. One nonunion case was classified as FFP type IIIc by Rommens. Eleven TITS screws were inserted to S1 or S2; three screws to S1 and eight to S2. Postoperative CT scan showed ten screws were placed in correct position. A neuropathic pain occurred after the operation in the patient with a zone 2 fracture. Another patient caused late infection. The size of sacral ala is a critical factor at S1 level. The decision of the screw direction at S2 level is easier than at S1, but the safety corridor of S2 is narrower than S1 in most patients. Our results were acceptable and TITS screws can be expected a less invasive stable fixation procedure. Disclosure: No significant relationships. C. Battiato 1 , L. Basiglini 2 1 Surgery, ASUR Marche Area Vasta 5, Ascoli Piceno, Italy, 2 Surgery, Asur, Ascoli, Italy Introduction: 3d reconstruction and rapid prototyping (RPT) from CT data could effort, in some surgical specialities, an important improvement in planning and during surgery. This technology can help the diagnosis but also the treatment of complex fracture. We think that in acetabular traumatology the application of RPT can reduce the operating time and can facilitate the understanding of fracture patterns and the reduction strategies. We show our first case of a bilateral acetabular fracture treated with the help of intraoperative £D solid model of the patient's pelvis. Material and methods: two acetabular complex fractures of both hips in the same patient were first of all studied with ct. The 3d radiological reconstruction was processed to obtain the 3d solid model using RPT. We perform the operation with this sterile solid model in the operative field. It was very useful in understanding the position of the fracments in the no looking zones of acetabula and also in pre-modeling the plate on this solid prototype. Results: The operating time, the blood loss and the fracture reductions resulted improved by using the 3d intra-operative model. Every person of the team could better understand every reduction step. The premodeling of the plate could effort easy positioning in one time. Conclusion: we can thing in this preliminary results that this technique can really improve the understand of complex fracture patterns, can help the reduction, can optimize the synthesis. Introduction: In ankle fractures involving the posterior tibial margin, articular congruity is believed to be a strong predictor for clinical S87 outcome [1] [2] [3] . In a separate submitted study, contemporary measurements of fracture displacement using quantification of threedimensional computed tomography (Q3DCT) were introduced. This study aims to correlate Q3DCT fracture displacement with clinical outcome. Material and methods: Twenty-eight patients with twenty-eight ankle fractures including a posterior malleolar fragment (AO/OTA type 44) were included. Post-operative CT-scans were evaluated using Q3DCT techniques. Posterior fragment size (%), postoperative gaps (mm 2 ), step-off (mm) and 3D-displacement of the posterior fragment were quantified. We evaluated early posttraumatic arthrosis, Foot and Ankle Outcome Score (FAOS) pain and symptoms subscales, American Orthopaedic Foot and Ankle Society (AOFAS) and Quality of Life (Short Form 36) at one year. Results: Q3DCT measurements showed a mean posterior fragment size of 11.8 % of the tibial plafond. 17/28 (61 %) of posterior fragments were surgically addressed. Early posttraumatic arthrosis, FAOS, AOFAS and SF-36 did not significantly differ between fixed or non-fixed fragments. Total gap surface showed a median of 14.5 mm 2 (IQR 4.7 -30.0 mm 2 ) ( Introduction: Despite advanced imaging techniques, classic measurements of post-operative fracture reduction (i.e. Knirk & Jupiter's ''classic'' two-millimeter displacement) 1 have not been revisited to date. The purpose of this study was to explore contemporary measurement techniques of postoperative fracture fragment displacement by using state-of-art quantification of three-dimensional computed tomography (Q3DCT). Material and methods: Twenty eight ankle rotational-type fractures including a posterior malleolar fragment (AO/OTA type 44) were evaluated using Q3DCT to quantify posterior fragment size (% of tibial plafond) and articular involvement (http://www. traumaplatform.org [2] ). Postoperative gap and step-off of the posterior fragment were calculated by virtually reducing fragments to their anatomical position. In addition, overall multidirectional displacement (mm) and gap-surface (mm 2 ) were measured. Measurements were compared to conventional to-dimensional computed tomography (2DCT) Results: Q3DCT revealed a median posterior fragment size of 11.8 % (IQR 5.9-23.8 %). 2DCT showed a median post-operative maximum step-off of 1.1 mm (IQR 1.1 -1.8 mm), compared to a median step-off of 0.6 mm (IQR 0.0 -1.1) on Q3DCT. Median maximum post-operative gap was 1.2 mm (IQR 0.0 -3.8) on 2DCT; median gap surface on Q3DCT was 14.5 mm 2 (4.7 -30.0). Overall multidirectional displacement was 0.7 mm (IQR 0.0 -1.1) Conclusion: Q3DCT is a feasible technique in the post-operative evaluation of posterior fragments. We propose total gap surface in mm 2 and overall multidirectional displacement as contemporary measurements. A separate study reveals the clinical relevance of these new measurements in predicting clinical outcome in a prospective patient series. References: 1. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68 (5) Introduction: Approximately 5 % of distal radius fractures results in a malunion, often causing pain and limited function. A corrective osteotomy is the preferred treatment to restore the anatomical configuration and optimize functional outcome. To reach anatomic reconstruction, detailed preoperative planning is essential. Conventional preoperative planning does not address complex deformations that are frequently present in malunions. Computer-assisted techniques with three dimensional (3D) images and models address 3Ddeformity and may optimize functional and radiological results in corrective osteotomies of the radius. The aim of this study was to summarize and evaluate the results of 3D-planned corrective osteotomies of malunited distal radius fractures. Material and methods: We systematically searched PubMed, EMBASE and the Cochrane library (1 January 2000 -1 March 2015 for studies that performed a 3D-planned corrective osteotomy on patients with a malunited distal radius fracture. We performed an S88 individual patient data meta-analysis (IPDMA) of included cases with focus on radiographic and functional outcomes of the procedure. Results: Fourteen studies with a total of 65 participants were included in the analysis. Improvement on volar tilt, radial inclination and ulnar variance showed statistical significance (p \ 0.05). All directions were improved to within 5 degrees of their normal value. Mean flexion-extension, pro-supination and grip strength showed statistically significant improvement (p \ 0.05). Complications were reported in four out of 65 patients (6 %). Conclusion: 3D-planned corrective osteotomies significantly improve both radiographic and functional results in patients with a distal radius malunion. Disclosure: No significant relationships. Introduction: Compartment syndrome of a limb is a severe and dynamic condition. A compartment syndrome is difficult to diagnose reliably and safely, a true gold standard does not exist. The pathophysiological conditions of the compartment syndrome affect amongst other things the elasticity of tissue. Material and methods: The usefulness of ultrasound based shearwave elastography for the early non-invasive diagnosis of acute compartment syndrome was assessed in a group of subjects by using the validated models (Wiemann et al.) to simulate conditions of a cut compartment syndrome. Results: With using the ultrasound based shear-wave elastography a measurement of the shear wave speed was done and a colour overlay was created. After analysis of the colour overlay we could show that the proportional intensity of the less elastic parts increase. We calculated a median intensity for less elastic parts of 24.6 % (12.9-42.9 %) at rest. When the intracompartimental pressure was increased it may be observed a increase of intensity for less elastic parts of the ROI (median of +30.0 %). Simultaneous the intensity for middle and very elastic parts decreased. Conclusion: The change of quantifiable shear-wave speed parameters in tissue elasticity as well as the strain of tissue can be registered and so compartment syndrome can be detected. The method presented in this study thus proved to be a useful tool in the early non-invasive diagnosis of acute compartment syndrome. Further studies are required to assess the reliability and validity of this new technique, the suitability and the benefits of this method, however, may already be expected. Introduction: The anterior cruciate ligament (ACL) has an important role in knee function and stability. Partial or total rupture of this ligament is a very common injury. Cruciate ligament rupture is highly associated with the development of osteoarthritis. Therefore, early diagnosis and treatment are essential. The aim of this study is to validate a new clinical test, the 'Lever Sign' test, comparing it to knee arthroscopy. Material and methods: Patients with post-traumatic knee complaints are prospectively included and examined by a surgeon and physical therapist for either ACL rupture or meniscal injury. The Lever Sign test, anterior drawer test, Lachman test and pivot shift test were used to diagnose ACL tear. Subsequently the patients underwent therapeutic knee arthroscopy. Using the arthroscopic findings as the gold standard, sensitivity and specificity were calculated. Results: Thus far 25 patients are included, of which 76 % male and 24 % female. Overall, the mean age was 33.6 years varying from 19 to 60. The sensitivity of the Lever Sign test was 63.6 % and 77.8 % for surgeon and physical therapist, respectively. In total, 14 out of the 25 included patients did not have a ruptured ACL. In all 14 cases, the Lever Sign test was negative, so specificity was 100 % for both surgeon and physical therapist. Conclusion: One of the major findings of this study is the perfect conformity, when the ACL is intact, between the outcome of the Lever Sign test and arthroscopic findings. The Lever Sign test shows to be very specific and may help in more accurately diagnosing ACL tears. References: Disclosure: No significant relationships. Trauma and Orthopaedics, Heart of England Foundation NHS Foundation Trust, Birmingham, Birmingham, UK, 2 Trauma and Orthopaedics, North Lincolnshire and Goole NHS Foundation Trust, Grimsby, UK Introduction: Rehabilitation following meniscal surgery is a crucial component of injury management, contributing significantly to improved post-operative outcomes. However the optimal S89 rehabilitation programme following meniscal repair remains uncertain. As such, the present study aims to examine the post-operative outcomes, including failure rates, in patients undergoing aggressive post-operative rehabilitation following all-inside meniscal repair. Material and methods: Data was collected on consecutive series of patients undergoing all inside meniscal repair between 2011-2014. Rehabilitation involved full weight bearing in a hinged knee brace for six weeks limited from 0 to 90 degrees. The primary outcome measure was defined as any re-operation due to failure of the primary procedure, whilst the secondary outcome measures were the Lysholm and Tegner functional knee scores functional knee scores. Results: A total of 68 patients were included in the study, with a mean follow up of 23.9 months. 31 (45.6 %) patients suffered an isolated medial meniscus injury, whilst 27 (39.7 %) suffered an isolated lateral meniscal tear. 36 patients (52.9 %) suffered a concurrent ACL tear, all of whom underwent synchronous ACL reconstruction. Over the course of the study period, there were no re-operations due to failures of the primary repair. Furthermore there was a significant increase in the post-operative Lysholm score following meniscal repair and rehabilitation (38.2 pre-operative vs. 85.23 post-operative; p \ 0.01). Conclusion: Aggressive rehabilitation protocols can facilitate significant increase in post-operative Lysholm scores, and is not associated with any failures requiring further surgery. This suggests early and free weight bearing following all inside meniscal repair is a safe and effective post-operative rehabilitation protocol Introduction: Hypothesis 1) A novel degradable silk-fiber based scaffold with mechanical properties similar to the native ACL is able to initiate ligament regeneration after ACL resection and reconstruction under in-vivo conditions. 2) The additional cell seeding of the scaffold with autologous stroma vascular fraction containing adipose derived stem cells is increasing the regenerative activity. Material and methods: Thirty-three mountain sheep underwent ACL resection and randomization to two experimental groups: 1) ACL reconstruction with scaffold alone (SA), 2) ACL reconstruction with cell-seeded scaffold (CS). Histological evaluation of the intraarticular portion of the reconstructed/regenerated ligament was performed after six and twelve months. Results: After six months, connective tissue surrounded the silk scaffold with ingrowth in some areas. The cell seeded scaffolds had significant lower silk content (p \ 0.05) compared to the unseeded scaffolds and demonstrated higher content of newly formed tissue (p \ 0.01). After twelve months, the density of the silk fibers decreased significantly (p \ 0.01), and the ingrowth of newly formed tissue increased in both groups (p \ 0.05). No differences between the two groups regarding the silk fiber degradation as well as the regenerated tissue were detected anymore. Conclusion: The novel silk-fiber based scaffold was able to stimulate ACL regeneration under in-vivo conditions. Additional cell seeding lead to increased tissue regeneration and decreased silk-fiber content, whereas these differences diminished after twelve months. References: Disclosure: No significant relationships. Introduction: Purpose: The aim of this study was to assess the clinical and functional outcomes of primary anterior cruciate ligament (ACL) reconstruction using the Ligament Augmentation Reconstruction System (LARS TM ) with a minimum follow-up of 10-years. Material and methods: The outcomes of fifteen patients who underwent arthroscopic ACL reconstruction using the LARS TM system between 2000 and 2004 with a minimum follow-up of ten years were observed. The International Knee Documentation Committee score (IKDC), Visual Analog Scale (VAS), Lysholm score, and Tegner Activity Scale were assessed. Clinical assessment was performed by Lachman testing, assessment of side-to-side difference on KT-2000 testing and plain radiography evaluation of osteoarthritis. Results: There were seven males and eleven females with a mean age of 29 years (range, 18 to 44 years) and a mean follow-up of 151.5 months (range, 120.4-165.0 months). Five patients (27.8 %) sustained a re-rupture of the LARS TM system and underwent revision surgery after a mean time of 23 months and four patients (22.2 %) presented with a re-rupture at final follow-up. The average IKDC score was 76.60 ± 18.18, the average Lysholm score was 88.00 ± 10.07 and the average Tegner activity score was 5 at final follow-up. Conclusion: Our results indicate that the LARS TM system should currently not be suggested as a potential graft for primary reconstruction of the ACL. In special cases (e.g. multiple revision procedures), however, the LARS TM system can serve as an alternative graft. Disclosure: No significant relationships. Introduction: To evaluate the clinical and functional outcomes for anatomic anterior cruciate ligament (ACL) reconstruction using the all-inside technique with a minimum follow-up of 24 months. Material and methods: Patients undergoing anatomic ACL reconstruction using the all-inside technique between January 2011 and October 2012 were reviewed for inclusion in this study. Functional outcome measures including the Lysholm score, IKDC-score, Visual Analog Scale (VAS) score, Tegner Activity Scale were used to evaluate outcomes before surgery and at 3-, 6-, 12-and [24 months. At final follow-up, anterior-posterior knee stability was assessed with KT-2000 measurements. Results: of the 92 patients who underwent primary all-inside ACL reconstruction, 79 patients returned to final follow-up with a minimum of two years. There were 53 males and 26 females with a mean age of 29 years (range, 18 to 54 years) and a mean follow-up of 29 months (range, 24 to 45 months). The IKDC-score (44.6 vs. 89.7, p \ 0.0001), Lysholm-score (53.4 vs. 93.1, p \ 0.001), VAS-score (5 vs. 0.1, p \ 0.001) and Tegner activity score (2 vs. 6, p \ 0.001) showed a significant improvement between baseline and final clinical follow-up. The mean side-to-side KT-2000 difference at final followup was 1.7 mm (range; 0 mm to 6 mm). Conclusion: The current data supports our first hypothesis that primary anatomic ACL reconstruction using the all-inside technique leads to improved functional outcome between baseline and clinical follow-up at 24 months. Further, there was no difference in knee stability between the ACL reconstructed-and the contralateral normal knee at 24 months, which confirms our second hypothesis. Introduction: To determine whether there are sex differences on objective and functional outcomes after anterior cruciate ligament (ACL) reconstruction utilizing the all-inside technique with a minimum follow-up of 24 months. Material and methods: All patients who underwent anatomic ACL reconstruction using the all-inside technique between January 2011 and October 2012 were reviewed and divided into two groups (group A: males and group B: females) that were equal according to the patients' number and age. Functional outcome measurements included the Lysholm score, IKDC -score, VAS-score, Tegner Activity Scale before surgery and at 3-, 6-, 12-and [24 months follow-up. Results: A total of 54 patients met the inclusion criteria study; 27 males and 27 females with a mean age of 29 years (range, 18 to 54 years) and a mean follow-up of 31 months (range, 24 to 45 months). The evaluated scores showed no significant difference between baseline, 3-, 6-, 12-, and [24 months clinical follow-up. However, women presented with a poorer outcome between baseline, 3-and 6-months leading to equal results at 12 and [24 months. The mean side-to-side KT-2000 difference and functional scores at final follow-up did not differ significantly between the two groups. In conclusion, our study shows that equal objective and subjective success can be obtained following primary anatomical ACL reconstruction utilizing the all-inside technique in both male and female patients. We found, that women need a longer time period to obtain the same activity levels compared to their male counterpart. Disclosure: No significant relationships. Introduction: It is technically difficult to evaluate objectively the rotational stability of the knee. Navigation systems give us such an option. The objective of this study was to evaluate knee rotational stability at least 2 years after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction (SB) and double-bundle ACL reconstruction (DB) in comparison with the contralateral healthy knee joint. Material and methods: In both groups, 20 cases were evaluated. The mean follow-up was 27 months (range, 24 to 33). For all measurements, the navigation system was used. All measurements were taken on both the reconstructed and healthy knee. All measurements were repeated 3 times for each knee joint. The nonparametric Wilcoxon test was used to evaluate results. Results: After the DB reconstruction, the mean external rotation of the tibia (ER) was 8.2°and the mean internal rotation of the tibia (IR) was 10.1°. In the contralateral healthy knee joint, ER was 8.5°( p = 0,431) and IR was 12.1°(p = 0.218). We didńt find any statistically significant difference in rotational stability between reconstructed and healthy knees. After the SB reconstruction, ER was 9.6°and IR was 13.1°. In the contralateral healthy knee joint, ER was 7.7°(p = 0.121) and IR was 9.8°(p = 0.045). We found statistically significant difference in internal rotational stability between reconstructed and healthy knees. Conclusion: The data shows that the DB reconstruction of the ACL restores the rotational stability of the knee joint without any significant difference in comparison to the contralateral healthy knee (p [ 0.05). Introduction: A novel technique called Dynamic Intraligamentary Stabilization (DIS) for treatment of acute anterior cruciate ligament (ACL) tears by using the Ligamys Ò implant system creates immediate joint stability close to the pre-injury level. The aim of this study was to biomechanically investigate the course of antero-posterior (AP) translational knee stability during the early post-operative phase. It is hypothesized that AP-translational knee stability is fully maintained over a simulated rehabilitation period of 50'000 gait cycles. Material and methods: Eight fresh-frozen human cadaveric knee joints were subjected to 50'000 cycles of 0°-70°flexion-extension movements in a custom-made test setup. AP-translational knee stability was assessed with simulated Lachman/KT-1000 testing in 0°, 15°, 30°, 60°and 90°of flexion in knee joints treated with DIS at cycle numbers 0, 100, 500, 2500, 10'000, 25'000, 50'000 and after Ligamys Ò explantation. Statistical analysis was performed using the Wilcoxon Signed-Rank Test with Bonferroni correction for multiple comparisons. The level of significance was set at p = 0.05. Results: AP translation increased for all degrees of flexion over the whole cyclic test. The highest increase of 1.4 mm was observed between cycle numbers 0 and 50,000 in 30°flexion. For all flexion angles the AP translation after 50'000 cycles remained lower compared to the state after Ligamys Ò explantation. Conclusion: DIS provides AP-translational knee stability close to the immediate post-operative level over a simulated rehabilitation period of 50'000 gait cycles and therefore supports the ACL during biologic healing. Disclosure: This study was funded by Mathys Ltd Bettlach, where J. Häberli was an former employee. Orthopedic Trauma, RWTH Aachen University Hospital, Aachen, Germany, 2 Orthopaedic Trauma Surgery, RWTH Aachen University Hospital, Aachen, Germany Introduction: A high percentage (50 %-60 %) of severely injured patients die prior admission to the hospital. Moreover, preclinical studies including autopsies are rare. In this systemic literature review, we searched for publications focusing on clinical and preclinical mortality and post-mortem examinations. Moreover, we aimed to prove the consistency and value of data in autopsy studies using a systematic review of literature. We have performed a literature research via PubMed/Medline database. The following search terms were used in different combinations: ''multiple trauma'', ''epidemiology'', ''patterns of mortality'', ''trauma deaths'', and ''autopsy''. References from available studies were searched as well. Relevant medical literature in English or German language published within the last four decades was included. Results: In this review we have identified marked differences in demographic parameters and injury severity between studies. In addition, the incidence of penetrating injuries was significantly different in studies (between 4 % and 38 %). Both unimodal and bimodal concepts of trauma mortality were mainly favoured. Thus, it is difficult to say which distribution is correct. Conclusion: We have identified clear inconsistency between publications. Further studies in this field are needed; however, we would like to encourage investigators to choose the inclusion criteria more critically and to consider factors affecting the pattern of mortality References: Disclosure: No significant relationships. Introduction: Dutch and American trauma systems have many similarities, but also important differences. Our objective was to compare characteristics and outcomes of polytrauma patients admitted to a US (Massachusetts General Hospital, MGH) versus a Dutch (Trauma Center West Netherlands, TCWN), Level 1 Trauma Center. Material and methods: The records of 1,378 blunt trauma patients C15 years of age with an Injury Severity Score (ISS) C16 admitted between July 1, 2011 and December 31, 2013 (640 from TCWN, 738 from MGH) were retrospectively analyzed. Results: The U.S. group had a higher mean Charlson Comorbidity Index (1.8 ± 2.8 vs. 1.2 ± 2.3, p \ 0.001) and ISS (25 ± 9 vs. 23 ± 8, p \ 0.001). In-hospital mortality was similar in both centers (11 % vs 10 %, p = 0.61), even after correction for baseline differences. MGH had a longer ICU stay (median 4 [IQR 2-11] vs. 2 [IQR: 2-7] days, p = 0.008) but shorter hospital stay (median 6 [IQR [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] vs. 8 [IQR 4-16] days, p \ 0.001). They also developed fewer complications (28 % vs. 37 %, p \ 0.001), but had a higher complicationrelated readmission rate (7 % vs. 4 %, p = 0.003). More US patients were discharged to a rehabilitation center (42 % vs 9 %, p \ 0.001) and less to home (41 % vs. 60 %, p \ 0.001). Conclusion: While mortality was similar between the two trauma centers, morbidity, hospital stay, and discharge disposition were different, pointing to different processes of care. The study of international variation in trauma care will allow further insight into the different trauma systems and the elements that should be adopted in order to improve the care overall. (2010) (2011) (2012) (2013) (2014) . Specificity of the country is an ,,abnormal'' structure of inhabitants because of the high % of expatriate employees compared to the native population, lack of (appropriate) insurance for the expats and the need of the employeŕs consent with the treatment of the employee. In case of lack of insurance the employer or employee should cover treatment expenses. Material and methods: In the years 2010-2014 234 patients were treated for pelvic/acetabular fractures mainly because of high-energy trauma 112 patients had unstable/displaced fractures indicated for surgery. Surgery was done in 65 patients. 22 were granted treatment abroad, 7 refused surgery, 12 not consented by employers. There were 3 open fractures, 79 additional abdominal injuries, 6 patients could not be operated. Diagnostics: plain x-rays, CT-scans, 3D-reconstructions. Surgery was performed in average on the 5th-7th postinjury day. Approach: anteriorly Pfannenstiel incision combined with a modified ilio-inguinal approach, dorsally a sacrum bridging doubleplating giving high mechanical stability for early mobilization. Results: Complication: 2 superficial, 0 deep infections, 1 transient sciatic nerve palsy, 3 implant failures (1 plate breakage, 2 screw migration). Patients returned to their previous activities within 4-6 months. In the follow-up period (average 28 months) patients had no or minimal pain with high patient satisfaction. Conclusion: Surgical management of unstable/displaced pelvic ring/ acetabular fractures enables early mobilization of the patients. The application of combined ventral-dorsal plating gives excellent mechanical stability. In our opinion this was also the cause that patients were predominantly pain-free in the follow-up period. References: Disclosure: No significant relationships. Introduction: Trauma is the leading cause of death in the young adults around the world. Since the majority of the victims are economically active, the social burden can be quite high. Injured patients rely on strategies that improve outcome and minimize sequelae. Identifying the profile of trauma admissions is an indispensable tool that should be used to optimize those strategies. Material and methods: All patients admitted to the trauma center of Hospital das Clinicas from December 2014 to September 2015 were analyzed. Data were retrospectively collected including age, gender, type and mechanism of injury, type and time of transport, hemodynamic status, Injury Severity Score (ISS) and outcome. Mortality during the first hour was also observed. Results: During the study period, 672 trauma admissions were registered, with 272 having an ISS over 15. of the major traumas, mean age was 36 years and 80 % were male. Blunt trauma compromised 88 % of the admissions. of those, the most common mechanisms were motor vehicle collisions (49 %), being run over (24 %) and falls (18 %). The majority were brought in by ambulance (64 %), and the mean time to arrival was 53 minutes. Twenty-five percent were hypotensive upon admission. Mean ISS was 38. Mortality in the first hour was 12 %. Conclusion: The profile of major trauma patients is a valuable parameter that can be used to improve quality of care. These characteristics should be used to optimize pre-hospital approach, transport logistics, and in-hospital strategies. Emergency General Surgical Unit, Aintree University Hospital, Liverpool, UK, 2 Aintree University Hospital, Liverpool, UK Introduction: Post traumatic stress disorder (PTSD) was initially described and is well recognized in conflict medicine, but is rarely reported in civilian trauma. Material and methods: A prospective study was conducted following a cohort of patients admitted to a level 1 UK major trauma centre during a 7 month period. Patient related outcome measures were measured during the initial admission and then at the first clinic visit 6 to 8 weeks after discharge. This included the EQ-5D QoL score, the Hospital Anxiety and Depression Score (HADS) and the 4 point PTSD screening tool -the Primary Care PTSD screen, by Prins, Ouimette, & Kimerling, which has been validated for use in civilian settings (Freedy et al). Results: A total of 86 patients attended follow up. From this group 9 patients were screened as having PTSD, giving a point prevalence of 10.5 %. On analysis of the subgroups, in a cohort with ISS [15 9.4 % of patients scored for PTSD, as compared to 12.5 % of patients with S93 ISS \15. 10.4 % of patients scored significantly abnormal on the HADS, and there was a correlation with this and a high PTSD score, with a further 14 % scoring moderately abnormal. 63 % patients had a tangible decrease in quality of life scores as defined by EQ-5D, but there didn't seem to be an association with high PTSD scores. Conclusion: PTSD is a real problem in civilian trauma, with a prevalence in our study estimated at 10.5 %. This fuels the need for psychological services input at major trauma centres. Disclosure: No significant relationships. Introduction: Pelvic fractures are implicated in morbidity and mortality following traumatic injury. We sought to study the impact of pelvic fractures on clinical course and outcomes of trauma patients with a pelvic fracture in comparison to the general trauma population. Material and methods: A cohort of 206 blunt trauma survivors, studied over 5-year period, 75 patients (36.4 %) had a pelvic fracture post-injury. To perform a pairwise, case-control study with 1:1 matching set, 60 patients of the pelvic fracture group (41 males and 19 females; age: 39.5 ± 2.2; Injury Severity Score (ISS): 26.6 ± 1.2) were compared to 60 patients without pelvic fracture trauma as controls (41 males and 19 females; age: 40 ± 1.7; ISS: 26.9 ± 1), both with matching demographic and injury characteristics. Results: Statistically significant differences were observed in Intensive Care Unit (ICU) length of stay (LOS), total LOS, and Marshall MODScore between pelvic fracture and non-pelvic fracture groups respectively. Shock markers of pH, lactate, LDH, and base deficit were all significantly altered in pelvic fracture patients when compared to non-pelvic fracture cohort upon admission. Moreover, our analysis showed a significant differences in inflammatory biomarkers (Prolactin, IL-6, and CRP), and clinical parameters (CPK, Hct, WBC, and Platelets count) over the 7 days clinical course in patients with pelvic fracture when compared to non-pelvic fracture cohort. Conclusion: In this stringently matched cohorts, analysis revealed that even upon admission, patients with pelvic fractures exhibited early biochemical and physiological alterations. In addition suggests that pelvic fracture affects the clinical outcome in severely-injured patients, independently of injury severity, mechanism of injury, age or gender. References: Disclosure: No significant relationships. Introduction: Pelvic ring fractures typically occur as a result of high energy trauma and might have long-term consequences on Healthrelated-Quality-of-Life (HrQoL). Many studies focused on functional outcome. However, only few studies focused on the HrQoL. Therefore, the purpose of this study is to conduct a cross-sectional analysis of patients using HrQoL-instruments. Material and methods: We used the EuroQol-5D questionnaire and the pelvic Majeed score to assess the HrQoL after pelvic ring injury. Mean hospital stay, complications of pelvic ring fractures and oneyear survival were measured. Results: All 272 patients (147 male, 125 female, mean age 58 ± 23,0 years) with pelvic ring fractures referred to our hospital for conservative-or surgical-treatment between January 2011 and June 2015 were included in this study. There were 170 A, 73 B and 29 C Tile type fractures (mean age 62 ± 23, 51 ± 21 and 44 ± 18 years, respectively). A high energy traffic accident was the most common trauma mechanism in type A, B and C patients. The mean injury severity score was 16 ± 13, 21 ± 13 and 34 ± 19. The one-year survival rate was 82 % A, 90 % B and 85 % in type C patients. All differences between the groups are statistical significant (P \ 0.05), except for the one-year survival rate (P = 0.27). Conclusion: We analysed all pelvic ring fractures from our center between 2011-2015. We will finalize our results concerning HrQoL after pelvic ring fractures soon. We will give an overview of the data above at ESTES 2016 and present our HrQoL results. Introduction: The goal is to record and evaluate trauma management in our University Hospital, while setting up the first trauma database in the country. Material and methods: Retrospective study of patients (n = 1128) between March and December 2014 using hospital records. ISS was used to categorize. Demographic information, injury patterns, hospital transfer, diagnostic and therapeutic procedures, duration of hospitalization, outcomes, complications and cost were recorded. Results: Overall number of surgical emergencies was 2506, with trauma constituting 45 % of those. An 8 % steady, incremental increase of trauma was observed, although the majority (52.4 %) could have been treated at a lower level healthcare facility and only 15.2 % were considered polytrauma. Only 9.7 % (n = 109) of the patients received first aid and were transferred to the hospital by the National Emergency Medical Services. Overall, 3.5 % of trauma patients underwent surgical treatment (75 % of surgeries categorized as major or critical), with 19.5 % of these patients undergoing 2-5 surgeries with 30 day surgical mortality 7.3 %. ICU admissions were only 0.7 %. Conclusion: Despite the lack of nationally organized trauma healthcare structure and database and a national financial crisis, it is possible to achieve respectable results. However, this effort shows the need for a national trauma database. Introduction: In Qatar, injuries are the leading killer and documenting their direct medical costs are necessary for the national prioritization and planning of healthcare systems. This study aims to quantify, analyze and report the direct medical cost of admissions of patients, injured as pedestrians, to the national trauma referral center, the Hamad Trauma Center [HTC] . Material and methods: This is a retrospective review of all pedestrian injuries admitted to the HTC between 1 Jan, 2009 to 31 Dec, 2012. Computations for pre-hospital, emergency department, in-hospital and management costs for patient were done using the technique previously reported by Tuma et al. Results: 281 pedestrian injuries were analyzed, all were male with a median age of 32 years (IQR, 24-39) and 12 in-patient deaths. The Ambulance Service was utilized by 265 (94.3 %) patients. The most common injuries affected the spine (41.3 %), head (38.4 %) and chest (28.5 %). The Injury Severity Score ranged from 2 to 66, with mean ISS of 13 (SD, 9.99 Introduction: Emergency Departments in Israel are constantly severely overcrowded. This situation has reportedly reached a crisis proportions. In mass casualty incidents EMS systems provide prehospital superb triage and evacuation. We assume that the Israeli ED overcrowding is due to lack of pre hospital triage. Overcrowding in the ED can worsen patient's outcome. Material and methods: This is a prospective cohort study in a tertiary facility mixed ED to scrutinize the indications for patients' referral. A questioner for paramedics, patients or their relatives who arrived by the national EMS or private services was developed to examine the reasons for referral to our medical center. Results: There were 315 questioners. 108(34 %) patients were referred due to trauma and 207 (66 %) due non-trauma related conditions. 236 (78 %) arrived by the national EMS and 67 (22 %) by private EMS. 193 (61 %) of the referrals were by patients request, 33 % were referral from other hospitals, 21 % from pre hospital emergency services, 8 % from general practitioner offices. Fifty percent of the patients were medical, 30 %surgical. 14 % were admitted to the shock-trauma center room and 8 % to the ED walking clinic. Only in 5 % of the referrals a pre hospital triage process was performed. Conclusion: patient preference was the main indication for transfer to our tertiary facility. No central command for pre hospital triage is practiced in non MCU scenarios. EMS central control triage process should be developed and forced in order to reduce overcrowding of the ED. References: Disclosure: No significant relationships. Introduction: Injuries represent 200,000 hospital admissions per year in Canada but little is known about variations in LOS for trauma admissions across Canada or the influence of recommended trauma system components on LOS. We aimed to assess the variation in LOS across Canadian trauma centers and provinces and to identify trauma system elements that may explain inter-provincial variations. Material and methods: We conducted a retrospective cohort study of adults admitted for major injury to level I and II trauma centers across Canada (2006 Canada ( -2012 . Multilevel linear models were used to compare risk-adjusted LOS across trauma centers and systems and to assess the impact of 13 recommended trauma system components on LOS. Analyses were conducted for all injury admissions then for severe traumatic brain injury and thoracoabdominal injury. Results: Mean LOS was 10.9 days for all injury admissions, 11.3 for severe traumatic brain injury and 10.9 for severe thoracoabdominal injury. Risk-adjusted LOS varied significantly from 9.6 to 15.5 days across provinces (p = 0.02) and from 8.5 to 15.5 days across trauma centers (p = 0.001). Variations were greater for TBI than thoracoabdominal injuries. Provinces with a prehospital definition of major S96 trauma, pre-hospital destination protocols, and no refusal policies had lower mean LOS than provinces without these trauma system components (p \ 0.05). Conclusion: We observed significant variation in risk-adjusted mean LOS across Canadian trauma centers and provinces and several recommended trauma system components were associated with reduced LOS. Results suggest that there is potential for reducing hospital days for Canadian injury admissions and that trauma system configuration may have a role to play. References: Disclosure: No significant relationships. Emergency and Trauma Surgery, Universty Hospital Aintree, Liverpool, UK, 2 University Hospital Aintree, Liverpool, UK Introduction: Readmission to hospital contributes to the substantial financial and capacity burden that emergency departments are faced with. The aims of this study were to identify reasons for emergency readmissions, and to implement changes in order to reduce such admissions. Material and methods: An initial audit cycle was carried of all patients readmitted between March 2012 and March 2013. Reasons for readmission were collated and the development of strategies to reduce such re-admissions were put in place. Once changes were implemented a re-audit was carried out between April and July 2014 and the audit cycle closed. Results: Between March 2012 and March 2013 5088 7,400 patients were admitted via the Emergency general surgery unit, of which 5088 were general surgical. 493 of 7,400 were readmissions (6.7 %); 51 % (n = 254) of which were general surgical emergency admissions. 100 patients (39 %) were readmitted due to pain, 20 % of which were due to inadequate analgesia. Implementation of change involved development of analgesic pain cards and patient education leaflets to reduced re-admissions. Re-audit showed between April 2014 and July 2014, 2479 patients were admitted; 1725 were general surgical. 151 of 2479 (6.09 %) were readmissions, 79 were general surgery readmissions (4.58 %). 3.8 % of readmissions were due to inadequate analgesia, compared to 20 % prior to implementation of changes. Conclusion: Overall this completed audit cycle achieved a minimal cost saving to the trust of £18,000 per annum, without taking into consideration financial implication of readmission, investigation cost and hospital pressures. This has been achieved by the use of improved prescribing and patient education. References: n/a Disclosure: No significant relationships. Introduction: Emergency abdominal surgery is associated with high mortality and morbidity rates in a population dominated by elderly comorbid patients with a severe acute physiological deranged condition [1] . The aim of this study was to evaluate the effect of a multimodal and multidisciplinary perioperative protocol in major emergency gastrointestinal surgery patients [2, 3] . Material and methods: The trial was a single center intervention study in a consecutive cohort. 600 patients [18 years old underwent emergency high risk abdominal surgery treated according to a perioperative protocol. 600 consecutive patients in the same department from January 1, 2011 were defined as the control group. The primary outcome was 30-day mortality. Secondary outcomes were 180-day mortality, length of stay in hospital and length of ICU stay. Outcomes were analyzed using an intention-to-treat approach. Results: The unadjusted 30-day mortality rate was reduced from 21.8 % to 15.5 % after the implementation of the protocol (P = 0.0049). The 180-day mortality rate in the control group was 29.5 % compared to 22.2 % in the intervention group (P = 0.0037). Median length of stay in hospital was 10 days (IQR 5-22) before and 11 days (IQR 6-21) after the introduction of the protocol. Additionally, the median ICU stay was reduced from 5 days (IQR 2-17) to 3 days (IQR 1-9). Conclusion: The introduction of a multimodal multidisciplinary perioperative protocol in a high risk major emergency surgery patient group is associated with a reduced mortality and ICU stay, while length of hospital stay was marginally increased. Introduction: Open fractures require joint input from orthopaedic and plastic surgeons as per BOA/BAPRAS guidelines. This is usually unavailable in most trauma units, resulting in transfer to specialised centres which may be costly and may jeopardise timely intervention. Joint input is not only necessary in acute settings but also elective care. This study aims to highlight the impact of a full time plastic surgeon within our regional trauma unit. Material and methods: Time from referral to review and intervention by a plastic surgeon, in addition to inpatient stay and cost, was S97 compared prior to and following the presence of a on-site consultant plastic surgeon. We also evaluated the effect of this on our elective care, in particular the foot and ankle, sarcoma and limb reconstruction services. Results: To evaluate the impact on acute care, nine patients were included within each group. Median time until review and intervention by a plastic surgeon was 6 and 9 days respectively in the retrospective group, compared to within 24 hours and 3 days in the prospective group. Cost of inpatient stay was £12,452.66 per patient in the retrospective group compared to £2,750.28 in the prospective group. Within elective sarcoma care, two patients were included within each group. Average time until review and definitive coverage was 8 and 20 days respectively in the retrospective group, compared to within 24 hours and 11 days in the prospective group. Conclusion: A reduction of 83 % and 67 % in review and intervention time was seen in acute cases, and in 87.5 % and 45 % of elective sarcoma cases. References: • combination of sternal fractures and concomitant injuries of the spine are subdivided in cervical, thoracic and lumbar spine. The distribution of level of vertebral fracture in combination with sternal fracture was analyzed in a statistical evaluation. Results: The highest incidence of a vertebral fracture at thoracic spine in combination with a sternal fracture can be seen at Th3/ 4(0.34 %; n = 86) and Th 5/6 (0.32 %; n = 81). Another peak can be seen at Th11/12 (0.36 %; n = 89). At lumbar spine the most frequent level is L1 (0.39 %; n = 97) and L2 (0.34 %; n = 84). A minor role as an associated fracture plays the cervical spine with a portion of 0.004 %. Conclusion: The statistic shows in the case of a sternal fracture the highest incidence of concomitant injuries of the spine at mid-level, as the most rigid part of the thoracic spine and at the thoraco-lumbar area [1, 2] . Conclusion: Traumatic massive haemorrhage can lead to the vicious cycle of ACoST and be catastrophic [2, 3] . Early, rapid, goal-directed transfusion is essential and can be provided using the MHP and point-of-care coagulation testing. We aim to increase ROTEM knowledge and practice using high fidelity simulation and a ROTEM interpretation algorithm with its incorporation into the MHP Introduction: Heart Rate Variability (HRV) is now considered as a new method for triage and predicting the mortality in trauma patients. Changes in HRV may be used as an index for sufficiency of treatment in trauma patients. According to the study conducted by Norris and colleagues a decrease in HRV (cardiac uncoupling) during ICU stay in trauma patients was associated with higher mortality [1, 2] . In this study we hypothesized that a rise in HRV (cardiac recoupling) in trauma patients may indicate sufficiency of fluid resuscitation and uncoupling indicate the need for further hydration or packed RBC transfusion. Material and methods: Fifty trauma patients were included in this study. An Electrocardiography (ECG) were captured at the onset of their admission, after hydration with ringer lactate the arterial blood gas (ABG) analysis and ECG were repeated. If a patient needed further hydration or packed RBC transfusion the ECG and ABG were repeated. Fast Fourier Transform was used for analysis of HRV .Then the changes of base deficit and HRV were compared. Results: A rise in HRV after hydration with ringer lactate were associated with normalization of Base Deficit (p value: .05). A decrease in HRV after primary hydration were associated with the need of transfusion and base deficit deterioration and normalization of Base Deficit after transfusion was associated with a rise in HRV (cardiac recoupling). Cardiac uncoupling (decrease in HRV) was also associated with higher need of ICU care. Conclusion: Cardiac recouping (increase in HRV) can be considered as an index for end point of resuscitation Introduction: Various studies have shown the deleterious effect of high volume resuscitation following severe trauma promoting coagulopathy by haemodilution, acidosis and hypothermia. As the optimal resuscitation strategy during prehospital trauma care is still discussed, we raised the question if the amount and kind of fluids administered changed over the recent years. Further, if less volume was administered, fewer patients should have arrived in coagulopathic depletion in the Emergency Department resulting in less blood product transfusions. Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging promising technique for the S103 management of non-compressible hemorrhage. Recently, both a linear and a fixed-distance model have been proposed to predict the correct placement of a balloon during fluoroscopy-free REBOA, in a male combatant population [1] . However, no such research has been performed on a civilian mixed population. The aim of this study was to develop a fixed-distance model in a civilian mixed population for REBOA implementation in the pre-hospital setting. Material and methods: 280 whole body CT scans from a civilian mixed population of trauma patients (height: 150-198 cm, 140 males) from the University Hospitals of Lyon were analyzed to calculate the distances from the superior border of the pubic symphysis (PS, overlying the common or superficial femoral arteries (FA)) on both sides to aortic Zones I (left subclavian artery to celiac trunk) and III (infra-renal aorta). Segments common to all CT scans in both zones were sought. The probability of existence in the general population was calculated by inversing 99 % certainty tolerance limits. Introduction: The aim of this study is to evaluate arterial patency following the deployment of a bare-metal or covered stent across a traumatic occlusive arterial lesion. Material and methods: Fifteen sheep (23-43 kg) underwent general anaesthesia and the laparoscopic induction of a left external iliac artery (EIA) thrombosis by means of repeated clamping. Animals were then randomized equally into one of three groups: no-treatment (control group), a bare-metal stent (BMS group) or covered stent (CS group). Animals were followed up for 14 days and no anticoagulants were administered postoperatively. Doppler ultrasound and computed tomography angiography (CTA) were used to evaluate EIA patency. Function of the injured limb was evaluated according to the ordinal Tarlov gait score (0 -4, ascending score better). Results: Compared to the control group, stent implantation resulted in an increase in the median (interquartile range) systolic velocity (SV, cm/sec) from 0 (0) to 31 (28-37) and 24 (21-29) in the BMS group and CS group, respectively (p \ 0.001). By post-injury day 3, there was no difference in the SV between the groups. At day 14, CTA demonstrated stent occlusions in 4 out of 5 animals in each stent group. The lowest Tarlov score occurred on post-injury day 1 (mean ± SEM): 3.0 ± 0.3, 3.2 ± 0.5, and 2.4 ± 0.3 in the BMS group, CS group and control group, respectively (p = 0.12). Conclusion: Stent (BMS or CS) implantation restores arterial patency of a traumatic occlusive lesion. High incidence of early rethrombosis does not affect the functional outcome in this ovine model. Introduction: Recently, IABO (intra-aortic balloon occlusion) for traumatic hemorrhagic shock cases has been re-recognized as a REBOA. It would be less invasive than aortic cross clamp. But devices used in the world are not so small (11 or 12Fr system) and needed to open groin access. We used to use 10Fr devices as REBOA catheter but have had a chance to evaluate and use 7Fr devices in clinical in Japan. So we examined the efficacy and safety about REBOA with 7Fr devices. Material and methods: Consecutive traumatic hemorrhagic shock patients whose FAST were positive and undergone REBOA for the latest 81 months were included. 10Fr or 7Fr IABO catheter were inserted to zone 1 with only Seldinger technique and ultrasonography guided method. All of them were underwent fundamental hemostasis by operative management (OM) or transcatheter arterial embolization (TAE). We sorted them into 10Fr group or 7Fr group. The primary end point was the changes of blood pressure (BP) and Shock Index (SI) before and after doing REBOA. The Secondly end points were survival rate in 30th days and the complications with REBOA or IABO devices. Results: 40 patients includes CPA were studied (10Fr were 27 patients and 7Fr were 13 patients). There were no significant differences in baseline characteristics. Systolic BP were significantly increased after REBOA and SI were significantly decreased in both groups. The changes of them were no significant difference. Survival rate and rate of complications did not differ significantly between them and no major complications. Introduction: The aim of this study is to evaluate the early survival and organ damage following 30 and 60 minutes of thoracic resuscitative endovascular balloon occlusion of the aorta (REBOA) in an ovine model of severe hemorrhagic shock. Material and methods: Eighteen sheep were induced into shock by undergoing a 35 % controlled exsanguination over 30 minutes. Animals were randomized into three groups: 60-min REBOA 30 mins after the bleeding (60-REBOA), 30-min REBOA 60 mins after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80 mins after the induction of shock. Animals were observed for 24 hours with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage. Results: Two animals of the n-REBOA group died within 90 min of shock induction; no hemorrhagic deaths were observed in the REBOA groups. Twenty-four hour survival for the 60-, 30-, and n-REBOA groups was 0/6, 5/6, and 4/6. Mean survival time was lower in the 60-REBOA groups versus 30-REBOA group (p = 0.005). In 60-REBOA, potassium and lactate were increased at 270-min time point: from 4.3 to 5.1 mEq/l and from 3.7 to 5.1 mmol/l, respectively. Both these values were significantly higher than in the n-REBOA group (p = 0.029 for potassium and p = 0.039 for lactate). Autopsy revealed acute tubular necrosis (ATN) in all died REBOA group animals. Conclusion: REBOA can be used to prevent early death from hemorrhage; however, 60 minutes of occlusion results in significant metabolic derangement and organ damage that offsets this gain. References: Disclosure: No significant relationships. Introduction: Mortality rate for hemodynamically unstable pelvic fractures remains high. The initial assessment of polytrauma by a multidisciplinary team is an essential step. We aim to quantify mortality in a cohort of patients with pelvic fracture and hemodynamic instability treated according an specific management algorithm in our hospital. Material and methods: Our trauma database (TraumaSur) was used to conduct a retrospective cohort analysis. We identified patients admitted to the ICU from 2003 to 2014 suffering from hemodynamically unstable pelvic fractures. We evaluated epidemiologic features, type of fracture (AO-OTA), associated injuries, ISS, TRISS, invasive and surgical procedures and mortality. Results: 114 patients presented hemodynamic instability despite fluid resuscitation. There were 77 patients in our study after excluding 37 patients with severe TBI. 61 % were males, mean age was 42.8 years. Mean ISS was 41.5. According to AO/OTA, 60 % type C, 26 % B and 15 % A, and open fractures in 7.6 % 74 % presented chest trauma with mean AIS score 3.54 and 57 % abdominal trauma with mean AIS 3.70. TRISS was 71.5 % We performed arteriography in 56 % in 168 minutes (average) after admission. In 20.9 % of these, pelvic external fixation was performed before arteriography and in 9.3 % also extraperitoneal packing. We performed external fixation in 80 %. Mortality was 14.3 %. Age (p.006), chest trauma severity (p.012) and TRISS (p.032) were associated to mortality. Although studies with large series of FBI patients have been published, there are none that specifically focus on the razor blade ingestions. Our hypothesis is that the ingestion of razor blade should be managed non-operatively. Material and methods: All patients admitted to our institution with a razor blade ingestion over the last five years were retrospectively reviewed. The primary outcomes analyzed were hospital length of stay (HLOS) and clinical outcomes. The study population was stratified according to the treatment (conservative vs. endoscopic). Results: There were 37 patients who met inclusion criteria. Average age was 29.2 years, 94.6 % were male and 86.5 % were inmates. A psychiatric disorder was found in 33 patients. A significant number of patients (54.1 %) had a previous or subsequent history of FBI (average ingestion per patients 1.7). The total number of admissions was 64. 12.5 % of the patients underwent a CT-scan. The treatment was non-operative in 77.6 % and endoscopic in 23.4 %. Zero patients S105 required surgery. The median number of chest or abdomen x-rays for each patient was comparable between the groups (7.0 vs. 7.5 respectively). The median HLOS was 3 days in the non-operative group and 3.5 days in the endoscopy group (p = 0.843). No gastrointestinal perforations were observed. Conclusion: Razor blade ingestions can be safely managed with a conservative approach. No advantages in terms of HLOS and x-rays performed were found in the endoscopic group. Introduction: Blunt abdominal trauma (BAT) is a major health care concern. Recognition of predictors of outcome can aid on its approach. We aimed to identify determinants of prognosis in patients surgically treated for BAT. Material and methods: Our study involved a retrospective analysis of the clinical records of all patients admitted to our hospital for BAT and in whom laparotomy was performed, between January/2007 and June/2015. Predictors for mortality and morbidity were evaluated in univariate and multivariate statistical analysis. Results: A total of 76 patients were included, with a mean age of 49.5 years and male predominance (76.3 %). The most frequent mechanism of trauma was road traffic accidents. Solid visceral organs were the most affected, mainly the spleen (53.8 %) and the liver (23.7 %). Severe postoperative complications (Clavien-Dindo classification equal or higher than III) were identified in 75 % of the patients. They were related to the presence of extra-abdominal injury (EAI) and shock, need for blood transfusion, New Injury Severity Score (NISS) and American Society of Anesthesiologists (ASA) classification. Twelve patients died during hospital stay. The determinants of mortality were the presence of multiple EAI, recognition of shock, ASA score and NISS. Logistic regression for mortality identified NISS (p = 0.041) and ASA score (p = 0.027) as independent risk factors. For morbidity, it attributes prognostic value to NISS (p = 0.004) and presence of shock (p = 0.047). Conclusion: In our study, we couldn't identify modifiable determinants of prognosis as it was mainly related to severity criteria. Recognition of clinical variables and severity scores associated with an adverse outcome can facilitate optimal approach to BAT. Introduction: To evaluate whether laparoscopy decreases the laparotomy rates for patients suffering from abdominal stabbing and blunt injuries. Material and methods: All patients undergoing laparoscopy over a 10-year period (2003-2013) in Far-Eastern Memorial Hospital for abdominal trauma were classified by the mechanism of injury. Demographic and perioperative data were compared using the Student t and Fisher exact tests. Results: There were 204 patients included in the time period, 85 of whom sustained stabbing injuries and 119 from blunt mechanisms. Patients with blunt injuries were more severely injured (Injury Severity Score, 17.6 vs. 4.5, p \ .001). Patients undergoing laparoscopy after stabbing injuries were based on the assumption of peritoneal violation by varied diagnostic methods. The most common indication for laparoscopy after blunt injuries was physical findings associated with S106 computed tomographic findings for hollow viscus and mesenteric injuries (53.8 %). The rate of laparotomy for patients sustaining stabbing and blunt injuries was 3.5 % and 10.9 %, respectively. Conclusion: Laparoscopy is a feasible and safe tool for the diagnosis and treatment of stabbing and blunt abdominal injuries. Introduction: Arterial shunting (AS) is a well-described method to control hemorrhage and rapidly re-establish flow, but optimal shunt dwell times remain controversial. We hypothesized that shunt dwell time is unrelated to outcomes after major vascular injury. Material and methods : A review (2005-2013) of all patients with AS after traumatic injury at our urban Level-I trauma center was undertaken. Patients who expired prior to shunt removal (n = 8) were excluded. Shunt complications were defined as dislodgement, thrombosis and distal ischemia. Patients were compared on the basis of shunt complications with respect to clinical parameters. Results: The 42 patients who underwent AS after major vascular injury were primarily young (median 26 years, ) males (100 %), severely injured , shunted vessel AIS 4 [3] [4] ) by gunshot (86 % Introduction: Platelet dysfunction is a feature of trauma-induced coagulopathy (TIC) and is associated with a poor outcome. Following major trauma, immobilization of platelets on activated leukocytes might contribute to TIC. This study investigated ex vivo, whether states of activation forwarded the prevalence of platelet-leukocyte aggregates (PLA) and whether this was associated with changes in the haemostatic potential of whole blood. Material and methods: Blood of healthy donors was pre-stimulated with selective and general leukocyte and/or platelet activators such as bacterial peptides (fMLP), protein kinase C activator (phorbolmyristate-acetate, PMA) and thrombin receptor activating peptide (TRAP) and was examined for changes in maximum clot firmness (MCF) on a rotation-thromboelastometer (ROTEM). Activation and platelet-leukocyte aggregation were assessed by flow cytometry. Blood cell counts were performed to investigate changes in platelet numbers. Results: Profound co-activation of platelets with leukocytes resulted in an immobilization of platelets on the surface of leukocytes and a significant impairment of MCF. Immobilization of platelets and reduction of MCF was dependent on the upregulation of the phagocytosis marker CD11b but did not occur when both cell types were stimulated selectively. None of the activated states was associated with altered platelet counts. Conclusion: Our data indicate that the immobilization of platelets on leukocytes is associated with an impairment of the haemostatic potential of whole blood. The observed mechanism is dependent on the up-regulation of phagocytic integrins but requires a co-activation of leukocytes with platelets. In states of coagulation factor depletion and systemic pro-inflammatory response, immobilization on leukocytes might contribute to platelet dysfunction and the amplification of TIC. Introduction: Patients with blunt solid organ injuries (SOI) are at risk for venous thromboembolism (VTE) and VTE prophylaxis is crucial. However, to date little is known about the optimal timing of Low-Molecular-Weight-Heparin (LMWH) administration in these patients. Material and methods: Retrospective study including adult trauma patients with SOI (liver, spleen, kidney) undergoing non-operative management (NOM) 01/2009-12/2014. Three groups were distinguished: LMWH administration B72 h after admission ('early LMWH-group'), [ 72 h after admission ('late LMWH-group') and 'no LMWH-group'. Patients and injury characteristics, transfusion requirements and outcomes (failed NOM, VTE, mortality) were compared between the three groups. Results: Overall, 179 patients were included; 44.7 % in the 'early LMWH-group', 34.6 % in the 'late LMWH-group' and 20.8 % in the 'no LMWH-group'. In the 'late LMWH-group', the ISS was higher than in the 'early' and 'no LMWH-groups' (median 29.0 vs. 17.0 vs. 19.0; p \ 0.001). The overall NOM failure rate was 3.9 %. Failed NOM was more frequent in the 'no LMWH-group' compared to the 'early' and late LMWH-groups' (10.8 % vs. 3.2 % vs. 1.3 %; p = 0.043). In the 'early LMWH-group' 27.5 % patients suffered from a high-grade SOI; none of these patients failed NOM. Mortality did not differ statistically. There were a trend towards more frequent VTE in the 'no LMWH-group' than in 'early' and 'late LMWH-groups' (10.8 % vs. 4.8 % vs. 1.3 %; p = 0.066). Conclusion: In patients with SOI undergoing NOM, the administration of LMWH within the first 72 h was not associated with an increased NOM failure or higher in-hospital mortality. Further Validation of this finding in larger cohort studies is warranted. Introduction: In the past decade adipose tissue became a highly interesting source of therapeutic cells for different surgical disciplines and regenerative medicine. The isolated stromal vascular fraction (SVF) is a heterogeneous cell population including the adiposederived stromal/stem cells (ASC), with high regenerative potential. Current isolation methods for cells from adipose tissue are dependent on enzymes such as collagenase. However, enzymes may impact safety and efficacy, complicate regulatory authorization and are expensive reflected in the cost of cell products. Material and methods: Therefore we compared classical enzymatic cell isolation methods to reduced enzyme concentration methods regarding cell yield, identity and potency. Further we aimed to develop a closed, sterile and safe isolation process limiting donor variations, risk for contaminations and unpredictability of the cell material. Results: Our results demonstrate that reduction of enzyme concentration to 30 % and 10 % result in lower cell yields. In contrast, the metabolic activity of the isolated cells as determined via cellular ATP decreased with increasing collagenase concentration. Reduced enzyme treatment resulted in a higher number of endothelial progenitor cells (CD45-/CD31+/CD34+), pericytes (CD45-/CD31-/ CD146+), and supra-adventitial cells (CD45-/CD31-/CD146-/ CD34+) and significantly higher adipogenic, osteogenic and chondrogenic differentiation potential. Further we found that a system incorporating non-enzymatic treatment steps is suitable to isolate therapeutically relevant subpopulations with high cellular ATP content and elevated differentiation potency. Conclusion: In this work we could show that the use of enzymes such as collagenase impacts cellular properties. Our findings support the concept of using non-enzymatic systems which allow the isolation of therapeutically active cells in a one-step procedure. (2), pulmonary disease (2), obesity (2), diabetes (1), psychiatric (6), nicotine (1) Introduction: Intramedullary nailing of osteoporotic proximal femoral fractures can be challenging because of poor implant anchorage in the femoral head. Recently, cement augmentation of PFNA blades with PMMA has shown promising results. Aim of this study was to assess the impact of augmentation on the fixation strength of TFNA blades and screws within the femoral head, and compare its effect with head elements placed in center or anteroposterior off-center positions. Material and methods: Eight groups were formed out of 97 polyurethane foam specimens, simulating isolated femoral heads with severe osteoporotic bone. The specimens in each group were implanted with either non-augmented or augmented TFNA blades or screws in center or antero-posterior off-center position, 7-mm anterior or posterior. They were mechanically tested in a setup simulating an unstable pertrochanteric fracture with lack of postero-medial support and load sharing at the fracture gap. All specimens underwent progressively increasing cyclic loading until failure. Varus-valgus and head rotation angles were monitored by an inclinometer mounted on the head. A varus collapse of 5°or a 10°head rotation were defined as the clinically relevant failure criterion. Results: Load at failure for specimens with augmented TFNA head elements (screw center: 3799 N ± 326; blade center: 3228 N ± 478; screw off-center: 2680 N ± 182; blade off-center: 2591 N ± 244) was significantly higher compared to the respective non-augmented specimens (screw center: 1593 N ± 120; blade center: 1489 N ± 41; screw off-center: 515 N ± 73; blade off-center: 1018 N ± 48), p \ 0.001. In both non-augmented and augmented head elements, failure load in center position was significantly higher compared to the respective off-center position, p \ 0.001. Augmented off-center head elements had significantly higher failure loads compared with non-augmented centrally placed implants, p \ 0.001. Conclusion: Cement augmentation clearly enhances fixation stability. Non-augmented blades outperformed screws in off-center position. Augmentation with TFNA has not been approved by FDA. Introduction: Progress in oncological therapy leads to an increase of pathological fractures. Pathological pelvic fractures usually require extensive surgical interventions. The use of conventional implants often is not to the utmost satisfaction of the surgeon due to the reduced bone quality. The photodynamic polymer can be used minimally invasive to stabilize the tumor-associated fractures. In combination with metal implants it provides a counter bearing for the stabilization of larger bony defects. Material and methods: The method used integrates the properties of light cured (photodynamic) plastics, used successfully for decades in dentistry, filled into Dacron (PET) balloon catheters. Through a small incision in Seldinger-technique a balloon catheter is inserted into the marrow cavity which has been previously expanded with use of a flexible cannulated drill. The balloon is filled with liquid plastic monomer, and using a system of visible blue light at a wavelength of 436 nm, is converted into a hard polymer. Results: So far four female patients suffering from an anterior or posterior pelvic ring fracture at an average age of 68 years (57 -75) were treated. 2 patients had a multiple myeloma, one patient suffered from breast cancer and one patient had a traumatic anterior pelvic ring fracture without tumor. In one patient the polymer was combined with sacral rods and an internal fixator to the lumbar spine. Introduction: Partial weight bearing is part of treatment schemes in orthopedic surgery and traumatology. The aim of the present study was to explore the extent to which partial weight bearing reduces tibia deformation, and also the effect of rear foot and forefoot loading. Material and methods: Tibia deformation (torsion, medio-lateral and anterio-posterior bending) was measured for rear foot and forefoot loading, 10 kg, 20 kg and half body weight instructions compared to full loading in five healthy male subjects using the ''Optical Segment Tracking'' approach, a motion-capturing based method that uses mono-cortically affixed screws. Results: 1. GRF was a good indicator of tibia deformation. 2. Participants significantly under-loaded during half-body weight instructions (P \ 0.001) while they overloaded when loading the forefoot only. 3. Partial-loading instructions led to highly significant and systematic reduction in all three types of tibia deformation with substantial variation between measurements (all P \ 0.001). 4. Forefoot usage was associated with significant, albeit moderate increases in GRFpk (P = 0.0031), in AP-bending (P = 0.0027) and in torsion (P \ 0.001), compared to rear foot loading. Interventional Radiology, University of Colorado -Denver, Aurora, CO, USA, 2 Surgery, University of Colorado -Denver, Aurora, CO, USA, 3 Surgery, University of Colorado -Denver, Aurora, USA S113 Introduction: Hyperfibrinolysis (HF), as exhibited by an elevated lysis at 30 minutes (LY30) on thrombelastography (TEG) is a specific predictor of hemorrhage in trauma. Unfortunately, the LY30 is insensitive and patients with normal LY30s frequently bleed. Also, the LY30 is slow, reporting 30 minutes after the maximum amplitude (MA). We hypothesized that the differential velocity plot between a native and a tPA-challenged TEG would revealing occult HF at a much earlier time point. Material and methods: We designed a software tool to analyze the tracings of simultaneous native and tPA-challenged TEG channels. Blood from 203 consecutive trauma activations was analyzed. The differential in the velocity of the two tracings was evaluated up to the MA. Receiver operating characteristics were plotted to compare this parameter (the ''delta-V-@-MA'') and the LY30 Introduction: Treatment of post-traumatic large bone defect can be very challenging, so we often suffer from treatment especially when it is chronic. We report 4 cases successfully treated large bone defect of lower extremity, by the application of free non-vascularized fibular bone grafts with preservation of the periosteum. Material and methods: We operated on 4 patients by the application of free non-vascularized fibular bone grafts with preservation of the periosteum. They consisted of 3 men and 1 women with a mean age of 28.7 years. Two cases occurred after sequestrectomy of osteomyelitis in the femur and tibia each, one occurred after incompletion of bone transport for lengthening in the femur, and one occurred after severe open fracture in the femur. Time to bone healing and complication were studied in these cases. Results: All cases achieved bone union, and the mean bone union period was 5.6 months (range, 4-8). We didn't have adverse medical event. Conclusion: For the bone defect occurred after infection or the large bone defect, the bone transport or vascularized bone graft are desired, however, the procedure is not simple, and patients bear great burden. We transplanted free non-vascularized fibular bone graft and were able to achieve good bone union in all cases. This treatment is simple and easy, and it is thought that biological activity is higher than normal free non-periosteum bone graft. This technique, compared to microvascular reconstruction and Ilizarov techniques, is a simple and successful procedure that is still valid option for some cases to bridge a large chronic bone defect. Results: The ExFix was repositioned, then repeated debridements were necessary so to assure the vitality of the fracture site. General broad spectrum antibiotics were started then followed by specific treatment, according to the bacteriological results. After sustained local and general treatment, secretion disappeared, skin graft was used to cover the defect and sequential method was used, external fixation being followed by intramedullary nail after all the signs of inflammation disappeared Conclusion: Infected fractures complicate complex high energy trauma; they require a prolonged, complex treatment, both local (optimal stabilization of the fracture and repeated and thorough debridements in the operating theatre) and general (antibiotics and supportive treatment) and a well trained interdisciplinary team References: S12. Introduction: The initial hematocrit (Hct) as a predictor of urgent hemostasis when trauma patients arrive at the emergency department. Trauma patients in our institute do not receive pre-hospital intravenous fluid. It may be able to predict the need for hemostatic procedures. Material and methods: The patients who met the institutional trauma activation criteria were retrospectively reviewed from our prospectively collected trauma database. Demographic data, initial Hct, vital signs on admission, injury severity score(ISS) and initial laboratory data were collected. The primary outcome was the need for hemostatic procedure which included laparotomy, thoracotomy, or angioembolization within 4 hours after admission. Logistic regression was used to measure the predictors of the primary outcome. Results: Out of 183 patients who met the trauma activation criteria between January to December 2014, 99 patients met the inclusion criteria. The median age was 34 years old. Seventy-five percent of patients were injured by blunt mechanism. Univariate analysis showed that the need for hemostatic procedures was related to the initial FAST (p = 0.017), INR (p = 0.001), and ISS (p = 0.001) and that the initial Hct results were not related to the need for hemostatic procedures (p = 0.46). Multivariate analysis showed prolonged INR, higher ISS, and increased base excess were related to the need for hemostatic procedures while older age and a negative FAST were protective factors for the need of hemostatic procedures. In addition to standard monitoring, the carotid artery was cannulated with a 5 Fr sheath to facilitate digital substraction angiography of the lower extremities. Two 10-mm and two 5-mm laparoscopic ports were placed into the peritoneal cavity, which was insufflated with carbon dioxide to maintain access. A proximal portion of the left external iliac artery (EIA) was exposed using diathermy and a dissector. A 3 cm section was identified and controlled, which was repeatedly clamped using a dissector in order to induce a thrombosis. Control was released after 30 minutes. Doppler ultrasound and angiography were used to evaluate arterial patency and measure blood flow velocities, comparing the injured left side against the un-injured right side. Results: of 4 animals enrolled, 3 occluding lesions were created successfully. Angiography demonstrated a sharp cut-off in all cases. In one animal the left EIA was inadvertently perforated, requiring ligation. Post-injury, there was a significant reduction in the median (interquartile range) systolic velocity (cm/sec), left versus right, (0 (0) vs. 22.0 (12.5-52.0); p \ 0.001). This pattern was also observed when measuring pulsatility index (0 (0) Introduction: Endovascular Aortic Balloon Occlusion (ABO) can be used to stop severe traumatic bleeding as a bridge to surgery. ABO also causes ischemia and reperfusion injuries to visceral organs. The S120 aim of this study were to investigate circulatory, metabolic and endorgan functional outcomes and relation to occlusion time in a nonhaemorrhagic pig model. Material and methods: High thoracic ABO introduced in randomised pigs (25-35 kg) (N = 6/group) during 15 min (ABO15), 30 min (ABO30), 60 min (ABO60) and control, followed by 3 h of reperfusion. Haemodynamic parameters, blood flow in superior mesenteric artery (SMA) and common iliac artery (CIA) and arterial blood gas were measured during occlusion and reperfusion. Markers of end-organ damage such as creatinine, CK, AST, ALT, lipase, intraperitoneal (i.p) concentrations of lactate, pyruvate and glycerol by microdialysis, were analyzed during occlusion and reperfusion. Results: During aortic occlusion, systemic blood pressure (SBP) increased while blood flows in SMA and CIA decreased. During reperfusion, SBP dropped but normalized as well as blood flows in SMA and CIA. Arterial pH decreased during reperfusion in parallel with increased lactate and potassium concentrations in all ABOgroups. Intraperitoneal lactate/pyruvate ratio remained increased during reperfusion in ABO30/60 while plasma creatinine, AST, CK and lipase concentrations increased. Glycerol i.p increased in all groups during reperfusion and did not normalize in ABO 30/60. Conclusion: Thoracic ABO and reperfusion causes metabolic acidosis, hyperlactatemia, hyperkalemia as well as damage to visceral end-organs. The severity of these end-organ effects is highly dependent on occlusion time. Introduction: The reported survival after an emergency thoracotomy for blunt trauma is very low in the vast majority of studies, and it is more difficult to find survivors without neurologic sequelae. Material and methods: An unrestrained male driver in his sixties presented after a blunt motor vehicle crash. He arrived in sinus tachycardia and transitioned to PEA upon arrival. ACLS was initiated and a right chest tube was placed, with minimal blood return. Leftsided ED thoracotomy (EDT) was performed revealing mild hemothorax with no hemopericardium. The heart filled with manual cardiac massage and the patient was taken to surgery for an exploratory laparotomy. He was found to have moderate hemoperitoneum secondary to hepatic and splenic lacerations, and mesenteric hematomas. A comminuted left femur fracture was diagnosed and treated with an external fixator. CT imaging revealed bilateral rib fractures, sternal fracture, T10 -11 fractures. Further laparotomies were performed on post-operative days (POD) 1 and 4. On POD 3, he was weaned off vasopressor agents and had ORIF of the L hip. Tracheostomy and gastrostomy were performed on POD 4. Results: Patient was discharged on hospital day 24 and returned to pre-injury level of function at 9-month. Conclusion: EDT after blunt trauma has an extremely poor survivability. When patients survive, the neurologic deficits are extremely burdensome. The role of EDT has been called into question in blunt trauma. Although a larger, well-designed series will be required to reach a consensus, this may cause us to reconsider an EDT for a blunt trauma patient. Introduction: Immediate identification of vascular injury requiring embolization in patients with pelvic bone isn't an easy task. There have been many trials of indicators of embolization in patients with pelvic bone fracture. Although Young and Burgess classification is useful in decision making of treatment, it is reported to have little value as indicator of embolization in major trauma patients. The aim of this study is to find out fracture patterns on predicting vessel injury by analyzing pelvic radiograph taken from major trauma patients with pelvic bone fracture. Material and methods: Among major trauma patients with injury severity scores (ISS) higher than 15 who visited our emergency room from January 2011 to June 2014, 170 patients were found with pelvic bone fracture in trauma series and thus pelvic CT angiography was taken. Setting aside patients with exclusion criteria, 126 patients were enrolled in this study for analysis of length of anterior pelvic ring displacement, fracture involving greater sciatic notch, iliac bone fracture involving sacroiliac joint, and sacral fracture. Results: Anterior pelvic ring displacement in Group I was shorter (3.8 Introduction: Iatrogenic cardiac injury, which requires urgent or emergent operation, is rare but is always a clinically significant situation. In this study, we report our experience of iatrogenic hemopericardium. Material and methods: We retrospectively reviewed 9 patients with iatrogenic hemopericardium who underwent emergent surgery from January 2010 to February 2014. Results: There were 6 male and 3 female patients, with median age of 65 (range: 56 -80). Six patients (67 %) were injured by pericardiocentesis, and one patient (11 %) was injured by coronary intervention. One patient (11 %) was injured by closed thoracostomy, and one patient (11 %) was injured during cardiopulmonary resuscitation. The most common injured site was right ventricle (n = 5, 56 %), and other sites were coronary artery (n = 1), right atrium (n = 1), left ventricle (n = 1), and unknown origin (n = 1). Occurrence of preoperative tamponade in these patients was 6 cases. Surgical treatment was carried out in all patients. Eight patients (88.9 %) underwent the cardiac repair through the sternotomy. of these patients, 3 patients (22 %) underwent the operation with cardiopulmonary bypass support. One patient (11.1 %) underwent only pericardiostomy. The overall mortality rate was 33 % (3 out of 9 patients). Cardiogenic shock associated with delayed diagnosis was the cause of death in all cases. Introduction: Platelets strongly influence hemostasis and a low platelet count predicts mortality in trauma. The role of platelet dysfunction in severe traumatic hemorrhage and coagulopathy needs to be further defined. The aim of this study was to evaluate the platelet function in a new experimental traumatic hemorrhage model. Material and methods: New Zealand white rabbits (3100-3800 grams; n = 10) were subjected after tracheostomy to trauma laparotomy, bilateral femur fractures, and 40 % hemorrhage of their estimated blood volume. Arterial blood gases, standard coagulation tests (platelets, INR, aPTT, fibrinogen), mean platelet volume, platelet aggregation using impedance aggregometry (Multiplate Ò ) with agonists collagen, arachidonic acid, and adenosine diphosphate (ADP), rotational thromboelastometry (ROTEM Ò )/ROTEM platelets, and fibrinogen binding of platelet were analyzed. Results: There was a significant rise in lactate, and a significant decrease in base excess and temperature after traumatic hemorrhage. Platelet count decreased from a median of 251 9 10 9 /L to 100 9 10 9 / L (P = 0.004) and the mean platelet volume increased from 5.1 fL to 6.1 fL (P = 0.0022). Impedance aggregometry with agonists collagen, arachidonic acid, and adenosine diphosphate (ADP) was all significantly decreased after traumatic hemorrhage (P = 0.007). There was a non-significant trend of increased fibrinogen binding of platelets after traumatic hemorrhage. However, the fibrinogen bindings of platelets were activated at a lower dose of ADP (1uM) (P = 0.0001). In this traumatic hemorrhage model, there was a significant decrease in platelet count and platelet aggregation using impedance aggregometry. At the same time larger and more reactive platelets were detected after severe traumatic hemorrhage. Emergency, Gunma University Hospital, Maebashi city, Japan, 2 Gunma University Hospital, Maebashi, Japan Introduction: Active arterial bleeding is a fatal complication in the acute phase of pelvic fracture. Early recognition of coagulopathy that is associated with bleeding in severe traumatic injury is important and treatment of coagulopathy is thought to lead to successful hemostatic management. The purpose of this study was to investigate whether patients with pelvic fracture and active arterial bleeding experience an early decrease in fibrinogen and the ratio of cases that require fresh frozen plasma. Material and methods: We reviewed medical records of pelvic fracture patients who were transferred to the emergency department of Gunma University Hospital between December 2009 and September 2015. Patients were divided into two groups: those with arterial bleeding (Bleed (+) group), and those without arterial bleeding (Bleed (-) group). The level of fibrinogen measured on arrival were compared between the two groups. The ratio of those in the Bleed (+) group that needed fresh frozen plasma within 24 hours of injury was also calculated. Results: Thirty-six patients were analyzed. There was no difference in the time from injury to blood sampling and in the level of fibrinogen on arrival between the two groups (P = 0.170). However, after about 8 hours of injury the level of fibrinogen is significantly (P = 0.000) lower in the Bleed(+) group than in the Bleed(-) group. There were 11 of 17 (64.7 %) with arterial bleeding who needed fresh frozen plasma within 24 hours of injury. Introduction: Obscure gastrointestinal bleeding is defined as an haemorrhage that persists or recurs after a negative endoscopy. In patients who present with bleeding, the etiology may not be evident on initial evaluation in 10-20 % of cases. Recurrent or persistent bleeding can pose a challenge to diagnosis and management. Material and methods: We present the case of a 67 year-old woman who came to the urgency with complaints of epigastric pain, vomits and one episode of lipothymia. She presented hypotension, tachycardia and melena, and had an haemoglobin level of 7.4 g/dL, so we decided to admit her, after initial stabilization. Both first and secondlook endoscopy and colonoscopy were negative. Within 48 hours of admission she maintained haemodynamic instability and the need for a total of 6 RBC units. In face of this clinical picture we decided a surgical approach. Results: During laparotomy we identified a mass lesion in the transition between the 4 th part of the duodenum and the jejunum, and performed an enterectomy with manual anastomosis. Post-operative period without complications, and she was released in the 7 th day post-surgery. The pathological examination reports a complete resection of a 5.5 centimeters gastrointestinal stromal tumor (GIST), positive for vimentine and CD117. Conclusion: GISTs are uncommon abdominal soft tissue malignancies. Most are found in the stomach (40-60 %) and intestine (30-40 %). Duodenal GISTs represent 3-5 % of these tumors. They tend to present with vague symptoms of anaemia, abdominal pain or occult abdominal bleeding. Occasionally they can cause more severe symptoms, like obstruction, perforation, and, more rarely persistent significant bleeding. References: Disclosure: No significant relationships. Introduction: The aim of this work is to present the case of a pseudoaneurysm of the hepatic artery after a cephalic duodenopancreatectomy with a spontaneous favorable outcome. Material and methods: 68 year old woman who underwent a cephalic duodenopancreatectomy due to an intraductal papillary mucinous neoplasm of the head of the pancreas. 5 months after surgery, she was admitted to the emergency room for melena. An urgent esophagogastroscopy was performed without noticing any alteration. A computed tomography angiography (CTA) showed a pseudonodular lesion, possibly a partially thrombosed pseudoaneurysm of the hepatic artery. Introduction: Damage control surgery involves an abbreviated operation followed by resuscitation with planed re-exploration. Our goal is to describe our experience with damage control techniques in treating thoracic trauma. Material and methods: We report a case of thoracic packing in a 21 years old male who suffered a fall from twelve meters high, with severe brain, chest and pelvic trauma. Results: Upon arrival, the patient was hemodynamically unstable despite of the pelvic binder application and a massive transfusion protocol was started. In plain x rays, a right hemo/pneumothorax was suspected, as well as a high-energy pelvic fracture. A right chest tube was inserted, and the patient was transferred to the angiography, where an embolization of both hypogastric arteries was performed. During the procedure, a hemorrhagic drainage [200 cc/h through the chest tube was recognized, so he was transferred to the OR where a right hemiclamshell approach was performed. Due to the impossibility of bleeding control, we decided to perform a chest packing, followed by external pelvic fixation, with the posterior stabilization of the patient. During the following days, the patient remained hemodynamically stable, but he experienced an increase of ICP which required a partial right frontal lobectomy, and ARDS with no complications. His subsequent evolution was favorable so he was discharged to a rehabilitation center 57 days later. Results: Thirty five years old woman has suffered polytrauma as a result of the jump from 4th floor. She was transported to operation theatre for the abdominal exploration, which revealed significant hemoperitoneum and retroperitoneal hematoma. Suture of the bladder rupture and drainage of the rectouterine pouch was performed during primary surgery. Fracture of the right femur was reduced and internally fixed with a nail during subsequent procedure. Due to the bleeding under cover of the open abdomen and circulatory instability was performed CT angiography and surgical revision approximately 10 hours after primary surgery. There was no significant intra-abdominal source of bleeding, but retroperitoneal hematoma has increased. Tamponade of lower left retroperitoneum was performed during this procedure. Another surgical revision was performed due to the continuing blood leakage from retroperitoneum in the following period. Tamponade has been extracted and drain and Vacuum-assisted closure system (VAC) has been applied. Complete suture and extraction of VAC was performed after two more days. She remained stabilized in following time and peroral intake was fully restored. Control CT revealed complete regression of the retroperitoneal hematoma. Conclusion: Retroperitoneal hematoma may be the obstacle to the early closure of laparotomy due to the risk of compartment syndrome. It causes prolongation of the therapy and may request repeated surgery. It is also risk factor of paralytic ileus. This case report highlights the successful use of VAC for management of retroperitoneal hematoma. Introduction: The use of laparoscopy has been integrated in surgical practice, and emergency surgery isn't an exception. However, its inclusion in the management of trauma patients has been slow. Material and methods: Case 1: 48 years old man brought to the emergency room after gunshot wound in the chest. An initial treatment was performed following the ATLS protocol. In the physical exam it was a hole of 1 cm of the bullet near the left nipple. In the auscultation was not hypoventilation. A portable chest X-ray confirmed the absence of pneumothorax or hemotothorax. An EcoFAST confirmed the absence of fluid. In the rest of the examination the outlet opening of the projectile was not evidenced. The Thoracoabdominal-pelvic TC showed the projectile into the subcutaneous tissue of the back. After placing left chest tube, laparoscopy was performed, which showed diaphragm injury. It was repaired with running nonabsorbable suture. Finally the projectile was removed S126 with an incision in the back. Case 2: 21 year old female who came to the hospital after aggression. Since the patient was hemodynamically normal, CT was performed, which showed abdominal free fluid, without pneumoperitoneum associated with bladder lesion. A laparoscopy exploration was performed, and an injury of intraperitoneal bladder was evident with urine in the peritoneal cavity, which was sutured using this approach in two layers with running sutures. Introduction: Horse riding has become a popular recreational activity. Injuries related to this activity are increasing. Material and methods: We conducted a retrospective study of medical records of all patients admitted to Rambam Medical Center due to horse-related injury between January 2010 and December 2013 Results: 125 patients were admitted due to horse related injuries. 17 patients were excluded due to lack of data. 67 adult (A) patients (age C 15 years) and 41 pediatrics (P) (age 1-14 years). There were 91 male patients (85 % adults, 83 % pediatric) and 17 Female (15 % A, 17 % P). injuries occurred while riding in 84 % (A 88 %, P 78 %) Head injury was most common injury(58 %) followed by maxillary fracture (37 %), upper extremity injury(36 %), lower extremity injury (33 %) and abdominal injury in (26 %) 51 % of the head injury patients had GCS = 15-13, 1 % had 12-9, and /5 % had GCS of B8. 30 % of the patients presented with complex injuries (iss[16). 45 % needed operation. Fourteen (8 %) were admitted to ICU. Mean Length of Hospital Stay was 7.14 days. No mortality was recorded in this cohort of patient. Conclusion: Horse related injuries may result in complex injuries. Safety educational programs should be initiated prior to engaging in horse related recreational activity. References: Disclosure: No significant relationships. M. Kiyono 1 , T. Noda 2 1 Okayama, Okayama Universal Hospital, Okayama, Japan, 2 Okayama Universal Hospital, Okayama, Japan Introduction: Regarding femoral shaft fractures with an ipsilateral proximal femoral fracture, there is a need to treat with paying attention to both fractures. We investigated the clinical outcomes of the combined fractures retrospectively, and were discussed the assessment and the treatment strategy. Material and methods: 6 patients were included in this study. The average age at the injury was 48 years old, the average follow-up period was 7 months. In the proximal femoral fractures, there were two femoral neck fractures and four intertrochanteric fractures. We investigated the initial treatment, the fixation method of the definitive treatment, the radiological evaluation including postoperative alignment and the period of bone healing, and complications related to the fracture treatment. Results: All femoral shaft fractures were underwent external fixation as an emergent stabilization. The fixation method of the definitive treatment of both fractures was performed with one implant in four cases, two implants in two cases. Postoperative malalignment was occurred in one case. All proximal femoral fractures obtained bone union, but one femoral shaft fracture was needed re-operation because of the delayed union. Conclusion: It is necessary to pay attention to the existence of the combination fracture pattern between the proximal femur and the shaft. Careful assessment using CT scan is mandatory. Our treatment strategy is to think much of anatomical reduction and stable fixation for the fractures of the proximal femur. The union of the shaft fractures tended to be delayed in some cases. Appropriate additional treatment for delayed/non-unions should be considered. Material and methods: This is a retrospective cohort study using trauma database. According to our hospital system, IHTS takes on trauma patients for three days on a week. On the other four days, trauma patients were managed by on-call surgeon. Between January, 2011 and December, 2011, 272 of major trauma patients were consecutively enrolled in this study. Results: In patients who were admitted to the department of trauma surgery, TD and TH with IHTS took significantly less than those without IHTS (TD: 137 minute vs. 283 minute, p = 0.002; TH: 302 minute vs. 635 minute, p \ 0.001). TO with IHTS took shorter than that without IHTS (200 minute vs. 256 minute, p = 0.202). In patients who were admitted to the other department of surgery (neurosurgery, etc) TD and TH with IHTS took 173, 331 minute (p = 0.001). They were lower than those without IHTS (289, 642 S127 minute, p = 0.001) TO showed no significant difference (238 minute vs. 283 minute, p = 0.497). In patients with TTA, TD and TH took statistically less time than those without TTA (TD: 168 Introduction: Inferior vena cava injuries are relatively uncommon however are associated with high mortality due to major blood loss and haemorrhagic shock. We present a case of a young man with a penetrating inferior vena cava (IVC) injury, cardiopulmonary reanimation (CPR) and successful survival after cohesive teamwork. Material and methods: Case report. Results: A 31-year old male patient was delivered to the emergency room in acritical condition after falling from a height of 6 meters. Endotracheal intubation was performed at the place of accident because of haemodynamic instability and shock. Primary assessment revealed two 2-cm widewounds penetrating the abdominal wall anda large amount of free fluid in the peritoneal cavity was detected by FAST. Successful cardiopulmonary resuscitation was done immediately after the patient was delivered to the operation theatre and at the time of damage control laparotomy. Penetrating liver V segment injury and IVC marginal injury were sutured and massive bleeding stopped. Lumbar vertebra injury, right kidney injury and large retroperitoneal hematoma with diffuse bleeding were also found and packed. Relaparotomy was done and packs removed on day 8 after the stabilisation of the general condition. Conclusion: Immediate laparotomy and haemostasis is the only chance of survival in patients with a penetrating liver and IVC injury. Introduction: Trauma is the leading cause of death in young patient group. Injury severity assessment is one of the main priority at the admission strongly determining treatment strategy. Material and methods: Retrospective data analysis and assessment of the results obtained with different trauma scoring systems (ISS, RTS, TRISS, AIS and GCS) at the Riga East University Hospital admission during the year 2014. Results: In total 190 polytrauma patients (ISS [16 points) were included. ISS less than 25 points were found in 99 patients and defined as moderate injury, however 91 patients with ISS more than 25 points were defined as life threatening injury group with increased risk of mortality (p \ 0.001). Statistically significant correlation were found between ISS and mortality (r = 0,423, p \ 0.001). Higher GCS provides a better prognosis and in our series mean GCS points were 12.26 (SD ± 4.45). Increasing mortality (p \ 0.001) and lower probability of survival (Ps = 33.91 %) were in 39 patients with GCS less than 8 points. RTS is the best early predictor of patient's physiological condition immediately after injury. RTS less than 10 points were strongly associated with increased mortality (p \ 0.001), and significantly reduced chances of survival (Ps = 35.42 %) (p \ 0.001). TRISS is combined score and the result is highly dependent on the patient's age, therefore in young patients with high-energy trauma and low RTS score TRISS is not effective. Conclusion: Combination of physiologic and anatomic parameters with mechanism of injury could provide better prognosis for severity of injury and treating patient as a whole. References: Disclosure: No significant relationships. Introduction: With the near-routine use of CT scan for imaging trauma patients, the diagnosis of pneumothorax has increased (1). The need for chest tube insertion remains controversial (2) . Our aim was to study the management of CT scan detected pneumothorax in blunt trauma patients in a community-based hospital including the decision to insert a chest tube. Material and methods: All chest CT scans of blunt trauma patients who were treated at Al Rahba Hospital during a 4-year-period (October 2010 till October 2014) were retrospectively studied. The studied data included demography, mechanism of injury, endotracheal intubation, pneumothorax volume, chest tube insertion, Injury Severity Score, hospital stay, and mortality Results: Chest CT scans were performed in 703 blunt trauma patients. 74 (10.5 %) patients were found to have pneumothorax on CT scan. 65 patients had pneumothorax detected on the CT scan before chest tube insertion. In those patients, 25 (38.5 %) needed chest tube insertion while 40 did not. Backward stepwise likelihood regression model has shown that independent factors that significantly predicted chest tube insertion were endotracheal intubation (p = 0.01), non UAE nationality (p = 0.01), and the pneumothorax volume (p = 0.03). The Receiver Operating Characteristic curve S128 showed that the best pneumothorax volume that predicted chest tube insertion was 30 milliliters. Conclusion: Chest tube was inserted in less than half of blunt trauma patients having pneumothorax detected by CT scan. Pneumothorax volume should be included in the decision-making regarding chest tube insertion. Observation of pneumothorax of volume less than 30 milliliters appears safe. Introduction: The modified posterior approach minimize the iatrogenic nerve injury and provides more visualization of the proximal humerus, while an anatomically precontoured plate on the posterolateral surface of the humerus provides stable fixation of these injuries. Material and methods: We performed a retrospective study of these fractures surgically treated in our centre between 2013 and 2015. Twenty-three patients underwent surgery. Patients characteristics, etiology and type of fractures were recorded. The surgery was carried out using a modified posterior approach, and the fracture was fixed with a posterolateral distal humerus plate. Average follow-up was 18.4 months (12-27). The results were evaluated clinically using the Quick DASH score, the MEPS, and the VAS for pain; and radiologically, using the conventional radiology to study bone consolidation. Complications associated with treatment and radial nerve palsy incidence were recorded as well. Results: Twenty-three patients went on to union (100 %). After one year, the average QD score was 5,73, the average VAS score was 0,33, and the average MEPS was 90,33. There were 15 excellent results, 5 good, and 3 fair, with no poor results. The incidence of radial nerve palsy prior to surgery was 39,1 %, whereas the incidence after surgery was 4,34 %. There was no failure of internal fixation. There were two superficial infections. Not extractions of material up to the date. Conclusion: Surgical fixation of these fractures through a modified posterior approach with a posterolateral plate results in high union rates and overall excellent functional results. Modified posterior approach provides excellent exposure to the humerus and minimize the iatrogenic nerve injury. References: Disclosure: No significant relationships. General Surgery, Royal London Hospital, London, UK Introduction: Polytrauma is most common cause of death in people under 40 years of age. Management of polytrauma patients has gone through a lot of changes in the last century. The trauma care is more organised which leads to better outcome of the patients. Material and methods: Data were obtained from the WHO Mortality database, European Trauma Registry and Pub Med covering data from 1979 to 2014. The target population for this study were patients 18 years of age or older with injuries rated via an injury severity score (ISS) equal to or greater than 16. These data were analyse according to country of origin and development of survival/mortality rates in time. Results: There is significant improvement in survival/mortality rate worldwide over last 35 years. The trauma network has better results in western European countries and USA in relative numbers. The numbers of survival/mortality rate is in plato phase for last few years. In terms of mortality, polytrauma with abdominal injury has the highest rate across countries. Conclusion: Over last 35 years we have noticed significant development in trauma care. This leads to major improvement of survival/mortality rate following polytrauma. Unfortunately there is stagnation in the last few years. Are we at the edge of what medicine can do for polytrauma patient? There is increase in total number of trauma over last decades. The trauma care is well levelled and patients receive high standard of care but the survival/mortality rates are not decreasing as before. Therefore prevention and awareness remains the key in trauma. Introduction: Sternal fractures (SF) were rare but potentially devastating event if unrecognized in the treatment course of trauma patients. A sternal lateral plain film was sufficient to diagnose isolated sternal fracture, however, because of frequent association with major injuries, SF should be evaluated more carefully. Computed tomography (CT) was often required for detailed survey. By using the information of initial assessment, we tried to determine which patients had higher potential risk and needed subsequent CT scans for chest trauma. Material and methods: We conducted a retrospective review in a Level I trauma center in Taiwan. This study enrolled all of the patients admitted for traumatic SF from July 2008 to December 2014. We retrieved and analyzed the patient demographic data, diagnostic methods, associated injuries, and clinical outcome. Results: A total of 86 patients were included. The mean age was 50.3, and 80.2 % were males. Overall in-hospital mortality was 4.7 %. Most patients (91.9 %) combined multiple organ injuries. Mediastinal widening (MW) (p = 0.012), hemodynamic unstability (UH) (p = 0.024), and Glasgow Coma Scale (GCS) B14 (p \ 0.001) were significant predictors for cardiac and great vessel trauma. MW (p = 0.032) and UH (p = 0.030) both correlated with higher intervention rate. MW was the only factor to predict mortality (p = 0.016). Conclusion: It's worthy for patients with sternal fractures to receive chest CT scans if they had MW and UH, not only because they had higher risk of associated heart and great vessel injuries but also were more likely needed to take intervention for those injuries. Introduction: For a period of 6 years 20 patients with diagnosis ''floating shoulder'' were operated and followed. Apart from disruption of the classic Goss ring, injuries to two additional rings: the scapula -proximal humerus and the sternal end clavicle -scapula. Material and methods: The retrospective analysis showed that five were women with average age 45 years and 15 -men with average age 35 years. The fractures of the scapula were as follows: the glenoid and the body -2; the scapular neck -2; the scapular body -17; the scapular spine (acromion) -5, the coracoid -3. The injuries of the clavicle were as follows: acromioclavicular dislocation -3, fractures of the acromial part -3, the diaphysis -10, fractures of the sternal end -2, sternoclavicular dislocation -1. Fractures of the humerus were as follows: Five of the proximal part and 1 of the metadiaphysis. Seven of the cases presented as multiple injuries, unclassifiable as floating shoulder, but as floating shoulder girdle; 2 of the patients had brachial plexus injury. Results: We had no cases of non-union or jatrogenic vascular and neurologic trauma. All patients with floating shoulder (13) regained full range of motion -mean Constant score (CS) 92; of the patients with floating shoulder girdle 2 had acceptable, 3 good and 2excellent results. Conclusion: A new classification of these polystructural injuries is necessary. We think that intraarticular gap or step-off over 2 mm and the Anavian criteria for the scapular fractures mandate ORIF. References: • Anavian J et al (2011) Material and methods: 28-year-old man was admitted to the intensive care unit of our centre after a traffic accident. On arrival he was hemodynamically unstable. On physical examination the patient had and open pelvic fracture, wound located in the perineum, and deformity of the left limb. X-rays and whole body CT showed hemopneumothorax, hepatic and splenic laceration, type 61-C2 open pelvic fracture, 31-B1 femoral neck, 32-A3 femoral shaft and 33-B2 supra-intercondylar fractures (AO). ISS = 32, NISS = 41. At first, the hemopneumothorax was drained, an external fixator was placed in the pelvis, a colostomy and an abdominal packing was performed. 48 hours later, when he hemodynamically improved, he underwent retrograde intramedullary nailing for the shaft fracture and screw fixation for the ipsilateral supra-intercondylar fracture. Then, he was placed on a traction table and underwent screw fixation for the neck fracture. Results: 8-weeks after surgery, partial weight bearing was allowed. 3-weeks later, the patient was walking with complete weight bearing, with complete recovery of all his injuries. 3-months after surgery, radiographs showed consolidation of all fractures. Conclusion: In politraumatized patients with this fractures is mandatory to prioritize vital injuries, but without forgetting that a quick surgery of these fractures is also vital for the patient. During surgery is important to avoid the consequences of unnoticed injuries when having the patient placed in the traction Introduction: The presence of a thoracic trauma significantly influences outcome of polytraumatized patients and is associated with higher mortality. One reason for the worse prognosis in the presence of thoracic trauma is the higher probability of developing pulmonary complications. One common pulmonary complication after multiple traumata is the acute respiratory distress syndrome (ARDS) with mortality rates of up to 45 %. Delayed diagnosis and treatment of pulmonary complications after multiple traumata further complicates the course in many cases. The aim of this study was to identify potential factors influencing the development of pulmonary complications in polytraumatized patients. Material and methods: We therefore retrospectively analysed patients admitted to our level I trauma centre between 2009 and 2011 with an ISS (Injury Severity Score) C16 and 18 years of age or older. Results: In total, 288 patients met our inclusion criteria, of which 158 (54.86 %) presented with thoracic trauma. Thoracic trauma was associated with a significant higher probability of developing pulmonary complications (50 vs. 34.6 %, p \ 0.05), mainly ARDS. Onset of ARDS manifested earlier in patients with thoracic trauma compared to patients without thoracic trauma (p \ 0.01). Conclusion: Injury mechanisms causing thoracic trauma were associated with a higher chance of developing pulmonary complications in our study population. This study shows that the absence of thoracic trauma does not protect from pulmonary complications. After multiple traumata this critical form of complication needs to be considered in the management and treatment of these patients. Introduction: Traumatic aortic injury is the second main cause of death from blunt injury. Motor vehicle crash (MVC) victims are likely to die at the scene due to rupture and exsanguinations to the chest. Material and methods: A 20-year-old woman driver at 16 weeks of gestation with twin pregnancy. She was involved in MVC and presented with chest and abdominal pain. Computed tomography (CT) scan revealed head injury with subarachnoid bleed, second-degree liver injury and grade three traumatic thoracic aortic injury (TTAI). Arch aortography showed an aortic disruption 1.5 cm distal to the left subclavian artery with pseudoaneurysm measuring 3.5 cm. Mapping of the aortic arch was done, endovascular stent deployed partial proximal to the left subclavian artery and then adjusted the stent distal to the left subclavian artery and the graft fully deployed. Flush arch aortography showed the pseudoaneurysm totally covered with no endoleak and the left subclavian artery was patent. Full hepranization was avoided during the stenting due to the risk of bleed from the head and liver injuries. Results: The patient was doing well at discharge. Ultrasound examination in the first month after discharge showed normal fetal growth. Transthoracic echocardiography in two months showed normal finding. At 37 weeks of gestation, she underwent ower segment caesarean section and delivered 2 healthy babies. Patients and babies were regularly followed-up at the out-patient clinic. Conclusion: To the best of our knowledge, this is the first reported successful thoracic aortic endovascular repair in a twin pregnant post MVC. Follow-up at the 7th month revealed healthy babies and mother. References: Merin G, Bitran Results: Across the study period, 331 NF admissions were recorded, of them 85 (25.7 %) dies, 74 % were males and a mean age of 50.8±15.4 years. Non-survivors were 14.5 years older and had a significantly lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors. Diabetes mellitus, hypertension, and renal impairment were significantly higher among non-survivors (p = 0.001). The primary site of infection that was significantly predictive of mortality was the sacral region (p = 0.005). Non-survivors had significantly lower hemoglobin (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.02) and had higher serum creatinine (p = 0.001). In addition, non-survivors had significantly higher median laboratory risk indicator for necrotizing fasciitis (LRINEC) scores (p = 0.001) and sequential organ failure assessment (SOFA) scores (p = 0.001) with a higher frequency of polybacterial and monobacterial gram-negative infections. While monobacterial gram-positive organisms were commonly identified among survivors (p = 0.02 for all). Monobacterial infections with Pseudomonas (p = 0.003) and Proteus (p = 0.006) were more commonly associated with death. Septic shock and multi-organ failure were the most common cause of death. Age (p = 0.001) and SOFA score (p = 0.02) were independent predictors of mortality. Conclusion: This study augments the data on factors predictive of mortality for NF. It reinforces the role of some identified predictors while highlighting the utility of the SOFA score. Stratification of studies (1980-1990, 1990-2000 or 2000-2010) , geographic location (Europe or North America), and trauma population (general or orthopedic). Meta-regression was used to analyze differences between decades of recruitment, geographic locations, trauma populations and treatment strategies. All statistical analyses were carried out in R (version 3. • Results: 53-year-old male attacked by cattle was resuscitated by flight doctor and transported to our emergency department. Grade V hepatic injury, Grade III right renal injury, bilateral massive pulmonary contusion, pneumothorax and frail chest, and right massive hemothorax were diagnosed. Resuscitation with massive transfusion was provided for his severe hemorrhagic shock status and angioembolization for hepatic injury and open chest lobectomy and rib fixation were performed successfully. On the day 3, ventilation associated pneumonia was diagnosed and that was successfully treated by antibiotics. However, on the day 9, ventilation failure and acute kidney injury were developed and his intra-abdominal pressure represented 20 mmHg or more. ACS was diagnosed, and the cause of ACS was non-occlusive mesenteric ischemia. Urgent ileectomy was performed and open abdominal management was selected for the management for ACS and ACS-induced multiple organ failure. On the day 10, severe ARDS was diagnosed because of the overlap of the severe chest injuries and ACS-induced multiple organ failure. Ventilation failure was re-occurred and V-V ECMO was provided. The circuit was successfully management without anticoagulant and V-V ECMO was free on the day 14. His abdomen was completely closed on the day 16. He was discharged from ICU on the day 24. Introduction: Traffic accidents and falls are the most common cause of death in childhood. The correct primary assessment and resuscitation strategy are of highest importance in order to reduce mortality. The damage control resuscitation (DCR) strategy targets on the ''lethal triad'' of acute coagulopathy, hypothermia, and acidosis seen in exsanguinating trauma patients to restore and preserve the vital physiology. Material and methods: Case We report a case of a 12-year old girl sustained severe multiple trauma (Injury Severity Score: 48) by a 20 m fall from a castle wall successfully treated with DCR strategy. Results: The girl returned to school and retained her former sports levels after 6 months. Conclusion: The DCR strategy with permissive hypotension, control of hypothermia, prevention of acidosis, minimization of crystalloid resuscitation and early use of blood products offers a rewarding treatment option in children who sustained severe multiple trauma. However, a general recommendation for standard application of this strategy cannot be made since predictive characteristics of the ''exsanguinating syndrome'' in children in which DCR strategy would be appropriate are not clearly identified yet. Generally, pediatric multiple trauma patients should be treated in approved trauma centers with proven expertise in pediatrics. Introduction: The aim of this report is to share our experience with the appliance of the fibular frozen allograft at a primary trauma defect of the distal radius included the radio-carpal joint too. Material and methods: The method was used in young patients at the age of 21 and 23. One of them was injured in a high energetic trauma -an accident with a motorcycle and the other one had gunshot injury. In the clinical practice this method is used in cases of giant cell tumor. The aim is a reconstruction of the defect to be done using a frozen allograft of the radial bone. At the beginning it is necessary to fix the fracture of the ulna bone with a DCP place and an external fixation is put on radio-carpal joint. Treatment of soft tissue injuries. Frozen graft must be fixation with DCP place to the rest radius bone. Wrist ligament reconstruction and fixation of the head of fibula with carpal bones using K-wires. Results: The follow up ranges from 1-4 years (mean 2,5 years) At last follow up, the average combined range of motion was 110°with range varying from 60-125°. Results: L.F.C., male, 19 years old, admitted to the ER after a motorcycle accident, with severe pelvic penetrating trauma: complex fracture and partial destruction of the anus and rectum. The patient was initially submitted to colostomy with mucous fistula, parcial suture and drainage of lacerations of the perineum and thigh, placement of fecal drainage device as a tutor and osteotaxis with pelvic external fixation. During hospitalization, several imaging exams were done, which confirmed a serious extent of the injury. It was also performed the definitive orthopedic surgery later on and he was discharged after 63 days of hospitalization, with the process of perineal healing taking place. Sixteen months after the accident, the patient was submitted to reconstruction of intestinal transit, with good clinical outcome, and finally fully recovered sphincter continence with pelvic physiotherapy. Conclusion: The authors present a case report of a serious pelvic injury, which involved from the initial approach multiple specialties. The early treatment of perineal and anorectal injuries is essential for the contamination control, avoiding morbidity and late mortality, often requiring multiple interventions Introduction: We present a successfully recovered case of unstable pelvic fracture with polytrauma treated by repeated angiography and pelvic packing for the stability of hemodynamics. A 50 year old female fell from the height of 10 m. She was in shock in spite of fluid and blood transfusion treatment. Unstable pelvic ring fracture was revealed and angiography was started immediately after the placement of a chest drain for the left hemo-pneumothorax. Arterial embolization could not control the bleeding and pelvic packing was performed with supra-acetabular external fixation and it subsided the shock status. Final diagnosis: unstable pelvic ring fracture with suicidal jumper's fracture, lumber spinal burst fractures, left proximal femur fracture, left olecranon fracture, right occipital lobe hematoma. Results: Next day, gauzes were removed. However arterial bleeding was still noted and pelvic packing was tried again. Angiography was performed and bilateral internal iliac arteries were embolized. Gauzes were removed carefully again 48 hours after prior packing and active bleeding was not observed. At day 21, unstable pelvic ring fracture was fixed by spinal instrumentation. At day 31, the proximal femur fracture was fixed with cephalomedullary nail and the olecranon was stabilized by a LCP. She recovered without any major complications except left hemiplegia, which is still getting better and could do walking rehabilitation. Conclusion: The timing of arteriography and embolization is controversial. The cautious, case by case approach is recommended including arteriography after the initial stabilization, pelvic packing, or both. A skilled radiologist is critically important and the surgical window should be carefully considered. Introduction: Bilateral flail chest injuries are challenging in treatment and comparatively often require an operative stabilization of the anterior chest wall to re-establish normal physiological conditions of the chest wall in shape and statics. Various procedures have been described which are technically sophisticated for the surgeon. Consequently there is an increasing interest in potentials of operative care and their effectiveness on the anterolateral chest wall. Material and methods: 12 human cadavers were prepared and the natural Sternum Position (NP) was marked. A digital probe was fixed to the sternum at the height of the 4 th intercostal space in order to measure and compare the stability of the thorax. Readings were taken in starting conditions and from every material combination of sternal displacement at 1, 2, 3, 4 and 5 cm sagittal distance from NP. Serial osteotomies were performed on 2 locations on ribs 2 -8 to induce bilateral flail chest Afterwards the stabilization was achieved with different implants: -Transsternal metalstrut -Several combinations of locking plate fixation. Results: The osteotomies lead to a subsidence of the sternum occurred to almost 75 mm from NP which corresponds to a maximal unstable situation. The unstable chest wall showed substantially more stabilization through the use of locking plates. Our material combinations showed a stability of up to 60 % of normal. The more ribs were treated osteosynthetically, the higher the stability of the chest wall. Conclusion: Locking plate fixation offers anatomically realignment of the ribs whereas metal strut support only lifts up the chest wall, but could not provide realignment of the dislocated ribs. References: Introduction: DCO is a currently widely accepted concept for the early management of polytrauma patients. It aids in determining the therapeutic path of the multiply injured patients based on their classification as stable, borderline, unstable or ''in extremis'', focusing on the advantages of decreasing operative trauma and therefore the physiological consequences of a second hit on the injured body by means of swift temporary skeletal stabilization and shortened operative time, even when not all damages have been addressed, in patients at high risk for the systemic complications of trauma such as pulmonary thrombosis, ARDS and multiorgan failure. Material and methods: For the past 3 years were treated 51 patients with severe polytrauma in border state. Methods of investigation are diagnostic -imaging, laboratory -actively monitored, not hemodynamic status, functional evaluation of respiratory function assessment deficit musculoskeletal systems. Results: By definitive stabilization in these patients achieve a stable hemodynamic, stable saturation, without abnormal coagulation, normal body temperature without the need for a catecholamine maintenance, control bleeding, inhibition of the pathological inflammatory responses, non-vital excision of tissue, prevention of ischemia-reperfusion injury, analgesia. Conclusion: Despite the achievements of modern medicine, mortality polytraumatic illness in intensive therapy wards in recent years S138 reduced a large percentage of the victims remain disabled. It is therefore necessary to conduct early rehabilitation to prevent complications, as the effects of severe combined injuries are serious and socially significant problem they often disabling sick for a long time, sometimes until the end of his life. References Introduction: Combinations of unstable chest wall injuries and ipsilateral fractures of the clavicle are mostly caused by a direct Impact to the chest wall from a lateral direction. Once the adducted arm is impinged from a lateral direction a typical midshaft fracture of the clavicle may commonly result. In case of severe Impact, the arm may crush the underlying ribs subsequently. Typically the anterior, lateral und posterior chest wall are involved in this injury as the typical regions. Since the chest wall is covered from strong muscles, dislocations of the ribfractures may result and thus lead to a deformity of the chest wall. Undislocated fractures are supposed to heal uneventfully. Material and methods: Six representative patients were chosen and followed up during conservative Treatment of a costoclavicular injury including chest X-ray (1, 2, 6, 12 weeks) . Two suffering from ribfractures anterior and lateral, two posterior and lateral und two involving all of the three regions. Conservative Treatment included analgetic therapy as well as training of the respiratory function while the patients were breathing spontaneously. Results: All of the patients recieved a chest drain during the first week due to pleural effusions or pneumothorax. Three patients showed only little dislocations of fractures during follow up. With good functional outcome after 12 weeks. The othes showed severe deformity of the chest wall accompanied by a reduction of the chest cavity. Anterior and posterior ribs showed huched deformity whereas the lateral chest wall showed a severe impression. Patients were suffering from pain and restriction of the breathing. Conclusion: Conservative treatment of costoclavicular injuries may be an option in undislocated fractures with reliable followup. Introduction: Hemodynamically unstable pelvic trauma is challenging even for Level I Trauma Centers. Papa Giovanni XXIII Hospital is a 1000 bed facility with all specialities. In 2011 Trauma S140 Team and preperitoneal pelvic packing (PPP) were introduced in our Hospital. This is a retrospective review of our experience. Material and methods: Retrospective review of our database from 9/2011 to 09/2015. Values are expressed in median and interquartile range. Results: From 9/2011 to 9/2015 we treated 24 patients. Median age was 51 years (42-64) with an Injury Severity Score of 34 (26-41). At the arrival in the Emergency Room systolic blood pressure was 94 (70-100), heart rate was 115 (90-129), base excess -7.5 (-10.7 --4.5), pH 7.24 (7.20-7.28) . Resuscitation was accomplished with 1250 ml (1000-2375) of crystalloids in the first 6 hours, 11 U (7-17) of packed red blood cell, 9 U (4-12) of fresh frozen plasma and 2 U (1-2.5) of platelets in the first 24 hours. PPP was done in 20 patients, while in 2 external fixation was sufficient to control bleeding and in other 2 patients angio was the only procedure. Time to procedure was 71 (53-187) minutes from arrival. Time to emergent PPP was 63 (58-101). Mortality was 29.2 %, mainly for traumatic coagulopathy, severe brain injury and multitrauma. Local control of bleeding was good. Conclusion: Hemodynamically unstable pelvic trauma remains a big challenge for trauma centers. We believe that Trauma Team and PPP produced a huge contribution to better management of these patients. 2 Surgery, Hamad General Hospital, Doha, Qatar, 3 Trauma Surgery, Hamad General Hospital, Doha, Qatar, 4 Radiology, Hamad General Hospital, Doha, Qatar, 5 Clinical Research, Trauma Surgery, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar Introduction: Degloving injuries (DIs) are serious injuries resulting from detachment of the skin and subcutaneous tissue from the underlying muscle and fascia. We aimed to evaluate the frequency, pattern, management and outcome of DIs in a single institute in Qatar. Material and methods: A retrospective review of trauma registry data was performed for all patients diagnosed with DIs between 2011 and 2013. Results: A total of 178 DIs patients were identified with mean age of 30.5±13 years (males = 162). Motor vehicle crash (MVC) was the main mechanism of injury (54.5 %) followed by falls (12.9 %). Around 80 % in had open DIs. Lower limbs were more frequently affected (44 %) followed by head and neck region (37.3 %). Traumatic brain and spinal injuries were found in 23.0 % and 14.2 % cases, respectively. Myoglobin was consistently elevated with an average serum level of 846 ng/ml. Early debridement was performed in 2 thirds of cases. Intermediate closed drainage was done under ultrasound guidance for 7 patients out of whom recurrence occurred in 4 patients who had to undergo closed serial drainage for recollection. The definitive treatment for these patients was finally a proper debridement with or without vacuum-assisted closure. One patient had to undergo serial drainages over 3 months before final resolution. Infection (n = 7, 4.0 %), hematoma (n = 4,2.3 %) and skin necrosis (n = 2,1.1 %) were rare. Mortality (overall;9 %) was higher in closed DIs (19.4 % vs. 6 Introduction: Management of polytrauma patients requires multidisciplinary skills. Trauma is a surgical pathology but a trauma patient not always requires surgical intervention. The purpose of this work is to raise the incidence of emergency surgeries in trauma patients of a first level trauma center and to highlight the role of the trauma surgeon. Material and methods: Results were extrapolated from the prospective register of trauma, analyzing data about patients [18 y.o. during a 15 months period. Surgery was recorded as in emergency if patients went directly in OR from the shock room. Results: During the period were recorded 868 adult patients with multiple trauma evaluated by the trauma team; of these 496 (57 %) were hospitalized. In 64 (7.3 %) was placed a chest tube in shock room. 91 pazienti (10 %) required surgery in emergency. In these patients, the mean age was 53.07 years, 75 % male. 67 % of patients had a CT scan before surgery. The mean ISS was 24.8. Were recorded 37(40.6 %) laparotomy, 20(21.9 %) angiography, 16(17:58 %) craniotomies, 6(6:59 %) pelvic packing, 4(4.39 %) limb revascularization, 4(4.39 %) hemostasis head and neck, 3(3.29 %) placements transducer PIC, 2(2.19 %) thoracotomy and 2(2.19 %) external pelvic-fixation; in 8 patients they were performed two or more emergency interventions. The mortality was of 20.8 %, after an average time of 1.88 days. Conclusion: Only 10 % of trauma patients require surgery in emergency. It's clear the need for the trauma tem and the surgeon to have not only surgical skills but also non technical skill to coordinate the multidisciplinary team composed of many specialists. References: Disclosure: No significant relationships. Introduction: A major advancement of trauma care has been the rapid access to trauma series CT scanning, to support primary survey assessment of major trauma patients. To facilitate patient transfer and practice principles of minimal patient handling, pre-hospital and emergency medicine services frequently use spinal immobilisation or transfer devices. However, concerns exist regarding the increased material density of these devices raising the dose of radiation exposure to patients. Material and methods: A retrospective cohort study was conducted for a 2 year period, from 2013 -2015, evaluating trauma series CT scans for the effect of the FERNO 65-EXL-R Scoop Stretcher on scan radiation dosage. Quantitative analysis was performed using data from electronic hospital records. Statistical comparison was made between patients scanned with and without the scoop stretcher in situ. Results: Over 300 scans were analysed having satisfied study entry criteria. The scoop stretcher was found to produce only an overall 1 % increase in dose requirement when compared to trauma patients scanned without. This was true even when corrected for patient BMI. Radiation dose differences are shown not to be statistically significant. When specifically assessing the neck to pelvis region, a 5 % dose increase was seen, likely to be due to the aluminium rods of the scoop stretcher. Conclusion: Current design scoop stretchers are safe for use in trauma patients undergoing trauma series CT scans, especially given the clinical advantage to be gained from minimal patient handling following poly-trauma. Future designs should seek to eliminate the use of metal components, in order to minimise excessive radiation exposure. References: Disclosure: No significant relationships. Orthopedics, University Hospital Lewisham, London, UK Introduction: Clinical case of 4 yrs old female child brought by her mum with left foot pain and background history of clinical manifestation of chicken pox. clinical examination were normal, and X-ray of the foot was performed to exclude soft tissue or bone infection due to lack of clinical feature patient was discharged home less than16 hrs of hospital discharge, patient developed fatal outcome. Post mortem revealed varicella and invasive streptococcus in the body. Material and methods: Clinical case report Results: Case fatality is discussed in clinically well child. Conclusion: Varicella and invasive streptoccccus infection in preschool children rare, but recognised complication. Case fatality are known a high index of suspicion is necessary to diagnosed this condition. This case highlight the complexity surrounding streptococcus infection in a healthy child. A clinically well child may die with sudden toxic shock syndrome following and invasive infection. Introduction: Blunt abdominal trauma represents 5 % of colon injuries, most frequently in the mobile segments of the colon. These injuries may compromise the bowel wall and/or mesentery. Of these, colonic deglovement associated with seat belt sign are quite rare. Mucosal ischemia and perforation may occur if not promptly identified. Material and methods: We report two cases of degloving colonic injuries as a result of blunt trauma to the abdomen after motor vehicle accidents, one being a child. Both patients had the seat belt sign. Moreover, bothe were treated surgically with resection and primary anastomosis. Results: A 5-year-old female patient was involved in a lateral vehicel collision. She had a two-point seat belt. She arrived both hemodinamically and neurologically intact. Whole body CT showed free fluid. At diagnostic laparoscopy, a colonic degloving was found. Diagnostic laparoscopy was carried on. The second patient was a 45-year-old male involved in a car accident, arriving with tachicardia and pallor. After stabilization, whole body CT showed ribs and sternum fractures, left pneumothorax and free fluid. Upon surgery, a 25 cm long segment wa degloved. Both patients were finally managed with laparotomy, resection of the injured colonic segment, and primary anastomosis. There were no post-operative complications. Introduction: Preclinical as well as in the emergency room the management of severely injured patients with complex facial fractures may be more difficult by compromising of the respiratory path. Besides, it is very important to figure out associated injuries of the eye and its nerval structures like the optic nerve. The aim of this study is to assess the frequency of injuries and to highlight potential difficulties in the management of these injuries. Material and methods: In a period of 2011-2013 we included 623 patients with a ISS C9 in our database of severely injured patients which were analyzed in retrospect. 18,8 % of these showed facial fractures. These were split into central, lateral and centrolateral midfacial fractures as well as in isolated fractures. The radiological diagnosis was carried out using thin-slice CT. Results: The average age, the severity of injury and mortality among patients with facial fractures did not differ compared to the overall population (47,3 ± 23,3 vs. 46,8 ± 22,0 years; 24,6 ± 13,1 vs. 23,0 ± 12,8; 11,1 % vs. 13,8 %) . The rate of intubation in the emergency room by patients with facial fractures were 17,6 % as opposed to a lower rate in the overall population at 10 %. No difference was seen in the hemoglobin values and arterial oxygen saturation. An optic nerve lesion was presented in 3.4 %. Conclusion: There are 20 % facial fractures in severely injured patients. The relatively high intubation in difficult airway situation requires adequate preparation in the emergency why a close interdisciplinary cooperation with colleagues of the oral and maxillofacial surgery must be guaranteed. References: Disclosure: No significant relationships. Introduction: Precise diagnostics and an adequate therapeutic approach are mandatory in the treatment of a prolonged air leak in polytrauma patients with a blunt thoracic trauma. The study aimed to evaluate the incidence, characteristics and management of a prolonged air leak following this injury. Material and methods: Data of 110 polytraumatized patients were elaborated retrospectively. Fifty-four patients with a pneumothorax and initial treatment by chest tube placement were assigned into two groups. Group A: air leak cessation within 5 days. Group B: air leak cessation on the sixth day or later. A detailed data evaluation on injury pattern, chest wall injuries, duration of air leak, and reason for drainage maintenance in place hospital length of stay, ICU stay, ventilator days, type and treatment as well as the delay of an operative intervention were analyzed. Results: In 7 cases a prolonged air leak occurred. We observed spontaneous air leak cessation in all these patients after 7.7 days in average. A shorter length of stay in absence of a prolonged air leak was statistically significant (p = 0.03). Operative intervention was indicated in 9 patients (8 %). Surgery was performed after 1.8 days in average when severe pulmonal lacerations were suspected and the patient's condition was suitable for a thoracic surgical procedure. Conclusion: Early recognition of a severe parenchymatous laceration and consecutive operative intervention leads to shorter hospital stays. Spontaneous cessation of an air leak can be expected within 12 days when optimal chest tube management is applied. Hemoglobin value and inflammatory markers (leucocytes, ESR, fibrinogen, CRP) together with IL1 and IL 6 are analysed in order to evaluate weather there is any correlation between them and the incidence of hospital stay and general complications (death, MSOF, ARDS). Results: The results show that the most reliable informations are given by CRP, IL1 and IL6; statistic analysis also revealed a significant correlation between the incidence of complications and that of initial anemia and its resistance to treatment. The rates of MSOF and that of ARDS were comparable for the ETC and DCS groups but they were significantly influenced by anemia and persistent inflammation. Conclusion: Clinical and biochemical criteria has been proven to be useful in polytrauma patients with femoral fractures. Our results suggest that biochemical markers are useful for establishing different steps of treatment. Introduction: Supracondylar fractures are the most common paediatric elbow fracture and the most problematic because of the potential for neurovascular compremise. The British Orthopaedic Association, Standards for Trauma guidelines set out recommendations for diagnosis, management and follow up of these patients. We have looked at how management in our district general hospital compares to these recommendations. Material and methods: Data was collected over twelve months retrospectively, for all paediatric, displaced supracondylar fractures. Notes were reviewed, looking at pre-operative assessment, operative documentation and post-operative plans. These were compared to the current BOAST 11 guidelines. Results: 26 paediatric patients were included, 13 males and 13 females. Pre-operative neurovascular status was documented in 92 % of patients. Surgical stabilisation was performed in 20 patients. Crossed, 1.6 mm K-wires were the preferred choice of fixation. 73 % of patients had post operative neurovascular status documented, and 54 % had post-operative radiographs within the recommended time period. Only one patient had the K-wires removed within the recommended period, but only four patients required more than two follow ups. Conclusion: Appropriate documentation is one of the most significant barriers to compliance with the BOAST 11 guidelines. The nature of surgical stabilisation is heavily influence by surgeon preference. Post operative care and follow-up was delayed in the majority of patients, althought all patients were followed up correctly. Education and re-evaluation is required to improve compliance in all areas of peri-operative care. References: (1) https://www.boa.ac.uk/wp-content/uploads/2014/12/ BOAST-11.pdf. (2) Introduction: Early hospital management of severe trauma must be protocolised to reduce the mortality. In unstable patients, the hemostasis should occur as early as possible to reduce the morbid consequences of post-traumatic shock. Material and methods: In case of ventilatory, circulatory or neurological distress, some surgical procedures can save life and should be performed without delay by the trauma surgeon or any surgeon under exceptional condition if necessary. We describe here the few lifesaving surgical procedures that are necessary to deal with these difficult situations. Results: Some of them are very basic, others are much more complex : invasive access of upper airway, decompressive thoracostomy, resuscitative or hemostatic thoracotomy, damage control laparotomy, preperitoneal pelvic packing and C-clamp exofixation pelvic, vascular shunt, decompressive craniotomy. All of these procedures are feasible for a general surgeon, but require versatile experience and prior training. Conclusion: Early management of severe trauma requires anticipation and experience. In unstable patients, some life-saving surgical procedures are needed and must be learned by any trauma surgeon. References: Disclosure: No significant relationships. Introduction: The optimal management strategy for hemodynamically unstable pelvic fractures remains controversial. Herein, we report an early experience of internal iliac artery ligation and preperitoneal pelvic packing as a damage control adjunct in patients with hemodynamically unstable pelvic fractures. Material and methods: We reviewed the medical records of four patients with hemodynamically unstable pelvic fractures underwent internal iliac artery ligation with preperitoneal pelvic packing. Internal iliac artery ligation was performed via hockey-stick shaped flank incision just as in kidney transplantation. Another infra-umbilical low mid-line incision was made for packing and the pelvis was directly packed with pads and hemostatic agents compactly. Results: Lowest systolic blood pressure and hemoglobin level before operation was 60 (50-70) mmHg and 7.65 (7.1-8.5) g/dl. Mean time to operation and operation time was 105 (85-120) minutes and 95 (75-130) minutes. There were no procedure related complications. Among them, three patients were survived after operation and one patient died in ICU because of sudden cardiac arrest during the first 24 hours S144 from operation. However, there was no evidence of hypovolemia before arrest in that patient who died. Conclusion: Our experience illustrates the potential role of internal iliac artery ligation and preperitoneal pelvic packing for the treatment of exsanguinating pelvic hemorrhage. This approach can be used rapidly and effectively as a damage control technique to hinder arterial pelvic inflow and reduce venous bleeding in an effort to control massive pelvic hemorrhage. Further study with more patients and long-term follow-up is required to determine the appropriate selection criteria for this potentially life-saving maneuver. Introduction: Increased numbers of patients at Major Trauma Centres puts pressure on speciality teams attending trauma calls in the Emergency Department (ED). The aim of this study was to develop and evaluate a tiered trauma call system that reduces the impact of these patients on specialities by providing response by the major trauma service to low acuity patients whilst Consultant delivered level of care for the most seriously injured patients. Material and methods: Retrospective data from the East Midlands Major Trauma Centre (EMMTC) database was used to define criteria for three trauma levels, code Green, Amber and Red, with code red activating the highest level of response. The tiered system was rolled out in January 2015 and prospective data collected for trauma called patients to August 2015. Results: Of 1082 of trauma calls, 7 %, 67 % and 26 % were Code Red, Amber and Green respectively. 2.8 % were escalated and 3.4 % de-escalated from the initial trauma call level. Code Red criteria showed 66 % sensitivity, 84 % specificity and 83 % overall accuracy at triaging patients to this level. The number of trauma calls attended by the acute specialities was reduced by 26 %, with an estimated 293 hours saved per month. Conclusion: The tiered trauma call system reduced the impact of trauma calls on speciality teams whilst providing an enhanced level of patient care for seriously injured patients and minimal impact on ED. Whilst the Code Red criteria showed high overall accuracy, further data and evaluation is required to refine these criteria. Introduction: Blunt cerebrovascular injuries (BCVIs) are rare but potentially devastating events. Recent reports have suggested that BCVI occurs in approximately 1 % of all blunt trauma patients with a resultant neurologic morbidity of up to 80 % and associated mortality of up to 40 %. The optimal management strategy for patients with these lesions is not yet established. Material and methods: From April 2011 through March 2015, patients were screened for BCVI if they met any one or more of the institutional screening criteria and underwent multi-detector computed tomography angiography (MDCTA) or magnetic resonance angiography (MRA). The types of injuries were morphologically categorized according to the Denver grading scale. Endovascular treatment was performed in patients with the need for cervical realignment in the acute phase or in those with multiple injuries. The mechanism of injuries, demographics, clinical findings, management of BCVI, and prognoses were evaluated retrospectively. Results: Fourteen patients with BCVI were identified from a total of 632 blunt trauma admissions (2.2 % incidence). Ten patients (71.4 %) underwent endovascular treatment for their BCVI without complications. Among these 10 patients, there were seven grade IV vertebral artery injuries (VAI), one grade II VAI, one grade III carotid artery injury (CAI), and one grade V CAI. Ischemic stroke was observed in one patient (7.1 %) suffering from bilateral grade IIs CAI. Conclusion: Although antithrombotic therapy with heparin or antiplatelets is the standard treatment for BCVI, application of endovascular treatment may be effective for preventing secondary stroke in patients who require cervical realignment or in whom antithrombotic therapy is prohibited because of hemorrhagic complications. Material and methods: It is a road accident between a track and a bus with 26 injured people and 2 dead who died immediately on scene. All injured were medevaced in the Emergency Department of ''Papageorgiou'' General Hospital of Thessaloniki and managed/ treated from the medical personnel of 1st Surgery Clinic AUTH who were on duty that day. Results: In one injured emergency right knee amputation was essential as damage control surgery and took place in the ED room due to the injured unstability. 8 patients had to be hospitalized and 4 of them underwent a surgical operation up to 24 hours after entering the clinic, through exploration laparotomy. All patients survived and were discharged up to the 7th post operational day. Conclusion: The management and handling of a mass casualties incident from a Role 3 civilian Hospital is a challenging issue. Readiness, knowledge of the procedures, roles and duties, the correct use of triage criteria, the early understanding of life threatening situations, efficiency of means and personnel, cooperation between all involved staff are of crucial importance for the successful outcome of these situations. Continuous training and realistic simulation exercises can reduce the stress level of medical staff when practicing in real procedures and maintain readiness level in high quality standards. Experimental animal studies showed a protective role of female hormones. The objective of this study was to examine the influence of age, gender, comorbidity and trauma scores on survival in polytrauma patients. Material and methods: Polytrauma is defined by the presence of two or more injuries that are potentially life threatening. This retrospective study included a total of 317 polytrauma patients over the period of 2008 till 2012. The primary endpoint was mortality within 30 days. Secondary endpoints were demographics, comorbidity and trauma scores at the time of the trauma. Results: The median age was 47(OQR 28-64). Mortality was 16.4 %, equally over man and women. Univariate analysis showed no significant effect of gender on the outcome (p = 0.126) in the overall group as well as after stratification for age with a cut-off at 50 years (p = 0.230 at\50 yr and p = 0.356 at[50 yrs). Multivariate analysis showed an overall effect of comorbidity (p = 0.018), the trauma and injury severity score (TRISS) correlated with outcome (p = 0.001). After stratification for age (50 yrs) gender showed to have a significant effect (p = 0.02), which was lost above 50 (p = 0.0869). Comorbidity is only a significant factor above 50 years (p = 0.034). Conclusion: Females under 50 have a significant better survival compared to males. This effect is lost above 50 years. This might indicate a role of the female hormones. Comorbidity has a significant effect above 50 years. Introduction: Trauma related axillary vascular injuries is generally associated with high morbidity and mortality rates. Although most of patients who are admitted to trauma centers sustain a blunt mechanism of injury, blunt vascular trauma is an uncommon diagnosis. In the early period after blunt trauma of the upper limb, progressive signs of vascular compromise may disappear because of collateral circulation even if the distal pulses are absent. Arteriography has assumed increasing importance in defining the site and extent of arterial injuries. Material and methods: Case report. Results: We report a case of a 59 year-old male admitted at emergency department after a tree fall on him presenting multiple traumatic injuries including right upper limb blunt trauma with clavicle, scapula and humeral fractures. He presented a palor and pulseless extremity with parestesis and paralysis indicating concomitant vascular and neurological impairment. Computed tomographic angiogram revealed complete occlusion of the axillary artery. Urgent surgical intervention was performed with exploration and repair of axillary artery and fracture fixation. Repair of the axillary artery was successfully done with interposition grafting. Postprocedure pulsations were present in the upper limb and subsequent angiography demonstrated no injure of distal extremity arteries. Conclusion: Failure to early diagnose arterial injuries can lead to irreversible ischemic changes or death. The most effective treatment for such injuries is early exploration and re-establishment of arterial continuity. Nevertheless, long-term outcome of upper limb injury not only depends on the vascular injury which can be successfully managed, but upon the outcome of the associated nerve injuries. References: H. Gill, W. Jenkins, S. Edu, W. Bekker, A. J. Nicol, and P. H. Navsaria, ''Civilian penetrating axillary artery injuries,'' World Journal of Surgery, vol. 35, no. 5, pp. 962-966, 2011. A.D. Shaw, A.A. Milne, J. Christie, A.McL Introduction: Among the conventional parameters for the assessment of polytrauma patients, those associated with the triad of death appear to be widely used. We assessed whether other parameters might be of use as well for identification of patients at risk of developing complications. Material and methods: Population based trauma registry. Inclusion criteria were: age [16 years, and Abbreviated Injury Score (AIS) [3 points) and treated in the intensive care unit (or Injury Severity Score (ISS)[16 points. The primary endpoint was hospital mortality. Patients were graded according their risk of death (stable patients: low risk of death (5-14 % mortality), intermediate risk patients (15-39 % mortality) and high risk ([40 %). Conventional clinical parameters on admission were assessed to assess their relevance to classify patients into these categories. Statistical analysis included univariate analysis. Results: 11.436 patients were included, the mean ISS was 22.7 ± 11.2 points, 73 % male, 95.6 % blunt injuries. Parameters associated with a mortality rate of 15-39 % were; systolic blood pressure on admission (range 76-90 mmHg), INR (range 1.4-2.0), base deficit (range 8-10), NISS (range 35-49 points) and packed red blood cells administered (range [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] . Two or more intermediate risk pathological changes were associated with a borderline condition and more than one high risk pathological change was associated with an unstable condition. Introduction: Traumatic lesions of the rectum, perineum and anus are rare but difficult to treat, requiring experience in terms of trauma and colorectal surgery. Material and methods: Case report of two patients admitted in Emergency Hospital of Bucharest. Results: We present two cases managed differently with and without colostomy. First case a male patient, 27 years old, bicyclist victim of a car accident, admitted to our hospital in emergency setting for right inguinal open wound with extension to ano-rectal region and pelvisubperitoneal space, complex pelvic trauma and lower limb fractures (ISS = 29). The patient was transported directly to the operating room. Perineal packing was performed with external pelvic fixation and lower limb fractures reduction along with external fixation in the same time. The clinical evolution was favourable, the patient being referred to a lower level local medical centre for continuation of the therapy. Second case also a male patient 35 years old, crushed by a tree, transferred to Emergency Hospital with a pelvic fracture and deep gap, about 20 9 10 cm, in the perineum, with the anus and S147 rectum displaced from their original site. Anal re-implantation was performed, suturing the median raphe, with pelvic packing and then inserting two pelvic drainage tubes, left colostomy and pelvic stabilization with a pelvic binding for bleeding control. The patient is going on recovery time. Conclusion: The assessment and management of pelvic trauma with ano-rectal injuries requires a multifaceted approach involving orthopedics and the trauma surgeon. References: Disclosure: No significant relationships. Introduction: Traumatic aortic rupture is a pathological entity with a high mortality. Blunt chest trauma accounts for 90 % of chest trauma in the civilian population in Europe and the United States and causes 20 % of trauma-related deaths. Missed aortic injuries can rupture and lead to subsequent death of the patient. Material and methods: Retrospective study of the patients admitted in a Level I Trauma Centre, diagnosed with aortic aneurysm identified with contrast-enhanced spiral CT imaging. Results: Between 2012 and 2015, 10 patients were detected with thoracic trauma and aortic lesions. Most of the patients were younger, median age 40 years old. For all these patients, a whole body CT scan was performed, and it was founded a saccular aneurysm of the ascending aorta closed to the aortic arch without leaking of contrast substance. Only for two patients we found the seat belt sign on the anterior thoracic wall -after primary preserving-life measures, the patients were referred to the cardiothoracic surgeons to repair the lesion. Conclusion: The helical CT evaluation of the mediastinum should be performed in all patients who undergo blunt thoracic trauma, irrespective of chest radiographic findings. Chest CT scan in all patients with a history of motor vehicle accident is highly recommended on the admittance. Orthopedic, Nishio Municipal Hospital, Nishio, Japan, 2 Orthopedic, Nishio MUNICIPAL HOSPITAL, Nishio, Japan Introduction: Anterolateral approach is less invasive to the muscle and advantageous to getting early gain-function, the pain after surgery and the dislocation prevention as compared to the Posterolateral approach in the BHA for the femoral neck fractures. We compare OCM (anterolateral muscle sparing approach in the lateral position) with the posterolateral approach in the BHA for the femoral neck fracture. Material and methods: BHA operated with OCM 40 (below OCM group) and PL 40 (below PL group) are compared for surgery time, bleeding during surgery, Hb before and after surgery, CK and LDH after surgery, time for starting walker and T-cane walking, length of hospital stay and complications. Results: OCM group is significantly better results in bleeding during surgery, Hb before and after surgery, CK after surgery, time for starting walker and length of hospital stay as compared to PL group. No significant difference in the operative time and complications between two groups was observed. As for complications, each group has one proximal femoral fracture and PL group has a cerebral infarction after surgery. Conclusion: OCM is a good approach meets resent aging society and medical economics as compared to PL approach, because OCM, muscle sparing approach in the lateral position is minimally invasive, can make early ADL recovery and needs no strict instruction for dislocation limb position for elderly dementia patients. Introduction: Metacarpal bone fractures are commonly seen in the emergency department. Current treatment still remains controversial. Different surgical techniques have been described. This study describes a minimal invasive technique with intramedullary use of k-wires for both subcapital and shaft fractures of the second to fifth metacarpal bone. Material and methods: A restrospective observational cohort study was performed. Patients who underwent surgery with this specific technique were identified over a time frame of 5 years. Patient characteristics, operative parameters and postoperative results were collected. Radiographic parameters, complication rates and associations between parameters were analyzed. Results: Seventy-nine cases were identified with displaced fractures of the second to fifth metacarpal bone. Nearly all fractures were located in the head (63 %) or in the shaft (33 %). Mean follow up period was 7,8 weeks. Average surgery time was 26 minutes. Most fractures (73 %) were fixed with only one intramedullary k-wire. Postoperative plaster immobilization was done in most cases (78 %). Radiographic fracture union was achieved in all patients. 78 % of the patients underwent hardware removal which was done in outpatient clinic under local anesthesia when planned ([70 %). Functional S148 results at the end of follow-up showed an impaired function with a mean of 15 degrees in 13 % of the patients. Impaired sensibility was found in less than 4 % of the cases. Conclusion: This minimal invasive surgical technique appears to be a quick and safe procedure for a wide variety of metacarpal bone fractures. Intramedullary k-wire fixation of these fractures leads to excellent bone healing and good functional results. References: The references include the following: Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review. Tibial condyle transplantation c) large medial tibial defect after trauma in young male with the follow-up of 9 years after surgery. Bipolar patellofemoral transplantation d) lateral femoral trochlear and patellar defect after trauma with chronic patellar instability and arthrosis in young female with the follow-up of 10 years after surgery. Results: All patients satisfied with no degenerative changes in X-rays Conclusion: Fresh-frozen massive osteochondral allografting is a salvage operation aimed at young, active patients with isolated large and deep knee defects to prevent or postpone the joint replacement. References: Disclosure: No significant relationships. Introduction: Aim of the study is to show how complex the surgery during total ankle arthroplasty (TAA) has to be to restore anatomy in posttraumatic cases. Material and methods: 39 TAAs were implanted in severe posttraumatic conditions in 37 patients between 2000 and 2011. TAAs used were AES (Biomet) (23 cases) and STAR (Link) (16 cases). Except the joint degeneration, many other pathologic conditions had to be simultaneously addressed, such as limited range of motion (ROM), distal tibial and/or hindfoot malalignment, subtalar osteoarthrosis, ligament imbalance, talomaleolar imingement etc. Thats why many surgeries were added: dorsal release (capsulectomy and resection of heterotopic ossifications), Achilles tendon prolongation, ligament balancing -release, resection and/or reconstruction, fibular prolongation osteotomy, medial malleolar intraarticular sliding osteotomy, distal tibial osteotomy, corrective talo-calcaneal arthrodesis, corrective calcaneal osteotomy etc. To plan the surgery, Meary a/p standing view was used in all cases. Material and methods: Case 1; 61 year old male injured open lateral condyle fracture of femur by to be bitten by a pig. After 5 months from initial debridement, I confirmed the size of bone defect was 3 cm(2) 9 3 cm in depth. The same size of bone was harvested from iliac crest and transplanted in the bone defect area of lateral condyle. After seven months from bone transplantation, I confirmed bone union and two 6.5 mm diameter osteochondral grafts and 4.5 mm diameter osteochondral graft were transplanted for the chondral defect lesion. Case 2; seventy year old male injured open lateral condyle fracture of femur by traffic accident. After 3 months from first debridement, I confirmed the bone defect (size 7 cm(2) 9 3 cm in depth) and the same size of bone was harvested from iliac crest and transplanted. And simultaneously two 10 mm diameter osteochondral grafts were transplanted for the chondral defect lesion. Results: In both case, Lysholm knee scoring scale were good. And 6 months after osteochondral autograft transplantation, second-look arthroscopy found cartilage repair. Conclusion: combination of bone transplantation and osteochondral autograft transfer is useful strategy for the large traumatic osteochondral defects of the knee joint. References: Tegner Y., Lysholm J., Clin Orthop Relat Res., 198, 43-108, 1985 . Disclosure: No significant relationships. Introduction: Many uncertainties dominate the field of proximal humeral fractures and yet no clear difference between the outcomes of operative versus nonoperative treatment has been found (1) . The aim of this study is to evaluate the health related quality of life (HRQoL), functional outcome and social participation in elderly patients after displaced three-and four-part proximal humeral fractures. The study design is a 10-year retrospective cohort study with a minimum follow-up of 1 year. Material and methods: We approached 150 patients, aged C65, treated for a three-or four-part proximal humeral fracture in the University Medical Centre of Groningen between 2004 and 2014. Of the 91 respondents, 84 % were women, 75 % suffered from a three-part fracture and 25 % from a four-part fracture. 59 patients had received non-operative treatment and 32 patients received operative treatment. Main outcome measures where the mean differences in EQ-5D, DASH, VAS for pain and WHODAS domain 6, between the nonoperative and operative treatment group. Results: No significant difference was found between the two treatment groups in mean EQ-5D index score (p = 0.43), DASH score (p = 0.78), VAS score (p = 0.19) and WHODAS 2.0 domain 6 score (p = 0.09). The complication rate was significantly higher in the operatively treated group (p = 0.002). Conclusion: There is no evidence of a difference in health related quality of life (HRQoL) and functional outcome 1 to 10 years after operative versus non-operative treatment in elderly patients with a three-or four-part humeral fracture. Social participation shows a trend towards operative treatment. Complications occur significantly more in the operatively treated group. Introduction: A chronic periprosthetic infection with attendant failure of the knee extensor mechanism is one of the most disastrous outcome following total knee arthroplasty and knee arthrodesis may be the last possible option treatment with the exception lover limb amputated. The aim of this study is to represent the results to achieve knee arthrodesis in patients with chronically septic total knee arthroplasty. Material and methods: In our retrospective study we reviewed the clinical record of 27 patients who were treated with Ilizarov circular external fixator for this condition. Male to female ratio was 13 : 14. Main age of the patients was 62,3 years. We used Cierny -Mader classification for the clinical and pathoanatomical assessment. For the assessment of the bone defect we used Engh classification. Based on Paley's description, we classified all our complications as problem, obstacles and complications. Results: Complete union we had in 22 (81,4 %) patients. Mean time for healing was 5,7 months, range (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) . Mean residual limb shortness was 4,7 cm and mean follow-up was 21 months. We also had a five nonunion (18,6 %) complications: three with septic intra articular nonunion, two had intolerance to the Ilizarov apparatus, so we removed earlier. Introduction: This poster presents some of the less common, but severe complications of humeral head fractures. Material and methods: This case describes a skiing accident that caused a comminuted proximal humerus fracture and typical luxation of the largest fragment. Considering the fracture character and the large head fragment, she underwent a surgery revision that was aimed at reconstruction of the proximal humerus. Peroperatively there was found an arteria axillary stenosis, caused by the pressure of the luxated fragment. After discision of the stenotic part of arteria, there was seen an intimal laesion with complete lumen occlusion. Results: Vascular reconstruction was made, using vena saphena magna graft. Because of the comminuted fracture and vascular complication, we decided to remove all fragments except for rotator cuff bone insertions and following humeral head hemiarthroplasty. Eventually, compartment syndrome occurred. Acute forearm and distal arm fasciotomy was made, as well as axillary bypass revision. Fasciotomy was treated using NPWT and early fully reconstructed. After the soft tissues were healed, the humeral head hemiarthroplasty was made cooperatively with orthopedic departement. Conclusion: Luxation and humerus fractures belong to everyday experience of any surgical or traumatological workplace. There is no problem with the diagnosis and it also supports a wide range of surgical treatments. But as shown in the poster, there is a possibility of some severe complications, so it is important not only to watch out for this, but most importantly to react swiftly. Cooperation of traumatology, vascular surgeon, orthopedist and finally an experienced rehabilitation facility should provide the optimal conditions. References: Disclosure: No significant relationships. adult proximal femoral fractures classified as AO/OTA 31 type were treated at our trauma center. Ten (0.88 %) patients had coronal shearing fractures. Of these, two patients who did not undergo a complete follow-up examination at 3 months were excluded. The operative procedures, type of implant, quality of reduction, positions of lag screw or blade and clinical courses were investigated in the remaining eight patients. Results: All included patients underwent osteosynthesis, and none underwent femoral head replacement. Six patients were treated with an intramedullary nail and two were treated with a compression hip screw type implant. The quality of reduction was good in seven patients and acceptable in one. With regard to the clinical courses, five patients achieved union, one exhibited delayed union, and two required cut out. Although there was no avascular necrosis of the femoral head, the cut out rate was high (25 %). Conclusion: Coronal shearing fractures could be treated using osteosynthesis from the aspect of femoral head circulation. However, strict operative procedures, particularly to achieve good quality of reduction and implant position, are required in these patients because of rotatory instability and shearing force. Introduction: The purpose of our study was to evaluate the objective and subjective outcomes, as well as the radiographic results after elbow arthoplasty. Material and methods: In the years between 2004 and 2011 32 elbow arthroplasties were performed. These were 24 female and 8 men patients with a mean age of 65,8 years. By the means of regular follow-up examinations we were able to recruit 14 patients for the study purpose. There were 11 women and 3 men included. The mean follow-up period was 40 months. In 13 patients a Tornier Latitude and in one case a Coonrad-Morrey implants were used. All patients were examined and evaluated using the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder, and Hand score (DASH). Radiographic postoperative outcomes were assessed performing anteroposterior and lateral radiographs of the injured elbow. Results: According to the MEPS, 12 patients achieved ''good'' to ''excellent results'' and two patients revealed a ''fair'' clinical outcome. The mean DASH was 29 (range, 0-68). The flexion of the affected elbow was 100°(range, 55-160°), the extension deficit was 17°(range, 0-45°), the pronation was 75°(range, 20-90°), and the supination was 77°(range, 45-90°). The following postoperative complications were seen: one elbow instability, one ulna-plus and one wound infection. The last patient needed a replacement of the prosthesis. Introduction: Few data exist regarding outcomes of operative treatment of acetabular fractures in patients older than 65 years. With the population living longer, and activity levels rising, acetabular fractures at that age group are becoming more frequent. No consensus about the optimal management of acetabular fractures in elderly patients has been established. Treatment alternatives include open reduction and internal fixation, nonsurgical treatment, percutaneous fixation and acute or delayed total hip arthroplasty. Material and methods: Retrospective study. Analysis of operatively treated patients older than 65 years with acetabular fractures in the years 2012 and 2013 was done. Results: 13 operatively treated patients older than 65 years in this group sustained acetabular fracture. 11 patients had an acetabular fracture with central dislocation and two sustained posterior wall fracture. Patients with central acetabular fracture dislocation were operated with ilio-medial approach and patients with posterior wall fracture were treated with Kocher-Langenbeck approach. In two cases of acetabular fractures with central dislocation good reduction was not possible. Due to secondary arthrosis and increasing pain, two patients were later operated with total hip endoprosthesis. One patient died postoperatively because of the hearth failure. Others returned to the same level of activity they had prior to the fracture. Conclusion: Our data shows that open reduction with internal fixation even in elderly patients shows good results with low level of complications. It has a low conversion rate to total hip endoprosthesis at short and midterm follow up. Orthopedics, University Hospital Lewisham, London, UK, 2 Orthopedic, Univ. Hospital Lewisham, London, UK Introduction: Data concerning the fatalities of BCIS is sporadic and rare. Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint in a patient undergoing cemented bone surgery. Our case studies describes a cardiac arrest in two patients undergoing a cemented hemiarthroplasty. This report provides further clinical evidence of the risks and consequences of fat embolization during hip arthroplasty surgery, and outlined family's expectation from these incidence. Material and methods: We studied prospectively the events of BCIS in these two patients between 2010 to 2015 over 5 years period. Embolization happened during the intraoperative procedures, due to high intramedullary pressures developing between cement and prosthesis insertion. Coroner post mortem examination confirmed death due to cement embolisation. Results: These case studies confirmed that numerous patient-related risk factors might have been implicated in the genesis of BCIS including old age, poor preexisting physical reserve, impaired cardiopulmonary function, osteoporosis. Although to reduce surgical risk, for BCIS we performed medullary lavage, good hemostasis before cement insertion, minimizing length of prosthesis, and venting the medullary canal. The patients developed fatal consequences. Conclusion: Conclusion While using bone cement in patients with co-morbid diseases, modern cementing technique may alter the patient's hemodynamic status during and after use of bone cement. It may lead to unexpected fatalities. Lack of knowledge among the patient or family member's education about death following cemented hip arthrosplasty surgery was highlighted in coroner inquest of surgical death. Orthopedics, Johns Hopkins University Hospital, Baltimore, MD, USA Introduction: Displaced femoral condylar fractures can require combined medial and lateral plating. To minimize soft tissue stripping and nonunion, smaller incisions are preferred. Our goal was to determine the average distance of the distal medial neurovascular structures identifying a medial safe zone for MIPO. Material and methods: Eleven uninjured lower-half torsos were dissected on the bilateral medial lower thigh. A 20 cm incision was done from the mid-point of the medial femoral condyle and 1 cm above the knee joint. Superficial and deep neurovascular structures were dissected. The distances to the medial vastus and adductor compartment were measured. Statistical analysis with median and weighted mean values with standard deviation was performed. Results: Average distances from adductor tubercle to Hunter's canal and adductor hiatus were 159.95 ± 31.4 mm and 94 ± 18.31 mm, respectively. The average distance of these to the femoral shaft was 31.81 ± 9.21 mm and 31.72 ± 7.77 mm, respectively. All specimens had a descending genicular artery (DGA) and femoral nerve branch to vastus medialis with a distance to adductor tubercle of 98.4 ± 16 mm. The muscular branch of DGA crossed the femoral S152 shaft at about 53.02 mm from adductor tubercle, while the osteoarticular branch ran along with the adductor magnus tendon. The nerve to vastus medialis was at the posterior border of this entering at an average of 142.63 ± 62.96 mm from adductor tubercle. Orthopedics, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan Introduction: Recently the number of Fragility fracture of pelvis (FFP) is increasing in Japan. And we treat FFP with conservative treatment usually. But sometimes surgical treatment is necessary. So we investigated progress of FFP 120 cases in our hospital. Material and methods: We experienced 120 cases of FFP from 2012 to 2015, and we had surgical treatment 6 cases. All Females and mean age is 79 years old (63-92 y) According to Rommens FFP classification, FFP type III a 5 cases, and IV 1 case. We selected ORIF treatment 4 cases, and Ex-Fix 2 cases. Results: All cases acquired bone union. The amount of bleeding of ORIF surgical treatment cases mean 405 ml. Ex-Fix cases had a tendency of delayed union. All ORIF cases recovered to cane gait level. Conclusion: 5 % (6/120 cases) of FFP cases needed surgical treatment. And In our cases 5/6 cases of ORIF group are FFP type IIIa. In the cases of FFP type IIIa, fracture line exists Iliac most thin part, so bone contact is very few. We suppose FFP type IIIa has a tendency of displacement of fracture site during conservative treatment. Introduction: With the introduction of the VA-LCP, improvement is possible in the preoperative planning of posterolateral tibial plateau fractures using the 3-column classification approach. Our aim was to establish and validate the revised 3-column classification approach to guide the surgical planning of these fractures, including the PLC fractures better. Material and methods: According to the revised three-column classification, the PLC is defined the anterior and posterior border of the fibular head, and the artificial axle of the 3 columns. CT-images of 36 patients were reviewed and classified twice online according to Schatzker and revised 3-column classification approach by 5 observers. The intraobserver reliability was calculated using the Cohen's kappa and the interobserver reliability using the Fleiss' kappa. Results: The intraobserver reliability showed substantial agreement according to Landis and Koch for both Schatzker and the revised 3-column classification approach (0.746 vs. 0.782 p = 0.37, Schatzker vs. revised 3-column, respectively). However, the interobserver reliability of the revised 3-column classification approach was significantly higher as compared to the Schatzker classification (0.531 vs. 0.669 p \ 0.01, Schatzker vs. revised 3-column, respectively). The Schatzker classification is rated as a moderate agreement and the revised 3-column classification as a substantial agreement. Conclusion: The revised 3-column classification is not inferior to the Schatzker classification, but rather superior with significantly higher interobserver reliability, most likely due to its more simple nature. In contrast to the Schatzker classification, the revised 3-column classification approach is a helpful tool in the preoperative surgical planning of tibial plateau fractures, particularly fractures of the PLC. Introduction: Tracheobronchial injuries occur up to 10 % in patients with blunt chest and neck injuries. The diagnosis of such injury may often be delayed due to masking by other debilitating injuries. Literature reports of delayed repairs of tracheobronchial injuries up to 15 years with successful recovery. We report a case of a delayed diagnosed left main bronchial laceration with an initial presentation of bilateral pneumothorax and pneumomediastinum that eventually progressed to left total lung atelectasis and consolidation seen in a 23 year old man which was successfully rescued using robotic sleeve resection and anastomosis. Material and methods: Sleeve resection and anastomosis was completed under the Da Vinci surgical system via a 2 arm approach and an assistant using 4 ports. The obstructive lesion of the left main bronchus was resected, and end-to-end anastomosis was performed with 4-0 PDS interrupted sutures. Follow-up of the patient was done at 2 weeks, 1 month, and 2 months post-operatively. Results: The patient was successfully extubated on post-operative day 1. Bronchoscopic examination done at 9 days postoperatively showed healing of the anastomosis with luminal patency. Serial post-operative chest radiographic films showed full and equal expansion of bilateral lungs. Conclusion: The left lung was still salvageable because the vasculature was not compromised from the initial injury. Thus, even though the diagnosis was delayed, and the initial left main bronchial laceration eventually resulted in total lung atelectasis and consolidation, S154 successful surgical treatment can still be accomplished with return of the lung function after initial resuscitation and stabilization of the patient's general condition. Introduction: Non-operative management of hemodynamically unstable patients with blunt abdominal solid organ injuries is challenging. REBOA is effective in subdiaphragmatic hemorrhagic trauma patients. However, REBOA needs transfer to radiology S155 department and is performed with fluoroscopy for safety and adequate balloon positioning, but that can become a cause of delayed resuscitation. We perform echo-guided REBOA in ER, and have achieved safety catheter insertion and adequate balloon positioning. In this study, we reviewed a series of hemodynamically unstable patients with abdominal solid organ injuries managed non-operatively, resuscitated in ER with echo-guided REBOA, and treated with angioembolization. Material and methods: The catheter was inserted using the seldinger technique and following protocol. 1 st ; Puncture the femoral artery and insert the guide-wire. 2 nd ; Check by sonography that the guide-wire is in the abdominal aorta. 3 rd ; Insert the sheath and balloon catheter through the guide-wire. 4 th ; Check that the position of the tip of the catheter is surely above the diaphragm by sonography. 5 th ; Inflate the balloon until the waveform of the blood pressure measured from femoral artery is disappeared. All reviewed patients were appropriately resuscitated with transfusions, and angiography was performed after CT scan. All REBOA was performed before CT scan. Results: Seven patients underwent REBOA in ER following severe blunt abdominal trauma. The 28-day survival rate was 86 % (6 of 7). There were no complications related to the procedure. Conclusion: Clinical series of hemodynamically unstable patients with abdominal solid organ injury resuscitated in ER with echo-guided REBOA and treated with angioembolization were described and their survival rate was 86 %. Introduction: This retrospective monocentric study analysed the outcomes of a modified direct reduction technique for diaphyseal humeral fractures with a proximal component. Plate osteosynthesis with a neutralisation plate, moulded peroperatively, was performed through an extended deltoid split approach. Material and methods: Since December 2013 eleven patients have been treated for a diaphyseal humeral fracture with a proximal component. A specific modified open reduction technique was used to treat this particular fracture type. Mobilisation was started immediately postoperatively. All patients were treated by the same surgeon and regularly procedure. Post-operative evaluation was performed every month up to six months with clinical and radiological assessment. Results: Our study population consist of eleven patients with an average age at surgery of 66 years. All injuries were the result of a simple fall or trauma. All fractures were of AO-classification type 12-C1. Our final results after six months follow-up showed no cases of wound infection, intra-articular screw penetration or avascular necrosis of the humeral head. There were no patients with permanent palsy of the radial or axillary nerve. Average postoperative shoulder active range of motion was good to excellent. Conclusion: Surgical treatment of diaphyseal fractures of the humerus with a proximal component is a difficult entity. Our goal was to improve reduction and enhance fixation while making the surgical procedure technically more manageable. This technique provides appropriate reduction and allows for early post-operative mobilisation. Furthermore this technique provides a more safe removal of hardware by reducing the risk of nerve damage. Introduction: Until now there is a lack of insight in weight bearing after lower extremity fractures. An innovative ambulant monitoring device, SensiStep, enables weight bearing measurements during gait. Moreover, SensiStep provides real-time feedback about weight bearing to patient and healthcare professional. Material and methods: Four consecutive patients who underwent surgical fixation or conservative treatment of lower extremity fractures with non-weight bearing and three additional patients with full weight bearing were monitored using the SensiStep. Following standard instructions and at least one conventional training session, patients were asked to walk 20 meters in a straight line. First, feedback was provided according to standard protocol and SensiStep was only used to register the amount of weight bearing. Secondly, SensiStep was also used to provide realtime insight and feedback about weight bearing and same measurements were repeated. All studies comparing pronator quadratus repair with no pronator quadratus repair in adult patients undergoing volar plate fixation for distal radius fractures, with a minimum follow-up of 12 months, were included. The primary outcome was functional outcome, measured with the Disability of the Arm, Shoulder and Hand questionnaire at 12 months follow-up. Secondary outcomes included range of motion, grip strength, post-operative pain and complications. Results: A total of 169 patients were included, of which 95 underwent pronator quadratus repair, while 74 patients underwent no pronator quadratus repair. After 12 months follow-up no statistically significant differences in DASH-scores and range of motion, especially in pronation and supination, were observed between the repair and the no repair group. Moreover, post-operative pain and complication rates were similar between both groups. Conclusion: In this systematic review we found no statistically significant differences between repair of the pronator quadratus muscle after volar plate fixation and no repair. Therefore, we do not recommend pronator quadratus repair after volar plate fixation in the distal radius. Orthopaedic Surgery, Kitasato University Medical Center, Kitamotocity, Japan S157 Introduction: The system of the new proximal retrograde humeral nail for the proximal humeral fracture should include the possibility of prevention of the humeral head, minor invasive operative procedure and protection of the rotator cuff. Material and methods: Entry of this nail occurs laterally underneath the onset of the deltoid muscle. Thread appendage in the nail assures angle and glide stability of the screws. The waschers can be used for increased incursion safety due to osteoporosis. Results: Ten proximal humeral fractures were applied by these new nails. We found that all fractures were achieved bone union and any complications were not occurred during surgery and after surgery. Besides the fact that there is no need for an anaesthesiologist, this technique has several other advantages. The procedure can be performed on an outpatient basis, there are fewer costs involved and in high-risk patients it is also an option. Conclusion: Split skin grafting without the intervention of an anaesthesiologist is possible and seems to be a good alternative to the conventional techniques. References: Disclosure: No significant relationships. Introduction: We report two cases of pathological fractures treated with intramedullary photodynamic fixation with the IlluminOss Ò system. Material and methods: The technique uses light cured polymers filled into Dacron balloon catheters. After closed reduction, the balloon catheter is inserted in the previously reamed medullary canal in Seldinger-technique. The balloon is filled with the liquid monomer which is then hardened by light application. The first patient had a pathologic fracture in the left radius shaft caused by multiple myeloma. The fracture was stabilized with a photodynamic standalone implant. The second patient had a nonunion of a pathological femur fracture due to metastatic prostate cancer. The initial nailing and two attempts of compound plate osteosynthesis had failed. Here, two photodynamic implants and a VA-LCP were used. Results: The postoperative treatment of the first patient comprised immediate functional exercising of the left forearm with full fracture healing after one year and a good functional result. For the second patient, the osteosynthesis dramatically reduced the pain and allowed immediate partial weight bearing. The construct was stable enough to prevent further dislocations, and to allow fracture healing to slowly occur. Conclusion: Photodynamic implants adapt to the morphology of the medullary canal, providing a tight fit. The entry point is not as strictly defined as for rigid nails. The implants do not inhibit endosteal remodelling and angiogenesis and can also be used as augmentation material for screws. Implant removal of the implant is probably very difficult The indications these implants should be placed carefully. Introduction: Distal radioulnar joint (DRUJ) instability may progress to osteoarthritis of the distal radioulnar joint, causing chronic wrist pain and dysfunction. Restoration of stability of the DRUJ and a full, painless arc of motion are the goals of surgical treatment. The ideal reconstruction technique would provide the stability of the Adams procedure while limiting surgical exposure. This study describes a minimally invasive procedure for stabilization of the distal radioulnar joint (DRUJ), using a suture-button construct placed percutaneously in the course of the distal oblique bundle in the distal interosseous membrane. Material and methods: Five fresh-frozen cadaveric specimens were used for this study. Dorsal translation of the radius relative to the ulna was measured in neutral position, 45 degrees of pronation and 45 degrees of supination. The DRUJ was then disrupted and translational measurements were repeated. Next, the TightRope was S158 percutaneously inserted through ulna and radius at an angle of 45 degrees to the radial insertion point, following the direction of the distal oblique bundle. After this procedure, translational measurements were repeated again. Results: Dorsal translation of the radius increased considerably after disruption of the DRUJ. This difference was statistically significant in neutral and supinated position (p = 0.043 and p = 0.043, respectively), though not in pronated position. After restoration using the TightRope system, translation returned to baseline values. The surgical procedure was easy to perform and took on average 10-15 minutes. Introduction: Double plate osteosyntheses offer an increased stability in periprosthetic femur fracture fixation. Another option are locking attachment plates (LAP), providing a bicortical screw fixation lateral to the prosthesis shaft. These two options, a lateral plate osteosynthesis with two locking attachment plates and an anterolateral double plate osteosynthesis were compared in a biomechanical test. Material and methods: Methods: Paired human femora with cemented Charnley hip endoprostheses were transversely osteotomized distal to the prosthesis stem. Each pair (n = 6 per group) was instrumented with either an anterolateral LCP double plate osteosynthesis or an lateral LCP with two LAP using a plate tensioner and cyclically (2 Hz) tested up to failure applying the Bergmann profile and a monotonically increasing load up to failure. The stiffness of both constructs was evaluated in a non-destructive four point bending and a torsional test. Statistical evaluation was performed with student t test for paired comparisons and Wilcoxon signed rang test (p \ 0.05). Results: The double plate construct showed a significantly higher number of cycles and corresponding load to failure (D: 39627 cycles±4056, 4463 N±906; V: 32927 cycles±3487, 3793 N±849, p = 0,004) and a significantly higher bending stiffness (D: 1610 N/ mm±249; V: 1077 N/mm±189, p = 0,03) and torsional stiffness (D: 16.9Nm/mm±6.3; V: 12.1Nm/mm±3.9, p = 0,03) Conclusion: Anterolateral double plating is another option in periprosthetic fracture fixation and provides additional stability compared to a single lateral plating construct with two LAP. There is wear and tear of the ligament and collagen. It causes pain in the heel and bottom of the foot. Previous research has attempted to explain the causes of plantar fasciitis, these include obesity, exercise and long periods of standing. The most common mode of treatment includes Extracorporeal Shockwave Therapy (ESWT), dry needling (+/-injection). Material and methods: Our study assessed the success rates of percutaneous dry needling and injection for plantar fasciitis. The sample consisted of thirty-two patients that had plantar fasciitis confirmed on Ultrasound imaging. The degree of fasciitis was assessed by looking at the thickness of the fascia and neurovascularity. Patients were symptomatic for over four months and had already received conservative treatments that were unsuccessful, including NSAIDS, foot wear with gel pads and physiotherapy. The procedure was performed by two consultant musculoskeletal radiologists. After the procedure patients were given a questionnaire to complete. This looked at pain score just before and upto a month after the procedure. Results: The outcome was promising. Over 85 % (22/27) of the patients were happy with the treatment. They report the pain had significantly improved after the procedure. Conclusion: Percutaneous dry needling and injection of the deep layer with ultrasound guidance is a successful non invasive treatment for plantar fasciitis. It allows faster recovery and reduces the rate of complications compared to more invasive procedures. References: Disclosure: No significant relationships. S159 P128 EFFECTIVENESS OF REGIONAL NERVE BLOCK ON CLAVICLE AND SHOULDER SURGERY Orthopedic Surgery, Hekinan Municipal Hospital, Hekinan City, Aichi prefecture, Japan Introduction: Shoulder and clavicle operations have often been performed under general anesthesia, but it requires more human resources and time than regional anesthesia. We adopted these operation under only regional anesthesia since 2014. The aim of this study was to consider the utility of regional anesthesia operation by comparing brachial plexus block and general anesthesia. Material and methods: 62 patients who underwent a clavicle and shoulder operation (ORIF and removing implant) were chosen in retrospective from January 1, 2013 to January 1, 2015. They were allocated in two groups: brachial plexus block group (BG, n = 31) and general anesthesia group (GG, n = 31). Brachial plexus block was performed using nerve stimulator and ultrasound. We evaluated the waiting days of ORIF, In-operation room time excluding operation time, complication and the annual number of general anesthesia cases. Results: In-operation room time for brachial plexus block was shorter than general anesthesia (mean BG-59.5 min versus GG-79.0 min). The annual number of these operations under general anesthesia could be decreased (26/26 case, in 2013 versus 5/31 case, in 2014). There were 4 complications of brachial plexus block cases (2-bradycardia, 1-Horner syndrome, 1-nausea). General anesthesia were 4 cases (all of low blood pressure). There were a few differences between the two groups for the waiting days of ORIF operation (BG-2.5 days versus GG-4.2 days). Conclusion: we found these operations under regional anesthesia to be effective. But nerve block has a learning curve for each operator, particular complications must be performed carefully. To present our early results from augmentation with allo-and autografts for 3-and 4-part fractures of the proximal humerus, stabilized with locking plates. Material and methods: 63 patients (47 female and 16 male mean age 69 years) were operated with angulary stable plates. According to the Hertel criteria, 30 % of the patients were eligible for primary arthroplasty. PHF were distributed as follows: 30 patients (12 with 3-part and 18 with 4-part fractures, 10 of them with varus dislocation and medial metadiaphyseal comminution) were stabilised with additional supplementation with 3-cortical ABG. Of the rest 33 (15 with 3-part and 18 with 4-part fractures; 25 in varus and 22 with medial comminution) 20 were stabilized with additional supplementation with fibular cryoallografts, 13 -with tibial strut allografts; 40 PHF were operated with MIPO LTD, and 23 -with DP approach. Introduction: In progressed osteoporotic disease conventional operative treatment of fractures often leads, especially in presence of long segment comminuted fractures to unsatisfactory results. Material and methods: Through a small incision a Dacron-balloon-catheter is inserted into the medullary canal after reaming with a flexible cannulated drill. The balloon is filled with a liquid plastic-monomer. Curing of the monomer using blue light (wavelength 436 nm) is achieved creating a customized intramedullary rod. The balloon adapts to their regular shape of the medullary cavity. After the curing process an angle-stable locking screw or a plate may be used in combination with the implant to increase stability. Results: Nine female patients with distal forearm fractures with an average age of 77,6 years were treated from 09/2011-06/2014. 3/9 distal radial fractures were treated with the Polymer in a retrograde fashion in combination with a locking screw. 1/9 patients was operated with a Hybrid-Osteosynthesis consisting out of the polymer and an angle stable palmar plate. 3/9 radial fractures obtained an extraarticular external fixator without the polymer. 2/9 patients were treated with palmar plate in combination with an external fixator. Mean follow up was 150,6 days. In all fractures bone healing was documented radiologically. Conclusion: Treatment of osteoporotic distal forearm fractures using an intramedullary polymer implant is suitable to manage long segment fractures. The radiolucent polymer allows radiological visualization of the entire bone and facilitates radiation therapy in select cases. Stability may be increased either with locking screws placed at any position of the implant as determined by anatomical safe zones or with plates. Introduction: The reduction of cortical bones mechanical resistance resulting from under pressure contact of any peripheral system device is well known to the orthopedic surgeons and it is ascertained in daily trauma practice. Some influential authors have deepened the biological aspects and consequently have inferred the possible clinical complications of a reduced periosteal blood supply and also of a damage of periosteal mechanoceptors. We have therefore decided to introduce a new cerclage system, consisting of a wire with some pure titanium spacers to reduce the contact zone to only 6 points. Material and methods: The low contact cerclage was applied to 30 patients with different femural fracture with patterns that were easily reduced by cerclage In all these patients the cerclage was associated with other osteosynthesis systems. The Xrays were taken every 30 days until the fusion was reached Results: In all the patients we observed a fast bone recovery and no case of implant failure. All these patients showed no creeping substitution near the cerclage and all reached rapid e complete recovery. The follow up was for all the 30 patients carried on until the radiographic evidence of bone repair with a mean of 4 months (from 3 to 6 months). Conclusion: This cerclage system, thanks to the spacers, reduces the perimetral extension of the pressure applied to the cortical bone and consequently prevent periosteal blood supply damage. Authors review first cases treated with the above mentioned system and open the discussion on this topic. Results: 824 Patients were treated with unfocused ESWT. Mean age was 57.58 years ± 20.05 (SD). 79,9 % of wounds were located on the lower extremity. The majority of treated wounds were posttraumatic (81 %). We achieved complete healing in 72 %, irrespective of etiology, of the wounds treated with defocused ESWT (0.1 mJ/mm 2 , 3 to 5 Hz). On average complete healing was seen after 47 days (.± 45 SD) following the first ESWT receiving 3 ± 2 treatments (mean ± SD; min-1 and max-11). In comparison of 54 patients with diabetes to 152 patients without diabetes (diabetes 41-91 years; non diabetes. 39-90 years) no significant difference in wound healing could be found (non diabetes 74 % vs. diabetes 70 %). Conclusion: During the last 10 years of treating chronic and subacute wounds of different etiologies with ESWT we could show excellent consistent results. Patients suffering from non-healing wounds with diabetes in the medical history respond as well as patients without diabetes. Introduction: Paediatric ESIN osteosynthesis enables early weight bearing without a cast. (1) However, a second removal operation is needed for common implants. Magnesium implants render a second surgical intervention. Rare-earth (RE) elements are frequently used for alloying to decrease degradation speed. Nonetheless, they are considered to be noxious. Aim of this pilot study was to evaluate the degradation of RE-free Zn-poor Mg-Zn-Ca ESIN implants in an in vivo sheep model to enable the use of ESIN implants in paediatric trauma. Material and methods: 7 sheep tibiae were implanted with two REfree magnesium alloys: alloy ZX10 (Mg-1Zn-0.3Ca, N = 3) and alloy ZX00 (Mg-0.3Zn-0.4Ca, N = 4). The materials were extruded to rods with a diameter of 3 mm and cut to a length of 25 cm, according to a preoperative length measurement of the sheep tibia. A standard implantation according to paediatric trauma osteosynthesis was performed using 2 ESINs (of diameter 3 mm) in the sheep tibia. All surgical interventions were performed under sterile clinical conditions. Continuous clinical CT imaging (Siemens Sensatom 64) was performed at 2, 6, 12, 24 and 52 weeks after implantation. Volume, surface and gas evolution were quantified with Materialise MIMICS, ver. 17. Results: No adverse effects could be noticed. A faster degradation and increased hydrogen gas production was seen in the alloy ZX00, visible degradation started after 2 weeks in vivo. Conclusion: Our investigations in a sheep model show that the degradation characteristics of RE free Mg alloys achieve the prerequisites for the use in paediatric orthopedics Orthopedics, University Hospital Lewisham, London, UK Introduction: Traumatic rupture of quadriceps tendon is a debilitating condition. This can result in intractable pain, limp, and instability of the knee. There have been various methods described for repairing or reconstruction of this quadriceps muscle complex including direct trans-osseous repair, muscle transfers, muscle and tendon sling, bone tendon allograft reconstruction and endoscopic repair techniques. Material and methods: Evaluation of results included pain scoring, gait evaluation, single leg stance and squatting. There was a significant improvement in pain (VAS mean values 7.9+/-1.4 to 2.8+/-0.8), limp and gait along with quadriceps strength. The deep squatting at 6 months post surgical repair became possible in all but one. Overall this procedure appears to be safe and associated with high patient satisfaction, without the morbidity of any tendon or muscle transfers. These augmention material did not fail when subjected to excessive loading during the rehabilitation period. Results: Evaluation of results included pain scoring, gait evaluation, single leg stance and squatting. There was a significant improvement in pain (VAS mean values 7.9+/-1.4 to 2.8+/-0.8), limp and gait along with quadriceps strength. The deep squatting at 6 months post surgical repair became possible in all but one. Overall this procedure appears to be safe and associated with high patient satisfaction, without the morbidity of any tendon or muscle transfers. These augmention material did not fail when subjected to excessive loading during the rehabilitation period. Introduction: The golden standard method of a tension band wiring (TBW) used for the internal fixation of olecranon fractures still have a high rate of complications and recent studies questioned the paradigm of converting posterior tensile forces into compression during active elbow extension. The aim of this study was to compare the stability of the TBW versus an alternative, novel olecranon tension plate (OTP) in a simulated complex fracture model. Material and methods: We tested 8 fresh frozen-pairs of cadaver proximal ulnae osteotomized oblique with an additional wedge fragment. The TBW and OTP were implanted pairwise. The elbow motion ranged from full extension to 90 degrees of flexion, and the pulling force of the triceps tendon ranged from 50 N to 250 N. The displacement of the fracture fragments was continuously measured with a video motion analysis system over 304 cycles. Data were assessed statistically using the Wilcoxon signed-rank test. P \ 0.05 was considered as statistically significant. Results: The cyclic loading tests showed displacements of the fracture fragments of 0,37 mm using TBW and 0,14 mm for OTP. Statistical analysis showed the difference to be (p = 0,31) not statistically significant. No plate breakage or screw loosening occurred. Conclusion: The concept of replacing prominent K-wires at the proximal end of the ulna using an low-profile plate with lag and S162 angle-stable screws demonstrated no statistically relevant advantages over TBW in a tested fracture model. Nevertheless, the higher stability offered by this new implant along with screw system that reduces the backing out of screws may find clinical usage. Introduction: Current methods of diagnosing peripheral nerve injury include clinical assessment and electrophysiological examinations. In the past MR imaging and ultrasound have only played a role in detecting mass lesions that compress a nerve however, we propose a wider use of these modalities. They provide high quality images to detect nerve injury and its associated soft tissue abnormalities. Material and methods: We illustrate three things in this article: the basic anatomy of extremities, specialised MRI and US techniques and image finding of nerve lesions and associated soft tissue damage. These modalities provide high quality images that give a more in depth knowledge of the distribution of nerves and their pathological classification, e.g. demyelinate vs axonal. They provide intrinsic and extrinsic information on peripheral nerve damage that may not be detectable on electrophyiopsological tests. We demonstrate the use of MRI and Ultrasound in diagnosing peripheral nerve lesions. We will provide images to explain advantages of using these modalities over others. Results: We demonstrate optimal Ultrasound and MRI techniques to assess nerve lesions. We use individual case examples to demonstrate the range of image findings in peripheral nerve lesions. We have had positive feedback from our clinicians in reaching diagnosis. In our institution we have a One Stop Clinic Model for an instant US in Fracture and Orthopaedic clinics. Conclusion: As well as clinicians, radiologists play a major role in assessing peripheral nerve lesions. Optimal radiological techniques to demonstrate nerve lesions and high quality images to illustrate a range of findings in nerve disorders will improve patient management. Introduction: Virtual medics is a not for profit organisation that is a world leader in the field of innovating medical and surgical education. We have developed a programme -ROSE -remote online surgical education. As a preliminary study we taught a group of students how to tie and hand reef knot using either face to face or virtual teaching and then assessed them. Material and methods: 20 first year medical students with no previous exposure/experience in suturing were enrolled. They were randomly allocated to one of two group -Pott or Blizzard. The virtual teaching was a high quality teaching video of the stitch. The Pott group received only face-to-face teaching for 15 minutes. The Blizzard group received only virtual teaching for 15 minutes. Both groups were then assessed immediately after, at one week, two weeks and one month. The Blizzard group had access to the online teaching materials for the follow up period while the Pott group did not. Results: The Pott group (face-to-face) all 10 received 100 % on initial assessment. The Blizzard group (virtual) 2/10 got 50 % and 1/10 got 25 %, 7/10 got 100 % on initial assessment. Follow up assessment is still pending but we expect a high rate of retention for those with access to online videos compared to just face-to-face teaching. Conclusion: Remote teaching of surgical skills leads to a good appreciation of technique with good assessment results. We expect S163 those with access to online resources to have greater retention of skills comapred to face-to-face teaching. More studies are needed. Disclosure: No significant relationships. Introduction: Tibial plateau fractures remain one of the most challenging problems in modern traumatology, due not only to their functional impact upon the limb, but also due to their diversity, which require, sometimes, several therapeutic means. The purpose of this paper is to illustrate the complexity of the algorithm for treating these fractures. Material and methods: This prospective study evaluates 68 patients operated between 1.06.2009 si 1.06.2013 for closed tibial plateau fractures -39 men, medium age 46 yrs (20-66). Fractures were classified following the AO classification; the implants used were : L/T plates (10 cases), angular stability implants in 10 cases, CREF (10 cases). The patients were evaluated regarding the functional scores, local and general complications. A mulitnodal multi-steps algorithm was finalized and the patients were analysed regarding the result compared to the compliance to this algorithm. Results: A 24 months follow-up showed excellent results in 38 cases, good in 12 cases, satisfactory in 10 cases and unsatisfactory in 8 cases . The complications were septic (2 cases) and 4 malunions. The results were significantly better after A and B type fractures than after C type. The critical points of the algorithm were: pre-operative planning, optimal treatment of depression, stable restoration of metaphyseal angle. Conclusion: Restoration of functional anatomy is mandatory in order to obtain an optimal result after tibial plateau fractures. A pre-operative '' check-list'' with key-points can prevent failures in reduction and fixation, with important functional consequences. Introduction: The management of supracondylar femoral fractures remains a challenging issue. Traditionally these fractures are treated with an open reduction and internal fixation using of an anatomical distal lateral femoral locking plate. However, with this technique nonunion rates of up to 20 % have been reported. One possible explanation for the suboptimal outcome could be instability and varus collapse at the medial cortex. A way to counteract this problem could be a second locking plate to the medial cortex. Material and methods: The observed population consists of 17 patients who were all treated for supracondylar femoral fractures, 7 of these were periprosthetic, by a double extra-medullary locked plating consisting of both the classical lateral locked plate combined with an additional medial angle stable plate. All patients with a minimum of 6 months of follow up were included. Three patients died due to unrelated causes. Two more patients got lost to follow up. The 12 remaining participants were evaluated for union, clinical outcome and complications. In this monocentric study, all patients were treated by the same surgeon. Results: At the time of submission all of the patients showed union of the fracture. Clinical outcome was generally excellent to satisfactory except for two patients who were good initially but required revision surgery at a later time. Two patients with complications were observed consisting of one infection, and one hardware failure. The preliminary results of this study indicate good union rates and clinical outcome in most patients treated with both a medial and lateral distal locking plate. Remarkably patients benefited from early weight bearing for short transfers. None of the patients has a flexion deficit. Demonstrating a possible further benefit of the procedure. Although this study is only based on a small set of patients it shows this might be a valuable alternative to managing supracondylar femoral fractures. Further research to determine the effect and the place of this technique, is warranted. References: Disclosure: No significant relationships. Results: In total, 16 consecutive patients with 16 tibia fractures were treated with a gentamicin-coated intramedullary nail. The patient population was subdivided into two groups. The first group consisted of 11 patients (68.8 %) with acute fractures who were treated with a gentamicin-coated intramedullary nail. The second group consisted of 5 complex revision cases (31.2 %). In our patient population no deep S164 infections could be noted after the treatment with a gentamicin-coated tibia nail. Nonunion was diagnosed in 4 patients (25.0 %), 1 of these was a revision case. Conclusion: The purpose of the study was to evaluate a gentamicincoated tibia nail in the prevention of implant-related infection. In our patient population no deep infections occurred after placement of the gentamicin-coated nail. Following this study and literature data, antibiotic-coated implants seem a potential option for prevention of deep infection in trauma patients. A description of the extra-curricular opportunities also available due to full salary while abroad. High quality images to fully illustrate the above. Results: Review of caseload and exposure My logbook for trauma included extensive experience including stab hearts, VATS thoracoscopy, trauma laparotomies, liver packing, splenectomy, pelvic packing, visceral rotation for retroperitoneal bleeding. My logbook for emergency general surgery included multiple laparotomies ([50), amputations, debridement for necrotising fasciitis. Academic opportunities (2 international presentations) and inexpensive trauma courses such as DSTC (run by Prof Boffard), ATLS were also available. Extracurricular activities included South African food and wine, sport (mountain climbing, rowing, sailing), travel, all within budget due to South African government salary. Conclusion: Spending a year in trauma surgery in South Africa on a full salary through AHP can be a once-in-a-lifetime experience professionally and personally. It is important to be aware of the drawbacks to a year abroad, and time your experience carefully. Introduction: Accidental hypothermia (AH) may lead to cardiac arrhythmias and cardiac arrest. The use of cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) may be warranted in patients with AH (core temperature \28°C and/or cardiac arrhythmia/asystole). Selection criteria are needed for optimal treatment and a successful outcome. Material and methods: A retrospective analysis was carried out. Based on the literature and our hospital's emergency protocol, we reviewed the patients' histories to identify prognostic factors that may affect the clinical outcome. Results: Nineteen adults and five children with AH were treated with CPB/ECMO from January 2007 till September 2015. Eight survived, sixteen died. The mechanisms of AH were environmental exposure (n = 10), drowning (n = 11) and avalanche burial (n = 3). None of the patients that drowned or were buried survived. Only two patients died following AH due to environmental exposure. Median potassium and lactate levels were significantly lower in the survival group compared to the non-survival group. Conversely, time to CPB/ECMO was significantly higher in the survival group, suggesting that response time is secondary to the mechanism responsible for AH. All survivors had cardiac electrical activity. None of the non-survivors did. Conclusion: Accidental hypothermia may result in death. Transport to an institution that can provide CPB/ECMO is crucial. The mechanism of hypothermia seems to be the most predictive factor as to the clinical outcome. Accidental hypothermia in the setting of drowning or asphyxia has a dismal prognosis and restraint from active treatment should be considered. CPB/ECMO should be administered in all patients with AH and circulatory collapse due to environmental exposure. Introduction: Impalement injury is a type of trauma defined as a penetrating wound caused by an object with a blunt tip. It's mostly related to falls and sexual activity. Usually, impalement injury is associated with wound contamination and possible injury to deep organs and blood vessels. The foreign body may be providing tamponade if a major vascular structure is injured; hence, there is a possible benefit to leaving the foreign body in place until radiologic evaluations are performed. Surgeons should obtain as much information as possible about the impaled object and mechanism of the injury. Material and methods: We report the successful management of impalement trauma to the left thigh. Results: A 32-year-old man fell approximately two meters and landed on tree branches. He impaled his left thigh on a branch that was 2 cm in diameter. The patient was transported to our emergency department. Antibiotics, analgesics and tetanus vaccination were administered. The patient was hemodynamically stable and XR showed a foreign body with approximately 10 cm in length. A computed tomographic angiogram showed the foreign body in the soft tissues of the left thigh closely to the femoral vessels but without extravasation of contrast. In the operating room, the foreign body was removed carefully, and the wound was explored, irrigated, drained and closed. The patient had an uneventful postoperative course. Conclusion: In hemodynamically stable patients the preoperative studies are of great importance. In our case computed tomographic angiogram confirmed the anatomic location of the tree branch and the absence of contrast extravasation, simplifying surgical approach. Introduction: Time management is precious to save life for severe traumatic patients. Once a patient occurred nonresponsive shock status, we usually performed thoracotomy and/or laparotomy in emergency room (ER). Unfortunately we experienced time consumption resulted in losing opportunities to transfer patients from ER to the operation room (OR). One of the reason of time consumption was delay to preparation of ready to use the OR. In order to resolve this problem we conducted team building training for our medical staff, especially OR nurses. Material and methods: OR nurses took lectures of team building approach and off-the-job training including assistance of operation in living animal. OR nurses discussed and changed the strategy of care for severe trauma patient who needed to urgent surgery. We surveyed the improvement of preparation for OR including surgical instrument and equipment for urgent surgery for trauma. Results: The survey showed 38.5 % (5/13) was prepared for OR in time before changes of strategy. In contrast 69.2 % (9/13) was successfully prepared in time after changes and they just spent 17.5 ± 9.4 minutes after the request to use OR by trauma surgeon. OR nurses acquired knowledge, assistance skills, consideration and confidence of strategy for severe trauma patients. They also modified preparation for operative equipment and surgical instrum. Additionally working in a team has not been reflected in the traditional courses that were available. The goal was to create a course that this focused on a team approach and flexible to adaptation to local protocols. Based on up-to-date adult learning models 85 % is practical simulation based team training. Material and methods: A database search of the ERC course data base (courses.erc.edu). Data were displayed according to country and month of the course. (7), Portugal (6), Belgium, Finland, Denmark (5), Hungary(4), Saudi Arabia, Sudan, Sweden, Switzerland and Romania (3), Jordan (2) Introduction: Exercises and their evaluation are an important element of preparedness for major incidents and disasters. Most S166 evaluation techniques rely on reports from observers overviewing elements of the exercise. Data from registration systems and observational cameras can also be reviewed to judge the functioning of a hospital during the response to a major incident. However, these observation techniques only show a part of the process the patients actually goes through and most data can't be reproduced. Material and methods: To develop a new, more interactive, modality of evaluation a compact action camera was positioned on head of patients during two major incident exercises. After the first exercise a protocol was designed to evaluate the patient perspective video, this protocol was used to evaluate the second exercise images. The camera recorded from the arrival at the hospital until admittance to one of the wards. The videos were evaluated and compared to the data gained from evaluations of observers, registration systems and the patient self. Results: We expect to present different insights through this technique. Results will follow shortly. Conclusion: The aim of this protocol is to develop a prospective, standardized method to evaluate a hospitals major incident response with the use of video images shot from the patients' perspective. Introduction: Cervical spine protection is performed at the very first step in the ABCDE principles to prevent secondary damage to the spinal cord. Thus, spinal immobilization has been a standard procedure in prehospital trauma care for many decades. In view of increasing reports of disadvantages and complications of immobilization, guidelines recommend thoughtfully provided indications for spinal immobilization and using a decision-support tool to facilitate rapid and valid on scene decision. The goal of this study was (1) to develop a new protocol providing indication for spinal immobilization in trauma patients and (2) to carry out the first applicability tests by emergency medical personnel via a questionnaire. Material and methods: Based on the current literature and guidelines, the E.M.S. IMMO Protocol for adult trauma patients was developed and graphically transfigured following a first (21 participants) and a second (50 participants) applicability test by a questionnaire. Results: The first survey was stopped after intermediate evaluation (21 participants) because 3 questions that verifies applicability of the protocol were frequently answered incorrectly. The protocol was therefore redesigned graphically to its current version. The applicability of the new version was confirmed in a second survey of a different set of 50 participants. However, responses to all questions regarding immobilization of trauma patients were now improved. Introduction: Infection is a major problem in orthopaedic surgery and is a major burden on the patient, surgeon and trust. Theatre doors, which are constantly opening and closing during theatre cases, interrupt laminar flow with wound contamination being a direct result from disruption in the laminar airflow system. Evans demonstrated the effectiveness of laminar flow systems in theatres in 2011. Material and methods: Data was collected over one day with five theatres including trauma and elective theatres being examined. There were six different consultant lists. The numbers of times the main theatre door and anaesthetic door were opened and closed were monitored respectively throughout the day. Doctor and nurse data was collected separately. Results: There were four theatres analysed over one day with six different consultant lists. Overall, doors were opened 663 times across 4 theatres in one day. Overall results showed that more nurses went in and out of theatre compared to doctors. One case in a trauma theatre had more nurses entering during trauma hip surgery compared to an elective theatre for a total hip replacement. General observations showed many staff were not aware of infection control and did not use the appropriate precautions. There was multiple staff with scrubs untucked and surgical masks being worn outside theatre. Conclusion: It is clear from the results collected that theatre staffs need further education on infection control within theatres and surrounding areas. Most importantly measures should be taken to reduce theatre traffic to in turn reduce the chance of prosthetic infections. References: Disclosure: No significant relationships. hospital to the MIH. The scenario again became reality when a neighbouring hospital had to evacuate in September 2015. This article evaluates and compares the exercise to the real events to further optimize future training. Material and methods: The events are analysed using the Protocol for Reports from Major accidents and Disasters, a standardised protocol to evaluate major incident medical response. Results: During the exercise 72 patients were received, 143 and 70 respectively during the 1995 and 2015 events. Personnel from the evacuating hospitals accompanied their patients and continued working in the MIH. Patient surge differed on all occasions. IT systems proved to be more prone to fail during real events. Legal implications to have staff from another hospital work in the MIH were protocolled during the deployment. The acute phase was comparable in all events and performance was good, however the exercises duration was too short to analyse the possible implications on multiday care. Conclusion: Large-scale major incident exercises are a great benchmark for the medical response in the acute phase of relief. The MIH has shown to be highly prepared for evacuation events, guaranteed by experiences from the past combined with regular training. Key differences between a true deployment and exercise are mainly found in the inability to train multiple days and operation of IT systems. Introduction: A clinical audit of patients with upper gastrointestinal bleedings gives a possibility to plan medical resources needed for a dedicated surgical unit. The aim was to analyze a workload (etiology, references, intensity, and prognosis) for gastrointestinal bleedings in a specialized unit. Material and methods: A total of 112 patients with upper gastrointestinal bleedings were included in the study. They were hospitalized from 2.2014 to 07.2014 at Sumy Regional Clinical Hospital. Exclusion criteria were a gastric stenosis (n = 5) and an ulcer disease without bleeding (n = 18). In a final analysis we compared two groups with bleedings: ulcer (n = 69) vs. nonulcer (n = 43). The statistical report was realized with risk and odds estimations, U-and z-tests, and calculations in AtteStat 2013. Results: The hospitalizations with ulcer bleedings were significantly more frequent comparing to nonulcer bleedings (U = 2,045). The patients with ulcers presented a majority (62 %) in the etiological structure of bleedings. The ambulance service of patient reference was dominant, especially for ulcers, among all others (self-reference, transport from public or private hospitals) (z = -3.7; p = 0.0001). One patient admission a day was observed in 77 % (p = 0.05). The workload for all bleedings was higher in a workday than in a weekend (OR 0, 93; CI 95 %[0, 3; 2, 1] ). The most expected event was «an ulcer bleeding in a workday», the most unexpected event was «a nonulcer bleeding in a weekend». Conclusion: The bleedings of ulcer nature remain epidemiologically the most common for the Sumy Region of Ukraine. Organizational risks persist in a patient reference modality (ambulance service) and in hospitalization during a workday at a dedicated unit Introduction: Application of cervical collars by emergency care professionals is a standard procedure in trauma patients. It is often observed that application of cervical collars is performed incorrectly. The objective of this study was to analyze the practical skills of professional rescue personnel concerning the application of cervical collars. Material and methods: Emergency care professionals (n = 104) were asked to apply a cervical collar Perfit ACE, Ambu) to a training doll (Airway Management Trainer, Laerdal) wherein each step that was performed received an evaluation. Furthermore, personal and occupational data of all study participants were collected using a questionnaire. Statistics was done with the software SPSS Statistics 22.0 (IBM, Ehningen). Results: Study participants included professional rescue personnel (80.8 %) and emergency physicians (12.5 %). Average occupational experience of all study participants in out-of-hospital emergency care was 11.1±8.9 years. Most participants had already attended a training on trauma care (61 %) and felt ''very confident'' in handling a cervical collar (84 %). Application of the cervical collar was performed correctly in 11 %. Most common error consisted of incorrect size adjustment of the cervical collar (66 %). No association was found between the correct application of the cervical collar and the occupational group of the test subjects (trained rescue personnel vs. emergency physicians) or the participation in trauma courses. Conclusion: Despite pronounced subjective confidence regarding the application of cervical collars, this study allows the conclusion that there are general deficits in practical skills applying cervical collars. A critical assessment of the current training contents on the subject of trauma care must, therefore, be demanded. Results: In group A; 10 undergone ORIF after secondary dislocation and instability, only 31 needed physiotherapy, no significant neurovascular complications noted, summer patients had subjective difficulties in being casted. In group B; 4 were reoperated, 2 casted after external fixator removal for up to ten days, 34 needed physiotherapy and three refused the recommended, 11 had pin track infection in 2-7 weeks from application, 10 had contractures in scar area/limited ROM/arthrosis, 4 needed corrections within 2-4 weeks, 2 Sudecks syndrome, one had no follow up. Conclusion: Favouring the casting method could simplify the treatment for practical reasons, as for the external fixator it could seem less convenient for patient and surgeon with many defined complications, yet they long term desolve. Concluding would be resolving the persistent dilemma that probably resolves with strictly individual patient personality and fracture personality approach. Introduction: Ligament injuries to the elbow are relatively common and often underdiagnosed, with either insufficient treatment or prolonged cast immobilization as a consequence. Material and methods: We conduct a prospective study of operative and non-operative treatment of acute elbow instability. For the first 4 months we have treated 17 patients -9 operatively and 8 -nonoperatively. The patients are stratified after O'Driscoll's classification, excluding the ones with stage 1 and 2 trauma, as they rarely present with acute trauma and are typically, if ever, seen with chronic pain; patients with stage 3A are eligible for non-operative treatment with early mobilization, the ones with 3B and 3C trauma -for operative treatment and early mobilization. The results are evaluated with the Mayo Elbow Performance Score (MEPS) and the Patient Rated Elbow Evaluation (PREE) at 1 month, 3 months and 6 months after the trauma. Results: At day 30 the non-operatively treated (7 with Introduction: Intussusception is rare in adults, being responsible for 1-3 % of all cases of gastrointestinal obstruction. We present the case of a gastro-duodeno-jejunal intussusception due to an inflammatory fibroid polyp (IFP). Material and methods: 60 year old man who was being assessed for epigastric pain and vomiting of 3 months duration. An esophagogastroscopy showed a pedunculated lesion in the gastric antrum prolapsing through the pylorus to the duodenal bulb. The patient was referred to General Surgery for epigastric pain, uncontrollable vomiting and melena for the last 7 days. At surgery a gastro-duodenojejunal intussusception was confirmed due to a polyp stuck at the angle of Treitz, with a great pedicle originated at the prepyloric antrum. The duodenum and first jejunal loop were very dilated. An additional 1.5 cm lesion was found in the subserosa of the gastric body. An antral gastrotomy and a pyloromyotomy were performed, as S169 well as a laborious reduction of the intussusception and a hemigastrectomy. The pathology report revealed an IFP -Vanek's tumor. Results: IFPs are rare, benign, solitary lesions, most commonly found at the gastric antrum. They can present with chronic abdominal pain, melena, anemia and rarely small bowel obstruction due to intussusception. Computerized tomography is the most accurate diagnostic tool. The management of adult intussusceptions remains controversial, as there are 3 options: primary resection, initial reduction followed by more limited resection, or reduction of the invagination without resection. Conclusion: Intussusception is rare in adults and it can be due to IFP. Treatment consists of reduction or resection of the affected gastrointestinal tract. Introduction: There are practical problems in managing colles fracture even one has friendly anaesthesia department. studies shows that 66 % patients needs admission after G. A. Colles fracture is a common fracture of old age associated with osteoporosis and has a substational lose of working hours in form of attendants with patients and economic burden. The pre anaesthesia requirements with increasing age and in presence of co morbid diseases are complex and time consuming like NPO, a long list of investigations and consultation with medical and cardiology department in case of uncontrolled co morbid disease and difficult to full fill these requirements in accident and emergency department and patient require admission to orthopaedic floor. Local hematoma block is a good alternative to general anaesthesia in terms of early management and discharge of patient from hospital reducing the cost. Material and methods: All the patients presenting with colles fracture after trauma in emergency department above the age of 60 are included and given local haematoma block with Inj. Xylocaine 1 % as haematoma block, closed reduction attempted. Patient assessed for pain on visual analouge scale and apprehension questionnaire. Total number of 100 patients included from 2010 to 2014. Results: The data was analysed using the chi-square test and severity of the pain by visual analogue scale and as well as a direct questionnaire about the severity of pain and about the procedure. Conclusion: Local hematoma block is a good alternative to general anaesthesia in terms of early management and discharge of patient from hospital reducing the cost. Introduction: Herman Boerhaave first described spontaneous rupture of the esophagus after the autopsy of Baron van Wassenaer, who died 18 hours after sudden onset of left chest pain subsequent to vomit. The most common precipitating factor is barotrauma from the postemetic rise in esophageal pressure. There is often a significant delay between rupture and treatment, leading to chemical mediastinitis, bacterial contamination with sepsis and multiple organ failure. It is a rare condition that requires early diagnosis, as delay is cause of high mortality. Material and methods: Authors present a case of a 60-year-old male patient admitted to the emergency department for left chest pain, dyspnea and vomiting. No history of trauma. Prior Nissen fundoplication and former smoker. No relevant laboratorial changes. Chest radiography showed left pneumothorax. CT chest corroborated the existence of left hydropneumothorax and pneumomediastinum. Intercostal drainage showed food fibers. Results: The patient underwent exploratory thoracotomy for suspected esophageal perforation. Rupture of the distal esophagus was identified, with profuse soiling of the pleural cavity and mediastinum. A damage control strategy was chosen, with placement of a T tube into the hole and pleural drainage. Placement of esophageal prosthesis was attempted without success. Final repair was done after resolution of the septic status. Postoperative period was uneventful. Conclusion: Boerhaave's syndrome is hampered by unspecified associated symptoms. Some imaging findings, such as pneumomediastinum and hydropneumothorax, may be the only initial findings. Early clinical suspicion leads to a timely diagnosis and maximizes the possibility of survival. Introduction: Calcium plays a key role in the coagulation and neuromuscular transmission and muscle contraction. Hypocalcemia is common among critically ill patients and is associated with increased mortality. We aimed to investigate the relationship between the rate of change of ionized calcium (iCa) and life prognosis in trauma patients who received MT. Material and methods: We assessed trauma patients who received MT and were admitted to our hospital between April 2008 and March 2014. MT was classified as receiving ]10 units of red blood cells within 24 hours of admission. Patients were stratified into two groups: survival and non-survival group. The relationship between patient background and iCa and iCa value variation after 3 or 6 hours was examined. The survival factors at the time of 24 hours from injury were analyzed by logistic regression. Results: A total of 138 patients were included in the study (Survival:102, . RBC transfusion (p = 0.04) and iCa after 6 hours (p = 0.04) and ionized calcium value variation within 10 % after 6 hours (p = 0.01) were significant differences between two group. Using logistic regression analysis, ionized calcium value variation within 10 % after 6 hours was independently associated with the survival factors at the time of 24 hours from injury (odds ratio = 3.73, 95 % confidence interval 1. Introduction: Our work is a retrospective cross sectional observational study focused on the length of stay (LOS) in the emergency department (ED) of the Humanitas Research Hospital of the patients with hip and femur fracture. The aim of the study is also to verify the quality of the LOS in the ED and the timing of access to ward and operating theatre. Material and methods: We have analyzed the access in the ED in a period of two years (september 2013 -september 2015) and we have extracted the access for hip and femur fracture. Humanitas ED, in the observation period, had 103.487 total access 11.413 of which for trauma. Within the access for trauma we extracted the hip and femur fracture which are a total of 453 patients. Results: Only the 31,34 % of the total access are male (142) and the remaining are female. The length of stay of the patient in ED were, for the 95,60 % of the total, under 24 hours. The average time of wait on a stretcher for the patient was of 8 hours and 41 minutes. Door to operating theatre time for the total was of 2,5 days. Conclusion: 125 patients were operated after 48 hours from the access in the ward, 40 patients weren't operated for clinical reasons and 288 patients were operated before 48 hours the access in the ward. The majority of the patients are elderly which benefit from the precocity of surgery to avoid pain and all the risks of a long stay on a stretcher in ED. Introduction: Penetrating abdominal trauma from transversal impalement is associated with multiple visceral and vascular lesions with high morbidity and mortality. Material and methods: Case report. Results: We present a case of a healthy 45 year old male victim of an accidental abdominal transversal impalement with an industrial compressed air gun and hose. He was awake, breathing spontaneously and eupneic, with hemodynamic stability and a Glasgow Coma Scale 15. The compressed air gun was in situ, through the left abdominal quadrants in an anteroposterior direction with an entry point left of the umbilicus and exit point in the left flank. After initial assessment and resuscitation, the patient was taken up for emergent laparotomy. Intraoperatively, the patient had a hemoperitoneum of 1L. We removed the foreign body, without major vascular lesions. There was a jejunal and sigmoid lacerations (AAST grade III and II, respectively). We performed segmental enterectomy with primary anastomosis and a Hartmann procedure. The patient received four red blood cell (RBC) and 4 fresh frozen plasma units during surgery. He was admitted in the intensive care unit. Recovery was complicated by superficial surgical site infection but was otherwise uneventfull. He was transferred to the surgical ward on the POD 10 and was discharged on the POD 16. Conclusion: Diagnosis and decision in major penetrating abdominal trauma remains a challenge. Trauma caused by a penetrating mechanism is associated with multiple organ injury and surgical exploration is mandatory. If possibly any in situ foreign body should be removed under direct visualization on laparotomy to prevent massive hemorrhage. Introduction: In setting of major trauma treatment, a delayed, missed or wrong diagnosis, could severely impact prognosis. A multidisciplinary approach seems to reduce time-to-diagnosis, time-totreatment and increase accuracy (1) . However optimal teamwork can be difficult, as different specialists are involved, communications often overlapped and a great synergy between team leader and members is required. High fidelity simulation can help in training non-technical-skills, in a team approach (2) (3) .Turin CTO's ER is planned to provide a multidisciplinary trauma team treatment for major trauma. Material and methods: A simulation room was built in the hospital, reproducing the ER ward. Scenarios were designed in order to train NTS, such as communication, team leadership, team membership followed by structured discussion and debriefing. Furthermore theoretical session was prepared, including CRM approach and methodical real time clinical data collection. A clinical and behavioural audit was performed, from August to November 2015, including all trauma team activations. Noise levels were measured. Both objectivable data (time to Ctscan eg) and observable (communication efficacy) were collected in a 21 points sheet. A further audit is scheduled in order to asses impact. Results: Data collection is not yet complete. Intermediate analysis of pre-course behaviours suggests a good adherence to protocol, as primary survey is concerned; anyway debriefing is often unattended, as well as anticipation is often neglected. Noise analysis is still under investigation. Conclusion: A trauma team training course, using an high fidelity approach, could improve non technical skills and increase the team membership, as well as team leadership, levelling out individual approaches to major trauma. Introduction: Injury-related death is a major contributor to global mortality, with a disproportionate number of injury-related fatalities occurring in Low-and Middle-Income Countries (LMICs). To reduce disparities between developed and emerging countries, the World Health Organization (WHO) and the International Association for Trauma and Surgical Intensive Care (IATSIC) developed the Guidelines for Essential Trauma Care (EsTC). This study aimed to utilize the EsTC guidelines to assess emergency medical systems in Albania. Material and methods: Based upon EsTC Guidelines, we conducted a cross-sectional descriptive study of hospitals in Albania between September 5, 2014 and December 29, 2014 . Assessment subcategories included: 1) characteristics of emergency services provided; 2) resources available in the emergency rooms; and 3) manner in which patients arrived at the facilities. Results: There were 11.2 ± 15.4 doctors present in the emergency rooms in primary, 9.0 ± 7.8 in secondary, and 4.0 ± 4.5 in tertiary S172 hospitals. Less than half of the hospital ERs had a ventilator available (34.8 % primary, 33.4 % secondary and 42.9 % tertiary) . Blood products to treat severe trauma patients were available in less than half of all ERs (30.4 % primary, 41.7 % secondary, and 42.9 % tertiary) . Approximately 50 % of all primary hospitals reported not having an operating room attached to ERs perform surgeries. Only 9.3 % of patients arrived at tertiary hospitals by ambulance. Conclusion: The emergency services in Albania need major reform in organization, education, and equipment. As the demand for healthcare in Albania continues to grow, results from this assessment indicate that hospitals are poorly equipped to handle increasing demand for emergency services. Introduction: Pelvic binders are a life-saving intervention for hypovolemic shock following displaced pelvic fractures. 1 This cadaveric study assesses intra-pelvic pressure changes with different binders, augmented by bandaging the thighs to aid effect. Access to femoral vessels via an in-situ binder was also assessed. Material and methods: Unstable pelvic injuries were created in two embalmed cadavers through disrupting the pelvic ring. A supra-pubic catheter connected to a water manometer measured intra-vesical pressure, which reflects intra-pelvic pressure. The femoral vessels were dissected in the left groin for each specimen prior to any intervention to allow inspection following binder application. Different binder designs were used for each cadaver, with each applied following lower limb bandaging with the knees slightly flexed. Inspection of the groins then determined if the femoral vessels were visible. A paired samples t-test in SPSS assessed any differences between the initial and final pelvic pressures. Results: Bandaging the lower limbs alone significantly increased steady mean intra-pelvic pressure (12.38 cmH 2 O) compared to the baseline, (8.73 cmH 2 O, p = 0.001). Additional binder application further increased steady mean intra-pelvic pressure compared to the baseline (15.13 cmH 2 O, p = 0.003). Steady mean pressures between bandaging alone and bandaging with the binder applied were not significantly different (p = 0.09). The improvised binder and trauma pelvic orthotic device both required cutting to access the femoral vessels, which reduced efficacy. Conclusion: Intra-pelvic pressure was significantly increased through bandaging the lower limbs alone, and this represents a simple measure to increase intra-pelvic pressure. Access to the femoral vessels varied with binder type and represents an important consideration in polytrauma patients. Introduction: Numerous studies in recent decades demonstrate the growth of violence in Brazil. According to records of the Ministry of Health of this country between 1980 and 2010 grew by 346.5 % in the number of people killed by firearms shooting (approximately 800,000 victims in this period). Based on this estimate, we report the care in the emergency room of a trauma victim with a firearm projectile in orbit, causing sphenoid sinus injury without neurological damage during initial care. Material and methods: Analysis of images obtained by CT without intravenous contrast, and patient data from the initial care until his transfer to hospital with neurosurgery service. Data were obtained from the medical records of the patient in the emergency room where she received initial care. Results: CT view posterior wall injury in orbit, integrity of the eyeball, damaged roof of the nasopharynx, and bullet lodged in the sphenoid sinus. Pneumoencephalus was suggestive but has not been clearly identified. The lesions are confined to the left side of the skull and there were no neurological deficits. Conclusion: Clinical manifestations of the disease depends upon the impacted foreign body in relation to surrounding structure and trauma energy. Diagnosis was made by history, physical examination and Ct scan. Clinical manifestations of the disease depends upon the impacted foreign body in relation to surrounding structure and trauma energy. Diagnosis was made by history, physical examination and CT scan. Introduction: The literature estimates the incidence of acute lowerlimb ischemia between 13 and 17 cases per 100,000 people per year, with a mortality rate as high as 18 %. Isolated lower limb ischaemia is an unusual presenting symptom of aortic dissection, although the totality of peripheral vascular complications in aortic dissection involving de arch and/or the thoracoabdominal segment is as high as 30 % to 50 %. Material and methods: Clinical case. Results: Clinical case: A 39 years old patient, female, admitted to the ER with a lower left limb ischemia, due to a complete iliac occlusion. She was immediately sent to the operating room were an embolectomy was successfully performed. Etiological investigation reveals, in a transesophageal echocardiography, a Stanford type B/DeBakey type IIIa aortic dissection. The patient was submitted to a thoracic endovascular aortic repair (TEVAR) with a tubular endograft 26 9 100 mm. She was discharged at the 8th postoperative day, without complications. Conclusion: The differential diagnosis of acute limb ischaemia is very extensive, and it's important to have in mind aortic dissection in young adults, even without the usual symptoms. Management of thoracic aortic dissection can be conservative or surgical (open or endovascular), but TEVAR has the lowest morbi-mortality in patients with complicated type B dissection, in comparison with open surgery or medical therapy. Aortic dissection should be included in the differential diagnosis of patients with acute limb ischaemia without chest pain and with normal blood pressure. TEVAR is the gold standard treatment of patients with aortic dissection. Surgery, Academic Medical Center, Amsterdam, The Netherlands, 2 Surgery, University Hospital Basel, Basel, Switzerland, 3 Surgery, Maasstad Hospital, Rotterdam, The Netherlands Introduction: Classification, the definition of an acceptable reduction and indications for surgery in distal radius fracture management are still subject of debate. The purpose of this study was to characterise current distal radius fracture management in Europe. Material and methods: During the European Congress of Trauma and Emergency Surgery (ECTES) 2015 a 20-question multiple-choice survey was conducted among the attending surgeons and residents of the Hand and Wrist session. Consensus was defined as more than 50 % identical answers (moderate consensus 50 % to 75 % and high consensus more than 75 %). Results: A total of 46 surgeons and residents participated in the survey. High consensus was found among both surgeons and residents for defining the AO/OTA classification as the preferred classification system. For the definition of an acceptable reduction, a moderate to high consensus could be determined. Overall, high consensus was found for non-operative treatment instead of operative treatment in dislocated extra-and intra-articular distal radius fractures with an acceptable closed reduction, regardless of age. We found high (surgeons) and moderate (residents) consensus on the statement that an intra-articular gap or step-off C2 mm, in patients younger than 65 years, is an absolute indication for ORIF. The same applied for ORIF in dislocated fractures without an acceptable closed reduction in patients younger than 75 years of age. Medicine, National and Kapodistrian University of Athens, Goudi, Athens, Greece, 2 4th Surgical Clinic, Attikon University Hospital, Haidari, Greece Introduction: Traumatic cervical spine injury (CSI) may lead to a secondary devastating spinal cord damage. The existing management in the acute setting as taught from ATLS, suggests the implementation of a rigid collar in every patient with suspected CSI. Although this is widely practiced by the medical community, there is no level I evidence to support it, and many researchers indicate that they have to be renewed. The commonly accepted idea is that immobilization in penetrating trauma is not mandatory and although immobilization in blunt spinal trauma is a must, the optimal method for that remains to be evaluated. Material and methods: We conducted a search in the following electronic databases: MEDLINE, PubMed and Cochrane Library. Searching criteria: English, adult, cervical spine trauma, acute management, immobilization, collar, publication after 1999. Results: We found more than 200 publications with relevant titles. No randomized clinical trial was found. We selected nine reviews, based on relativity and reliability, as the main core of our study, which were classified according to levels of evidence. Only one S174 article supports the use of collars. The other eight suggest their limitation because of adverse effects, or question their effectiveness. Conclusion: Collars in current practice are used to prevent spinal cord damage, after unstable spinal fracture. They have adverse effects, and there is no level I evidence to support their use. Alternative methods to immobilize the spine rise as proposals to be evaluated. A prospective control randomized trial is pending. References: Kwan, Irene, and Frances Bunn. ''Effects of prehospital spinal immobilization: a systematic review of randomized trials on healthy subjects.'' Prehospital and disaster medicine 20.01 (2005) Introduction: Colonoscopy as a method of investigation and treatment of colorectal diseases is routinely performed by surgeons and gastroenterologists worldwide for its benefits widely recognized. However the method is not without risks and possible complications among the strongest being bleeding and perforation. In case of diagnostic colonoscopy perforation rate is between 0.03-0,3 %, powerful and potentially fatal complication that requires immediate therapeutic approach. Material and methods: Between June 2012-October 2015 a team of two surgeons have performed in Surgery Hospital Dr Carol Davila a total of 798 colonoscopies, all with sedation. In this way we achieved a 98 % complete investigation . Investigations were performed for diagnostic purposes, and have taken 187 biopsies. Results: The complications were: local bleeding that required no treatment and 2 colonic perforations (0.25 %). The two perforations were located in the sigmoid in a case being barotrauma with diverticular perforation and one case of mechanical perforation. Diagnosis was quickly established in both cases, within 6 hours, by clinical, laboratory and imagistic means (abdominal ultrasound, ultrasound and X-Ray). We practiced surgical treatment which consisted in suturing the perforation with subsequent favorable development. Conclusion: Although colonoscopy major risks and potentially fatal, yet it is indispensable in making the diagnosis and treatment of colorectal diseases. It also has the effect of preventing colorectal cancer and establishing diagnosis in early curable forms. Material and methods: Level IV retrospective clinical and radiological analysis of patients presenting from January to December 2012 at a Level 1 Trauma Unit. All skeletally mature patients with isolated femur shaft fractures independently of their mechanism of injury were included. Exclusion criteria were: ipsilateral fracture of the lower limb, neck and supracondylar femur fractures, periprosthetic and incomplete fractures. Their clinical records were analysed for blood transfusion requirements, pulmonary complications, surgery time, duration of hospital stay and analgesic requirements. Results: A total of 106 patients met our inclusion criteria. There were 74 males and 32 females. Fifty seven (54 %) patients were in the 'early splinted' group and 49 patients (46 %) were in the 'delayed splinted' group (p [0.05). The need for blood transfusion was significantly reduced in the 'early splinted' group (P = 0.04). There was a significantly higher rate of pulmonary complications in the 'delayed splinted' group (P = 0.008). All other parameters were similar between the two groups. Conclusion: The early application of Thomas splints for isolated femur fractures in non-polytraumatized patients has a clinically and statistically significant benefit of reducing the need for blood transfusions and the incidence of pulmonary complications. References: Disclosure: No significant relationships. Most of them are not dedicated for children. It is not allowed to develop standards approaches both for intensive care and surgery as well as rehabilitation. Material and methods: The aim of our research is to evaluate the efficiency of treatment for children with combined and isolated sTBI. We studied 129 children with sTBI (GCS B 8). They were hospitalized between 2005 and 2010. 58 % of them had combined trauma. Statistical analysis of 230 parameters revealed significant factors for prognosis of severe TBI outcomes. Results: There are: mydriasis (p = 0.0019), GCS level (p \ 0.05), hypoxia (pO2\60 mmHg) (p \ 0.05), hypotension (cystolic BP\90) (p \ 0.05), intracranial pressure [26 mm Hg. for more than 30 minutes Marshal scale 3, 4 and 6 (p \ 0.05), ISS 45 ± 4 in groups with GCS = 6-8 score. There was not significant influence of ISS on outcomes in the groups of combined injuries with GCS = 3-5 score. Conclusion: Prospects for improving outcomes for children with severe combined or isolated TBI we associate with early restoration and maintenance of vital functions, early identification and elimination of damage which complicate general vital functions, followed by early restoration of anatomical arrangements. Under these conditions, the fundamental importance is the maintenance of ''physiological corridor'' (vital functions) under the multi-modal monitoring control. The monitoring of intracranial pressure must be used as a important criterion for determining for the method of treatment In 41 % of cases, no documentation of any follow up was made. Conclusion: We found a significantly higher rate of incidental findings particularly in the older population which may be explained by the trauma population profile in the UK. The majority of incidental findings may prove benign but there needs to be improved systems to ensure appropriate follow up. References: Introduction: To identify the profile of patients with minor cranioencephalic trauma admitted to a level 1 trauma center and verify that the routine use of CT (computed tomography) benefits these patients, 45 CT reports were analyzed. Material and methods: The data collected were transcribed onto a form, which contained patient evaluation using the Glasgow Coma Scale (GCS), all of whom were classified as mild trauma patients (14 or 15), CT findings and CT indications. Of these patients, twelve were 14 on the GCS and thirty-three were 15. Results: Among those patients requiring CT, thirty one (68.9 %) had lost consciousness, three (6.7 %) were less than 15 on the GCS and were admitted for less than two hours, one ( Non availability of fluoroscope and portable radiographic machines at many hospitals of developing countries leads to difficult situation in managing simple fractures. The orthopaedic surgeons are left with choice of clinical judgment after reduction of colles fracture and later on radiographs done in radiology department. Material and methods: Material and methods Study conducted at Fazle Omar Hospital Chenab Nagar on 50 patients with non intra articular colles fractures and reduction was done without using the fluoroscope. The reduction was assessed by clinical assessment like shape of the wrist and clinical palpitation of radial styloid and POP back slab applied and later on post reduction check radiographs in radiology department. Results: Results The post reduction radiographs were assessed for reduction if meets acceptable criteria, patients were discharged otherwise again attempt is made. Thirty patients post reduction radiographs meet acceptable criteria. Orthopaedic Surgery, Fazle Omar Hospital, Chenab Nagar, Pakistan S178 Introduction: Introduction The burden of trauma is large and neglected in low income developing countries as compare to discussion about communicable diseases. The socioeconomic impact of injury related disability is magnified in low income countries, where there are often poorly developed trauma care and rehabilitation centers. Injuries contribute to poverty and economic, social costs have an impact on individuals and society. Sometimes simple fractures like colles fracture are not treated with standard recommendations. Non availability of fluoroscope and portable radiographic machines at many hospitals of developing countries leads to difficult situation in managing simple fractures. The orthopaedic surgeons are left with choice of clinical judgment after reduction of colles fracture and later on radiographs done in radiology department. Material and methods: Material and methods Study conducted at Fazle Omar Hospital Chenab Nagar on 50 patients with non intra articular colles fractures and reduction was done without using the fluoroscope. The reduction was assessed by clinical assessment like shape of the wrist and clinical palpitation of radial styloid and POP back slab applied and later on post reduction check radiographs in radiology department. Results: Results The post reduction radiographs were assessed for reduction if meets acceptable criteria, patients were discharged otherwise again attempt is made. Thirty patients post reduction radiographs meet acceptable criteria. Introduction: There are practical problems in managing colles fracture even one has friendly anaesthesia department. studies shows that 66 % patients needs admission after G. A. Colles fracture is a common fracture of old age .The pre anaesthesia requirements with the increasing age and in presence of co morbid diseases are complex and time consuming like NPO, a long list of investigations and consultation with medical and cardiology department in case of uncontrolled co morbid disease and difficult to full fill these requirements in accident and emergency department and patient require admission to orthopaedic floor. Local hematoma block is a good alternative to general anaesthesia in terms of early management and discharge of patient from hospital reducing the cost. Material and methods: All the patients presenting with colles fracture after trauma in emergency department above the age of 60 are included and given local haematoma block with Inj. Xylocaine 1 % as haematoma block, closed reduction attempted. Patient assessed for pain on visual analogue scale and apprehension question era. Total number of 100 patients included from 2010 to 2014. Results: The data was analysed using the chi-square test and severity of the pain by visual analogue scale and as well as a direct questionnaire about the severity of pain and about the procedure. Introduction: Opioid narcotic withdrawal has many symptoms in common with other Emergency conditions. The clinical opioid withdrawal scale (COWS) is a method for determining the presence and severity of withdrawal from narcotics. Material and methods: COWS criteria include pulse, sweating, restlessness, pupil size, bone and joint aches, running nose, tearing, gastrointestinal upset, tremor, yawning, anxiety and goose bumps Results: By looking for drug paraphernalia, needle tracks, empty drug bottles and having high sense of suspicion the emergency health team can reach the correct diagnosis which could be confirmed by drug testing and a trial of opiates. The patient can then be referred for treatment. Conclusion: Opioid withdrawal has symptoms in common with other Emergency conditions. COWS is a way to reach the correct diagnosis and prevent serious morbidity. Introduction: Hand and wrist injuries are one of the most common injuries seen in adults. The Patient Rated Wrist Evaluation (PRWE) questionnaire has been developed as a patient-reported outcome measure of pain and disability to evaluate the outcome after hand and wrist injuries. The aim of this study was to evaluate the structural validity of the existing Dutch version of the PRWE (PRWE-NL) in patients with hand or wrist injuries, and to investigate the appropriateness of reporting subscale scores. Material and methods: In a retrospective study, all patients aged 18-65 years treated either surgically or conservatively for an isolated S179 hand or wrist injury were recruited. Patients were excluded if they were unable to speak or read Dutch. Confirmatory factor analyses were used to investigate the structural validity and Cronbach alpha's and coefficients omega are used to investigate internal consistency. Results: A series of confirmatory factor analyses revealed that all models (i.e. a single factor model, a 2-and 3-correlated factor, and 2 bifactor models) were associated with adequate model fit. However, inspection of the factor loadings, the explained common variance (ECV) and the different coefficient omega values revealed that the PRWE-NL should be considered an unidimensional trait. In addition, PRWE-NL subscales were associated with unacceptably low levels of reliability independently of the global PRWE-NL factor. Conclusion: This study suggests that the PRWE-NL measures an unidimensional trait. A single score should be used for the PRWE-NL, without subscale scores. Introduction: To analyze trauma epidemiology, pattern of lesions or death profile in a Level I East-European Trauma Centre. Material and methods: A prospective observational study of patients admitted to a Level I East-European Trauma Centre and enrolled in our trauma registry, between January 2012 to January 2013, was conducted, with the inclusion criteria: (1) trauma lesions, (2) New Injury Severity Score (NISS) higher than 15. Results: There were 141 patients admitted during the study time interval, 102 males (72.3 %), mean age 43.52 ± 19.00 years, and NISS of 27.58 ± 11.32. The trauma aetiology was traffic-related injuries 101 (71.6 %), falls 28 (19.9 %) and crushing injuries 7 (5.0 %). Only one case of gunshot wound was encountered in our study. Out of traffic-related injuries, the automobiles were involved in 56 (55.4 %) and motorcycles in 9 (8.9 %) patients. The bicyclists accounted for 2 (2.0 %) of patients and pedestrians hit by vehicles were in 33 (32.7 %) cases. High-velocity falls were found in 7 (25.0 %) patients, whereas low-velocity falls accounted for 21 (75.0 %) of cases. The overall mortality was 30.00 %, and the dead patients had a NISS of 37.63 Conclusion: Our trauma pattern profile is similar to the one found in West-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-toauto vehicles collisions. A trauma registry, with prospective enrolment of patients, is a very effective tool for constant improvements in trauma care. References: Disclosure: No significant relationships. Introduction: The Royal London Hospital is a major trauma centre in London and is home to London's Air Ambulance. As part of an annual audit of time to CT in major trauma we examined whether type of trauma (blunt/penetrating), seniority of team leader (consultant/non-consultant) or code red activation affected the time to CT scan. Trauma is a major cause of death and CT scanning is an invaluable tool in detecting major injuries in the severly injured patient. Guidelines suggest that CT scans should be performed within 60 minutes of arrival and ideally within 30 minutes. Material and methods: We reviewed all major trauma patients that attended the Royal London Hospital between September 2014 and September 2015 using the trauma database that the hospital employselectronic health record and PACS imaging. Results: In total there were 3418 trauma attendances to the Royal London Hospital in the time period that we examined (12 months). We are currently examining the data and are calculating time to CT in all trauma, blunt, penetrating, code red (pre-hospital or hospital activated) and seniority of team leader. Early analysis appears to demonstrate an increase in time to CT if not led by a consultant. Conclusion: Consultant led trauma likely leads to fewer delays. Other results are pending but we expect code red trauma to get to CT faster than other trauma. There is still work to do to improve time to CT in trauma. Introduction: Subtalar arthrodesis can be used either as a primary procedure or as a secondary salvage procedure following a trauma of the hindfoot. Both the primary and the secondary arthrodesis are technically demanding procedures and even in experienced hands high complication rates have been reported. The aim of the current study was twofold: 1) to assess the union-and complication rate following post-traumatic arthrodesis and 2) to determine predictors of non-union and postoperative wound infections (POWI). Material and methods: All consecutive adult patients with subtalar arthrodesis following traumatic injuries between 2000 and 2014 from a level 1 Traumacenter were retrospectively analyzed. Patient, injury and surgery characteristics were collected. Outcome measures were (non-)union and POWI. Results: A total of 88 patients met the inclusion criteria. Primary arthrodesis was performed in 33 patients and secondary arthrodesis in S180 55 patients (37 in situ arthrodesis, 18 correction arthrodesis). Union was observed in 86 % of all patients. For primary, secondary in situ and secondary correction these percentages were 93 %, 83 % and 94 % respectively (NS). None of the collected characteristics were significantly associated with non-union. In 12 patients (14 %) a POWI was observed, the POWI rate did not differ between the groups. Patients with an open fracture or an infection following primary osteosynthesis had an increased risk of developing a POWI (p = 0.031, p = 0.046 respectively). Introduction: Proximal tibiofibular joint (PTFJ) dislocations are very rare injuries that can occur together with tibia shaft fractures. PTFJ instability can lead to chronic pain of the proximal fibula with snapping of the fibular head and even peroneal nerve palsy (1) . Furthermore in complex tibial fractures correct length and rotation only can be restored after referencing with the fibula. Material and methods: From 2001 until 2014 we diagnosed 7 out of 663 patients with tibia shaft fractures having PTFJ dislocation. In most cases, the tibia fracture was nailed in a closed technique. The proximal fibula was exposed by a lateral approach exposing and preserving the peroneal nerve. After anatomical reduction the fibula was transfixed to the tibia with a positioning screw (3) . This provided correct length and rotation of the tibia. The positioning screw was removed after six weeks prior to full weight bearing. Results: Most of our seven cases were caused by a high-energy trauma. After 7 months four patients showed excellent results with full range of motion and returning to their sports activities as before the accident. Two patients had an impaired function due to associated injuries. One patient was lost to follow up. None complained of persistent pain or instability of the PTFJ. Conclusion: PTFJ dislocation can easily be overlooked (2) . We recommend a high index of suspicion of this injury with high energy tibia shaft fractures especially in cases where there is an intact fibula. It is important to diagnose and fixate this dislocation anatomically to achieve good results. Introduction: Traumatic duodenum ruptur it's rare: only 2-5 % of lesion in abdominal trauma, and 33 % of this in close trauma. We present a case report of diagnosis and management of a case of traumatic duodenum ruptur in a jung motorcyclist during a motocross race, in an emergency of a periferic hospital. Material and methods: Literature review and presentation of a case report Results: A.B. came in our emergency service the day after a fall with abdominal trauma during a motocross race. The first FAST evaluation in a racetrack side was negative. This patient at the moment of presentation in emergency department ad abdominal pain and vomiting. The abdominal X-ray was normal but US found free fluid. At the blood tests only modest increasing of pancreatic enzymes and a very high PCR. The CT exament was diriment for a diagnosis of lesion of duodenum/jejunum. In operating contest was repaired a lesion of third part duodenal anterior wall. After 5 days from the surgical intervention ad a suture leak and associated pleural effusion. After 3 day was transferred at our DEA were the surgeon decide for conservative therapy. Conclusion: The duodenum ruptur it's rare but is possible in direct abdominal trauma in epigastrium. Often the diagnosis is late and the lesion is associated of a peritonitis. The surgical therapy is often burdened whit complication of suture because the diagnosis is late and the duodenum wall is bruised. Introduction: The anterior hip, especially obturator (anteroinferior) dislocation is a rare injury, representing approximately less than 10 % of hip dislocations. The mechanism of anterior dislocation requires excessive joint motion and greater external force induced at trauma or traffic accident. Lower occurrence rate of avascular necrosis of femoral head is reported in obturator dislocation in comparison with posterior dislocation, but prompt reduction seems to be demanded to avoid it. Material and methods: A 17 years old healthy young man was introduced to our emergency department with severe acute pain which appeared during wrestling match. He was unable to move his left lower limb fixed his hip joint in 80°of flexion and abduction, and external rotated. AP and lateral radiographs showed an obturator S181 dislocation of hip joint without any evident bone injury, indicating type 2A Epstein dislocation. Results: Closed reduction after sedation with Thiopental was tried, which was in vain probably because of the insufficiency of relaxation in surrounding muscles of hip joint. Subsequent closed reduction under general anesthesia using Sevoflurane and muscle relaxant succeeded eventually. A Magnet Resonance Imaging examination was performed which revealed the existence of wounded capsule and surrounding muscles of hip joint extensively at the day after reduction. Conclusion: We report here a rare case of wrestling injury with obturator dislocation, which we managed to reduce by closed method under general anesthesia in combination with muscle relaxant finally. And we also discuss the pathological nature of obturator dislocation based on the previous literatures. Introduction: A 15-year-old boy presented to the emergency department with a painful right leg after falling off his skateboard, with immediate inability of weight bearing. Conventional radiographs showed a displaced medial femoral neck fracture, Delbet type III, without injury to the epiphysis. Material and methods: Surgical treatment consisted of closed anatomical reduction and internal fixation by means of three cannulated screws under direct fluoroscopy view, within 24 hours after trauma. Results: Postoperative radiographs demonstrated anatomical reduction of the fracture and good position of screws in the femoral neck and head. He was not allowed weight bearing during the first 6 weeks and was not allowed to perform sports and other high-risk activities during the first 3 months. After 6 months of follow-up, there is no evidence of complications and the patient regained full function. Oxford Hip Score (OHS) was 48/48 and Hip disability and Osteoarthritis Outcome Score (HOOS) was 100/100. Conclusion: A true femoral neck fracture is rare in childhood ( \ 1 % of all pediatric fractures), and reported complication risks are high, e.g. avascular necrosis (6.7-28.6 %), premature physeal closure (5.5-33.3 %), non-union (5.5-8.3 %) , coxa vara (8.3 %), and early arthritic changes (8.3 %). [1] [2] [3] [5] [6] Anatomical reduction results in superior functional outcome; and therefore, open reduction and internal fixation (ORIF) is preferred over CRIF by some authors. [3] [4] Thus, regarding the high complication risk for inacceptable fracture reduction in this very young population, when anatomical reduction cannot be achieved with CRIF, one should not hesitate to convert to ORIF. References: 1 Nayeemuddin et al. J Pediatr Orthop B. 2009; 18(6) :314-9. 2 Quick and Eastwood. Clin Orthop Relat Res. 2005; (432):87-96. 3 Bali et al. Clin Orthop Surg 2001; 3(4):302-8. 4 Song. J Bone Joint Surg Br. 2010; 92(8):1148 -51. 5 Dendane et al. Orthop Traumatol Surg Res. 2010 96(2):161-5. 6 Flynn et al. JBJS Br. 2002; 84-B:108-12 Results: Postoperative radiographs demonstrated anatomical fracture reduction. Further treatment consisted of a non-weight bearing plaster cast during two weeks, full weight bearing with exception of the first metatarsal joint during the following four weeks, and no gymnastics during the following three months. Patient A had no evidence of complications three months after surgery. She returned to pre-injury level of gymnastics; Foot and Ankle Outcome Score (FAOS) and Foot Function Index (FFI) were good. Patient B required reoperation after six months due to re-fracture after new trauma. Three months after reoperation, there were no complications. She discontinued high-level gymnastics, but started a new career in athletics; foot function was good. Conclusion: Epiphyseal fractures of phalanges are rare, but predominantly seen in adolescent athletes, where hallux valgus is a common predisposing factor. 1-2 Operative management may be required, especially in Salter Harris type III and IV injuries, to prevent angulation, shortening and non-union. As bare foot athletes (e.g. gymnasts, dancers) are likely to undergo repetitive trauma, one must consider a fracture of the hallux after acute and chronic complaints even in children. Introduction: Spleen injury occurs in almost 45 % of blunt abdominal trauma. This is usually the result of motor vehicle accidents, falls and sports accidents. Recognition of patients with cryptic consequence of blunt trauma may be challenging. Material and methods: We describe the case of a 17 years-old male, admitted to the emergency department of a small countryside Hospital, for the persistence of left thoracic pain, consequent to a thoracic trauma occurred 8 hours earlier. Light fall on the snow from his snowboard was reported at the presence of his parents. Results: At preliminary survey, only left chest pain at finger compression, good general health condition and hemodynamically stable (Shock Index, SI = 0.65). Suddenly in the emergency room, patient began to unremittingly hiccough. E-FAST was performed showing free fluid in three quadrant, estimated blood loss of 800 cc no alteration at the thorax. Hemodynamically stable (SI = 0.8) a CTscan was carried out: significant haemoperitoneum, with a multifocal splenic laceration (grade III-IV at AAST injury scale). After few minutes the patient became unstable not responding at conservative therapy and at cristalloyds bolus. For those reasons patient underwent an emergency laparotomic splenectomy. Conclusion: During hospital stay, the patient reported a different dynamic: he fell down during acrobatic jump with the snowboard. History is fundamental in trauma management. Diagnosis of intraabdominal injury may be very sneaky in young people. Abdominal examination does not rule out spleen rupture. Persistent hiccups 8 hours later was the trigger sign of spleen rupture in hemodynamically stable patient. Conclusion: Nonoperative treatment of dislocated distal radius fractures with an acceptable closed reduction leads to good functional outcomes after 12 months. However, nonoperative treatment leads to a high percentage of secondary surgery (40 %). Introduction: Isolated dislocation of pisiform is rarely reported in the literature. This type of injury could be neglected in acute period. We report a case of an isolated dislocation of the pisiform without carpal bone injuries but combined with ipsilateral distal radius fracture successfully treated by percutaneous fixation of two Kirschner wires. Material and methods: 47-year-old man suffered an injury to his left hand by falling down from the trees. The radiographs revealed a dislocation of the pisiform and associated injury including an ipsilateral distal radius fracture. Precise mechanism of the injury was unknown. Results: A closed reduction of the pisiform was attempted under C-arm image intensifier. Direct pressure was applied to relocate the bone with a slightly dorsi-flexed position. However, stable reduction was not maintained. Therefore, the pisiform was reduced into its position and fixed to the triquetrum using two Kirschner wires percutaneously following the open reduction and internal fixation of the distal radius fracture. The wrist was immobilized with a long arm plaster splint for 3 weeks. The plaster splint was off at 3 weeks at which time physiotherapy and active exercise were initiated. The kirschner wires were removed 12 weeks later and the radiographs revealed the pisiform to have relocated to the correct position. At the 9 months follow-up, the patient was clinically well without severe pain or neurological problems. Conclusion: A high index of suspicion is required to identify this type of injury in traumatic patients. Our technique could be an effective and reliable method for treating a dislocated pisiform without resection. Introduction: Watercraft-related trauma have increased dramatically in the recent years. Although its popularity is increasing, there is a paucity of published data on personal watercraft (PWC) related injuries in Qatar. We aimed to evaluate Jet Ski and motorboat-related injuries in Qatar using a nationally representative sample. Material and methods: A retrospective review of trauma registry data of all patients who suffered PWC associated injuries and treated at the level 1 trauma center of Hamad General Hospital (HGH) between 2008 and 2014. Distribution of patient demographics, mechanism of injury, injuries sustained, mode of transportation, severity scores and outcomes by Jet Ski and motorboat-related injuries were compared. Results: A total of 39 patients were identified with PWC-related injuries, majority of them were young adults (72 %) aged between 21 and 40 years. Twenty-six were injured in Jet ski accidents and thirteen sustained motorboat-related injuries. Patients injured in Jet ski accidents were younger than those involved in motorboat accidents. Chest injury was the most common type of injury. However, the severity of injury was highest in patients sustained head trauma as compared to other body regions. There were no significant differences in injured anatomical regions, severity, or outcomes between Jet ski and motorboat-related injuries. Two mortalities were reported; one in jet ski-related accident which occurred due to severe head injury and the other patient died due to drowning following motorboat accident Conclusion: PWC-related injuries are not uncommon and possess a potential severe injuries and disabilities among young. Strict regulation with public awareness is needed for efficient safety. References: 1. Kim, C.W., Smith, J., Lee, A., Hoyt, D.B., Kennedy, F., Newton, P.O Introduction: Rockwood types IV,V surgical stabilization of the AC joint has been recommended. Anchor suture had the advantages of S184 decreasing the risk of complications. Our objective was to evaluate the effectiveness of the use of one suture anchors to augment the repair of CC ligament with temporary AC fixation with two K-wires. Material and methods: Between June 2012 and February 2015, sixteen patients with Rockwood type IV and V AC dislocation were treated at Zagazig university hospital. Transverse incision based just superior to the coracoid process and extending laterally towards the AC joint. Coracoid process is exposed to clear out the origin of CC ligament remnants and stay sutures were taken into these remnants. Two drill holes were placed on the superior surface of the clavicle. Anchor suture into the base of the coracoid, then passed through the drill holes in the clavicle. Accurate reduction of the AC joint is done then fixed with 2 smooth K-wires. Repair of the AC ligaments, tightening the 4 strands of the anchor and lastly tightening the stay sutures of the CC ligament. Results: excellent results are obtained according to constant Murley score (92.6). Postoperative radiographs confirmed anatomic reduction in all patients. Residual subluxation occurred in two patient. All patients except one were satisfied with the results in terms of functional performance and cosmetic appearance. Conclusion: single anchor with repair of the CC ligament appear to be good procedure for manging type IV and V AC dislocation. Department of Orthopaedics and Traumatology, General Hospital, Znojmo, Czech Republic Introduction: The menisci play an important role in load transmission and shock absorption of the knee. The purpose of this study was to determine radiological and clinical long-term results after medial meniscectomy. Material and methods: Between 1985 and 1989, 66 patients underwent isolated total or subtotal medial meniscectomy. Cases with other injury (ACL, cartilage, lateral meniscus etc.) of both knees before, at the time of surgery or afterwards were excluded from the study. 51 patients visited the last follow-up control. The minimum follow-up was 25 years. Results: Considerable osteoarthritic changes (grade II or more) in the medial compartment of the operated knee were evident in 12 % of cases (6 patients), 2 patients already underwent high tibial osteotomy (HTO), and in 1 knee, the medial unicompartmental arthroplasty (UCA) was already implanted. In all but one case, there was no marked degeneration of the medial compartment of the contralateral knee (grade II or more). The significant tibiofemoral axis difference (varus deformity 2°or more) between operated and normal knees was apparent in 45 % of cases (23 patients; cases after HTO or UCA were not included in this group). The results after the surgery according to Lysholm was excellent in 24, good in 14, moderate in 5 and bad in 5 cases; 3 patients who already underwent HTO or UCA were not evaluated. Conclusion: Osteoarthritis after the medial meniscectomy developed ''only'' in approximately 1/6 of cases but the tibiofemoral axis changed in 1/2 of evaluated knees. References: Disclosure: No significant relationships. Introduction: Disruption of the tibiofibular syndesmosis require adequate stabilization of the ankle mortise to ensure satisfactory healing of the syndesmotic ligaments. Numerous internal fixation techniques for stabilization of the syndesmosis have been used. The suture button device appears to have advantages over screws with improved reduction, maintenance of reduction, sufficient biomechanical strength. However, reoperation for device removal due to the button irritation is more common than anticipated. Osteolysis of the bone near the implant and subsidence of the device may occur. Therefore, it is possible that hybrid technique of the temporal syndesmotic screw fixation and the eternal suture button fixation may reduce the complication and have better clinical results. Material and methods: We performed hybrid technique of two syndesmotic screws and a suture-button for a syndesmosis injury in a 17-year-old male high school soccer player. Syndesmotic screws were removed 7 weeks after surgery and the suture-button was maintained. Results: He resumed soccer completely 5 months after surgery and could show good performance in the last game of his high school soccer career. He can also play soccer without any symptoms after graduation from the high school. The Japanese Society for Surgery of the Foot Ankle-Hindfoot (JSSF) score improved from 36 points to 100 points two years after surgery. Conclusion: This hybrid technique is expected to reduce the risk of screw breakage, screw tunnel enlargement, re-widening of syndesmosis, irritation pain of the button and button migration. This is a good alternative procedure for patients who want to resume sports activity without risk of re-widening of the syndesmosis. Introduction: Anatomical attachment site of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) is located just below the antero-inferior tip of the fibula which can be arthroscopically mis-identified as the distal end of the fibula. We report a new technique for arthroscopic ATFL and CFL reconstruction using an allograft Achilles tendon with safe creation of an anatomical fibular tunnel. Material and methods: The patient was a 20-year-old professional ballerina. The clinical results were evaluated using the Japanese Society for Surgery of the Foot Ankle-Hindfoot scale (JSSF) score. She underwent anatomical arthroscopic ATFL/CFL reconstruction using an allograft Achilles tendon. The tendon was designed to reverse-Y-shaped construct. A talar tunnel was drilled through the accessory anterolateral portal. A guidewire was inserted into the fibular footprint in the direction of the long axis of the fibula through the subtalar portal under radiographic guidance. A 6-mm-diameter fibular tunnel was over-drilled. The tendon was introduced to the tunnels with a aid of the passing pin and fixed with 15-mm-long 5.5mm-diameter tenodesis screws. ROM exercise was started on the second day after the surgery. Full weight bearing was allowed on the third postoperative day. Results: She attained good ankle stability. She returned to the stage at 3.5 months after surgery. JSSF score improved from 69 points to 100 points. The follow-up period was 14 months. Conclusion: This new technique provides not only cosmetic benefits but also less invasion, full range of motion, strong stability, and early recovery. Disclosure: No significant relationships. Introduction: Chronic hip dislocation associated with acetabular apophyseal avulsion in adolescence is rare. Whilst superior acetabular rim fractures have a documented theoretical risk of hip instability, we have not found a case of chronic dislocation resulting from this. Material and methods: We report a case of a 12-year-old healthy boy who initially sustained a missed right acetabular apophyseal avulsion after falling from a quad bike. This was missed on the initial radiograph and a subsequent radiograph following weight bearing a few days later showed a hip dislocation that was also missed. Upon diagnosis at 6 weeks he underwent open reduction but also required acetabuloplasty to stabilise the hip. Results: At 2 years follow up, he was enjoying pain free swimming, cycling and walking. His Harris hip score was 87. Conclusion: This case reinforces the need for recognition, that in the patient presenting with knee or thigh pain exclusion of hip pathology is required. It also explores the pitfalls of diagnosis associated with rare patterns of injury and the need for adequate investigations such as examination under anaesthetic, arthrography and MRI. The use of acetabuloplasty is shown to be a useful strategy for the unstable hip resulting from irreparable acetabular rim fracture. Introduction: Osteogenesis imperfecta (OI) is a heritable disorders of connective tissue characterized by narrow and deformed diaphyses. Because of poor bone quality, patients with OI experience high rates of bone fracture and often develop non-unions. We report on a case of humeral shaft nonunion successfully treated by a locking plate for mandibular bone in patient with OI. Material and methods: A 23-year-old male with type III OI who has a history of corrective osteotomy of his right humerus at the age of 8 felt gradually increasing pain in his humerus. He was sustained a humeral shaft pseudoarthrosis with a broken K-wire used in the previous operation. He referred to our hospital and underwent internal fixation using Ender nail with iliac bone graft. However, at 2 years after operation, bony union wasn't achieved with Ender nail breakage and he complained of a pain and activity limitation. Results: He underwent reoperation for his humeral nonunion using a locking plate to achieve rigid fixation. As his humerus shaft was extremely narrow with severe deformity, we used a locking plate for mandibular bone which was contoured to fit the anterior surface of the humerus. One year after, bony union was achieved and he is free from pain and has returned to his preinjury activity with no symptoms. Conclusion: Humerus nonunion with OI was successfully treated by a mandible locking plate. Although the optimal fixation device for fractures or non-unions with OI hasn't yet been established, this plate could be a good treatment option for narrow and severely deformed bone. Disclosure: No significant relationships. Introduction: Horseback-riding is considered to have to the highest mortality of all sports, but equestrian sports are associated with a multitude of injuries, ranging from minor to fatal. We undertook this study to review serious and life-threatening injuries related to equestrian sport activities. Material and methods: After obtaining review board approval (TR-DGU-ID 2013-50), we screened the German Trauma Registry (n = 122.000; 2002-2012) for major equestrian injuries (ISS C9). Parameters: demographics, types/severity of injuries (AIS/ISS), early physiology, rescue modality, (emergency) surgical care, methods of resuscitation, length of stay and major complications (hemorrhagic shock, coagulopathy, mortality). SPSS statistics was utilized for analysis (IBM, Version21) . Results: A total of 679 athletes were included and four major injury mechanisms were identified: Falls (n = 427), Horse-kicks (n = 188), Horse roll-overs (n = 34), and the carriage related accidents (n = 30). Individuals with a horse roll-over had a two-fold risk for pelvic ring (32.4 %) and abdominal injuries (35.2 %). Horse kicks often resulted in facial injuries (29.3 %). Especially females (75.5 %) sustained falls during horse-back riding, leading to head (n = 204, 47.8 %) and spinal injuries (n = 109, 25.5 %). In contrast, carriage accidents involved older males (57±13yrs), causing severe chest (63.3 %) and extremity injuries, resulting in significant injury severity (ISS 20.7 ± 10.6 pts). In the carriage group, 16 % were in hemorrhagic shock on scene, 24 % were coagulopathic at ER admission, and a 16.7 % in-hospital mortality was observed. Conclusion: Young female riders are especially at risk from falling, horse-kicks or horse roll-overs. However, the highest injury severity and most fatalities affect older males in carriage-related accidents. Male horseman and carriage drivers must also be targeted by prevention initiatives. analyzed, secondarily, a parametrical study of influence of inclination of fixation belt on amount of forces acting on lumbar vertebrae was performed. Inclination of belts was modeled in range from +15°to -20°. Results: Without use of HANS a pressure force of almost 5500 N acted on Th12-L1 region during model crash, distal areas were loaded with descending tendency. With use of HANS maximum computed forces did reach 3000 N. Compression force acting on lumbar vertebrae was highest by highest tested inclination of security belts (20°) -almost 7000 N, by zero inclination the force was solely 3500 N. Conclusion: All lumbar spine fractures in Th-L region in our rally drivers patient group are of type A 1.1 according to AO classification. These fractures are caused by axial overload. Maximum of force does act on L1 body, distal areas are loaded with descending tendency, therefore majority of fractures occur on L1 body. Inclination of upper part of fixation belts does substantially influence amount of compression forces acting on lumbar spine and in higher inclination can represent significant risk factor of fracture. Orthopedics, University Hospital Lewisham, London, UK, 2 Orthopedic, University Hospital Lewisham, London, UK Introduction: Septic arthritis in a young healthy individual is a rare but serious complication after knee injury. This case report presents a non virulent organism led to bilateral migratory septic arthritis of the knee joint and resultant activity limitations and participation restrictions. The purpose of this case report is to highlight a rare and unique pathology, the serious effects that a joint infection can have on musculoskeletal function, and the challenges encountered during the clinical management Material and methods: The subject was a 41 year-old young male patient who injured his right knee while playing. Within 3 days, the subject developed a right sided knee joint infection that spread into left knee joint after 3 days of arthroscopic intervention of the right knee. The infection was surgically debrided five times during a 7week inpatient hospital stay. Outpatient physical therapy was initiated after 10 wks in order to restore musculoskeletal function and made significant improvements on the Knee Outcome Survey and the Lower Extremity Functional Scale. Success in physical therapy and completion of additional strength training exercise allowed to normal life style. Results: After musculoskeletal injury, joint infection can happen in young healthy individual. Repeated arthroscopic irrigation may prevent soft tissue damage, partial or complete degradation of articular cartilage, and arthrofibrosis causing significant disability. Physical therapists must incorporate evidence-based treatment principles including eccentric exercise, core stability, and lower extremity strength training. Conclusion: Poly microbial and arthroscopic irrigation and physical therapy and completion of additional strength training exercise allowed patient to normal life style. Introduction: Postoperative excessive fracture collapse in intertrochanteric fracture is a problem that needs to be addressed. The purpose of this study is to predict the amount of postoperative collapse by preoperative 3D-CT and to compare 1-and 2-lag screw nailing systems about postoperative collapse in each fracture type. Material and methods: The radiographs of 220 consecutive patients of Jensen III, IV, V intertrochanteric fracture treated with short femoral nail at our institution were analyzed. We classified these cases into two groups by 3D-CT. Group A that has fracture line proximal to anterolateral bony eminence of intertrochanteric line was 80 cases and group B that has fracture line distal to this bony eminence was 140 cases. A single-screw system(Gamma 3 Locking Nail; Stryker) was used for 90 cases and 2-screw system(Intertan; Smith and Nephew) was used for 130 cases. The systems were compared according to the amount of postoperative fracture collapse in each fracture type. Results: Group A showed significant large amount of fracture collapse compared to group B (P = 0.01). In group A, the cases treated with 1-lag screw system showed significant large amount of fracture collapse compared to the cases treated with 2-lag screw system(P \ 0.05), while there is no significant difference between 1-and 2-lag screw systems in group B. Conclusion: Group A is likely to have fracture line proximal to the attachment portion of the iliofemoral ligament, and it is considered very unstable fracture type. 2-lag screw nailing system used in this series has a high rotation stability, and it is useful in the treatment of unstable intertrochanteric fractures. Introduction: The supraacetabular external fixator (SAEF) is frequently performed for anterior pelvic ring fractures. However, it is S188 associated with impairments, such as septic-aseptic loosening, problems with hygiene and mobilisation. The complication rate sums up to 60 %. In the view of these drawbacks the subcutaneous fixation techniques have been described. We enhanced this technique towards a subcutaneous plate osteosynthesis. The objective of the non-randomized study was to evaluate feasibility and potential complications. Material and methods: An incision lateral to the anterior iliac spine is digitally tunnelled with a suprapubic incision in a plain between the subcutis and the fascia. A prebent 3.5 mm reconstruction plate is positioned accordingly. Both ends are fixed with cortical screws; symphyseal screws can be directed divergent and augmented with cement. Results: Between 2013 and 2015 we operated 21 consecutive patients. The mean age was 70 years (30 to 93). A bilateral anterior stabilisation was performed in 7/21, a posterior sacroiliac screw fixation in 13/21. The latter procedure predominantly in the geriatric population. Neurovascular complications, superficial or deep infections were not observed. Depending on age and co-morbidities the Merle D'Aubigné score averaged 12. Implant removal was performed in 3/21 patients after consolidation. Conclusion: The iliopubic plate does not bridge the symphysis and preserves a physiologic joint mobility. At the same time the unilateral stabilisation prevents an early implant loosening. The placement of 2 or more divergent screws in the ilium and pubis provides higher pullout-forces and stability. Preliminary results demonstrate a clinical and radiological result superior to the SAEF. Introduction: Proximal femoral fractures are common fractures of the elderly. According to their comorbidities, patients are often treated with anticoagulants and recently new oral anticoagulants (NOAC) are increasingly administered. Those patients are a big challenge in the perioperative management, because surgery should be performed as soon as possible, but until now there are no antagonists for NOACs available. Also, proper tests for the quantification of the anticoagulatory activity of NOACs are still not available. Material and methods: A retrospective database of patients requiring surgery due to proximal femoral fractures was generated. Patients treated with NOACs at the time of the fracture were compared to patients under VKA-therapy, Patients without anticoagulation formed the control group. Primary endpoint of the study was the time to surgery. Secondary endpoints were the length of hospitalization and the incidence of complications during and after surgery. Results: Patients with proximal femoral fractures, which were operated by osteosynthesis (28.02 vs. 78.43 hours, p = .047) or prosthesis (42.29 vs. 96.68 hours, p = .029) and received NOACs at the time of their fracture, had a significantly shorter preoperative waiting time, compared to patients that were anticoagulated by VKA and treated with vitamin-K. Patients on NOACs with intracapsular proximal femoral fractures, who were treated by osteosyntheses had also a significantly shorter preoperative waiting time than VKA patients treated with vitamin-K alone (5.1 vs. 74.5 hours, p \ .001 Results: About seventy percent cases are female. There were 17 cases of upper extremity fracture including 12 cases of distal forearm fractures and 7 cases of lower extremity fracture including 3 cases of tibial shaft fracture. Injury mechanisms are 13 cases of low energy trauma and 11 cases of high energy trauma. According to Gustilo-Anderson classification, about a half of the series are type 2 injury. Twelve cases were treated by the provisional external fixations which were converted to the internal fixation. All fracture healed except for one non-union case of proximal tibial fracture in which the bone graft was necessary. College of Medicine, Swansea University, Swansea, UK, 2 Trauma and Orthopaedic Surgery, Morriston hospital, Swansea, UK Introduction: Gamma nails are widely used in extracapsular femoral neck fractures. Component parts include the nail, lag screw and locking screws. These are packaged separately and retrieved intraoperatively following measurements. However, this increases theatre traffic, and therefore infection risk. 1 This study assesses whether nail length can help predict component part lengths. Material and methods: Trauma theatre logbook records for a teaching hospital were reviewed for a one year period. Following exclusion, cases to be included in the study were evaluated for demographic details and lengths of the gamma nail component parts. Correlation between the component parts was assessed in SPSS, and its strength determined. Results: In total 126 femoral nails were placed and, following exclusion criteria, 104 patient records with 105 gamma nails were reviewed. There were 64 females and 40 males with 58 nails on the left and 47 on the right. The mean ratio of nail length to lag screw length was 4.11:1, and nail length to locking screw length ratio was 8.14:1. Spearman's rank correlation co-efficient (r) for the nail length to lag screw correlation r = 0.417, and for nail length to locking screw length r = 0.580 (p \ 0.05 for each of these correlations). Conclusion: This study confirms a significant correlation between lengths of the component parts of a gamma nail and the lag and locking screw lengths, which can be reliably estimated by dividing nail length by 4 and 8 respectively. This can help surgeons predict lengths of screw used with the gamma nail system, thereby reducing theatre traffic. Introduction: In recent years, atypical femoral fractures in patients on long-term oral bisphosphonates (BPs) for osteoporosis have been reported. We report on patients with atypical femoral fracture who underwent invasive treatment at our hospital. Material and methods: Between November 2011 and December 2014, operative treatment was administered in 6 cases (7 limbs) of atypical femoral fractures. The mean age of the patients was 65.7 years and all of the patients were female. All patients underwent osteosynthesis using antegrade intramedullary nails. A history of BP administration, premonitory symptoms, mechanism of injury, fracture sites, type of fracture, lateral bowing of the femur, and time to bone healing were studied in these cases. Results: BPs had been used in all cases, but were discontinued after surgery and teriparatide was administered. Premonitory symptoms were observed in 3 cases. All cases resulted from minor injuries. Six limbs had subtrochanteric fractures and one had a shaft fracture. All limbs had transverse fractures. Two limbs exhibited deformation, with lateral bowing of the femur. The mean time to bone healing was 27.6 weeks; delay in fracture healing was observed, but all cases achieved bone healing. Introduction: Fragility fractures of the pelvic ring (FFP) are increasing in frequency 1 . These fractures are usually treated by bed rest, administration of pain killers followed by mobilization with walking aids. Therefore, new concepts for surgical treatment have to be developed to address the functional needs of the elderly patients. The purpose of this case series is to evaluate the efficacy of percutaneous trans-sacral screw (TTS) fixation for FFPs using fluoroscopybased navigation. Material and methods: From January 2014, Seven patients (all female, mean age: 79.7 y) with FFPs were operated with navigated percutaneous fixation. According to AO/OTA system, there were 4 cases of B3 type and each 1 case of B1, B2 and C1 type. In these patients, 3 patients were treated with TTS fixation; 4 patients were treated with TTS fixation, screw or plate fixation for pubic fractures. The entry point on the skin was determined by 2D-fluoroscopic images using a passive optoelectronic navigation system. Postoperative CT scans were performed for postoperative evaluation of screw placement. The intra-operative blood losing, operating time, complications were observed. Pain orientated full weight bearing was allowed immediately for all patients. Results: The average operating time was 101 min. The blood loss ranged from 10 to 20 ml. There were no wound infections, neurovascular injuries and other organ injuries. The postoperative pelvic X-ray and three-dimensional CT showed that all the screws had good position. Introduction: The application of taper wedge stem in elderly is controversial because of their bone vulnerability and relatively wide medullary cavity. This time, radiological evaluation of femoral neck fractures in elderly treated with hemiarthroplasty using taper wedge stem were performed. Material and methods: 36 consecutive patients of femoral neck fracture were treated with hemiarthroplasty using taper wedge stem(Ovation hip system; Japan MDM) from April 2014 to March 2015 in our hospital. In these patients, 33 patients that had no trauma and no surgical intervention of contralateral hip joint in the past were analyzed. 6 men and 27 women, and the mean age was 82.5 years old. For these patients, Canal Flair Index(CFI), stem fixed position in the Gruen's zone classification, varus-valgus stem insertion, and postoperative stem subsidence were measured. Results: There were 12 patients with CFI less than 3.0. In these patients, stem fixed position was II, VII in 9 patients(75 %) and III, VII in 3 patients(25 %) and varus stem insertion was seen in 2 patients(17 %) and stem subsidence of more than 1 mm was seen in 4 patients(33.3 %) at the final survey. There were 21 patients with CFI more than 3.0. Fixed position was II,VI,VII in 17 patients(81 %) and varus insertion was not seen and subsidence of more than 1 mm was seen in 2 patients(9.5 %). Conclusion: It is concern that malposition of hip prosthesis cause periprosthetic fracture in elderly. It was suggested in this study that it is necessary to pay attention to the occurrence of varus insertion and subsidence. References: Distal fixation of proximally coated tapered stems may predispose to a failure of osteointegration (HJ cooper, AP Jacob, JA Rodriguez The Journal of arthroplasty 26 (6) Introduction: With the progress of aging society, fragility fractures of the pelvic ring (FFP) are increased. In this study, it is to find the relationship between the tilting angle of anterior pelvic plane (APP) obtained from patients and the study using a finite elemental method (FEM). In this study, it is to find the relationship between the tilting angle of anterior pelvic plane (APP) obtained from patients and the study using a finite elemental method (FEM). Material and methods: In the FFP using a pelvic model of the 75-yearold woman who is subjected to operative treatment, it is studied by FEM. The stress concentration from new bone model to reduce fracture and implants based on the CT data is checked using FEM. The APP tilting angles of anterior +10°, natural 0°, posterior -10°, -20°, -30°and posterior -40°were used. On the other hand, 12 cases with postoperative FFP, are examined the standing APP tilt using the standing X-p.Postoperative standing APP tilt, measured by using a 2D3D matched technique, are compared with the results of FEM. Results: The stress concentration of the pelvis was changed by the pelvic tilt. When the APP tilt became posterior, the stress of the S1 and S2 has clearly increased. Also, average standing APP tilt is -32.3°( 21-43°), that data is support the results of FEM. Conclusion: Than that the data from FEM and clinical data matches, pelvic posterior tilt appears to be one of the development factors of FFP. Disclosure: No significant relationships. Introduction: Osteoporosis is a common and potentially devastating disorder with a US prevalence of 3 % to 9 %. We report on 10 patients who presented to our service over a 12-month period. We also review the current literature on prevention and treatment, and describe the specific management of each admission. Material and methods: Radiology exported all Dexa Scan ordered over a 6/12 timeframe on patients admitted into Trauma & Orthopaedic Surgery with fracture of suspected osteoporotic nature. Each patient course was reviewed from admission to discharge, and subsequent follow-up in outpatient department. Results: Atraumatic fracture of vertebra, neck of femur (NOF) or distal radius are often associated with osteoporosis. While often prevalent in elderly patients, our patient cohort consists of 30 % in their 40 s and 40 % in their 50 s: only 1/10 is over 70 years of age. In each case XR and CT were used to assess the degree of fracture, possible retropulsion and management. Conservative management with a hyperextension brace is preferred in isolated vertebral compression fractures without retropulsion. Dexa scan was requested on all patients who were deemed to be at risk of osteoporosis. Key measures for prevention include: diet; exercise; non-smoking; falls risk; and medications (including glucocorticoids, anticoagulants and antiepileptics). Bisphosponates slow bone resorption, however they require careful restrictions. Other medical treatment includes: Oestrogen: Calcitonin; Denosumab; and Parathyroid (PTH) hormone. Conclusion: We report on a series of 10 patients who presented with atraumatic fractures consistent with an underlying diagnosis of osteoporosis. We discuss their investigation and management in the light of recent guidelines. Introduction: The diagnostic evaluation of pancreatic injuries has improved dramatically in recent years. However, it is sometimes difficult to diagnose pancreatic injuries because there are no specific signs, symptoms, or laboratory findings associated with the condition. Advanced inflammation and autodigestion are found surrounding the sites of pancreatic injury if diagnosis is delayed. Therefore, surgical treatment after delayed diagnosis increases the risk of mortality and morbidity. Material and methods: A 47-year-old man was referred to our emergency department having experienced blunt abdominal trauma caused by a fall with associated pancreatic injury 5 days prior. His vital signs were stable status. Laboratory tests revealed a white blood cell count of 21,310 /mm 3 , a mild increase in serum amylase/lipase levels (471/688 U/L), and a C-reactive protein level of 25.71 mg/dL. An abdominal computed tomography (CT) scan revealed discontinuity between the pancreas head and neck with peripancreatic fluid collection. Results: ERCP was performed. ERCP demonstrated disruption of the pancreatic duct with leakage at the neck portion of the pancreas. A 5-Fr 9-cm endoscopic pancreatic stent was inserted. Next, percutaneous catheter drainage (PCD) was performed at the site of peripancreatic fluid collection. A follow-up CT scan revealed no exacerbation of the pancreatic injury and decreasing volumes of peripancreatic collection. The patient's symptoms improved and the patient was discharged on hospital day 26. ERCP was performed 7 months after initial admission, and revealed mild stricture of the leakage site without leakage. The stent was removed. Introduction: Grade V liver laceration with major hepatic vein injury and hemodynamic instability requires an immediate surgery. Herein, we report a case of severe liver laceration with major hepatic vein and portal vein injury successfully managed by the portal pedicle and hepatic vein ligation, followed by delayed hepatectomy. Material and methods: A 10-year-old boy referred to our hospital with an abdominal distension and hemodynamic instability after traffic accident. Blood pressure was 70/40 mmHg. On laboratory findings, hemoglobin was 8.3 g/dL, platelet count was 85,000/mm3, prothrombin time international normalized ratio (PT INR) was 2.13. An abdominal computed tomography (CT) showed an active bleeding from right hepatic vein, right portal vein, and right inferior hepatic vein with extensive liver laceration of right hepatic lobe and large amount hemoperitoneum. Results: An immediate laparotomy was performed. After ligation and division of gallbladder neck, the right portal pedicle was secured using Glissonean approach. The coronary ligament and the right S192 triangular ligament were dissected, and the root of right hepatic vein was ligated. After locating the liver to left side, injured inferior vena cava; the root of right inferior hepatic vein, was sutured. However, parenchymal resection could not be performed because of diffuse oozing from disseminated intravascular coagulopathy (DIC). Perihepatic pad packing was performed and the abdominal wall was closed temporarily. After 2 days from the initial operation, completion right hemihepatectomy was performed without massive uncontrollable bleeding tendency. Conclusion: Severe liver injury in hemodynamically unstable patient was could be successfully managed with an immediate vascular control and delayed hepatic parenchymal resection. Introduction: Liver abscess is a relatively rare condition, in developed countries; etiology is most often pyogenic (with the biliary tract being the most common source of infection). It can present with typical fever, right upper quadrant pain and jaundice but often the presentation is nonspecific. We present a case of septic shock due to a liver abscess caused by gastric and hepatic perforation by a fishbone. Material and methods: Case Report: An 87 year old female patient was admitted to the emergency department for hypotension, malaise and chills. A CT scan was performed and showed an heterogeneous nodular lesion in the left hepatic lobe and a linear hyperdense image, measuring 3.2 cm, stretching from the gastric lumen, across the gastric wall, to the hepatic lesion. These aspects were suggestive of a foreign body (likely a fishbone) perforating the gastric wall and causing an hepatic abscess. The patient was submitted to an exploratory laparotomy that revealed a left hepatic lobe abscess and a fishbone piercing the liver. The abscess was drained, the fishbone was removed and an epiploplasty was performed. The patient was admitted to the ICU for severe septic shock, she was discharged to the ward 3 days later and completed a 12 day course of antibiotics. Results: Foreign body migration from the gastrointestinal tract to organs such as the liver, spleen and bladder is exceedingly rare but possible. Conclusion: Liver abscess due to foreign body migration is an elusive but potentially life threatening condition. CT is crucial for diagnosis and surgery is the cornerstone treatment. 10.1007/s00464-015-4308-5). Initially the procedure was applied on uncomplicated inguinal hernias and proved potentially safe in addition of being time and effort saving. As a more advanced stage in the application of DAH technique, the author has tried in this study on irreducible indirect inguinal hernias. Material and methods: This is a multicentre study applied between September 2013 and March 2014. The study recruited sixty five patients with irreducible indirect inguinal hernia within the first eight hours from irreducibility. In all cases hernia has to be reduced smoothly with minimal to moderate pressure under general anesthesia prior to start of the surgical procedure in fifty three patients. Persistently irreducible hernias were reduced during the procedure by combined intra-peritoneal sac traction and external pressure prior to extra-peritoneal gas insufflation. This later method of hernia reduction was applied on the remaining twelve patients. Follow up duration ranged between 24 and 17 months. Results: All 65 patients underwent the DAH procedure that was completed without deviation from the original technique nor conversion to open surgery. All results' data is tabulated. No observed complication related to technique nor recurrence in any of the operated patients over the follow up duration. Introduction: The cut blood supply from herniating tissues at the level of the neck of the hernia sac would induce distal gangrene. In the traditional surgical approach, exploration starts from the herniation side and cutting through the neck of the sac would cause mass reduction of the hernia content. This method would release all ischemic tissue metabolites and toxins back to systemic circulation. Systemic inflammatory response would be irreversibly elicited and organ failure cascade might be initiated. Applying a new concept of exploration and tissue manipulation that avoids such a situation has been tried in this study. Material and methods: This is a multicentre study that recruited thirty one cases between January 2012 and March 2015. Hernias were of paraumbilical and indirect inguinal types with proved resected gangrenous tissue histologically. All strangulated hernias proved gangrenous herniated tissues without revealing manifestations of systemic inflammatory response. The concept applied mandates vascular pedicle control prior to hernia reduction. Ischemic tissues are resected and bowel continuity is regained. No ischemic tissue perfusion trial was given. Hernioplasty technique is applied as usual. Results: Patients' physiological and biochemical data through all stages were recorded and tabulated. No organ failure was precipitated in any of the cases. Hernioplasty techniques and results showed unremarkable complications. Conclusion: Non of the patients showed any of the systemic inflammatory response criteria nor organ failure. The proposed concept insures safe recovery after repair of any anatomical type strangulated hernia. The new concept is recommended to follow in strangulated hernias of any anatomical type. Application on wider scale is invited. References: (12) references Disclosure: No significant relationships. Introduction: Painful groin mass is a common complaint among patients presenting to the emergency department. Although quite rare, the hernia sac can contain colonic diverticulae and the appendix, which can also complicate with inflammation and perforation. We present two cases of acute diverticulitis and acute appendicitis, both complicated with perforation and mimicking a strangulated inguinal hernia. Material and methods: Both patients were male and admitted to the emergency department complaining of a painful irreducible groin mass. Patient A was 47 years old with a history of immunosuppressive therapy for an autoimmune hepatitis, diabetes, and a right inguinal hernia. Patient B was 66 years old with a history of HIV, diabetes, congestive heart failure, and a right inguinal herniorraphy thirty years ago. Upon presentation, both were hemodynamically stable, with a palpable and irreducible groin mass, reddish and warm. Initial treatment with fluids and analgesia was followed by surgical management. Results: Both patients were initially submitted to exploration via inguinotomy revealing pus upon hernia sac opening, a perforated appendicitis in patient A, and a perforated diverticulitis in patient B. The first was treated with a Parker-Kerr and a Lichtenstein techniques. The latter had an exploratory laparotomy by a low midline incision, showing an inflamed sigmoid colon and the perforation at its distal portion, with no fecal spillage, treated with a Hartmanńs procedure. Both patients had uneventful postoperative recovery. Conclusion: Although rare, acute diverticulitis and acute appendicitis should be part of the differential diagnosis of complicates inguinal hernia presentations. Both can be life-threatening, specially in selected immunosuppressed patients. Introduction: The treatment of severe hepatic trauma with hemodynamic instability is indeed a challenge for the trauma surgeon. Most of them are treated in two stage surgery fashion. The first operation focuses on hemorrhage control and the second one on the definitive repair. Although rare, bleeding control with perihepatic packing method is impossible to be carried out and can be achieved with selective ligation of hepatic artery. Material and methods: We present a case of severe hepatic trauma in hemodynamic instability status which is treated successfully with selective ligation of hepatic artery. Results: A 27-year-old man was admitted in our hospital with a hemodynamic instability status. Physical examination revealed a 2 cm wound above the right costal arch, caused by a sharp tool. The patient underwent immediate laparotomy; we found a penetrating liver laceration of segment V with active arterial bleeding. Our attempt to control bleeding with perihepatic packing resulted unsuccessful, meanwhile Pringle maneuver resulted successful. In these circumstances we performed ligation of right hepatic artery, T-tube in the common duct and multiple drains about the liver were placed. Red blood cells, fresh frozen plasma and broad-spectrum antibiotic therapy was given. Liver function tests were altered and returned to normal within two weeks. The patient was discharged on the fourteenth postoperative day uneventful. The follow-up showed no abnormality of liver function. Conclusion: In cases of severe hepatic trauma with hemodynamic instability when the control of bleeding with perihepatic packing method fails and portal vein remains intact, selective ligation of hepatic artery is the chosen option. Introduction: Control of hemorrhage in major injuries of the liver remains a challenge for surgery even nowadays. Surgeons often face difficult situations in its management. The aim of this study was to evaluate our experience in controlling hemorrhage in severe liver trauma. Material and methods: The study was conducted prospectively, in the time frame of January 2009 to December 2012. We analyzed 173 patients with hepatic trauma. Results: Temporary hemostatic maneuvers in urgent laparotomy were: bimanual compression in 13 cases (15.3 %), Pringle maneuver in 23 cases (27 %), perihepatic packing in 10 cases (11.8 %), tamponade into the injury tract in 4 cases (4.7 %), and Foley balloon catheter in 2 cases (2.4 %) . While, definitive hemostatic methods in urgent laparotomy included: electrocautery coagulation in 12 cases (14.1 %), hemostasis and bile-duct ligation with hepatic closure in 41 cases (48.2 %), hemostasis and bile-duct ligation without hepatic closure in 6 cases (7.1 %), tamponade with vascularized omental flap in 7 cases (8.2 %), anatomical hepatic resection in 1 case (1.2 %) atypical hepatic resection in 7 cases (8.2 %), and ligation of the right hepatic artery in 1 case (1.2 %). Surgical techniques performed in planned relaparotomy were: left hepatectomy in 1 case (16.6 %), right hepatectomy in 1 case (16.6 %) and atypical hepatic resection in 4 cases (66.7 %). The success of treatment has a statistically significant relationship with grade of liver injury (z = 5.2912, p = \ 0.00001), associated intra-abdominal injuries (z = 4.0743, p = 0.00005), the quantity of blood transfusion (p = 0.03207) and age (p = 0.04944). Conclusion: Perihepatic packing and the application of two-stage surgery has significantly increased the survival rate in severe liver trauma. Introduction: The liver is very often injured in blunt abdominal trauma but hepatic artery pseudoaneurysm is a rare complication. (1) Material and methods: Case report. Results: A 21-year-old female, with no remarkable past illness, was brought to our Emergency Department after have fallen from a height of 5 meters. Primary assessment revealed the patient to be pale and tachycardic, with thoracalgia and right arm pain. A computed tomographic (CT) scan displays free abdominal fluid and hepatic laceration. Surgical exploration revealed large volume hemoperitoneum and 3 liver lacerations of the VI and VIII segments, controlled by packing. Postoperative CT scan revealed large volume liver haematoma of the VII segment and a 6 mm right segmentar hepatic artery pseudoaneurysm with hepato-portal arteriovenous fistula. The fistula obliteration by catheter embolization was ineffective because S195 of the collateral circulation and a partial hepatectomy was performed (VI and VII segments). Conclusion: Despite the growth of minimally invasive therapeutic options for the treatment of such lesions many patients still need anatomical resection of the liver. References: (1) Introduction: It is recommended that laparoscopic cholecystectomy (LC) during the index admission should be the best strategy for patients with mild biliary acute pancreatitis (MBAP). However, the optimal surgical timing is controversial considering the uneven patients' stratification for pancreatitis severity in previous studies and that patients are often discharged from hospital and readmitted for elective cholecystectomy. The aim of this study was to determine the outcome of patients homogenously categorised for MBAP according to the newest pancreatitis classifications, undergoing cholecystectomy with different timing. Material and methods: We retrospectively identified patients undergoing cholecystectomy from 2006 to 2013 for MBAP, according to the 2012 Revision of the Atlanta Classification and the Determinant-Based classification of acute pancreatitis, and stratified them in two groups: index cholecystectomy (IC) and interval-delayed cholecystectomy (IDC, after at least 4 weeks). Results: 103 patients were analyzed in this study. IC was performed in 40 patients (38.8 %) while IDC in 63 patients (61.2 %). The two groups were similar in comorbidities and pancreatitis severity at admission. There were no differences for conversion rate, operation length, total length of hospitalization and overall complication rates. However, IDC patients had a 33.3 % rate of re-hospitalization for recurrent biliary events while waiting for the elective procedure and showed a higher rate of acute cholecystitis at histological diagnosis than IC (11.1 % vs 0 %, p = 0.041). Conclusion: Among MBAP patients, classified following the new pancreatitis severity scores, cholecystectomy during the index admission is the best treatment option in order to avoid further undesired hospitalizations for recurrent pancreatic and biliary disease while waiting for surgery. Introduction: Pancreatic injury is a rare complication of abdominal blunt trauma but it can pose a great challenge to manage. Material and methods: A 69-year-old male, previously healthy, was brought to our emergency department (ED) after falling down a well and staying partially submerged. At the arrival the patient presented a Glasgow Come Scale of 15 and referred intense left abdominal pain. His body temperature was 30,5°C, arterial blood pressure of 84/46 mmHg and an heart rate of 122 bpm. The FAST scan performed in the ED revealed massive hemoperitoneum and the patient was promptly transferred to the OR. Results: Exploratory laparotomy revealed a massive hemoperitoneum secondary to a near-complete section of the pancreatic body associated with minor splenic laceration. Therefore, distal pancreatectomy with total splenectomy and abdominal drainage was performed. The patient was kept under massive blood transfusion protocol, slowly rewarmed and remained under close surveillance during the first 48 hours in our surgical intermediate care unit. A type A (International Study Group on Pancreatic Fistula) pancreatic fistula developed but the patient was discharged on day 11. The fistula was managed by a slow removal of the operatively placed drains. Conclusion: Although rare, pancreatic trauma can be a cause of massive hemoperitoneum and poses a challenge to the surgeon. In case of main pancreatic duct injury, surgery with distal pancreatectomy remains the most performed treatment. Introduction: Penetrating abdominal trauma (PAT) continues to be the most frequent cause of death in the first four decades of life and is S196 the leading cause of trauma admission to the World [1] . Today, trauma is a major problem for public health in some countries [2, 3] . Material and methods: In our study are included, demographic data, parameters hemodynamic in admission, the severity of the injuries (AIS, ISS, RTS, TRISS), PATI index, presence of shock on emergency department (ED), the number of injuries organs, the timing of the operation, complications, length of stay in hospital, morbidity and mortality. Results: We have recorded 102 patients (Pt) [93(91 %) male & 9(9 %) female] with PAT in this study. Of 102 Pt, 47 (46 %) were coming from Tirana and 55 (54 %) from another hospitals. The mean age was 34.6 (10-80) years. The distribution of data based on mechanism of injury was; 2 (2 %) of Pt was after BI, 34(33 %) of Pt was after GSW, 55 (54 %) of Pt was after SW, 11(11 %) of Pt was after STW, were included in our study Conclusion: In PAT male are a mainly affected and general in the third decade of life. Compared with previous studies, SW are the leading cause of PAT, followed by GSW, rate of negative laparotomy is 15 % in our study … a result of management depends on the presence of shock on admission, PATI index and gravity of Introduction: The management of splenic injuries has shifted from operation to non-operative treatment to preserve spleen because of the postoperative risks of overwhelming post splenectomy infection (OPSI). The objective of this study is to investigate the therapeutic options of splenic injuries using medical records of Chonnam National University Hospital. Material and methods: From January 2009 to December 2013, we retrospectively reviewed the medical records of 123 consecutive patients with traumatic splenic injuries. Demographic characteristics, therapeutic options such as conservative treatment, angiographic embolization and emergency operation and clinical parameters were analyzed in this study. Results: 33 patients and 90 patients underwent operative and nonoperative treatment, respectively. A significant difference in preoperative systolic blood pressure was found between operative and nonoperative treatments (93.0 vs. 105.9, P = 0.023). However, there have been no significant differences in hematocrit (P = 0.706), blood transfusion (p = 0.552), contrast blush (p = 0.351), age (P = 0.897), angiographic embolization (p = 0.348), morbidity (p = 0.162), mortality (p = 0.573) and Injury severity scale (p = 0.197) between both treatments. Conclusion: This study demonstrated that emergency splenectomy was a preferred option in patients with unstable hemodynamic state. In addition, non-operative treatment may be a possible therapeutic option in patients with stable hemodynamic states. References: 1. Hsieh T-M, Tsai TC, Liang J-L, Lin CC. Non-operative management attempted for selective high grade blunt hepatosplenic trauma is a feasible strategy. World Journal of Emergency Surgery. 2014;9 (1) Introduction: Damage control laparotomy (DCL) is a technique utilized to care of massively injured trauma patient. We conducted microbiologic analysis of the pad used for packing in DCL and studied its association with morbidity and mortality. Material and methods: This is a retrospective review of patients undergoing immediate laparotomy at Chonnam National University Hospital Trauma Center between 2011 and 2015. DCL was defined as temporary abdominal closure at the initial surgery. 18 consecutive patients undergoing DCL were analyzed. Microbiologic samples from pad used in DCL were collected. Results: 15 microorganisms were cultured. Samples from 12 (66.7 %) patients were positive by microbiologic culture and six (33.3 %) patients were negative. Morbidity rate (91.7 % vs. 66.7 %) and mortality rate (41.7 % vs. 16.7 %) were higher in patients with positive culture than patients with negative culture. Infection rates such as surgical site infection (75.0 % vs. 33.3 %) and sepsis (41.7 % vs. 16.7 %) were higher in culture-positive patients. Four patients underwent two or three take back surgeries and all samples from these patients were positive for microorganism(100 %). Conclusion: There was a high infectious complication rate in patients with positive culture of pad. And two or more frequent take back surgery seems to increase risk of infection in DCL. Introduction: The great vessels composed by aorta and vena cava which maintain the circulatory system of human body. Great vascular trauma (GVT) is a devastating event if unrecognized in the treatment course of trauma patients. Because of its rarity, there is no current algorithm or consensus for GVT. In the present study, we demonstrated the clinical presentation and outcome of GVT and the feasibility and safety of current management in GVT. Material and methods: We conducted a prospective collection retrospective review in a Level I trauma center in Taiwan. This study enrolled all of the patients suffered from GVT from Jan 2009 to Dec 2013. We retrieved and analyzed the patient demographic data, clinical presentation, injury location, injury severity score (ISS), management, the hospital stay and mortality. Results: The cohort consisted of 73 patients: 61 aortic trauma and 12 vena caval trauma. The mean age was 41.7 ± 17.8 years. Most patients have multiple trauma with high ISS The management including surgery, stenting, angiography embolization and conservative management. The mortality rate is 26.0 % (19/73) . The unstable hemodynamic status and high injury severity score are independent factors to predict mortality. Furthermore, vena caval injury is another isolated predictor of mortality. Conclusion: In conclusion, GVT is a rare injury with a dismal prognosis. The mortality of GVT was related to severe associated injuries, furthermore, GVT is an indicator of severe multiple trauma. This aortic injury should be managed either stenting or operation, but the surgical repair is the better procedure for vana caval injury Introduction: The incidence of abdominal vascular lesions, after a blunt abdominal trauma is rare, aprox 5-10 %. Car accidents are the most frequent cause of this type of injury. Lesions of the abdominal aorta may present in 3 possible ways: as an intraperitoneal hemorrhage; a contained hematoma; or as thrombosis of the vessel. When the first case happens, hypovolemic shock may appear secondary to the bleeding. Therefore the early recognition of this type of injury is essential for the survival of the patients. Material and methods: Male, 29 years old, victim of work-accident, fall of fruit pallets (weight of 800 kg) over the anterior surface of the thorax and abdomen. At the initial evaluation (ATLS) the patient presented signals of periferic hypoperfusion and diffuse pain when palpating the abdomen. CT of the thorax-no lesions. Abdominal CTpresence of free fluid in the abdominal cavity of great volume Abdominal aorta: evidence of a posterior injury with image of endoluminal subtraction at the level of L1-L2. CT of vertebral column-Chance fracture, with retrolisthesis of L1 over L2. Results: The patient was submitted to emergent surgery. Intraoperative findings: -disruption of the inferior mesenteric artery at its origin, and endothelial lesion of the infrarenal aorta. Managementaorto-aortic bypass with interposition graft of Dacron. -retrolisthesis of L1 over L2. Management-reduction of the fracture and percutaneous fixation with Longitude. Introduction: Open abdomen has become a common technique in the management of abdominal sepsis. We present a series of cases of open septic abdomen treated by using intermittent therapy with intra-abdominal irrigation with a modified VAC-Ulta Ò associated with ABThera Ò dressing, comparing with ABThera Ò dressing suction therapy alone. Material and methods: Retrospective study of 12 patients with temporary abdominal closure for abdominal sepsis. During the initial laparotomy washing of the peritoneal cavity was performed with warm saline. Six patients (Goup 1, between 2013 and 2014) were treated by KCI ABThera Ò dressing, and keeping constant suction pressure -125 mmHg. For the second group (Group 2, between 2014 and 2015) the mentioned dressing was used, and we performed also intermittent intra-abdominal instillation with modified VAC-Ulta Ò . By programming the device, intermittent flushing was performed each hour with 250 cc of saline heated inside the abdominal cavity and keeping for 5 minutes. Results: Primary fascial closure was achieved in 100 % of patients with instillation therapy, 4 of them in the first change after 3 days, and the other 2 patients in the second change (6th day). In the group 1, only 3 of them were closed (at 3th, 6th and 11th day). Two of them remained with the open abdomen and the other one died. Conclusion: The results obtained by combining the intra-abdominal instillation therapy with suction seem to be promising, regarding the rate of abdominal closure, reducing the time to primary fascial closure and consequently in fewer complications associated with open abdomen. References: • Emr B, Sadowsky D, Introduction: Road accidents are by far one of the most common forms of trauma in Portugal despite the investment in the safety of roads. The patient was brought to our ER by the pre-hospital team and presents with an acute abdomen after a car accident. She was traveling in the back seat without using a seat belt. Material and methods: A 77 years-olds woman was admitted to our ER after a car accident with complaint of thoracic and abdominal pain. She also complained of her left forearm. She was hemodynamically stable with a GCS of 15. The lung auscultation showed absent sounds in the left side and the abdomen palpation was consistent with an acute abdomen. She performed a thoracicabdominal and pelvic CT-scan that showed a diaphragm rupture with herniation of the abdominal fat and bowel in to the left thorax and a moderate haemoperitoneum. The forearm X-ray diagnosed an ulnar fracture. The patient underwent an explorative laparotomy which confirm the diaphragm rupture and a laceration of the mesentery. The laceration was sutured and the abdominal contents was placed back in the abdominal cavity. The diaphragm was then sutured. Results: The postoperative went well and the patient was discharged three weeks after the initial surgery. Results: The patient's outcome was very good, and was discharged home after 7 days. Conclusion: Sufficient vigilance and suspicion of small bowel injury must always be considered following blunt abdominal trauma. Patients with small bowel lacerations must be managed according to the injury scale (I to V). When surgery is taken in a early stage, the outcome is very good with minimum septic contamination and decreased morbidity and mortality. The aim of this presentation is to report a case of liver abscess due to intrahepatic gallbladder perforation. Material and methods: We report a rare case of liver abscess due to acute cholecystitis in a patient with Type 2 diabetes mellitus and its clinical presentation, diagnosis and treatment. Results: A 64-year-old woman was admitted to our emergency department in sepsis conditions with concomitant type 2 diabetes mellitus. She was somnolent, tachypneic, with fever (38 -39 C°), a pulse rate of 110 beats/min, and a blood pressure of 95/60 mmHg. Laboratory studies upon admission showed slight hyperglycemia (186 mg/dL), leukocytosis (21100/mm3), low hemoglobin levels (8.9 g/dL), hyperbilirubinemia (6 mg/dL), and a moderate increase in C-reactive protein (12 mg/L). The chest X-ray detected right sided pleural fluid. Abdominal ultrasound and computed tomography revealed acute cholecystitis, two hypodense areas that extended in 2,3,4,5 segments of the liver, and communication between the hypodense area of the liver, and the gallbladder. For two weeks, the patient was treated with empirical antibiotics therapy. After two weeks, the patient underwent surgical intervention where communication between acute cholecystitis and liver abscess was observed. In these circumstances, we performed a cholecystectomy, and drained the abscess. Intraoperative culture obtained during operation resulted negative. The patient was discharged without complications on the 11th postoperative day. Introduction: When resection is performed, a minimally invasive approach even to pancreatic resection is gaining momentum. Laparoscopic surgery has swept through other areas of surgery in recent years. Laparoscopic distal pancreatic resection has increasingly been described as a feasible and safe procedure, although accompanied by a high rate of conversion and morbidity. The aim of of this paper is to describe the clinical characteristics, indications, technical procedures, and outcome of laparoscopic distal pancreatic resections with spleen prezervation. Material and methods: We present a case of a patient with tumoural formation in spleen hillum, apparently away from pancreatic tail, without characteristic symptomatology. Results: Laparoscopic evaluation revealed a pseudotumor related to pancreatic tail, and we performed excision of it. Histo-pathologic result shows necrotic pancreatitis. A follow-up of at least 3 months was available for all patients. Splenic vessel preservation was possible. The hospital stay was 6 days. Conclusion: Laparoscopy proved especially beneficial in patients with postoperative complications as they had a relatively short hospital stay. Solid and cystic tumors of the distal pancreas represent a good indication for laparoscopic resection whenever possible. Resection of the pancreas is complicated by the retroperitoneal location of the pancreas, its intimate relationship to other organs such as the spleen, stomach, duodenum, and its relationship to major vascular structures such as the superior mesenteric vein, splenic vein, portal vein, branches of the celiac axis, and superior mesenteric artery. Distal pancreatectomy with en-bloc splenectomy has been considered the standard technique for management of benign and malignant pancreatic disorders. However, splenic preservation has recently been advocated. Results: There were under discussion including some aspects, still subject to controversy, the extirpation scale, critical points of surgery risk, attitude on protection genitourinary innervation. For this purpose the present surgical considerations towards: rectal anatomy and mesorectum; TME and its limits on dissemination aspects of pathology and tumor grading, pelvinc recurrence and adjuvant therapy. Was analyzed the rate of complications, and the patients QOL as subject of TME. Our study did show a nonsignificant higher positive circumferential resection margin rate in patients undergoing laparoscopic anterior resection compared with open resection. Conclusion: There are a total of six critical points in rectal surgery that can improve the success rate in colorectal surgery. Laparoscopic TME is feasible in almost all patients with lower rectal cancer regardless of whether they have undergone chemoradiation therapy. It is mandatory to excise lymph station 1 and then, minimum one noninvaded station. In vertical plane the principle is applied, usually 1,2 and 3 stations are excised. In lateral plane TME excise only one lymph node station. WHY? Disclosure: No significant relationships. Results: Over the years we performed different surgeries from exploratory laparotomy to hemostasis, pancreatography, pancreatic drainage, necrectomy, necrosectomy, partial pancreatectomy, and also duodenopancreatectomy and latety we were a little more conservative in our therapy so that nonoperative management has gain his place in our standards. Morbidity and mortality was higher in penetrating trauma with ductal injury but once the diagnostic was positive a suitable therapy was applied Conclusion: The key for an optimal management is represented from an accurate and early diagnostic. Morbidity and mortality is determined by main pancreatic duct involvement. Lately nonoperative management became the therapy of choice for proximal ductal injury References: . -Asensio JA, Petrone P, Roldan G, Kuncir E, Demetriades D. Pancreaticoduodenectomy: a rare procedure for the Results: The number of cases were 27 and 42 for EG and LG. The groups were independent of age and ISS, but males were dominant in LG. The mortalities irrespective of injury grades were 40.7 % (EG) and 23.8 % (LG) with no significant difference, but those of Grade IV and higher were 42.9%(EG) and 21.9%(LG) with significant difference. The incidences of PhP were 40.7 %(EG) and 19.0 %(LG) with obvious decrease. Mortalities of the cases with PhP were 50.0 % (EG) and 71.4 % (LG) with no significant difference, but those without PhP were 36.4 % (EG) and 8.0 % (LG) with significant decrease. Conclusion: The survival rate of blunt hepatic injury with OM was improved in recent ten years. The improved outcomes may be attributed to changes in our surgical procedures from damage control by PhP to definitive surgery with complete hemostasis Introduction: Approaching a multiple trauma patient requires care and focus while still maintaining some speed of action. Material and methods: We present the case of a 21-year-old male, who was brought to the emergency department after a traffic collision with multiple injuries including blunt chest and abdominal trauma. Results: At the time of admission, the patient presented with a GCS of 14, spontaneous breathing with a high-flow oxygen mask at 12L/ min, maintaining a peripheral oxygen saturation of 100 %. There was dullness on percussion and absence of breath sounds in the left hemithorax. The abdomen was diffusely tender on palpation. A FAST ultrasound uncovered a splenic injury and a left pulmonary contusion with left hemopneumothorax, with subsequent placement of a chest tube. Because there was still dullness and absence of breath sounds on the bottom two thirds of the left hemi-thorax, the patient had a CT of the thorax and abdomen, which showed the presence of a diaphragmatic rupture, with thoracic herniation of the stomach and partly the spleen. He underwent a laparotomy with reduction of the herniated content, splenectomy and closure of the diaphragmatic tear with suture. After 11 days the patient was discharged. 2 months later he presented with normal X-ray, CBC and free of symptoms. A 42 year old diabetic man developed emphysematous gastritis due to clostridium perfringens after a below knee amputation. The patient was treated with antibiotics and resection of the greater curvature of the stomach in the manner of a sleeve gastrectomy. A 42 year old diabetic man with chronic osteomyelitis of the foot developed left upper quadrant pain and sepsis nine days after guillotine below-knee amputation. A CT scan showed gastric pneumatosis with portal venous gas. Laparoscopy demonstrated purulent ascites and full thickness necrosis along the greater curvature of the stomach. Esophagogastroduodenoscopy found sloughing of the mucosa along the greater curvature but an otherwise healthy stomach. The necrotic portion of the greater curvature was resected, leaving the lesser curvature and antrum in the manner of a sleeve gastrectomy. The patient had a successful and uneventful recovery.. Gram positive rods were found on pathology exam of the resected portion of stomach. Results: Emphysematous gastritis is a deadly infection with even the most recent literature showing mortality rates of 60-80 %. The origin of infection are thought to include both local infection due to mucosal disruption and hematogenous spread from distant foci. The initial treatment is fluid resuscitation and antibiotics. Though several dozen case reports have been published, the collective understanding regarding indications and timing of surgical intervention continues to develop. Conclusion: Prompt diagnostic laparoscopy and limited gastric resection allowed this patient an expedient recovery from this deadly condition, and we advocate that this surgical approach be used whenever the diagnosis of emphysematous gastritis is made. Introduction: The duodenal hematoma is a rare disease that occurs more frequently in children, after a blunt abdominal trauma. The anatomical location of the duodenum near the vertebral column, combined with its rich vasculature contributes to the development of this entity, which is often complicated with a traumatic acute pancreatitis due to duodenal intimate relationship with this organ. Material and methods: The authors present a clinical case of a patient of 15 years admitted in the E.R with abdominal pain and vomiting after trauma in the right upper quadrant in the previous day, while playing football. Computed Tomography revealed extensive hematoma of the 2 nd and 3 rd duodenal portion with a significant reduction in its lumen, associated with heterogeneity of pancreatic uncinate process. Hyperamylasemia and hyperlipasemia was also consistent with associated traumatic pancreatitis. Results: Given the hemodynamic stability and the absence of pneumoperitoneum, the patient underwent conservative treatment with placement of nasogastric tube, hydration, analgesia and parenteral nutrition. The patient progressed favorably and was discharged one month later. Conclusion: Conservative treatment is currently the first-line approach in the closed duodenal injury, with a great success rate especially when the diagnosis is made early on. When this approach fails, surgery becomes necessary to drain the hematoma. Introduction: Acute pancreatitis is a common and potentially fatal condition. Studies show that standardisation and optimisation of management protocols can improve morbidity and mortality. In 2005 the British Society of Gastroenterology revised their 1998 pancreatitis management guidelines to provide 11 parameters which could be audited. These guidelines included the use of a scoring system to determine severe pancreatitis within 48 hours, escalation to HDU or ITU in severe pancreatitis, an ultrasound scan within 24 hours and definitive management of gallstone pancreatitis (ERCP or laparoscopic cholecystectomy) within 2 weeks. Material and methods: At Guy's and St Thomas' Hospitals approximately 100 patients with acute pancreatitis were admitted in the first 6 months of 2015, above the national average. A cohort of 60 of these patients were audited retrospectively to determine compliance to guidelines. Our practice was re-audited following the introduction of a pancreatitis clerking proforma. Results: The initial results were poor with deficiencies in both the initial assessment and management. A clerking proforma was introduced. Preliminary results from the re-audit does show an improvement in the initial assessment of acute pancreatitis yet continuing difficulties implementing the correct management. Conclusion: It has become clear that compliance to the BSG guidelines depends not just on the willingness of the clinician to be thorough in their initial assessment but the availability and prioritisation of appropriate radiological, ITU, operative and endoscopic resources. Introduction: Male, 58 years old, no previous medical history, was brought to the ER after falling from a ladder over a construction bar. The accident resulted in extensive perianal trauma presenting with perianal hemorrhage and extensive disruption of the anal canal. Under physical examination, multiple lacerations and total disinsertion of anus and rectum were found. Material and methods: A surgical exploration under general anesthesia was performed finding a complete disruption of the posterior sphincter area and a high rectal lesion. Local surgical debridement with perianal tamponade was performed and diagnostic laparoscopy allowed to rule out any intra-abdominal lesions. A lateral colostomy was made for fecal diversion. Results: The patient remained in a surgical care unit. A second operation took place two days later with sphincter reconstruction and closure of the rectal laceration. No complications occurred and the patient was discharged home after 10 days of hospital admission, maintaining ambulatory wound care and monthly surgical consultations. Conclusion: Blunt and penetrating injuries of the anus and rectum are uncommon, with optimal treatment still subject of debate. Care should be individualized and diagnostic laparoscopy can play an important role in excluding intra-abdominal lesions. Extensive injuries often require fecal diversion with a colostomy before definitive treatment is undertaken. References: Herzig, D. O. (2012) . Care of the patient with anorectal trauma. Clinics in Colon and Rectal Surgery, 25 (4) Introduction: Toothpick ingestion is implicated in gut injuries which may cause severe complications, mimicking diseases causing acute abdomen. Material and methods: A 18-year-old man with a 3 day history of swallowed wooden toothpick. Upper and lower abdominal pain was admitted with acute pain in the left upper quadrant. CT image shoved toothpick impaction at the splenic flexura of the colon. Results: The foreign body was detected and successfully removed with colonoscopy. The abdominal radiograph showed free air as a sign of perforation after colonoscopy. Along with conservative management patient discharged without surgery. Conclusion: There is need for a greater awareness about the dangers of a swallowed toothpick. Endoscopic approach should be considered in the first line management for toothpick perforations. Introduction: Primary hydatid cyst of the gallbladder is an unusual and very rare localization of hydatid disease. The pathogenesis of the primary gallbladder hydatid cysts is not well-documented. Material and methods: A 32-year-old woman was admitted suffering from constant mild pain in the right hypochondrium reflecting to the epigastrium. The ultrasound examination showed that daughter cysts in the lumen of the gallbladder. MRI T2-weighted sequence demonstrating daughter cysts in the lumen of gallbladder with hepatic parenchyma free of cystic lesions. Results: The diagnosis of primary hydatid cyst of gallbladder was supported and surgery has been decided. A laparoscopic cholecystectomy was performed. It permitted a total removal of the cyst without rupture. The histopathology confirmed the presence of hydatid cyst of the gallbladder. At six month follow up, the patient has had no recurrence of hydatid disease. Conclusion: Primary hydatid cyst of the gallbladder is a very rare clinical entity. Surgery is always required for the treatment. Laparoscopic approach should be the first option. The purpose of this study was to compare TACE versus OAS in patients with isolated abdominal trauma. Material and methods: We included subjects registered in the Japan Trauma Databank (JTDB) from year of 2004 to 2012. After a multiple imputation for missing values in studied variables, subjects who suffered a severe to critical injury on the definition of the Abbreviated Injury Scale in abdomen but other region and underwent whether TACE or OAS were included. Subjects with out-of-hospital cardiac arrest were excluded. Study outcomes were in-hospital mortality and duration of hospital stay. A propensity score matching estimated from the covariates to predict TACE or OAS and mortality extracted matched pairs of subjects with balanced background characteristics. Intergroup comparison showed the study outcomes in propensity score matched subjects. Results: Of 123462 subjects registered in JTDB, 241 propensityscore-matched pairs with TACE or OAS were selected. The predicted mortality based on the Trauma Injury Severity Score finely balanced (4.4 % versus 4.1 %, P = 0.795) . TACE significantly related to lower in-hospital mortality in comparison with OAS (3.3 % versus 9.5 %, P = 0.009), however did not significantly affect length of hospital stay (17 days versus 17 days, P = 0.523). Subsequent OAS after TACE was 6.6 %. Conclusion: This retrospective study demonstrated needs for prospective trials to test TAE versus OAS in relatively hemodynamically stable patients with abdominal injuries. References: Disclosure: No significant relationships. Introduction: Laparoscopic surgery (LS) is not only an accepted procedure for digestive surgery but also an emerging technique in emergency general surgery in Japan, such as cholecystectomy and appendectomy. However little was known about this procedure for patients with abdominal trauma. The purpose of this study was to compare usefulness of LS and open surgery (OS) in patients with abdominal trauma. Material and methods: Subjects was selected from the Japan Trauma Data Bank (JTDB) from January, 2004 to December, 2014. A propensity score to undergo LS instead of OS was calculated from age, gender, initial vital signs, the Abbreviated Injury Scale (AIS) of each region, the Injury Severity Score (ISS), proportion of undergoing the focused assessment with sonography for trauma. The primary outcome was in-hospital mortality and the secondary outcomes was length of hospital stay in survivors (LOS) and proportion of undergoing blood transfusion (%BT). Results: Eighty-six subjects with LS and 4,933 subjects with OS were included from JTDB. A propensity score matching selected 66 matched subjects with LS or OS. There was no significant difference in mortality (0.0 % vs. 7.8 %, p = 0.058) and LOS (13 days vs. 17 days, p = 0.129). LS was associated with significantly infrequent blood transfusion (odds ratio 0.36, 95 % confidence interval 0.15-0.84). Conclusion: Despite sample size in this study was small, this study showed that LS for hemodynamically stable patients with abdominal trauma might be feasible. Further studies were needed to assess feasibility and efficacy of LS for abdominal trauma. Introduction: Lesions of the biliary duct following a blunt abdominal trauma occurs infrequently, and even more so when it occurs in the intrapancreatic biliary duct. With the increase of conservative treatment in blunt abdominal trauma, the diagnosis of this entity can be difficult and delayed. Material and methods: A 51-year-old male patient was treated following a bicycle accident. Initial CT scan showed multiple bilateral rib fractures and grade 2 liver injury in segment VII. On the basis of these findings and the stability of the patient, a conservative treatment was adopted. On the 9 th day following admission he developed a progressive jaundice. This prompted an MR-cholangiography, which only revealed an increased amount of abdominal fluid without dilatation of the bile duct and without apparent injury of the duct. Upon the onset of fever and general worsening of the patient's condition, an exploratory laparotomy was performed on the 16 th day following admission, revealing plenty of intraperitoneal bile fluid, but a visual examination of the bile duct failed to determine the site of injury. Results: An intraoperative ERCP was performed, revealing a lesion of the intrapancreatic bile duct, after which a biliary stent was inserted. In the early postoperative period the patient developed a leak through the external biliary drains placed during laparotomy. A new ERCP was therefore performed, together with the insertion of a coated metal prosthesis, after which the patient progressed satisfactorily. Conclusion: MR cholangiography and ERCP play a fundamental role in the diagnosis and actual treatment of these injuries, and this constitutes the best option. Introduction: It is difficult to diagnose a febrile patients with acute right lower quadrant abdominal pain, with previously undergoing appendectomy, as stump appendicitis. Material and methods: We presented a case report of stump appendicitis. Results: A 65-year-old female patient who had previous appendectomy for more than 40 years ago had right upper quadrant abdominal pain, right back pain and hematuria for 3 days. She was diagnosed pyelonephritis and went back to her home after she was prescribed the antibiotics. However, after the pain migrated to right lower quadrant abdomen and exacerbated, she was transferred to an emergency department of the study hospital. Physical examination of abdomen revealed the rebound tenderness in right lower quadrant and her laboratory data revealed increase in white blood cell count of 22,700 / mm 3 and C-reactive protein concentration of 32.09 mg/dL. Abdominal computed tomography (CT) showed a tubular structure extending from the left side of cecum, and a calcification at the ventral of the cecum with inflammation sings. CT scan also showed air density around the liver in peritoneum cavity. She underwent right hemicolectomy. On the operation there was an acute pan-peritonitis and penetration of the stump appendix to the ascending colon. Pathological findings showed an acute necrotic inflammation and perforation of the stump appendicitis. She discharged to home on postoperative day of 19. Conclusion: We tend to rule out the possibility of acute appendicitis because of their previous appendectomy, however it is infrequent but important to make the diagnosis of stump appendicitis . Introduction: Acute episodes of cholecystitis account for a considerable proportion of acute surgical admissions in the UK today. The traditional management approach has been to treat the acute episode with antibiotics, and eventually discharge with either a follow-up in clinic, or scheduled elective cholecystectomy. However over the last few years, the guidelines have advised offering laparoscopic cholecystectomies during the index acute admission (1), ideally within 7-10 days of diagnosis of acute cholecystitis: -''hot laparoscopic cholecystectomy'', providing the biliary pathophysiology allows for a surgical approach (2) (3) . Material and methods: Despite the guidelines, it is widely known that NHS trusts rarely offer ''hot laparoscopic cholecystectomy''. Therefore we audited one month's worth of data from our busy London district general hospital's acute surgical take, in order to assess what the staus quo really is, with relation to the management of patients presenting with acute cholecystitis. Results: In December 2014, 159 general surgical admissions were made, of which 25/159 were related to gallstones. 15/25 were confirmed on ultrasound (US) to have acute cholecystitis, and 10/15 were found to have ''acute cholecystitis with no duct dilation'' and would therefore be deemed appropriate for ''hot laparoscopic cholecystectomy''. However, only 2/10 who were eligible for ''hot laparoscopic cholecystectomy'' ended up having this. Additionally, although all 25 should have eventually had surgery, only 4 of the remain 23 eventually ended up having surgery. Conclusion: We have identified several areas which need improvement. These need to be addressed and reaudited in order to strive to provide the appropriate acute surgical treatment and subsequent management. References: (1) Surgery, General Hospital of Tripolis, Tripolis, Greece, 2 Rheumatology, General Hospital of Athens G.Gennimatas, Athens, Greece Introduction: Primary adrenal insufficiency subsequent to bilateral adrenal hemorrhage is a rare and life-threatening complication of the antiphospholipid syndrome. The aim of this study is to report such an uncommon case that presented with clinical manifestation of acute abdominal pain. Material and methods: A 40 year old, male with a history of primary antiphospholipid syndrome, diagnosed two years ago after the occurrence of pulmonary embolism and popliteal thrombosis, receiving anticoagulant medication that was discontinued for a 3 day time of period in order to undergo a surgical dental excision, was presented with acute abdominal pain of right upper quadrant. Laboratory testing and clinical evaluation revealed signs of ileus and elevation of CRP and amylase in serum and urine. The patient was positive for LA 1 , b 2 -GPI IgG and b 2 -GPI IgM, a CL IgM and aCL IgG ANA, anti-dsDNA antibodies. Results: The abdominal computed tomography demonstrated a bilateral adrenal hemorrhage. In 21 days after his initial admission to hospital, the patient was re-examined. Further testing revealed hyponatremia, hyperkaliemia indicative of mineralocorticoid deficiency. Therapy with fludrocortisone was initiated in addition to his regular medication. Conclusion: The development of acute adrenal failure as a result of bilateral adrenal haemorrhage in the context of antiphospholipid syndrome is a life-threatening condition that should be promptly detected. Therefore, patients diagnosed with antiphospholipid syndrome should be assessed and followed thoroughly. Introduction: Caecal diverticula represent a rare benign patology in the Western World. Usually congenital they are among the true diverticula of the colon and in most cases asymptomatic. An accurate preoperative diagnosis in case of complications is difficult especially in emergency setting Material and methods: Case report. Results: Case 1. A 61 year old caucasian female admitted for pain in the right iliac fossa in the last 72 hours. Clinical examination showed positive Blumberg and Mandel signs, while the ultrasonography showed moderate pericecal liquid, enlarged appendix and pericaecal fat stranding. Blood tests showed 14,12 9 10 3 leukocytes and Hb = 12,5 g/dl. Intraoperative localised purulent peritonitis surrounding a 4 cm ulcerated caecal tumor, and an appendix without signs of inflammation were found. Case 2. A 33 year old caucasian woman admitted for pain in the epigastrum irradiating to right iliac fossa for 48 hours. Clinical examination showed positive Blumberg sign and the abdominal ultrasonography showed only moderate oedema of the pericecal fatty tissue. Leukocytosis and normal Haemoglobin have been noticed. McBurney laparotomy revealed retrocaecal appendix without signs of inflammation along with a 12/10 cm caecal tumor requiring median celiotomy for proper inspection of the abdominal cavity. The impossibility to rule out caecal neoplastic disease (no frozen sections available during night time) required right hemicolectomy for both patients. The HP exam showed perforated caecal diverticulitis in both cases. Conclusion: Complicated caecal diverticulitis should be considered a differential diagnosis of right iliac fossa pain both in young and old patients. Big pseudotumoral inflammatory masses often require extensive surgeries. References: Disclosure: No significant relationships. A. Kocsis 1 , A. Németh 2 1 Iv. Trauma Department, Trauma Centre, Budapest, Hungary, 2 General Surgery Department, Trauma Centre, Budapest, Hungary Introduction: A 45 years old male swallowed polyurethane self-expandable foam (commonly used to insulation) by suicidal intention. The patient was transferred to a toxicology department. Material and methods: Despite the injury the patient was found in good general condition. Radiographical assessments showed that the oesophagus and the cranial part of ventricle was filled with the foam. Thoracic surgeons planned a total oesophagus extirpation. Results: Thanks to a lucky relationship with a company dealing with laboratory reagents we had opportunity to make an urgent experiment to examine the foam's effect to oesophageal tissues. The polyurethane foam was filled into rat's oesophaguses. The trial demonstrated that the foam does not adhere to mucosal tissues. Conclusion: According to the experimental results we performed an endoscope assisted gastrotomy. During the intervention the whole consolidated foam was removed without injuring the oesophagus. No secondary intervention was necessary. References: Disclosure: No significant relationships. Introduction: The caustic ingestion results in erosion and necrosis of digestive tract, moreover, induces spillage of intraluminal fluid and spread of bacteria. All of these result in severe sepsis and threaten the life of patients. Because of the advance of endoscopic technique and knowledge of this injury, more authors advised conservative management. On the other hands, the extension surgery was advocated by others. Because of still controversial, we presented our clinical practice and outcome of patients with caustic ingestion and evaluate the feasibility and safety of extensive surgery. Material and methods: We conducted a retrospective review in a medical center in Taiwan, enrolled all of the patients with caustic ingestion from Jan 2007 to Dec 2013. We retrieved and analyzed the demographic data, clinical presentation, injury location and range, the kinds and amount of ingested caustic agent, management, the surgical timing and procedure, the hospital stay and mortality. Results: The cohort consisted of 138 patients: 24 of them need emergent operation. The mean age was 52.2 ± 17.8 years. For patient who need emergent operation had the worse endoscopic severity. The mortality rate is 58.3 % (14/24). Initial shock and perforation of gastrointestinal tract are independent factors to predict mortality. Furthermore, initial extensive surgery showed benefit effect on survival. Conclusion: In conclusion, caustic injury is a risky injury with a dismal prognosis. The mortality is extremely high and is related to peritoneal contamination and initial hemodynamic condition. Extensive surgery to remove all of the necrotic tissue prevents further progression of sepsis that might reduce the mortality. A 3- year old child presented as a Level 1 Trauma with a traumatic posterior hip dislocation and acetabular fracture after being struck by a vehicle on a bicycle. The patient was neurovascularly intact. Imaging revealed a posterior dislocation of the left hip. The patient was taken to the operating room for closed reduction under anesthesia with radiographic guidance. The patient was stabilized and discharged with instructions for partial weight bearing. A review of the literature was performed to discuss the incidence, management, complications and outcome of pediatric traumatic hip dislocation. Material and methods: Literature review was performed using OvidMD, Cochrane, and Pubmed using the following keywords: ''pediatric hip dislocation'', ''traumatic pediatric hip dislocations,'' ''traumatic hip dislocation,'' and ''hip dislocation.'' Results: Literature search revealed 15 relevant articles with 115 patients sustaining hip dislocation. Average age was 9.5 years; 70 % were boys, 103 were posterior dislocations, 8 were anterior dislocations, 3 were central/obturator dislocations, and one was unknown. Conclusion: The management of traumatic hip dislocation in the pediatric population is divisive. Some advocate for reduction in the emergency room, while others for reduction in the operating room under general anesthesia. Diagnosis is multimodal and related to the patient's age. Initial diagnosis is made by the history and physical examination, followed by radiography. Hip dislocations require emergent reduction due to a number of sequelae. Multiple studies describe treatment options with differences in outcome. Generally, pediatric hip dislocations have a good prognosis. Long-term follow up into adulthood has not been documented. Further studies are needed to investigate long-term sequelae. References: • Introduction: The number of Total Knee Arthroplasties(TKA) performed grows annually, and therefore the expected to complications, including periprosthetic fractures (potentially serious), will grow as well This paper aims to describe the epidemiology of periprosthetic knee fractures of the femur at our hospital, and compare the results obtained with an osteosynthesis plate to those with a retrograde nailing(Group 1 vs Group 2). Material and methods: This is a retrospective study of 20 patients operated at the Universitary Hospital Doce de Octubre (Madrid) between June 2011 and November 2014, and treated with a plate fixation (12 patients, 46 %) or intramedullary nail retrograde (8 patients, 31 %). Results: The patients had, at the time of the periprosthetic fracture occurred, a mean age of 81.2 years (range 51-96). 90 % were women (18) Based on the classification of Lewis-Rorabeck, 95 % of fractures were classified as type 2, the remaining 5 % were type 3 The mean follow-up time was of 26 months (range 8-47). The average time since the introduction of the ATR to the periprosthetic fracture was of 36.05 months (range 1-120). The average healing time was 5.2 months (range 4-24) and the range of motion (ROM) was 1128 (90-120) The clinical and radiological results were used to compared Group 1 to Group 2 resulting in ROM(p0.96), healing time(p0.14) and mal-union of the fracture(p0.49); finding no statistically significant differences in any of them. Conclusion: There are no differences between the two techniques in terms of clinical and functional outcomes A correct classification, coupled with good planning and execution of the surgical technique is the basis of proper therapeutic management. Introduction: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), is a critical complication after pelvic and lower extremities fractures. In this study, we evaluated thrombin-antithrombin III complexes (TAT) and D-dimer levels after surgery for fractures of the pelvis and/or lower extremities, and evaluated their prognostic accuracy for the development of postoperative VTE. Material and methods: 96 patients with fractures of the pelvis and/ or lower extremities who were surgically treated were analyzed prospectively. The TAT and D-dimer levels were measured on postoperative day 7. The usefulness of TAT and D-dimer for the diagnosis of VTE was examined using Receiver Operating Characteristic (ROC) curve analysis. The optimal cut-off levels were set on the basis of having the highest Youden index. Results: Postoperative VTE was diagnosed in 23 patients including 7 patients with PTE. The ROC curve analysis indicated that diagnostic accuracy for the TAT test was higher than the D-dimer test. At the optimal TAT cut-off level (3.0 ng/ml), sensitivity was 90.0 % and specificity was 71.2 %. At the optimal D-dimer cut-off level (7.4 lg/ ml), sensitivity was 90.9 % and specificity was 57.5 %. Conclusion: Our results revealed that the TAT tests measured 7 days after surgery had superior diagnostic power for predicting postoperative VTE. Although sensitivity of the TAT test was comparable to that of the D-dimer test, specificity of the TAT test was greater than that of the D-dimer test. TAT can be a useful marker for the diagnosis of postoperative VTE in patients with fractures of the pelvis and/or lower extremities. References: Disclosure: No significant relationships. Introduction: The demand for bariatric surgery is highly increasing and the postoperative complications are seen more frequently. Bariatric emergencies are increasingly seen in the emergency departments S216 and serious outcomes are reported following non bariatric surgeon intervention. Such complications are attributed to technical errors, suboptimal clinical evaluation, failure of effective communication with bariatric teams, and delayed either presentation or management of such cases. Reported mortality is around 2 %, increasing to over 6 % in case of surgical revision. Material and methods: This is a multicenter study on all types of bariatric surgery patients after their discharge home. Between August 2009 and January 2014 patients following any type bariatric surgery were discharged with the proposed ''book of instructions''. This includes all patients' instructions, possible complains and instructions to patients, postoperative complications, recommended management by emergency and/or general surgery doctor and contact information of the original surgical team. Results: Bariatric surgery complications are tabulated per type of bariatric surgery, needed investigations, conservative management, surgical intervention and the operating team whether the original operated the first time or any other team and the final outcome. Degree of obedience to the protocol is documented. Finally the overall morbidity and mortality data is recorded and compared to literature. The awareness of bariatric emergencies and the effective management are the gold standards for best outcomes. The proposed ''book of instructions for bariatric patient follow up'' proved effective in achieving lower morbidity and mortality results. A universal protocol for such identity is needed as a standard. Further evaluation is invited on larger scale studies. Introduction: Although sternal fracture is a relatively common injury, the treatment guideline has not yet been established. Herein, we report a patient with sternal fracture and thoracic spinal body fracture who underwent non surgical treatment and developed a severe respiratory distress. Material and methods: A 59 year-old patients came to emergency room (ER) after falling down. The patient underwent computed tomography (CT) on chest, abdomen, brain, cervical and thoracic spine which revealed sternal fracture and multiple thoracic and lumbar body fracture. We decided to have conservative treatment for the spinal fracture and the sternal fracture as well, because the sternum was not displaced and had no associated injury. Results: On 38 th admission day, he was discharged. However, after 3 months, he complained respiratory difficulty and underwent chest CT which revealed severe kyphosis and posterior displacement of sternal fracture with decreased lung volume. We, cardiothoracic surgeons planned to have surgery for the displaced sternum and spines with neurosurgeons. Conclusion: Surgery for sternal fracture has not been commonly performed, however, it is simple and is known to have better attachment of fragmented bone compare to conservative treatment. Even though the displacement is not so severe at first time, it can be progressed when sternal fracture is combined with spinal fracture. We suggest for surgical approach in such case rather than conservative treatment Introduction: A 65-year-old woman brought in at the emergency room was assumed to have a distal radial fracture. The X-ray showed, besides the fracture, a five-centimetre corpus alienum between radius and ulna. It turned out to be a broken K-wire that had migrated from an olecranon tension band placed in 2009 following an olecranon fracture. Material and methods: A retrospective literature search about K-wire migration was conducted to gain information about the best treatment. Results: Numerous case reports on K-wire migration show that this phenomenon may occur throughout the body and cause serious local problems. K-wire migration from the shoulder joint has been described extensively, including eight fatal cases, mostly due to pericardial tamponade. We have traced three case reports about K-wire migration from the upper extremity distal of the shoulder joint. All three cases involved intravasal migration towards the heart, necessitating surgery for removal of the wire. Case reports about K-wire migration from the lower extremity reveal less serious complications. All these case reports described migration of a minor part of the K-wire. Conclusion: Our case is unique because distal K-wire migration from the elbow has never been described in literature before. Though the potentially serious consequences should not be ignored, we assessed that the risks attached to removal of the K-wire outweighed the minimal risk of the K-wire migrating towards the heart given its size (entire K-wire). Added to the absence of complaints, this was reason for us to adopt a wait-and-see policy and monitor the patient over time. Introduction: Small bowel obstruction (SBO) due to internal herniation is a well-described complication of laparoscopic gastric bypass (LGBP), predominantly on Petersen's space. However, with its numerous presentations, from mild to severe, an early diagnosis may be problematic. The authors describe a case of small bowel obstruction due to an internal hernia through Petersen's space as a late complication from gastric bypass surgery. Material and methods: A 40-year old male operated of LGBP for morbid obesity in 2010 presented with abdominal pain and vomits. Epigastric pain aggravated on palpation, no guarding. Plain x-ray showed air-fluid levels, no pneumoperitoneum. Leukocytosis and hypokalemia. CT scan reported diminished caliber of small bowel adjacent to the mesentery root, but no visible obstructive cause. Failure to improve after 48 hours of nonoperative management so we opted for the surgical approach. Results: After an exploratory laparotomy, an internal hernia through Petersen's space was confirmed and its content distorted and reduced, with no signs of small bowel necrosis. The mesenteric gap was sutured closing Petersen's space. Discharge after 3 days. Conclusion: As LGBP increases, its complications become more prevalent. In the emergency department, a high level of suspicion should be a concern when in contact with SBO after bariatric surgery. Introduction: Posterior column screws (PCS) play a important role for fixation of the posterior column from anterior approach in acetabular fracture surgery, but it is challenging even for experienced surgeons to insert the screw through the safe zone between anterior and posterior column because of its narrowness and misdirection of the screw. We analyzed the insertion pathway and the safe zone of PCS in order to insert it accurately. Material and methods: Eleven Japanese adults who was brought into the emergency department at our hospital and taken pelvic CT scan were included in this study. Their pelvic CT scan data were imported into VirtualPlace Ò (AZE, Ltd., Tokyo, Japan).By using the software, 20 uninjured acetabula were assessed the maximal intramedurally length from inner plate of iliac bone to ischial tuberosity or spine and the cross-sectional area of the safe zone. The cross-sectional area was automatically calculated by tracing the cortical bone around the safe zone on the image superimposed the orthogonal plane to the insertion pathway of PCS. Results: The mean age was 48.2 (31-71) years old and the mean BMI was 23. 3 (20.4-24.9 ) kg/m 2 . The maximal intramedurally length from inner plate of iliac bone to ischial tuberosity was 142.0 ± 11.0 (127.7-158.5) mm and to ischial spine was 93.0 ± 7.9 (87.1-104.4) mm. the cross-sectional area of safe zone toward ischial tuberosity was 303 ± 64 (202-398) mm 2 and ischial spine was 180 ± 21 (141-210) mm 2 . Conclusion: The area of safe zone to insert the longer PCS was 303 mm 2 , but it might be narrower depending on the reduction of posterior column fragment when we actually insert PCS We got two early complications (6 %) (sciatic nerve palsy and a case of vascular complication) and 6 late complications (15.38 %) (3 osteoarthritis, 2 heterotopic ossification and one avascular necrosis) When we apply the Matta's nomogram, we find that only 2 people have a chance of 40 % or more of developing complications in next two years (similar to our study). Conclusion: Surgical treatment achieved good results. After the study, we observed a rate of poor functional results between 18-20 %, The Matta's nomogram can help to predict the need for total hip replacement in next two years. In our case, we obtained similar results than the nomogram predicted, so we can say that in our working group, the nomogram is a good predictor. References: • Both column fractures of the acetabulum: epidemiology, operative management and long-term-results. Gänsslen Introduction: In this case report, we present a patient who had a humeral shaft fracture, previously this patient had a nonunion fracture distal to the new fracture. So we have to treat a fracture of the proximal third of the humeral shaft, plus a focus of nonunion on the distal third. Material and methods: The requirement, in this case, of an extended approach, with visualization of the radial nerve, made us opt for an extended posterior approach (Gerwin's approach), with detection of the radial nerve and the external brachial cutaneous nerve with exposure of more than 90 % of the humeral shaft, something that we don't achieve with other approaches For that, we use the Gerwin's approach, identifying the radial nerve and the external brachial cutaneous nerve. Refreshing the edges of the fracture and using an autologous iliac crest graft and finally making the osteosynthesis with an extraarticular humeral plate. Introduction: Fat embolism syndrome (FES) is one of the disastrous complications of femur fractures. Since we experienced the case of FES following the skeletal traction, we strictly perform either external fixation or internal fixation for the treatment of femur shaft fractures caused by high energy. In this study, clinical courses were reviewed and the efficacy of our treatment strategy was evaluated. Material and methods: From 2007 to 2013, the registry data and charts were reviewed retrospectively, including femur shaft fracture cases injured by high-energy trauma. Open fractures, implants for immediate fixations and definitive fixations, and complications were investigated. Results: 61 cases/ 63 femurs (male: 45, female: 16), average age: 39.9 years old. Open fractures: 18 cases Immediate fixation implants: 57 cases (internal fixation: 29, external fixation: 28) Definitive fixation implants: IM nail-54 femurs, plates-2 femurs, external fixations-5 femurs 2 minor infections. 3 FESs: Case1-a femur fracture combined with ipsilateral hip dislocation. He was diagnosed as FES immediately after the reduction of the dislocation, which took 6 hours from the injury. Case2-18 hour delay for the fixation due to the communication problems with operating room. Case3-the patient was transferred from other hospital following shock and FES without operative fixation and in spite of immediate external fixation, died in 3 weeks. All fractures were healed except case 3. Conclusion: No complications with FES after immediate femur fixations. A femur fracture with ipsilateral hip dislocation could potentially lead to the worst scenario and thorough care should be taken. The smooth communication with operating room personals is mandatory. References: 1) Weiss W, Bardana D, Yen D. Delayed presentation of fat embolism syndrome after intramedullary nailing of a fractured femur: a case report. J Trauma. 2009 Mar;66 (3) Introduction: Distal femoral shaft fracture, called infra-isthmal fracture, occasionally result in nonunion due to insufficient fixation of the distal fragment. The purpose of this study was to determine the treatment strategy of postoperative nonunion of infra-isthmal femoral fractures. Material and methods: Seven patients with 8 non-unions of distal femoral shaft fractures resulting after standard intramedullary nailing were treated. They were all male and aged from 25 to 80 years (average 55.7 years). As for the biological activity of nonunion, 5 cases had hypertrophic nonunion type and 3 cases had oligotrophic nonunion type. We evaluated the outcome of these cases. Results: One case has been treated with exchanging nailing (EN). Four cases have been treated with EN combined with bone graft. One case have been treated with augmentation plating (AP). Two cases have been treated with AP combined with chipping osteotomy. All cases obtained bone union without complication and infection. The mean follow-up was 7 months. Conclusion: We performed EN combined with bone graft in early cases. However, the young cases with hypertrophic type had obtained bone union with only EN and compression. Therefore, bone graft is not always necessary if the case is hypertrophic and is treated with enough stability. In cases with AP, bone union was shown from the medial side, opposite to the plate and bone graft. This suggest that stability for distal fragment is important even in oligotrophic nonunion. In these fractures, we should keep in mind that obtaining stability of distal fragment with reliable surgical technique and proper implant selection is important. Traumasurgery, University Medical Center Utrecht, Utrecht, The Netherlands, 2 Traumasurgery, University Medical center Utrecht, Utrecht, The Netherlands, 3 Surgery, UMC Utrecht, Utrecht, The Netherlands Introduction: Dysregulation of the immune response to severe trauma forms the basis for severe complications such as Multiple Organ Dysfunction Syndrome. Literature revealed that a splenectomy in selected severely injured trauma patients is associated with better outcome. We hypothesized that a splenectomy results in a diminished absolute leukocyte number in the peripheral blood of severely injured trauma patients. Material and methods: All adults with blunt splenic or hepatic injuries with an ISS [15, admitted to our level one trauma center between 2007 and 2015 were included. Patients were grouped according to the injured intra-abdominal organ (spleen vs. liver) and the treatment they received (operative (OM) vs. non-operative (NOM)). The absolute leukocyte count was measured on several time points after trauma. Results: A total of 129 patients were included, of whom 56 patients sustained splenic injuries and 73 suffered hepatic injuries. Nineteen splenectomies were performed and 12 patients required liver repair surgery. Splenectomized patients had slightly increased leukocyte numbers during the first weeks of observation compared to all other groups. This difference was most prominent after two weeks, where absolute leukocyte counts were significantly increased in splenectomized patients compared to the NOM splenic patients, respectively 20.07 vs. 12.79 (p:0.01). Conclusion: We are the first to show that a splenectomy results in altered leukocyte kinetics in peripheral blood of trauma patients. These observations contribute to the assumption that the spleen plays a modulatory role in the innate cellular immune response to trauma. Moreover this forms a first explanation for the beneficial effects of a splenectomy on outcome of severely injured trauma patients. References: Disclosure: No significant relationships. Introduction: Medial clavicle fractures are rare injuries as accounting for 2-3 % of all clavicle fractures. The symptomatic nonunion rate in medial clavicle fractures with conservative treatment is reported to be 8 %. We present a rare case of medial clavicle nonunion which was successfully treated with an inverted distal clavicle locking plate. Material and methods: A 53-year-old male working for the construction industry fell from the second floor of a house during his work and sustained a left medial clavicle fracture. The patient was initially treated conservatively at another hospital. He was referred to our hospital 9 months after his initial injury with complaints of abnormal mobility, pain and activity limitation. A hyper-mobile pseudoarthrosis was evident, and a surgery was planned. For preoperative planning, the life-size 3-dimensional model of the mirror image of the contralateral clavicle was created. It was revealed that an inverted ipsilateral locking plate for distal clavicle fitted nicely. We performed open reduction with debridement of the pseudoarthrosis tissue and internal fixation using the locking plate. Results: The plate selected preoperatively fitted to the medial clavicle without any contouring. Bony union was achieved and he returned to his preinjury activity without any symptom. Conclusion: Medial clavicle nonunion was successfully treated by an inverted distal clavicle locking plate. Although the optimal fixation device for medial clavicle has not yet been established, this method can be a treatment option. References: Disclosure: No significant relationships. Introduction: We have routinely performed venous thromboembolism (VTE) screening by imaging examinations pre-and postoperatively since July 2009. The purpose of this study was to investigate the incidence of VTE in patients with pelvic and/or leg fractures by routine imaging examinations. Material and methods: Records of the patients with pelvic and/or leg fractures between May 2009 and August 2015 were retrospectively reviewed, and the incidence of VTE by routine imaging examinations was investigated; (1) deep venous thrombosis (DVT) screening by ultrasonography in all patients (2) pulmonary thromboembolism (PTE) screening by contrast-enhanced computed tomography (CECT) in patients with pelvic and/or bilateral leg fractures and patients with proximal DVT detected by ultrasonography. Results: Of the 300 patients with pelvic and/or leg fractures, 24 patients (8 %) were diagnosed with PTE and 89 patients (30 %) were diagnosed with DVT. One patient had symptomatic PTE. Among 44 patients who received routine CECT, 23 patients (55 %) were diagnosed with asymptomatic PTE; 17 patients were diagnosed by CECT for patients with pelvic and/or bilateral leg fractures and 6 patients were diagnosed by CECT after detection of proximal DVT. PTE was detected preoperatively in 11 patients and postoperatively in 13 patients. The incidence of PTE in patients who received routine CECT was not affected by gender, age, the duration from injury to operation and injury severity score. Conclusion: The rate of PTE was high in patients who received routine CECT, that is, patients with pelvic and/or bilateral leg S223 Introduction: Collatamp G is a system performing localized drugdelivery; based on type-1 collagen matrix obtained from bovine Achilles tendon, it consists of a collagen sponge saturated with gentamicin, which creates considerably higher local concentrations, lethal for bacteria, while avoiding the risk of systemic toxicity and associated side effects. Moreover, collagen is a biocompatible material with proven wound-healing and haemostatic properties, thus Collatamp G accelerating hemostasis and wound healing. Material and methods: The authors present 8 cases where Collatamp G was used as an adjacent method to the treatment of osteitis of long bones following closed or open fractures. Surgical debridement was performed prior to Collatamp usage. The patients were skeletally mature (18-52 yrs), had no known allergic reaction to collagen; with no significant associated pathology . The patients were evaluated clinically and radiologically. Results: In all the cases, the collagen matrix enhanced the granulation reaction, thus helped healing while negative subsequent cultures . When the bone defect was small, no bone graft was necessary (3 cases), while in 5 cases, the Papineau method was applied, with secondary bone grafting. In all the cases, the local effect was optimal, and the duration of treatment was considerable less Conclusion: Collatamp G has certain advantages: the matrix itself is fully resorbable, while it provides carefully controlled, secure for the patient, mathematically modeled both rapid and prolonged release of Gentamicine. The cases we present demonstrate that the product stimulates healing, helps granulation and performs anti-microbial action, thus being a useful tool in treating bone infections. References: H. Knaepler Local application of gentamicin-containing collagen implant in the prophylaxis and treatment of surgical site infection in orthopaedic surgery-International Journal of Surgery Volume 10, Supplement 1, 2012, Pages S15-S20 Disclosure: No significant relationships. Introduction: Patients with large long bone defects present a challenge. Such was also the case in a motorcycle accident of a young male, where bone fragments (up to 8 cm) were found on the road. After initial necrectomy of the open femoral fracture and external fixation 19 cm of bone defect was left. Material and methods: Following extensive preoperative planning an intramedullary nail was laid through both fragments and used as a railway for double bone transport with Ilizarov whilst retaining functional reposition. Many complications occured postoperatively, including: ischiadicus palsy, blockage of transport, wire bending due to severe tension, soft tissue problems, diminished ROM in the knee, toe flexion contractures and other. All of this was addressed through several operations. In the end a docking site spongioplasty reinforced with a LCP plate was made followed by quadriceps release with Joudet technique. Results: A multidisciplinary team consisting of physical therapists, nursing staff, dietitian, psychologist, pain management specialist, neurologist and others prepared a rigurose rehabilitation programme which was modified on the go. It was primarily executed intrahospitaly, secondarily at a rehabilitation institution and tertially at home. 2 years after the injury the patient was fully rehabilitated with no pain and no limitations in daily activities. Conclusion: Covering large long bone defects is always a marathon. Complications should be expected and their solutions planned and executed with great consideration of basic surgical principles and philosophy, supported by experience of senior surgeons. A well organised multidisciplinary team is a must. References: As this is a case report we shall not list references. Our wish and goal is to present all of our experiences with long bone defects gained in the past years in University Medical Centre in Ljubljana, Slovenia. Disclosure: No significant relationships. Introduction: Nowadays, colonoscopy is performed more frequently. Because of that, there are more complications, and colon perforation is one of them. The optimal treatment of colon perforations is still controversial. Material and methods: The objective is to know the spanish surgeons' opinion about the treatment of endoscopic colon perforation, for which a survey was sent by email to all members of the ACS Results: 109 surveys were received. Spanish surgeons prefer to operate immediately if the diagnosis of the perforation is during endoscopy (66 % with proper bowel preparation and 79 % with poor preparation) and after that, the decision to operate depends on the signs and symptoms In colon without pathology, if peritonitis is mild, they prefer laparoscopic suturing (83 %), while if peritonitis is severe, they preferred first laparoscopic suturing (27 %), and laparoscopic resection (24 %) with colostomy. In a pathological colon, in mild peritonitis the preference is the open resection and anastomosis (40 %), followed by laparoscopic resection (31 %), while if the peritonitis is severe, they prefer open resection with colostomy(45 %) followed by laparoscopic resection (33 %). Conclusion: In the future more and more defects will be repaired endoluminally. However, by the time surgery is recommended for large defects, poor preparation and difficult locations, although it is true that the choice of definitive treatment must be appropriate to the means available. Traumasurgery, University Medical Center Utrecht, Utrecht, The Netherlands, 2 Traumasurgery, University Medical Center RWTH Aachen, Aachen, Germany, 3 Surgery, UMC Utrecht, Utrecht, The Netherlands, 4 Major Incident Hospital, University Medical Center Utrecht, Utrecht, The Netherlands Introduction: Severely injured trauma patients are at risk for developing infections. Recent studies have shown that platelets play an important role in inflammatory reactions. Platelets are a source of chemokines, cytokines and growth factors. Therefore we aimed to investigate the potential role of blood platelet numbers in the early diagnosis of infectious complications in severely injured trauma patients. Material and methods: All adults with blunt splenic or hepatic injuries with an ISS [15, admitted to our level one traumacenter between 2007 and 2015 were included. We excluded patients who underwent a splenectomy for their splenic injury as it is known that splenectomy influences blood platelet numbers. We compared platelet and leukocyte counts over time between patients who had infectious complications and those who had an uncomplicated course. Results: A total of 125 patients were included, of whom 47 patients were diagnosed with infectious complications. During the first week of observation patients who developed infection had significantly lower platelet counts after 7 days (283 vs. 209, p0.038). There were no differences observed in blood leukocyte numbers after one week of observation. The leucocyte count was only significant higher after 24-48 hours after admission in the infection group compared to the non-infectious patients (11.7 vs 9.8, p.0.030). Conclusion: Infection in severely injured trauma patients is associated with lower platelet counts after one week of hospital stay. Platelets might therefore better predict infection than leukocytes in severe trauma. Furthermore, this observation contributes to the assumption that platelets are involved in the immunologic response to severe trauma. References: Disclosure: No significant relationships. Introduction: Despite a high volume of medical literature regarding liver hydatidosis, the high level evidence coming from Randomized Controlled Trails is lacking. The aim of the current study is to describe the perioperative outcomes of cystic echinococcosis and to systematically review the literature about the subject. Material and methods: Retrospective study of patients with hydatid disease admitted between Jan 2014 -July 2015 in a Emergency Hospital of Bucharest, a tertiary university affiliated center. Results: Our 18 month data included 33 patients, 56 % female, 25 (75.8 %) from open group (OG) and 8 (24.2 %) from laparoscopic group (LG). We do not find any statistical significant difference between OG and LG regarding age (OG/LG = 45.6/30.8, P = 0.598), diameter of the cyst (OG/LG = 13.6/10.1, P = 0.246), in-hospital stay (OG/ LG = 15.4/9.1, P = 0.106), in-hospital costs (OG/LG = 8558/8507, P = 0.598), intraoperative visualization of a biliary tract communication (P = 0.16), intrahepatic localization of the cyst (P = 0.578), postoperative morbidity according to Clavien-Dindo classification (P = 0.729) and postoperative biliary leakage (P = 0.701). Conclusion: A minimally invasive non-radical approach for cystic echinococcosis is safe, with a relative contraindication for minimally invasive approach for central cysts, thick walled cysts, and recurrent disease. Orthopaedic Department, Assiut University Hospitals, Assiut, Egypt Introduction: Surgical nonunion is a rare complication of vertically unstable sacral fractures. Patients present either after failed conservative treatment or as an overlooked injury in a polytrauma patient. Material and methods: We report the surgical treatment of 7 patients with sacral non-union. Age ranged from 20 to 52 years. Six patients presented after failed conservative treatment and one after failed iliosacral screw fixation. Shortening (from 10 to 44 mm), pain and inability to walk were the presenting symptoms. Neurological complications were associated in 4 patients. The fracture was Denis type II in 6 patients and Denis type I in one. Open reduction was done in all cases. Bone resorption with significant bone gap was found in 6 patients, for which autogenous iliac bone graft was used to avoid sacral narrowing and sacral root compression. Osteopenia was reported in all cases. Posterior lumbopelvic fixation was done in 4 patients, sacral plating (small LCP) in one, ilio-iliac plate in addition to iliosacral fixation in two. Anterior pelvic ring release and stabilization was done in 4 patients. Results: Six patients achieved fracture union after the index operation with healing time ranging from 16 to 20 weeks. One patient needed revision with re-fixation and bone grafting. Conclusion: This is a report of surgical management of sacral nonunion showing difficulties and possible solutions in dealing with these patients. Bone grafting as an exceptional indication was used and stable internal fixation was done using either lumbopelvic fixation in cases with significant vertical migration or direct sacral or iliosacral fixation in other cases. Introduction: Traumatic brain injury (TBI) is a lethal trauma, which not merely impact the patient's life but also results in the neurologic sequela. Pediatric traumatic brain injury (PTBI) was considered to have better outcome than TBI in adults. Because of its rarity and lacking of follow-up, there is no definite answer of the prognosis of PTBI. In this study, we demonstrated the presentation and outcome of PTBI and analyzed the risks of dismal prognosis. Material and methods: We conducted a prospective collection retrospective review in a Level I trauma center in Taiwan. This study enrolled all of the pediatric patients aged from 0 to 6 suffered from PTBI from Jan 2005 to Dec 2014. We retrieved and analyzed the patient demographic data, clinical presentation, injury mechanism, initial Glasgow Coma scale (GCS), injury severity score (ISS), management, the hospital stay, morbidity and mortality. Results: The cohort consisted of 360 patients. Among them, 214 were boys and 146 were girls. The main causes of PTBI were fall (63.9 %), followed by abusive head trauma (19.4 %) and motor vehicle crash (16.7 %). Younger age and severe trauma mechanism were associated with higher rate of positive finding in computed tomography. Younger age, motor vehicle crash, abusive head trauma and initial lower GCS have higher risk to develop seizure. Furthermore, initial lower GCS is isolated predictor of neurologic dysfunction. Conclusion: In conclusion, PTBI is a rare injury with a favorable prognosis. The mortality of PTBI was related to severe associated injuries. The initial lower GCS might be an indicator of long-term neurologic dysfunction. References: Mortality in children with severe head trauma: predictive factors and proposal for a new predictive scale. Neurosurgery 2010, 67 (6) Introduction: Defensive medical practice represents an increasing concern in European countries and is reported to account for rising healthcare expenditures. Malpractice liability, current jurisdiction and the increasing claim for accountability result in additional diagnostic requests with marginal clinical benefit. Investigations that evaluate prevalence and expenditures for the health care system in Austria are lacking so far. Material and methods: Orthopaedic and trauma surgeons and radiologists from public hospitals in Austria were invited to complete a study questionnaire retrieving personal estimation of the quantity of defensive requests and patient contacts in a typical month, working time usage for defensive considerations and prior confrontations with malpractice liability claims. Analysis of expenses was based on the average national gross income for physicians and the average national reimbursement for the provided services. Results: The prevalence of defensive medicine was found to be 97.7 % and 28 % of all diagnostic examinations are requested for defensive reasons with a correlation between defensive practice and prior confrontation with judicature. The treatment of high-risk patients tempts 81 % of doctors to request additional defensive investigations. Defensive procedures account for annual expenses of 421 million Euro. Labour costs for defensive practice amount to 42 million Euro per year representing the financial resources for 425 full-time employees. Compared to the total annual public expenditures on hospital-based medical care, the defensive share of expenses amount to 3.51 %. Conclusion: Defensive medical practice represents a serious challenge in Austria. Our results indicate the urgent necessity for confrontation with and solution for the increasing effort of self-protection within the health care system. References: Disclosure: No significant relationships. EDUCATION IN TRAUMA -HAVE WE FOUND THE BEST WAY YET? General Surgery, Royal London Hospital, BB, UK Introduction: Trauma is recognised major cause of death for people under the age of 40 worldwide. Well equipped trauma centre and trained staff is therefore needed to provide the best possible care and improvement of outcome in patient following trauma. Material and methods: Materials about educational pathway and trauma system has been collected for 15 countries in the world. The major focus was on length of training, exposure to procedures, courses and other factors. Results: There are significant differences worldwide in education pathway for trauma. Some countries prefer more critical care involvement while others surgical or military. The level of exposure to critical care/surgery corresponds with trauma network in the same country. Conclusion: Trauma education is very important for management of trauma/polytrauma patients. There should be huge focus on education in trauma pathway. The level of knowledge and experience usually corresponds well with the same country but there is not much relevance in between nations worldwide. The co-operation of countries in trauma care may therefore become problematic. Introduction: Injury is a global problem but the approach to injury prevention and care varies greatly between countries. US surgical leadership has propagated training and implementation of trauma systems with the goal of setting standards for injury care throughout the world. However, information on global disparities in injury outcomes is sparse. The ultimate aim of this research is to document the benefits of surgical leadership against the global burden of injury. The objectives of this preliminary study were to compare road traffic accident (RTA) mortality rates across high-income countries and identify determinants of observed variations. Material and methods: Data were extracted from the WHO website and other sources for 34 OECD countries (2010) . Associations between mortality rates and determinants were described with Spearman correlation coefficients. Results: The countries with the highest RTA mortality rate were Korea (14.1 per 100,000), Greece (12.2), and Portugal (11.8). Those with the lowest mortality were Iceland (2.8), Sweden (3.0), and the UK (3.7). Increasing GNI per capita (r = -0.68), per capita health expenditure (r = -0.63), physicians per habitant (-0.39), speed limit enforcement (r = -0.36), and helmet law enforcement (r = -0.39) were all associated with a decrease in RTA mortality. Conclusion: A significant variation in RTA mortality exists, even among high-income countries. Health care investment and legislation enforcement have a positive influence on RTA mortality. This study represents a first step towards evaluating global disparities in injury outcomes with the goal decreasing the burden of injury worldwide. The next step will be to evaluate the influence of trauma system education and implementation. Lim J Use of intra-medullary stacked nailing in the reduction of proximal plastic deformity in a pediatric Monteggia fracture Medial subtalar dislocation: Importance of clinical diagnosis in distinguishing from other dislocations Evaluation and management of subtalar dislocations References: References: Hecser L et al., Boerhaave syndrome. A case report Successful surgical strategy in a late case of Boerhaave's syndrome Disclosure: No significant relationships Modern management of splenic trauma Practice Management Guidelines for the Evaluation of Blunt Abdominal Trauma: The EAST Practice Management Guidelines Work Group Whole Body Imaging in Blunt Multisystem Trauma Patients Without Obvious Signs of Injury Abdominal trauma-a review ATLS. 9th. American College of Surgeons Management of liver trauma Management of blunt liver trauma in 134 severely injured patients Eastern Association for the Surgery of Trauma. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline Current management of hepatic trauma Laparoscopic closure of perforated gastro-duodenal ulcer: 15 years' experience in our centre. Videosurgery and other Miniinvasive Techniques Definitive or conservative surgery for perforated gastric ulcer?-An unresolved problem Meta-analysis of Laparoscopic Versus Open Repair of Perforated Peptic Ulcer Disclosure: No significant relationships. P244 ''HOLD ON TO LIFE Median length of stay was the same for both appendicitis and normal appendix groups: 2 days (IQR 2-3) compared 2 days (IQR 1-3) p = 0.32. The estimated theatre time (£191,000) and length of stay (£9,000) for negative appendicectomies incurred an approximate cost of £285,000 annually to the hospital. Conclusion: The negative appendicectomy rate remains unacceptably high. A reduction in this rate will reduce costs to the hospital by freeing up theatre time and beds and most importantly will prevent harm to patients from unnecessary surgery. References: 1) Centre, H.S.C.I., Main Operations Summaries Disclosure: No significant relationships. References: Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis Pandanaboyana Sanjay, Devender Mittapalli, Aseel Marioud After hemodynamic stabilization, Computed Tomography scans revealed an haemoperitoneum associated with a liver mass in the segments II/III. We decided an urgent surgical approach and found a 7 cm ruptured tumour that was actively bleeding. The haemostatic control was difficult, so it was performed an incisional biopsy and liver packing which was removed 48 hours later. There wasn't evidence of cirrhosis. In the post-operative period it was identified chronic Hepatitis B virus(HBV) infection. The pathology report confirmed the histology of hepatocellular carcinoma. Proper staging was made and liver resection (left lobectomy) was performed three weeks later. Conclusion: Chronic HBV infection is the cause of approximately one third of cirrhosis and more than three quarters of HCC. Although there wasn't evidence of cirrhosis, this clinical case shows a rare cause of spontaneous haemoperitoneum. Early approach is essential. In this case, the first surgery was life-saving and the last has curative intent Disclosure: No significant relationships. P257 ENCAPSULATED PERITONEAL SCLEROSIS -IS HAEMOPERITONEUM A PROGNOSTIC FACTOR FOR SURVIVAL? Delayed presentation of traumatic diaphragmatic hernia: a diagnosis of suspicion with increased morbidity and mortality.Trauma Mon. 2013 Spring Epidemiology of ruptured abdominal aortic aneurysms in a welldefined Norwegian population with trends in incidence, intervention S207 References: 1 Intestinal infarction by internal hernia in Petersen's space after laparoscopic gastric bypass Disclosure: No significant relationships Since the identification as causative agent in pseurisk of CDI. Between 2010-2014, we analyzed retrospectively all patients undergoing colectomy (emergent and non-emergent colectomy) with the following procedural terminology: right hemicolectomy, left hemicolectomy, partial colectomy with anastomosis and Hartmann colectomy. We have collected patient's characteristics, combination of antibiotics given perioperatively and 30-day postoperative out Screw Position: A Finite-Element AnalysisCT Scan Assessment of the Syndesmosis: A New Reproducible Method Moldova resuscitation processes, medications administered, decision tools and duration of CPR for IHCAT. References: 1 Disclosure: No significant relationships. fractures or patients with proximal DVT Late complications. Fractures of the pelvis and acetabulum Cardiovascular risk associated with celecoxib or etoricoxib: a meta-analysis of randomized controlled trials which adopted comparison with placebo or naproxen Assessing the cardiovascular risk between celecoxib and nonselective non steroidal antiinframmatory drugs in patients with rheumatoid arthritis and osteoarthritis Disclosure: No significant relationships After the cement has been injected the nail is immediately inserted. After the cement has set the hose is removed. The locking holes of the nail are cleaned of cement and the nail is ready for insertion. Results: We have used this modification of antibiotic cement intramedular nail coating in one clinical case and encountered no problems with intraoperative nail preparation. The nail preparation time was less then 15 minutes. Conclusion: Antibiotic cement coated intramedullary nail can be easily prepared intraoperative with minimal preoperative preparations using commercially available intramedular nails and standard, commercially available cement mixing systems. References: Thonse R, Conway JD. Antibiotic Cement-Coated Nails for the Treatment of Infected Non-unions and Segmental Bone Defects This fracture may lead to severe functional problems, and therefore, needs correct reduction. Material and methods: 16 children (11 boys and 5 girls) with Supracondylar humeral fractures. They included 2 open fractures. The mean age was 7.8(4-13) years. 5 cases were Gaartland type II, 11 cases were Gaartland type III. The mean of waiting period until operation 0.3(0-2) days. minimum follow up period was 6 months, with no patients lost to follow up. We performed percutaneous pinning for all cases. The mean follow up period was 4.7(2*8) months. Outcomes were assessed according to Baumann angle (BA), tilting angle (TA), carrying angle (CA),the Flynn's criteria. Results: The elbow range of motion was 3°*135.3°. The complications were 2 cases (ulnar nerve palsy). They finally recovered Also, the functional results in 10 patients were excellent and in 5 patients were good and one case was poor. Conclusion: All cases were almost satisfactory. We removed the wires 8 weeks after the operation in the case of poor functional that may have resulted from limitation of elbow range of motion. A long immobilization period may cause the contracture even in children. References: Treatment of displaced supracondylar fracture of the humerus in children by open pining from lateral approach: an investigation of clinical and radiographical results How to become a trauma surgeon: analysis of the current situation and concepts for career development in the new common field of orthopaedics and trauma surgery YEARS LIVED WITH DISABILITY DUE TO EXTREMITIES' INJURIES AMONG HOSPITALIZED ROAD TRAFFIC ACCIDENT VICTIMS IRAN S228 Introduction: Apart from the burden that road traffic injuries impose to society in terms of death, between 20 and 50 million suffer nonfatal injuries annually, mostly causing disability registered in Trauma Research Center of Kashan University of Medical Sciences were included in our study. International Classification of Diseases and Causes of Death (ICD 10notable for authorities, policy makers and strategic planners. References: 1 Using disability-adjusted life years to assess the burden of disease and injury in Rhode Island Age, female gender, previous disability and low education level were all significant predictors of worst health status at 12 months. Female gender was the strongest predictor of worst health status. Initially the lowest rated dimension was Usual activities, however at 12 months the lowest rated dimension was Pain/ Discomfort. After 12 months 64 % had not yet returned to work, only \ 4 % had a working incapacity recognized 3 Social And Preventive Medicine Discharge letters inform general practitioners about of injuries: 82.5 % post-intervention, 61 % pre-intervention Results: There are two modes of trauma care in Shanghai. The first one is emergency trauma center, the other one is the emergency department first-diagnosis system. The first one is better than the second one in equipment, trauma score and trauma professional team. Low proportion of using of trauma database was a severe problem in the two modes. Conclusion: Trauma care systems develop unbalance in Shanghai P146 Israeli Trauma Group I O045 Martínez Casas I P289 Midoes A. P062, P227 Č apek L. P205 Č ernohorský P. P205 Š vec M. P205 Š ír M. P032 Ž igman Ž . P107 S245 Introduction: Periprosthetic femur fracture fixation on the level of the prosthesis stem remains problematic. Plate extension to the greater trochanter provides a longer lever arm with less screw loading. The stability of two Vancouver type B1 constructs, a hook plate anchoring in the greater trochanter (H) and a subtrochanterically placed locking attachment plate (L) with bicortical embracing screw configuration lateral to the prosthesis shaft were compared in a biomechanical test. Material and methods: After bone mineral density evaluation, paired human femora with cemented Charnley hip endoprostheses were transversely osteotomized. Each pair (n = 6 per group) was instrumented with either a hook plate or a locking attachment plate using a plate tensioner and subsequently cyclically (2 Hz) tested up to failure applying a monotonically increasing load with Bergmann profile. The bending stiffness of the plates was evaluated in a four point bending test. Statistical evaluation was performed with t-test for paired comparisons. Results: Hook plate fixation exhibited a significantly lower number of cycles and corresponding load to failure (H: 26177 cycles ± 2777, 3118 N ± 778; L: 37423 cycles ± 5299, 4242 N ± 1030, S156 Disclosure: No significant relationships. Introduction: Implant-related irritation at the entry site is known to be a disadvantage of elastic stable intramedullary nailing for clavicle fractures. The purpose of this study was to compare implant-related irritation rates of intramedullary nailing with or without an end cap for displaced midshaft clavicle fractures. Material and methods: Two cohorts of patients treated with intramedullary nailing with or without end cap were matched and compared. Primary outcome was patient reported implant-related irritation. Secondary outcome parameters were complications. Results: A total of 34 patients with end cap were matched to 68 patients without an end cap. There was no difference in implantrelated irritation (41 % versus 53 %, P = 0.26). Significantly more minor revisions were observed in the group without end cap (15 % versus 0 %, P = 0.03). For complications requiring major revision surgery, significantly more implant failures were observed in the end cap group (12 % versus 2 %, P = 0.04). Regardless of their treatment, patients with complex fractures (AO/OTA B2 -B3) reported significantly more medial irritation compared to patients with simple fractures (AO/OTA B1)(P = 0.02). Conclusion: The use of an end cap after intramedullary nailing for displaced midshaft clavicle fractures did not result in lower patient reported irritation rates. Although less minor revisions were observed, more major revisions were reported in the end cap group. Based on the results of this study, no end caps should be used after elastic stable intramedullary nailing for displaced midshaft clavicle fractures. However, careful selection of simple (AO/OTA B1) fractures might be effective in reducing implant-related problems after intramedullary nailing. 3 Surgery, Maasstad Hospital, Rotterdam, The Netherlands Introduction: There is no consensus as to whether patients with initially dislocated distal radius fractures and an acceptable closed reduction should receive non-operative or operative treatment. The purpose of this study is to evaluate functional outcomes in non-operatively treated patients with dislocated distal radius fractures with an acceptable closed reduction. The primary outcome is the Disability of the Arm, Shoulder and Hand scores (DASH)-score at 12 months. Secondary outcome is the number of secondary surgeries due to redislocation or symptomatic malunion. Material and methods: Retrospective study. Between 2007 and 2011, all consecutive adult patients with an unilateral dislocated distal radius fracture with an acceptable closed reduction that were treated non-operatively were included. DASH-scores in that time period were prospectively collected at t = 0, 3, 6 and 12 months. Patients that received secondary surgery were included if the operation was performed within one year after the initial trauma. Results: One-hundred and sixteen patients were included. The mean age was 58 years and 79 % of the patients were female. Fractures were classified according to the AO/OTA classification as follows: AO/OTA type A (49 %), AO/OTA type B (3 %), AO/ OTA type C (48 %). After 12 months the median DASH-score was 11. Forty-six (40 %) patients received secondary surgery. No significant difference in DASH-scores between the patients that were treated non-operatively and patient that received secondary surgery were found. S183 Introduction: The aim was to assess trends in incidence rates, health care use and productivity loss of patients admitted with a tibial shaft fracture in the Netherlands since 1986. Material and methods: Data of all patients admitted with a tibial shaft fracture between 1986-2012 were extracted from the National Medical Registration. Results: Between 1986-2012 80,222 patients were admitted with a tibial shaft fracture. The crude incidence decreased with 13 % to 13.8/ 100,000 person years (py) for men, for women the incidence remained unchanged (7.2/100,000 py). An incidence peak is seen in men aged 15-19 years, and in women aged 10-14 years. In both genders incidence increases after [75 years. In 2012 [50 % of patients between 20-80 years were operated. The mean hospital length of stay (5 days/patient) increased with age for men and women. Since 1993 the HLOS has reduced by half. In 2012, total health care costs for all patients were €13.6 million. Mean costs per patient were higher for women (€10,700) than men (€7,100) and increased with age. Main cost determinants were hospital costs in younger patients and rehabilitation and nursing care in the elderly. In addition, costs for lost productivity were €23 million (€18 million spent for males). Costs per absentee were higher for men (€16,500) than for women (€9,300). Conclusion: The incidence of tibial shaft fractures is bimodally distributed. Hospital length of stay has decreased, but healthcare costs rise, especially in older women. In 2012 the total costs for health care use and lost productivity were €63.6 million. References: Disclosure: No significant relationships. Introduction: Simple isolated thoracic and lumbar spine fractures occur during frontal crashes of rally drivers. Primary aim of study was to create computer model of rally driver during frontal crash and to identify the distribution of forces on lumbar spine. Secondary goal was to verify influence of inclination of fixation belt on amount of forces acting on spine. Material and methods: Driver model was created using MSC.A-DAMS-Lifemodeler software. Primarily, load of lumbar spine was Introduction: Diagnosis of fracture pattern of femoral trochanteric fracture by plain X-ray is more difficult in elderly patients because it is often poor quality due to osteoporosis. In this study, relationship between 3D-CT classification proposed by our previous paper and X-ray classification were investigated. Material and methods: 234 femoral trochanteric fractures over 65 year-old (44 males, 190 female) were investigated. Fracture was classified to 2part, 3part, and 4part with combination of 4 fragments; Head (H), Greater trochanter (G), Lesser trochanter (L), and Shaft (S) in 3D-CT. Five subgroups of 3 part were 3 part G(S): (small fragment of G), 3 part G(B): (big fragment), 3 part G-L (large fragment including lesser trochanter) 3 part G(W): (whole fragment), and 3 part L. AO/OTA, Evans, Jensen classification were used in X-ray classification. Results: Numbers of each group were as follows; 2 part: 47, 3 part G(S): 30, 3 part G(B): 37, 3 part G-L: 80, 3 part G(W): 16, 3 part L : 8, 4 part : 16 cases. 120 fractures were classified as unstable in 3D-CT. However, 50 cases in AO/OTA, 85 cases in Evans, and 47 cases in Jensen classification of these 120 fractures were classified as stable. 3 part G-L type was recognized as unstable in 3D-CT classification, but was often classified as stable in each X-ray classification. Conclusion: This result shows that it is difficult to evaluate the fracture patterns, especially 3 part G-L, using plain X-ray. 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern. References: Disclosure: The authors declare no conflicts of interest. This study was supported by AOTAP Research Seed Grants 2010. Introduction: Patients with tumors of the large bowel that present with obstruction or perforation have a poor long term prognosis, worse when compared to patients with similar staged tumors operated electively. The main objective of this study was to evaluate whether inadequate oncologic resection is a cause leading to worse outcome in patients undergoing emergency colectomy. Material and methods: Retrospective analysis of colectomies with oncologic intent between 2011 and 2014: emergency colectomies were compared to elective colectomies. Adequacy of oncologic resection was determined by the number of lymph-nodes resected within the colectomy specimen. Subtotal colectomies were excluded. Results: One hundred sixty one colectomies in 157 patients were analysed. Twenty three (14.3 %) colectomies were performed urgently: 14 for obstruction and 9 for perforation. Males more commonly underwent emergency colectomies, 20.5 % vs. 7.6 % (p = 0.0225). Patients undergoing emergency colectomy were older, 77.5 y' ± 10.6 vs. 70.5 y' ± 11.5 (p = 0.0058) and more commonly diagnosed with metastatic disease perioperatively, 40.9 % vs. 19.9 % (p = 0.0486). Following a median follow-up of 16 months, 12 (54.5 %) patients operated urgently were dead. Mean number of lymph-nodes resected within the colectomy specimen was 13.4±4.1 in emergency colectomies and 13.9 ± 4.7 in elective cases (p = 0.5491). Proportion of colectomies with a minimum of 12 lymph-nodes was 69.6 % in emergency colectomies and 73.9 % in elective colectomies (p = 0.6215). Repeat analysis excluding metastatic patients on presentation reveals non-inferior results for emergency colectomies compared to elective colectomies, 85.7 % vs. Introduction: A number of scoring systems have been developed over the last several decades to evaluate the severity of trauma and predict the mortality and morbidity of the patient. The penetrating abdominal trauma index (PATI) [1] and injury severity score (ISS) [3] are the two most commonly used scoring systems. However, new studies are needed in order to improve the approach and care of the trauma cases and to predict the possible results [2] [3] [4] . Material and methods: Parameters analyzed were demographics, presence of shock, etiology of injury, Injury Severity Score (ISS) and Introduction: Acute cholecystitis is an usual cause of admission at emergency room, the recommended treatment being a cholecystectomy. Nevertheless in elderly patients, with septicaemia, poor general status or multiple associated morbidity the best treatment could be a percutaneous approach. Material and methods: Retrospective analysis of all cases of percutaneous cholecystostomy (PC) undertaken in Surgery Department 1, between January 2010 and December 2014, by review of clinical files. Results: During this 5 year period there were twenty ultrasound guided PC. There was a slight predominance of male gender, with median age of 80 years. The entire population was classified with ASA III or ASA IV, the majority taking anticoagulant therapy. The number of days of cholecystostomy and hospital stay was 7 and 15 days respectively. The most frequently identified agent was E. Coli. The mortality rate was 10 % and 20 % of patients were submitted to subsequent cholecystectomy. Conclusion: In presence of a non fit patient that precludes general anaesthesia, PC is a valid and secure option when exclusive medical treatment is obviously insufficient. Percutaneous approach can be, in this way, a definitive procedure in high-risk patients or a bridging procedure that allows optimization for subsequent cholecystectomy. Introduction: In this study we have analyzed the incidence of critical thoraco-abdominal injuries which required hospitalization and surgical intervention, in patients who have misused the angular grinders.Material and methods: In the Bucharest Clinical Emergency Hospital there have been registered in the last five years a small number of such cases of trauma. The patients presented penetrating thoraco-abdominal injuries. One of the cases presented posttraumatic evisceration with multiple intestinal injuries and localized peritonitis which needed immediately laparotomy with enterectomy and multiple enteroraphies. Another case presented thoracic injuries associated with the opening of the pleura and the pericardium which needed hemostasis and pleural drainage. Results: The evolution of the patients was simple, without complications. The immediate transport from the accident site and the surgery being performed in less than one our from the injuries are important factors for the further evolution of this patients. Conclusion: The thoraco-abdominal injuries produced by broken grinder discs at high speed are associated with impressive parietal injuries which involves the evisceration of the internal organs and retention of foreign bodies (disc fragments). The use of protective shells for this devices reduces the risc of some serious accidents which can be lethal. Introduction: A 45 year old male was brought to the emergency department with a sawing related penetrating injury to the abdomen. An abdominal ultrasound imaging was performed. There was no free fluid visible. Possible injury of ascending colon could not be ruled out. Penetration inside abdominal cavity could not be confirmed. Material and methods: Due to the dimensions of the penetrating object (lenght over one meter) obtaining a CT scan was not possible. The option of shortening the object was abolished due to fear of inflicting further injuries. Therefore the patient underwent an emergency laparoscopy. Results: Penetration inside abdominal cavity was excluded. Debridement of the wound was done along with wound irrigation and subcutaneous drainage. Appropriate antibiotic prophylaxis was given. After the procedure the patient was transferred to surgical intensive care unit. First postoperative day the patient was transferred to general ward. All normal bodily functions were restored. Second postoperative day the patient was discharged home. Conclusion: Three months after the accident the patient has resumed his normal routine. There were no early or late complications. Although there are guidelines for management of penetrating abdominal injuries sometimes we cannot follow them. Such was this case due to the dimensions of the foreign object. Impalement injuries present special challenges for prehospital and hospital care.Introduction: The aim of this study is to show the impact of the positioning of the reduction clamp on the syndesmosis reduction and the contribution of fractures, changing the osseus anatomy of the fibular sulcus. We hypothesized that anatomic reduction of the syndesmosis cannot be reliably achieved without reconstruction of the fibular sulcus of the tibia. Material and methods: A prospective study of 22 patients with malleolar fracture with lesion of the syndesmosis after ORIF. Standard measurements were made to assess the accuracy of syndesmosis reduction. CT measurements included: The length of the fibular incisura, its anterior and posterior width, depth, translation and rotation of the fibula. Results: Early results: In 40 % of all cases the syndesmosis was malreduced. In 75 % of them there was fracture of the posterior triangle of the tibia (Volkmann fragment) and/or anterior tuberculum (Tillaux-Chaput fragment). In patients without such fractures the rate of malreduction was much lower -25 % . In the group of patients with well reducted syndesmosis (60 %), fracture of the sulcus was found in only 33 % of them and 66 % were without fracture. Conclusion: Reduction of the syndesmosis is more dependent on the clamp position in the cases with fractures that change osseous anatomy of syndesmosis and the risk for malreduction is significantly higher. In order to reduce the risk for syndesmosis malreduction and to improve the prognosis in these patients it is important to restore the anatomy of the fibular sulcus prior to reduction and fixation of the syndesmosis.Introduction: Proximal postoperative digestive fistulas represent one of the most severe complications and a serious challenge for the surgeons. Regardless the efforts directed for its treatment the mortality rate stays high, and there still exist no promising treatment method. Material and methods: Authors report a series of 16 patients with postoperative digestive fistulas. M:F ratio -11:5, median age -53.3±4.2 years. According to the GI tract level fistulas were as follows: stomach -1, duodenum -7, jejunum -1, duodenum + colon -1, colon -4, colon anastomosis -2. Vacuum assisted local treatment was applied for localization and management of fistulas. The method was applied after relaparotomy for diffuse peritonitis or during staged necrosectomy with isolation of the fistula from the rest of the abdomen and protection of the adjacent viscera. All the patients received enteral feeding through nasointestinal probe distal to fistula in selected cases, compensation of digestive secretions loss (bile, pancreatic juice), and supportive complex treatment. Results: The median time to fistula closure was 34.2±7.4 days. Median hospital stay -163±6.5 days, including ICU -11.5±4.3 days. Mortality rate -12.5 %. Conclusion: Topical negative pressure treatment is an opportunity for digestive fistulas therapy, especially for proximal ones. Associated with complex treatment for protein and hydroelectrolyte imbalances correction, including early enteral nutrition this method facilitates the adequate protection of the abdominal wall skin, reduces the hospital stay and mortality rate. Introduction: Splenic flexure volvulus reflects the rarest form of colonic volvulus, approximately 1 %-3 % of cases. We describe the unusual incidence of splenic torsion 24 hours after successful endoscopic management of splenic flexure volvulus. Material and methods: A 27-years old autistic patient, presented in our hospital with acute abdominal pain and marked abdominal distention for 24 hours. The performed plain abdominal radiograph revealed distension of the large bowel in the splenic flexure from the middle of the transverse colon until the beginning of the sigmoid colon. Initial blood tests showed white cell count of 12.5 9 10 3 /lL, while routine liver, renal function tests and serum amylase level yielded nil abnormal. Results: The endoscopic restoration of large bowel volvulus was attempted successfully. Twenty four hours later, was detected an abrupt hematocrit fall from 40 % to 29 % while the urgent computing tomography imaging, revealed abundant fluid and clots in the left hypochondriac region. The patient submitted in emergency laparotomy revealed a twisted, congested spleen with multiple ruptures on its surface. A redundant sigmoid colon was also detected. Splenectomy and sigmoidectomy in order to avoid a recurrent volvulus, were performed. The patient was discharged on the 4 th postoperative day. Conclusion: The review of the literature revealed 3 cases with Asperger's syndrome (an autism spectrum disorder) in which ligamentous laxity had been detected, a citation which is in accordance with the findings of our case. We present this case due to the coincidence of two rare entities the splenic flexure volvulus and splenic torsion which are connected with causal relationship. and internal fixation (ORIF). The objective of this study was to evaluate parameters that might be prognostic factors for the surgical outcome that can be expected. Material and methods: 167 consecutive patients with a mean age of 41.8 years and a mean follow-up period of 10 months were surgically treated by one experienced surgeon at a level I trauma center within 10 years. According to the AO/ASIF classification 65 A1, 34 A2, 51 B1 and 17 B2 fractures were identified. Radiographic findings were quantified according to the Matta, Brooker and Epstein grades. Posttraumatic arthritis and avascular necrosis of the femoral head were evaluated. For each outcome measure and complication subgroup analyses according to fracture type, age and gender were performed. Results: Of all patients, reduction was rated anatomic in 63.5 %, imperfect in 22.2 % and poor in 14.4 %. Degenerative changes were observed in 49.7 %. 37.9 % were affected by heterotopic ossification, 21.6 % by posttraumatic arthritis and 5.4 % by avascular necrosis of the femoral head. 15.0 % were diagnosed with a nerve damage and 4.8 % sustained an infection. Total hip arthroplasty was performed in 10.2 %. Revision surgery due to secondary loss of reduction seroma/ hematoma and wound infection was indicated in 6.0 %. Conclusion: In conclusion, fracture type, age and gender could be identified as parameters that might influence the surgical outcome after ORIF of high-energy acetabular fractures. Disclosure: No significant relationships. Introduction: Much has been studied/recommended for both in and pre hospital non-traumatic arrests but little for in-hospital cardiac arrests in trauma [IHCAT] . Describing the factors that will predict a successful response to resuscitation will inform trauma care providers of the necessary steps to take when faced with IHCAT. This study will analyze the characteristics of IHCAT patients who survived and compare them with the non-survivors. Material and methods: A retrospective analysis of data on all patients who experienced IHCAT, from 1 January 2010 to 31 December 2013, was conducted from the trauma registry of the Hamad Trauma Center, the national trauma center of Qatar. The epidemiologic characteristics and clinical outcomes of survivors are described and compared with non-survivors. Results: 205 admitted trauma patients had an IHCAT during the study period. The majority were males with a mean age of 33 years. There were 22 survivors and 183 non-survivors. There were no significant differences between the groups for the following: Age, ISS, ICU LOS, LOS, mechanism of injury, male sex and pre-hospital cardio-pulmonary resuscitation [CPR] Introduction: Heterotopic ossification (HO) is a well-recognized complication of acetabular fracture surgery. Incidence of HO is much higher in posterior approach than in anterior approach. Irradiation and the administration of NSAIDs are the most popular prophylaxis of HO. Celecoxib is COX2-inhibiting NSAID and is known to reduce gastrointestinal disorder. Material and methods: 200 mg celecoxib was administered orally two times a day for 4 weeks to 22 patients who were operated through posterior approach. There were 18 males and 4 females with average age of 54.5 years. The fracture type according to Judet-Letournel classification was; 14 Posterior wall (PW), 3 Transverse(Tr)+PW, and remaining 5 cases were each Tr, T-shaped, PC+PW, ABC, and atypical type. Femoral head fractures were seen in 9 cases, and mean ISS was 13.8. Mean follow-up period was 16.1 months. Results: According to Brooker's classification, all 22 cases were class 0-2. No class 3 and 4 were observed. Time to operation was 6.9 days on average. Trochanteric flip osteotomy was performed in 7 cases, and supplemental anterior approach was performed in 4 cases. There were 6 cases of high energy trauma. Brain injury was seen in 3 cases.No complication such as gastric disorder or cardiovascular event was found in this series. Conclusion: Celecoxib inhibits severe HO effectively even if there are the factors which may generate HO. Celecoxib is known to associate with cardiovascular event, but there were no event in this series. It supports the recent report that celecoxib does not increase cardiovascular event compared to non-selective NSAID in Japanese patients. Introduction: The specific problems in diagnosis and treatment strategy in patients with ankylosing spondylitis with cervical spine injury were discussed. Material and methods: 26 patients suffering from ankylosing spondylitis were treated for cervical spine fractures between 1987 and 2015. The average age of the patients was 60.3 years (40 -86). On admission 14 patients were neurologically intact, 2 patients presented with a radicular neurologic deficit (C V/C VI), 6 patients showed signs of incomplete paraplegia (C V, C VI) and 4 patient presented complete paraplegia. Three patients developed preoperative progressively neurological deficits. Radiographic examination revealed typical changes of the cervical spine with unstable dislocated fractures. Preoperative management included closed reduction of the fractures and temporary stabilization with Halo-jacket or stiff-collar. In 10 cases operative treatment was performed within the first 24 hours. 12 cases were operated within the first week after injury. In 3 cases operative treatment was performed six months after injury because of pseudarthrosis. Results: The condition of the patients with intact preoperative neurological findings remained unchanged. The neurological status improved in 6 patients postoperatively. Conclusion: The clinical outcome of patients with fractures in ankylosed spines, is considerably worse compared to the general trauma population. Bechterew-Patients with suspicious spinal injury should be fully checked up radiological with CT and MRI for spine