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Yurac, Ratko

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Author: Carazzo, Charles ×

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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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    Risk Factors for Failure of Non-operative Management in Isolated Unilateral Non-displaced Facet Fractures of the Subaxial Cervical Spine: Systematic Review and Meta-Analysis
    (2024) Cirillo, Ignacio; Ricciardi, Alejandro; Cabrera, Juan Pablo; López Muñoz, Felipe; Romero Vlverde, Lyanne; Joaquim, Andrei; Carazzo, Charles; Yurac, Ratko
    Study Design: systematic review.Objective: To evaluate risk factors associated with failure of non-operative management of isolated unilateral facet fractures ofthe subaxial cervical spine in neurologically intact patients.Methods: A systematic review of the PubMed, Embase, LILACS, and Cochrane Library databases was conducted in order todetermine risk factors associated with failure of non-operative management in isolated unilateral facet fractures of the subaxialcervical spine without facet and/or vertebral displacement, in neurologically intact patients. Our research was in line with thePRISMA Statement and registered on PROSPERO (CRD42023405699).Results: A total of 1639 studies were identified through a database search on May 5, 2023. In total, 7 studies from the databaseswere included, along with 1 study found through a manual citation search. The evidence showed high clinical heterogeneity, aserious risk of bias according to the ROBINS-I tool, and a predominance of retrospective cohort studies. In comparison to lesscomplex facet fractures, lateral floating mass fractures were found to have 5.41 times higher odds of failure of non-operativemanagement (OR = 5.41; 95% CI = 1.32, 22.19). We calculated the potential association between lower absolute fracture heightand non-operative treatment success [Fracture height (percentage) Mean Difference = 17.51 ( 28.22, 6.79 95% CI); Absolute height Mean Difference: 0.46 ( 0.60, 0.31 95% CI)]. Other risk factors were not included in the meta-analysis dueto lack of data. The level of certainty was rated as “very low”.Conclusions: Lateral floating mass cervical facet fractures and larger fracture fragment size (measured either in absolute termsor as a percentage) are significant risk factors for failure of non-operative treatment.

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