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Povzetek: Introduction: Considerable heterogeneity exists in the configuration and implementation maturity of trauma systems across European healthcare settings, and the opportunities for guideline-informed high-quality care varies considerably. Therefore, the European Society of Trauma and Emergency Surgery (ESTES), with its constituent national societies, has developed comprehensive consensus recommendations for care-context appropriate treatment of polytrauma patients in Europe, from the pre-hospital setting to the first surgical phase. Methods: Adhering to the RAND/UCLA Appropriateness Method (RAM), ESTES conducted a three-round modified Delphi consensus. National society expert delegates assessed Grade of Recommendation (GoR) A and Good Clinical Practice Points (GPP) elements of the German Society of Trauma Surgery (DGU) “S3 guidelines for polytrauma/severe injury management” for appropriateness and implementability within their respective healthcare systems. Results: In the first consensus round, 82 GoR A and 57 GPP recommendations were analysed. Of these, seven GPP were rephrased for clarity and four were removed due to redundancy or conflicting content. Consequently, 135 recommendations (82 GoR A and 53 GPP) remained, with 128 (77 GoR A and 51 GPP) deemed appropriate and necessary, and seven as uncertain due to expert disagreement. Conclusion: These ESTES recommendations constitute the first cohesive Europe-wide framework for managing the polytrauma patient from the prehospital setting to the end of the first surgical phase. They serve as a foundational tool for the development of national guidelines, particularly in regions with evolving trauma systems, and promote alignment towards a uniform standard-of-care across Europe.
Ključne besede: polytrauma, injury, guidelines, recommendations, consensus
Objavljeno v DiRROS: 20.05.2026; Ogledov: 295; Prenosov: 172
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Povzetek: To achieve early mobilization of patients with unstable pelvic fractures, the osteosynthesis methods used must withstand the loads in the pelvis during everyday movements. There is currently no predictive tool to assess how suitable these methods are for this purpose. The development of such a tool requires an understanding of the effects of joint and muscle loads on the structural behavior of the pelvis during movement. To further this cause, the stress–strain state of the pelvis during a sit-to-stand transfer of a healthy adult male was analyzed. Muscle and joint reaction forces during the motion were predicted using a rigid-body musculoskeletal model. These loads were then utilized in the first-ever dynamic structural analysis of the pelvis during a sit-to-stand transfer using the finite element method. Several similarities in stress distributions during sit-to-stand transfer, gait, and standing were identified by comparing the finite element analysis results with literature. The common areas of increased stress between the three motions are the acetabular notch, the superior edge of the obturator foramen, the attachments of the gluteus maximus on the ilium, and the lesser sciatic notch. The results also provide important insights into global behavior of the pelvic ring and indicate the locations of concentrated stress during sit-to-stand transfer.
Ključne besede: pelvis, structural analysis, sit-to-stand transfer, finite element method, inverse dynamics, muscle forces
Objavljeno v DiRROS: 09.04.2026; Ogledov: 252; Prenosov: 187
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