Browsing by Author "Dittmar, Michael"

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    Mechanical Instability After Civilian Thoracolumbar Gunshot Injuries: A Systematic Review to Support Classification Development
    (2025) Ricciardi, Guillermo; Cirillo, Ignacio; Cabrera, Juan; Alvarenga, Otávio; Neves, Emiliano; Carazzo, Charles; Dittmar, Michael; Guiroy, Alfredo; Yurac, Ratko; Schroeder, Gregory
    Study DesignSystematic Review.ObjectivesIdentify risk factors for mechanical instability in thoracolumbar gunshot wounds to develop a new classification system.MethodsA systematic review following PRISMA 2020 guidelines was conducted across multiple databases from January 1, 1990, to September 12, 2024 (PROSPERO: CRD42023458804).ResultsOf 2400 records, 33 studies (3195 patients) met inclusion criteria, mostly retrospective and single-center, with varying definitions of instability. Direct comparison was limited due to clinical heterogeneity. Only 12 studies defined mechanical instability, mainly using the Denis three-column theory. Instability was reported in less than 10% of cases, except for one higher-rate outlier. The main markers included vertebral body comminution and potential ligamentous injury. Management was mainly conservative, with a low fixation rate (1.5-9.7%). Imaging relied on CT and static X-rays, with some studies advocating for dynamic radiographs.ConclusionThere is a lack of standardized definitions for mechanical instability in civilian thoracolumbar gunshot injuries. Four recurrent unstable patterns were detected, with vertebral body comminution as the most consistent marker. The need for a standardized classification system and further prospective studies is evident.
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    Predicting early complications in patients with spinal gunshot wounds: A multicenter study
    (2024) Ricciardi, Guillermo; Cabrera, Juan; Martínez, Oscar; Matta, Javier; Vilchis, Hugo; Perez, Jeasson; Carazzo, Charles; Dittmar, Michael; Yurac, Ratko; AO Spine Latin America Trauma Study Group
    Introduction: There is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage. Research question: we aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds. Material and methods: This is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression. Results: Results: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68-7.30), dirty wound (3.32, 1.50-7.34), GCS ≤8 (3.56, 1.17-10.79), hemodynamic instability (2.29, 1.07-4.88), and multiple bullets (1.97, 1.05-3.67). Discussion and conclusion: Spinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.

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