AO offers a wide range of special activities through the course week to foster networking, address special interests, and introduce emerging practices or technologies.

The Trauma update was hold on Tuesday, 11.12.2007, 13:30–14:45 at the Theater Saal of the Davos Kongresszentrum.

Moderator: R Buckley, P Messmer

Thomas Gross erhielt die mit 10’000 Euro dotierte Auszeichnung für seine Studie zur Polytrauma-Behandlung am Universitätsspital Basel mit dem Titel «Der Einsatz eines multifunktionalen bildgestützten Interventionsraumes (MBI) in der Initialphase stationärer Schwerverletzten- Versorgung: Erwartungen, Realität und Perspektive».

Der Innovationspreis der Deutschen Gesellschaft für Unfallchirurgie (DGU) wird jährlich von der Firma DePuy gestiftet und prämiert Arbeiten, die Innovationen in der Unfallchirurgie zum Thema haben. Die Auszeichnung ist mit 10’000 Euro der höchstdotierte Preis der DGU.

EBSQ Traumatology, FMH Allgemein- und Unfallchirurgie sowie Viszeralchirurgie,

e-mail: tgross@uhbs.ch

Mitglieder:

Lic.phil. Felix Amsler, Dr. Corinna Attenberger, Dr. Philipp Füglistaler, Dr. Rolf Hügli, Prof. A.Ludwig Jacob, PD Dr. Peter Messmer, Dr. Ida Montali, Dr. Marcel Schüepp

Ethikkommission
Ref. Nr. EK:159/02

Sponsoren: Schweizerischer Nationalfond (NCCR- CO-ME), Freiwillige Akademische Gesellschaft Basel, Wissenschaftlicher Fond der Schweizerischen Unfallversicherungsanstalt (Suva), Bundesamt für Unfallverhütung (bfu), CARCAS Schweiz, Interventionelle Radiologie Universitätsspital Basel (USB), Wissenschaftlicher Fond USB

Studiengenehmigungen: Ethikkommission beider Basel, Schweizerischer Datenschutzbeauftragter

Abstract:

„Der Einsatz eines multifunktionalen bildgestützten Interventionsraumes (MBI) in der Initialphase stationärer Schwerverletzten- Versorgung: Erwartungen, Realität und Perspektive“.

Auszeichungen: Innovationspreis 2007 der Deutschen Gesellschaft für Unfallchirurgie (10’000,- Euro) für Habilitationsschrift Gross T. „Der Einsatz eines multifunktionalen bildgestützten Interventionsraumes (MBI) in der Initialphase stationärer Schwerverletzten- Versorgung: Erwartungen, Realität und Perspektive“.

The effect of computer-aidance and image-guidance on multiple trauma treatment is not yet well known. Particularly the impact of technology integration on clinical and economical outcome is of utmost interest concerning well-being of patients, handling of personnel and health-care costs but also for the future development and use of this modern and expensive technology.
Solution

The main technological challenge is the installation of a robust and networked environment of all the imaging and image guidance modalities within the MIGTS. Following former evaluation in a retrospective study of the practice of multiple trauma management in the Kantonsspital Basel 1997-99 since September 2000 a prospective protocol studies all multiple trauma patients by a special 24 hour on call service to evaluate clinical and organisational data for the initial emergency treatment. Up to now, data of more than 500 patients passing the emergency room were collected. Since the integration of the MIGTS in multiple trauma management in February 2003 the potential influence of the MIGTS on emergency multiple trauma management is evaluated following a study protocol with a quasi-randomised design that was accepted by the local ethical committee (Ethikkommission beider Basel). Thanks to third party funding apart from clinical data psychological assessment of the trauma team members as well as subjective outcome of patients and socio-economic evaluation of the procedure was initiated. First publications of results were already presented (s. publication list Dr. T. Gross).

Group members, approval and supporting institutions

Publications and study documents

Abstract

Kurzfragebogen… (deutsch)

short-MTMA questinonnaire  (english)

Publications with respect to this topic

Gross T, Messmer P, Amsler F, Fueglistaler-Montali I, Zuercher M, Huegli R, Regazzoni P, Jacob A.
Impact of a Multifunctional Image-Guided Therapy Suite (MIGTS) on emergency multiple trauma care.
Br J Surg 2010; 97:118-127

Fueglistaler-Montali I, Attenberger C, Fueglistaler P, Jacob A, Amsler F, Gross T.
In search of benchmarking for mortality following multiple trauma – a Swiss trauma center experience.
World J Surg 2009; 33:2477-2489.

M.T. Hirschmann, · K.-N. Uike · M. Kaufmann · R. Huegli · P. Regazzoni · T. Gross
Qualitätssicherung interdisziplinärer Polytraumaversorgung
Anaesthesist (Springer Medizin) 2007 · 56:673–678;DOI 10.1007/s00101-007-1192-y

T. Gross, F. Amsler, W. Ummenhofer, M. Zuercher, A. L. Jacob, P. Messmer, R. W. Huegli
Multiple-trauma management: standardized evaluation of the subjective experience of involved team members
European Journal of Anaesthesiology 2005; 22: 754–761

T. Gross, F. Amsler, W. Ummenhofer, M. Zuercher, P. Regazzoni, A. L. Jacob, R. W. Huegli, P. Messmer
Interdisziplinäres Schockraum-Management unfallchirurgischer Patienten aus der Sicht der Mitarbeitenden
Chirurg 2005 · 76:959–966; DOI 10.1007/s00104-005-1068-0

Clinical trial registration

Ref. Nr. EK:159/02

Complex bone fractures affecting joints require exact reposition of the fracture elements (reduction). Understanding the fragments’ configuration and reciprocal positions is essential for operation planning. Unlike in long bone fractures, where 2D x-ray pictures are the standard, in fracture sites close to joints CT scans are nowadays routinely taken. Although a volume dataset is then available, planning is still performed only on 2D reconstructions in standardized viewing panes (coronal, axial, sagittal).

Solution

We suggest improving planning process by creating a true 3D reconstruction of the CT volume. We are developing a virtual reality computer tool to simulate fracture reduction and ostesynthesis planning on such a 3D model. An immersive environment with stereoscopic visualization is implemented using shutter glasses and user interaction is performed over a haptic stylus for force feedback sensation. After fragment reduction the individual steps of the operation (osteosynthesis) can be simulated. The project is being realized at the Berne University of Applied Sciences (UASB).

Computer Perception and Virtual Reality Group

SensAble Inc

Trauma patients often present with fractures that require operative treatment. This operation should when ever possible be carefully planned by the surgeon. This comprises correct implant and positioning depending on fracture configuration, morphology of surrounding intact bone and anticipated load bearing of the affected limb. In general only 2D conventional x-ray images are available, although the fracture itself is a 3D object. Volume data such as CT scans of the fracture site result in higher radiation exposure for the patient an are not generally available.

Solution

CAPP suggests employing a 3D computer model on which the operation can be simulated. This computer model is based on a database of CT scans of generic bones. The dataset corresponding best to the patient’s 2D x-ray pictures is selected and the patient’s fracture transposed onto the generic 3D bone by the surgeon. This model is then employed for operation planning.

For intra-operative x-ray imaging mobile fluoroscopy devices are routinely employed. Due to their typical form they are commonly referred to as “C-arm”. In bone fracture treatment (osteosynthesis) repetitive fluoroscopy x-ray images must be taken to check accuracy of the procedure and monitor progress of the operation. Ideally each fluoroscope image is taken in the same projection as the previous. However, between two imaging series the C-arm is pulled away from the operation site, such as not to hinder the surgeon. Currently an iterative procedure consisting of repetitive x-ray shots is necessary until the previous device position and therefore fluoroscopy projection is found again. This results in high radiation exposure for OR team and patient and prolongs operation duration.

Solution

The MEPUC project envisages tracking the C-arm with a navigation system and employing a robotic device to position the fluoroscope. CARCAS Switzerland sustains cooperation with industrial and academic partners for robotic and navigation.