Background/Methods: The actual number of accidents in e-scooter drivers in Germany seems to be significantly higher than the current figures suggested by the Federal Statistical Office of Germany. This study examines prevalence and characteristics of e-scooter injuries and compares them with e-bike and bicycle injuries wich were presented via the university emergency room of a level1 trauma center within 17 months. Results: 68 accidents in e-scooter drivers were included, of which only 11.8% were recorded by the police. Significantly more of them were male than female (p=0.032) with a mean age of 31.1 (±13) years. We registered 34 accidents in e-bike riders and 356 in cyclists. E-scooter riders were significantly younger than e-bikers (p<0.001) and cyclists (p=0.01). In all groups, most injuries occurred to the head, followed by injuries to the upper extremities. E-scooter riders had a significantly longer length of stay in hospital, as e-bikers (p=0.003) and as cyclists (p=0.001). 52.9% of e-bikers and 53.3% of cyclists wore a helmet, compared to only 1.5% of e-scooter riders. Conclusion: The patient collectives examined showed different causes and profiles of injuries. The reasons for an increased proportion of seriously injured e-scooter riders compared to cyclists are electromobility, driving under the influence of alcohol and inadequate wearing of a helmet on e-scooters when head injuries dominate. 73.5% of the e-scooter accidents recorded by us were not registered by the police and therefore do not appear in the current statistics. As a result, a much higher number of e-scooter accidents can be assumed.

Introduction: Surgical management of pelvic and acetabular fractures due to high-energy trauma is one of the most challenging in orthopedics. Most patients are often associated with other life-threatening injuries. For decades, these fractures were treated conservatively till the classification of fractures was established by Judet in 1960. Several studies demonstrated that accurate fracture reduction decreases the incidence of post-traumatic arthritis and improves functional outcomes. This study aims to focus on prevalence of the surgical outcome of displaced pelvic ring and acetabular fractures in periphery trauma care center with the limited facility. Method: This is a descriptive observational study conducted at trauma hospital from 1st September 2016 to 31st August 2020. Ethical approval was obtained from the Institutional Review committee (Reference number:020/2020). The age groups more than 20 with displaced fractures of the pelvis ring or acetabulum were included in the study while isolated pubic rami fractures and pathological fractures were excluded from 136 patients. Convenience sampling method was used. Operative plans were decided after radiographic X-rays and 3D reconstruction CT scan evaluation. Point estimate and 95% Confidence Interval was calculated. Result: Among 136 pelvis acetabular fracture only 64(47.05) underwent surgical management. The average time duration from injury to surgery was 7 days. All patients were able to weight bear 3 months while 23 patients had a tingling sensation in their lower extremities for 6 months post-operatively. Conclusions: The prevalence of clinical outcomes in pelvic-acetabular fracture were similar with other studies done in similar settings. Keywords: acetabulum; fracture fixation; pelvis.

Introduction:
Early patient assessment is relevant for surgical decision making in severely injured patients and early definitive surgery is known to be beneficial in stable patients. The aim of this systematic review is to extract parameters indicative of risk factors for adverse outcome, to improve decision-making and identify patients who would benefit from early versus staged definitive surgical fixation.

Methods:
Following the PRISMA guidelines, a systematic review of peer-reviewed articles (published between 2000 and 2022) was performed. The primary outcome was the pathophysiological response to polytrauma including coagulopathy, shock/haemorrhage, hypothermia and soft tissue to determine the treatment strategy. Articles were screened independently by two authors, discrepancies were resolved by consensus in common meetings. Quantitative values for relevant parameters indicative of an unstable polytrauma patient were obtained.

Results:
The initial systematic search using MeSH criteria yielded 1550 publications. Included were articles to the following topics: coagulopathy (n=37), haemorrhage/shock (n=7), hypothermia (n=11), soft tissue injury (n=24)). Thresholds for stable, borderline, unstable and in extremis conditions were defined according to the existing literature: Coagulopathy: International Normalized Ratio, viscoelastic methods (Rotem/TEG); Haemorrhage/shock: lactate, systolic blood pressure, haemoglobin; Hypothermia: degrees celsius; Soft tissue trauma: traumatic brain injury, thoracic/abdominal and musculoskeletal trauma.

Conclusion:
In this systematic literature review, we summarize publications by focusing on different pathways that stimulate pathophysiological cascades and remote organ damage. We propose that these parameters can be used for clinical decision making within the concept of safe definitive surgery (SDS) in the treatment of severely injured patients.

Introduction
The goal of this study was to identify variables that lead to modifications of three different treatment strategies in polytrauma patients.
Methods
Retrospecitve cohort study of polytrauma patients. Stratification according to Early total care (ETC), safe definitive surgery (SDS), and damage control orthopaedics (DCO). Variables of interest: injury severity, and pathophysiologic parameters at admission of hemorrhagic shock, coagulopathy, hypothermia, and soft tissue trauma.
Results
Inclusion of 527 polytrauma, mean age 54.8 (SD 19.9) years, mean ISS 26.9 (SD 9.0) points, and overall mortality was 20.5%. ETC (n=21, 3.9%), SDS (n = 284 53.9%), and DCO (n = 222 42.1%). Factor associated with ETC were AIS Abdomen (OR 2.1, 95%CI 1.1 to 4.0, p = 0.026) and AIS Spine (OR 2.0, 95%CI 1.2 to 3.4, p = 0.007). AIS upper Extremity and AIS lower extremity were associated with SDS (OR 1.8, 95%CI 1.1 to 2.8, p = 0.012 and OR 1.3, 95%CI 1.0 to 1.7, p = 0.036). AIS head was associated with DCO (OR1.5, 95%CI 1.3 to 1.8, p < 0.001). Mortality rate was highest in DCO (29.7%), followed by ETC (23.8%), and SDS (13.0%). Complication rates were comparable during hospitalization.
Conclusion
Decision making of treatment strategy in polytrauma management bases on injury pattern and pathophysiologic response to the injury and the treatment. SDS is a valid treatment strategy when all pathophysiologic parameters from hemorrhage, coagulopathy, soft tissue injury and temperature are taken into consideration.

Background: Since endothelial cells rapidly release Angiopoietin-2 (Ang-2) in response to vascular injury and inflammatory stimuli, we aimed to investigate if its serum levels increase in polytraumatized patients, mainly focusing on concomitant central nervous system injuries (CNSI). Methods: Our study population consisted of 28 blunt polytrauma survivors (mean age, 38.4 years; mean ISS, 35) who were directly admitted to our level I trauma center within one year. We assessed the serum Ang-2 level at admission and on days 1, 3, 5, 7, and 10 during hospitalization. Results: The mean Ang-2 level amounted to 8286 ± 1060 pg/mL at admission, 3.5 times the reference value provided by a healthy control group. It increased from day 0 to day 3 (p=0.018) and decreased from day 3 to day 10 (p=0.001), not differing between day 0 and day 10. Subgroup analysis revealed a significant increase in the mean Ang-2 level only in the non-CNSI group (p=0.009) but showed similar continuous decreases starting with day 3. In the CNSI group (including 15 patients), Ang-2 was released into the circulation immediately after polytrauma, resulting in a higher mean Ang-2 level than in the non-CNSI group at admission (11083 ± 1312 pg/mL versus 3963 ± 622 pg/mL; p<0.001). Conclusions: Serum Ang-2 levels assessed at admission show the potential as an additional tool to diagnose brain and spine injuries in polytraumatized patients. This procedure would not result in significant extra work and expenses if included in routine daily blood sampling and analysis in clinical practice.

Introduction:
It is known that the amount and timing as well as the surgical procedure itself play a crucial role in polytraumatized patients. Still there is little knowledge, which factors should be considered most when it comes to evaluating the damage dealt to the patient by surgery. The aim of this study was to approximate a definition of the Surgical Load.

Methods:
A standardized questionnaire was developed by experts from SICOT-Trauma committee. Questions included relevance and composition of the Surgical Load, operational staging criteria and stratification of operation procedures in different anatomic region. The questionnaire was completed online by members of the SICOT society.

Results:
196 trauma surgeons from 63 countries with a median of 13 years work experience in polytrauma care participated between 06/27/22 and 08/16/22. Surgical Load (SL) overall was considered as very important (77%; important: 20.9%). Intraoperative blood loss (43.2%) and soft tissue damage (29.6%) were chosen as the most relevant factors. Staging procedures were mostly planned according to body region (56.1%), followed by bleeding risk (18.9%) and fracture complexity (9.2%). Open surgical procedures of the pelvis (SL=3.55), spine (SL=3.36), long bones (SL humerus=3.01; SL femur=3.33) and knee (SL=3.24) or elbow joint (SL=3.12) were ranked highest in their Surgical Load. Percutaneous or intramedullary procedures as well as more distal fractures were constantly ranked lower.

Conclusion:
The surgical load depends relevantly on the anatomic region and the operative procedure. Multiple aspects need to be considered when choosing the operational treatment and planning a staged surgical approach.

Introduction: Pelvic ring injuries are very common injuries in polytrauma. Between 30 and 60% of them are fatal. Up to 20% of fatal cases are the result of uncontrolled bleeding. Existing methods of hemostasis have advantages and disadvantages. Our aim was to develop a new method of pelvic tamponade through anatomical and experimental studies and to test it in praxis. Materials and methods: "Zhukovsky balloons", which are used to stop postpartum uterine bleeding, were used as tamponade. As a preliminary anatomical study, we used 11 anatomical specimens of the abdominal and pelvic region and 1 artificial pelvic model. After balloon positioning, computer tomograms of 6 anatomical models were taken and their position was studied, then made a material fixation by plastination and layer-by-layer slices were performed; the safety of the method was approved. In the second section, pelvic balloon tamponade was tested on an animal model. First, venous plexus lesions were made using laparoscopy. The treatment group received pelvic tamponade and infusion therapy. The control group received only infusion therapy. After the experiment, euthanasia and laparotomy were performed. Total blood loss in the pelvis was measured and the efficacy of the method was evaluated. A clinical validation of the technique was then performed in the clinic. Conclusions: Based on our findings, we developed a new method of minimally invasive pelvic tamponade. The model proved to be suitable and harmless in our analyses. Subsequent studies confirmed the effectiveness of the new method in clinical praxis.

Objectives: in 2023, we must have the courage to say that the famous external fixator of the Algerian army health services ( FESSA ) initially dedicated to soldiers injured during battles, continues, thanks to its accessible installation technique and its low cost, has save the functional or even vital prognosis of hundreds of patients, but that said, over time, have we forgotten the principles of setting this fixation ?

Materials and methods: in our presentation we present a number of clinical cases with a critical eye on the installation technique and the errors not to be made

Results: the majority of the exposed cases have unfortunately resulted in a complication, namely joint stiffness, malunion following a technical defect or bad timing of ablation.

Discussion: ranging from the one-piece fixator to the articulated fixator, from static fixation to dynamic fixation, orthopedic surgeons have tried to provide maximum precision regarding the installation of this process but also a technique for correcting technical defects in the background after damage orthopedic control.

Conclusion: in conclusion, we would like to send a message to all teachers, that a large chapter on the biomechanical bases of osteosynthesis in general and external fixation should be reintegrated into the training program of future orthopaedic surgeons ,particulary in order to hope to eliminate a large number of complications and therefore retakes .

Background:
Antegrade femoral intramedullary nailing through a greater trochanter has been proposed for the treatment of diaphyseal femoral fractures.
Aim : to predict if there is a relation between deformity at the fracture line and eccentric placement of the nail and union ratel diaphyseal femur fractures treated with intramedullary nails.
Methods:
40 patients (10 females) with diaphyseal femoral fractures enrolled in this study who underwent antegrade nailing and investigated retrospectively .The parameters involved:1- degree of malposition of distal tip of the nail from the femoral notch (DDT), 2- degree of coronal malalignment of fracture line, 3- coronal orientation of distal nail relative to femoral notch, 4-degree of fracture comminution, 5- Union time. Mean age 44 (23–62) years. Causative injury was high injury trauma in 20 cases.
Results
Statistical analysis of the results revealed A positive correlation between coronal malalignment of fracture line , distal tip malalignment , fracture line malalignment , degree of fracture comminution and union time Spearman’s correlation) was moderately statistically significant. The difference in union rate according to degree of coronal malalignment of distal tip relative to femoral notch (Kruskal Wallis; p = 0.002) was statistically significant.
Conclusion
Cronal malalignment of femoral fracture line increase by 1⁰ would increase union time by 0.350 months. Also distal tip malalignment by 1mm icrease union tome by 0261 months. So it is mandatory to aligne the femoral nail perfectly to get proper union time.

AIMS: 1. To find the optimum duration of prophylactic antibiotics for prevention of Infection in type 3a and 3 b open fractures. 2. Identify the modifiable and non-modifiable risk factors for infection in open fractures. MATERIALS AND METHODS: In our prospective study between November 2019 to December 2020, 204 patients of Gustilo type 3A and type 3B open tibial fractures were enrolled. Patients are randomized into 2 groups (group A and group B) receiving 2 days of prophylactic antibiotics and 3 days of prophylactic antibiotics. The outcome was measured by the incidence of infection based on CDC criteria. Secondary outcomes included other risk factors of infections like timing of antibiotics, timing of index procedure, patient co-morbid factors and injury related factors. RESULTS: Superficial surgical site infection was noticed in 7 patients (6.7%) among 2 days antibiotics group and 8 patients (8%) among 3 days antibiotic group. Deep surgical site infection was noticed in 8 patients (7.7%) among 2 days antibiotics group and 10 patients (10%) among 3 days antibiotics group. Diabetes mellitus (p value 0.008), lactate normalization time (p value 0.02), prolonged procedure indicative of higher grade of injury (p value 0.032 and delay in wound closure (p value <0.001) were found statistically significant for infection. Also noticed lesser infection rate among patients who had early antibiotics administration and lower GHOISS score. CONCLUSIONS: No significant reduction in infection rate with prolonged prophylactic antibiotics therapy for more than 2 days. Prolonged serum lactate normalization period is predictive of infection.

Background: Amputation is a serious limb trauma with high disability and fatality rate, and amputation therapy is often adopted. With the continuous development of microsurgical technology, successful replantation of high-level limb amputation has been reported by many scholars, but all of them were single limb replantation, or cross-over replantation was used to treat multiple high limb amputation injuries. There have been no clinical reports of multiple limbs with simultaneous high-level limbs amputation and successful replantation. In addition, functional reconstruction of the high-level limb surviving replantation has always been a difficult problem, and the function of the reimplanted limb is often inferior to that of the prosthesis, resulting in unsatisfactory final effect. Case: We report a case of successful upper arm and thigh level replantation in a 26-year-old male who sustained a twist-traction type of injury by a industrial mixer. The patient was brought to our institution 6 days after replantation in the local hospital, along with serious infection and poorly fixed humerus and femur. Infection was controlled, the humerus and femur were firmly re-fixed, the upper limb function was reconstructed by tendon transposition, nerve release, and wrist fusion, the lower limb shortening deformity was repaired by Ilizarov bone transport, and the foot drop deformity was corrected by tendon fixation. Result: On his last consultation, the patient had pain-free ambulation without assistance, can write his name using the replanted hand，he was very satisfied with the outcome. Replantation of the amputated upper arm and thigh is still a worthwhile procedure.

Introduction: Gluteal compartment syndrome (GCS) is a rare but devastating condition with a paucity of literature to help guide diagnosis and management. The purpose of this study is to describe the risk factors and patient characteristics associated with GCS to facilitate early diagnosis. Methods: This is a retrospective case series of GCS at a Level I trauma center. Patients undergoing gluteal compartment release between 2015 and 2022 were identified. Extracted data included demographics, presenting symptoms, operative findings, and postoperative outcomes. Results: 14 cases of GCS were identified. 12 (85.7%) were male, with a mean age of 39.4 ± 13 years and a mean BMI of 25.1 ± 4.1 kg/m2. 12 (85.7%) patients did not present as traumas and only 3 had ≥1 fracture. Mechanisms included ballistic (1), “found-down” (6), ground-level fall (1), and iatrogenic (6) causes. 9 patients reported drug use; 8 reported >2 substances, most commonly cocaine (7) and heroin (7). Hemoglobin (11.7 ± 4 g/dL) was low (5 had Hgb<10 g/dL). Creatine kinase (49,617 ± 60,068 units/L) was elevated in all cases, and lactate (2.8 ± 1.6 mmol/L) was elevated in 9. Postoperatively, mean ICU length of stay was 12 ± 23 days, with 13 patients requiring at least seven days. Conclusion: GCS is more likely to present in a young to middle-aged, otherwise healthy, drug-using male who is either found-down or experienced an iatrogenic injury. Recognizing that GCS is different from that of the leg or foot may help avoid delays in diagnosis and treatment.

Introduction
This review aims to evaluate the outcomes of limb salvage compared to primary amputation in patients with severe open tibial fractures.

Materials and Methods
A comprehensive search on PubMed, MEDLINE, Embase, Web of Science, Scopus, CENTRAL and CINAHL was performed from inception to 19 January 2022. The primary outcome was to evaluate clinical and functional outcomes. Secondary outcomes were to evaluate pain, patient preference, quality of life, and patient preferences. Methodological quality was evaluated using the MINORS criteria.

Results
Sixteen studies with 645 patients met inclusion criteria. The methodological quality was moderate based on the MINORS score. The majority were male. Mean age was 36.3 years. There was no significant differences in the length of hospitalization (n=8), return to work rates (n=9), return to sport rates (n=4) and quality of life scores (n=4). Patients with primary amputation had a significantly lower risk of total complications (RR0.21, 95%CI 0.08 to 0.53, p=0.001) (n=10), infections (RR0.46, 95%CI0.25 to 0.85, p=0.01) (n=9), number of surgeries (MD-4.17, 95%CI-6.49 to -1.85, p=0.0004) (n=6). Patients with primary amputation were able to ambulate significantly earlier (MD-4.06, 95%CI-7.65 to -0.46, p=0.03) (n=3). Three studies found a significantly higher cost of hospitalization in limb salvage patients. Functional outcomes were similar in both groups.

Conclusion
While patients with primary amputation had better clinical outcomes in the short-term, functional outcomes were not significantly different in both groups. Despite the heterogenicity of the results in this review, surgeons need to contextualise the decision making for their patients and incorporate these findings.

Background: For multiple trauma injuries, surgical treatment is performed on the premise that the general condition has been controlled according to Early Appropriate Care, and internal fixation is performed as early as possible. In particular, in the treatment of trunk trauma including vertebral and pelvic fractures, delay of surgery prevents position change and getting out of bed, and causes pneumonia and thromboembolism, which increases the risk of systemic complications. Methods: From October 2019 to December 2022, 18 cases of multiple trauma with surgical treatment for thoracolumbar fractures and pelvic fractures (10 males, 8 females, average age 38 years, average ISS 23) were treated at our trauma and critical care center. We investigated the patients about the evaluation of the general condition based on the perioperative blood data, the waiting days from admission to definitive internal fixation, and the postoperative outcomes. Results: The average number of waiting days was 1.8 days (44 hours), and the average lactate levels at admission and before surgery were 3.5 and 1.7, respectively. There were no surgeries that deviated from EAC criteria. All patients were transferred to other hospitals for rehabilitation, and there were no deaths. The average postoperative follow-up period was 13.4 months, and the Japanese Orthopaedic Association Score at the final follow-up was 22/29. Conclusion: We thought that good outcomes were obtained by early surgery.