Injury. 2025 Oct 8:112788. doi: 10.1016/j.injury.2025.112788. Online ahead of print.

ABSTRACT

BACKGROUND: Mild traumatic brain injury (mTBI) is commonly associated with alcohol use. We investigated how inpatient admission patterns after mTBI vary for patients with alcohol use disorder (AUD).

METHODS: This was a retrospective cohort study of patients with mTBI from the American College of Surgeons Trauma Quality Program dataset. Mixed regression models measured associations with inpatient admission, including among a subgroup of patients with AUD. Effect modification was tested for age, race, and acute intoxication.

RESULTS: 78,937 patients with mTBI were included, and 7.0 % had AUD. AUD was associated with increased admission odds (OR, 1.83; 95 % CI, 1.67-2.01). Black patients and those presenting intoxicated had this effect reduced. Among a subgroup of patients with AUD, acute intoxication reduced admission odds (OR, 0.73; 95 % CI, 0.59-0.91).

CONCLUSIONS: AUD increased inpatient admission odds after mTBI, while acute intoxication reduced these odds among patients with AUD. These findings help contextualize care for the common diagnostic constellation of mTBI and AUD.

PMID:41077492 | DOI:10.1016/j.injury.2025.112788

Injury. 2025 Oct 4;56(12):112785. doi: 10.1016/j.injury.2025.112785. Online ahead of print.

ABSTRACT

INTRODUCTION: The treatment options of orthopedic surgeons for older adults with proximal humeral fractures (PHF) may vary according to chronological age. This study aimed to present the treatment modalities, complications, and mortality rates after PHF in octogenarians, nonagenarians, and centenarians from the Turkish national database.

METHODS: This retrospective study was conducted using health records from the National Health Record System of Ministry of Health Turkey for individuals aged 80 and over who presented to public, private, and university hospitals from January 2016, to October 2024. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) code S42.2 (code for closed PHFs) was used to identify patients. A total of 9799 patients were included and categorized into three age groups: octogenarians (80-89 years), nonagenarians (90-99 years), and centenarians (≥100 years) and 4 groups according to treatment modalities (conservative, osteosynthesis, reverse shoulder arthroplasty (RSA), and hemiarthroplasty). Early systemic complications, revision surgery and mortality rates regarding 30-day and 90-day were recorded.

RESULTS: The mean age of the study population was 85.1 ± 4.2, ranging between 80-106 years. The female ratio was 76.1 %. Octogenarians comprised 84.3 % of the entire study population, whereas 15.5 % were nonagenarians and 0.3 % were centenarians. Conservative treatment was the most preferred across all age groups (62.3 %). Among patients initially managed conservatively, 7.0 % (n = 425) subsequently required surgical intervention, with no statistically significant difference in surgical conversion rates across the three age groups. Only 77 patients (0.8 %) underwent RSA. No differences were observed in the ratio of early systemic complications between octogenarians, nonagenarians, and centenarians. 30-day and 90-day mortality rates were 4.9 % and 10.2 %, respectively. RSA was associated with the highest risk of 90-day mortality (HR: 2.222, 95 % CI: 1.328-3.718; p = 0.002), with centenarians exhibiting an even greater risk (HR: 2.879, 95 % CI: 1.193-6.949; p = 0.019).

CONCLUSION: Conservative treatment remains the most preferred approach for PHFs in the patient population over the age of 80. Given the significantly higher mortality rates in centenarians and in patients undergoing RSA, individualized treatment decisions should prioritize functional outcomes, patient comorbidities, and life expectancy.

PMID:41075714 | DOI:10.1016/j.injury.2025.112785

Injury. 2025 Oct 4;56(12):112783. doi: 10.1016/j.injury.2025.112783. Online ahead of print.

ABSTRACT

BACKGROUND: Upper extremity fractures (UEFs) are a growing public health concern in China, yet comprehensive epidemiological data remain limited. This study examines the burden, trends, and risk factors of UEFs in China from 1990 to 2021.

METHODS: Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed the incidence, years lived with disability (YLDs), and causes of UEFs in China. Age-standardized rates (ASRs) were calculated, and trends were assessed using regression models. Sociodemographic index (SDI) associations and global comparisons were evaluated.

RESULTS: In 2021, China recorded 11.1 million new UEF cases, a 31.92% increase since 1990. The age-standardized incidence rate (ASIR) rose by 7.97%, contrasting with a 20.92% global decline. Fractures of the radius and/or ulna had the highest ASIR (404.52 per 100,000), while shoulder fractures saw the steepest YLD increase (42.69%). UEFs were more prevalent in males, except among children (<1, 10-14 years) and older adults (≥65 years), where females predominated. Falls accounted for 72.98% of UEFs, followed by road injuries (13.38%). Rehabilitation needs (YLDs) grew by 32.28%, with SDI-linked trends showing a plateau at SDI 0.59-0.72.

CONCLUSIONS: China's increasing burden of UEF, influenced by factors such as falls, an aging population, and urbanization, contrasts with the global downward trends. Immediate targeted actions (implementing fall prevention strategies for the elderly, enhancing road safety for young people, and broadening access to rehabilitation services) are essential to address this escalating public health issue.

PMID:41075713 | DOI:10.1016/j.injury.2025.112783

Injury. 2025 Sep 30;56(12):112779. doi: 10.1016/j.injury.2025.112779. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to investigate on the influence of physical workload and workers' compensation status on fulfillment of patients' expectations, return to initial work, and functional outcome after surgical treatment of complex proximal tibial fractures.

METHODS: This prospective study included 114 patients with complex tibial fractures (AO/OTA type B and C). At final follow-up, an individualized questionnaire based on the Hospital For Special Surgery-Knee Surgery Expectations Survey (HFSS-KSES) was used to assess whether preoperative expectations had been met. In addition, the condition of the knee joint, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used. Physical workload was assessed using the REFA classification. Physical workload and workers' compensation status was corelated to duration of incapacity to work (weeks), fulfillment of expectations, and functional outcome.

RESULTS: Patients with higher physical workloads showed longer incapacity to work (20.1 weeks on average) and were significantly less likely to report a complete return to their initial professional activity (r=-0.21). Their preoperative expectations were significantly less frequently fulfilled (r=-0.29). Workers' compensation status was associated with lower satisfaction and higher workload demands. Reintegration programs proved effective, enabling a high percentage of patients to return to work without restrictions (p = 0.04). Significant negative correlations were found between workload and functional outcomes (KOOS dimensions, residual pain, quality of life).

CONCLUSION: Individualized, job-oriented rehabilitation with realistic expectations is crucial for improving return to work, especially for high-workload patients. Future research should integrate physical and psychosocial factors in rehabilitation strategies.

PMID:41072123 | DOI:10.1016/j.injury.2025.112779

Injury. 2025 Sep 30:112778. doi: 10.1016/j.injury.2025.112778. Online ahead of print.

ABSTRACT

OBJECTIVE: Prehospital performed Extended Focused Assessment with Sonography in Trauma (EFAST) has poor sensitivity for pneumothorax (PTX) when compared to scans performed in hospital. This study describes the computed tomography (CT) location of PTX detected after an initial negative prehospital EFAST.

METHODS: Trauma patients treated by New South Wales Ambulance (Aeromedical Operations) who underwent prehospital EFAST between 1st August 2022 and 31st December 2023 were included if they were found to have PTX on CT imaging following a negative or indeterminate prehospital EFAST ultrasound. Patients were excluded if prehospital pleural decompression was undertaken. Corresponding CT imaging was manually analysed for the location of each PTX and mapped to two-dimensional coordinates on an unfurled thoracic cage.

RESULTS: Of 58 patients median (IQR) age was 29 (20, 58) years. The majority (76 %) were male who had sustained blunt trauma. The median (IQR) estimated PTX volume was 8 % (4-10) with 43 % of patients having a pneumothorax located to either the second intercostal space or most anterior portion of the chest on CT-mapping. The midpoints of each locule were anatomically distributed with a median (IQR) of 4th (3rd-5th) intercostal space and distance from the sternal edge (cm) of 4.1 (2.5-5.1) on the right, and 4.4 (3.5-5.2) on the left. Most PTX were sonographically occult due to apical, retrosternal, or posterior position.

CONCLUSION: Most traumatic PTX missed by prehospital EFAST were truly sonographically occult, but a significant number corresponded with the traditional scanning landmarks, particularly the parasternal 4th intercostal space. This reinforces current literature advocating this scanning region. The balance between optimal detection and sono-paralysis should be considered for ongoing education and governance.

PMID:41067963 | DOI:10.1016/j.injury.2025.112778

Injury. 2025 Sep 30;56(12):112780. doi: 10.1016/j.injury.2025.112780. Online ahead of print.

ABSTRACT

OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are commonly used for postoperative pain management. Concerns about their potential impact on bone healing have been raised. This study investigated the relationship between ketorolac use and postoperative complications following clavicle surgery, including nonunion rates.

METHODS: This retrospective cohort study used the TriNetX Research Database to identify patients who underwent surgical fixation of clavicle fractures between 2002 and 2022. Two propensity-matched cohorts were created: patients who received postoperative ketorolac and those who did not. Primary outcomes included nonunion diagnosis and revision surgery; secondary outcomes included opioid use, wound disruption, surgical site infection, and infected hardware at 30 days, 90 days, 1 year, and 2 years postoperatively.

RESULTS: 5,264 patients were in each cohort after matching. Nonunion diagnosis was similar between the ketorolac and no-ketorolac groups at 30 days (16 vs. 18, P=0.731), 90 days (31 vs. 40, P=0.284), 1 year (93 vs. 88, P=0.708), and 2 years (104 vs. 100, P=0.777). Similarly, revision surgery for nonunion was comparable between the two groups at all time points, 30 days (<10 vs <10, P=1), 90 days (<10 vs <10, P=1), 1 year (24 vs. 20, P=0.546), and 2 years (27 vs 26, P=0.890). Opioid prescription rates were comparable across all time points but trended lower in the ketorolac group: 30 days (1,827 vs. 1,906, P=0.108), 90 days (1,967 vs. 2,051, P=0.092), 1 year (2,340 vs. 2,428, P=0.085), and 2 year (2,574 vs 2,642, P=0.185).

CONCLUSION: Ketorolac use following clavicle surgery was not associated with increased nonunion or revision surgery rates. Although opioid prescription rates trended lower in the ketorolac group, the difference was not statistically significant.

PMID:41061370 | DOI:10.1016/j.injury.2025.112780

Injury. 2025 Sep 20;56(11):112770. doi: 10.1016/j.injury.2025.112770. Online ahead of print.

ABSTRACT

INTRODUCTION: A dedicated Major Trauma Ward (MTW) is core to the function of a Major Trauma Centre (MTC). MTCs are central to the hub-and-spoke model of an inclusive Major Trauma System (MTS). The implementation of the London Major Trauma System is heralded to have increased the in-hospital odds ratio of survival of traumatically injured patients by 19 %. There is no one universal definition of Major Trauma, but the National Institute for Health and Clinical Excellence (NICE) provides the definition, "Major trauma is defined as an injury or combination of injuries that are life-threatening and could be life changing because it may result in long-term disability". Major Trauma is a disease requiring multidisciplinary and multi-specialty input at every stage of the continuum of care. However, there is no formal education for staff on a MTW on the care of these complex, severely injured patients. The Trauma ORchestration of Continuing Healthcare (TORCH) course was established in 2018 to help to address this educational void. The aims of this paper are to describe the rationale for the course, report the feedback, and identify key strengths and areas for improvement.

METHODS: A mixed methods study was undertaken with simultaneous quantitative and qualitative analysis. Descriptive statistics of quantitative data was undertaken to describe delegate demographics. Thematic analysis of the 136 attendee responses to course feedback was performed. Course feedback was assimilated contemporaneously at the end of each course via online survey.

RESULTS AND DISCUSSION: There was an 88 % (136/154) response rate to feedback. Attendees included 96 doctors, and 16 nurses and allied health professionals. The 2019 course of 24 delegates did not stratify participant demographics. The largest group of doctors (39 %) were Senior House Officer grade, with 41 % of all doctors coming from a surgical background. Feedback themes identified as course strengths include the multidisciplinary curriculum approach. Speakers include Consultants from 12 different specialties and multiple therapists across the continuum of trauma care. Lectures based on real life case discussion was found to be an engaging and thought provoking medium of education with the focus on MTW based decision making commonly required of MTW junior staff. Areas for future development include the continued delivery of the TORCH course outside of London and consideration of course validation for quality assurance, and a "train the trainer" model to allow for course expansion and sustainability in other MTSs of the UK and Ireland to implement formal, high quality education for staff on MTWs.

PMID:41045758 | DOI:10.1016/j.injury.2025.112770

Injury. 2025 Sep 30;56(11):112777. doi: 10.1016/j.injury.2025.112777. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior shoulder dislocations are common in emergency settings, requiring effective procedural sedation and analgesia (PSA). Ketofol (ketamine-propofol) and etofen (etomidate-fentanyl) are widely used, but their comparative efficacy remains debated.

OBJECTIVES: The aim of this study was to compare the efficacy and safety of ketofol versus etofen for PSA in shoulder dislocation reduction.

METHODS: This randomized clinical trial enrolled 92 patients (46 per group). Ketofol (0.75 mg/kg) or etofen (0.15 mg/kg etomidate + 1.5 µg/kg fentanyl) was administered. Outcomes included sedation depth, hemodynamics, adverse events, and recovery times.

RESULTS: Ketofol provided deeper sedation (RSS 4.5 vs. 4.1, p < 0.001), better analgesia (VAS 1.64 vs. 2.64, p < 0.001), and easier reduction but had more emergence reactions. Etofen showed faster onset and fewer respiratory events but caused myoclonus.

CONCLUSION: Ketofol offers superior analgesia and sedation, while etofen ensures rapid recovery and hemodynamic stability. The choice depends on clinical priorities.

CLINICAL TRIAL REGISTRATION: IRCT20220824055790N1.

PMID:41045757 | DOI:10.1016/j.injury.2025.112777

Injury. 2025 Sep 24;56(11):112775. doi: 10.1016/j.injury.2025.112775. Online ahead of print.

ABSTRACT

OBJECTIVE: Although rare, shark bites can cause complex injuries requiring specialized management. This study aims to describe the surgical and medical management of shark bite injuries in New Caledonia.

METHODS: A retrospective, descriptive, single-center study including 22 patients hospitalized between 2011 and 2023. Demographic data, attack context, injury types, surgical treatments, infectious complications, and length of hospital stay were analyzed.

RESULTS: The median age was 33.5 years (IQR 15); 82 % were male. Spearfishing was the most common context (32 %). Injuries predominantly affected limbs, with musculoskeletal damage (82 %), nerve injuries (32 %), vascular injuries (27 %), and fractures (18 %). Infectious complications were rare (9 %), but identified pathogens were polymicrobial and marine-derived. The median hospital stay was 5 days (IQR 6, range 1-50 days).

CONCLUSION: Shark bites require rapid, specialized surgical care. Local organization enabled effective management. Empirical antibiotic therapy should cover marine pathogens.

LEVEL OF EVIDENCE: IV.

PMID:41037958 | DOI:10.1016/j.injury.2025.112775

Injury. 2025 Sep 23:112772. doi: 10.1016/j.injury.2025.112772. Online ahead of print.

ABSTRACT

BACKGROUND: While domestic violence (DV) - encompassing abusive action towards children, intimate partners, and elderly patients - is frequently reported at US trauma centers each year, contemporary data on DV trends and outcomes remain limited.

METHODS: We identified all trauma patients with DV using the 2018-2021 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database. Temporal trends were analyzed using the Cochran-Armitage test. Multivariable logistic and linear regression models were used to assess the association of DV with in-hospital mortality, hospital duration of stay (LOS) and non-home discharge.

RESULTS: Among 4190,728 trauma admissions, 8677 (0.2 %) involved DV, with the majority being children (73.6 %), followed by adults (19.5 %) and elderly patients (7.0 %). DV-related trauma admissions increased significantly from 2018 to 2021 (1.7 to 2.0 per 1000 trauma admissions, trend test P < 0.001). DV victims were more frequently female (48.8 vs 39.0 %), Black (30.7 vs 15.2 %), and insured by Medicaid (61.8 vs 18.0 %). DV was associated with higher in-hospital mortality among children (AOR 4.86, 95 % CI 3.88-6.10) and elderly patients (AOR 2.59, 95 % CI 1.42-4.73). Children with DV had significantly longer LOS by 2.1 days (95 % CI 1.8-2.4 days). Children (AOR 2.98, 95 %CI 2.30-3.85) and elderly DV patients (AOR 1.60, 95 %CI 1.15-2.23) had increased odds of non-home discharge.

CONCLUSION: DV-related trauma admissions have risen significantly across national trauma centers. Enhanced protocols at trauma centers may provide critical opportunities for DV identification and intervention as well as prevention strategies.

PMID:41033958 | DOI:10.1016/j.injury.2025.112772

Injury. 2025 Sep 23;56(11):112771. doi: 10.1016/j.injury.2025.112771. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to evaluate the feasibility and efficacy of longitudinal bending measurements to monitor the progression of fracture healing. Standard methods for evaluating bone healing rely on the assessment of radiographs, which is subjective in nature and intractable during the first several weeks of healing due to the delayed timeframe of radiographically visible mineralization. In contrast, bending measurements can provide a direct objective measurement of fracture stability that is sensitive to soft callus formation during the acute healing phase.

METHODS: In this study, a direct electromagnetic coupling (DEC) sensing system, which measures bending compliance, was evaluated in an exploratory observational study of diaphyseal tibial fracture patients. Longitudinal measurements were obtained from five patients at their clinical visits and remotely from 14 patients in their homes.

RESULTS: The DEC bending data satisfied repeatability criteria of less than 10 % precision error in 12 of 14 remote patients. As expected, bending compliance decreased with time for 17 of 18 fractures that resulted in union. One fracture resulted in non-union, and the corresponding bending compliance increased with time. The bending compliance rate of change, determined as early as 4 weeks post-injury, detected significant differences between patients with and without non-steroidal anti-inflammatory drug (NSAID) use and between patients with and without co-morbidities.

CONCLUSIONS: These results demonstrated the feasibility of remote bending measurements using DEC, which provide a precise metric of early fracture healing rate that may be invaluable for clinical patient management and as an outcome measure in clinical research.

PMID:41033087 | DOI:10.1016/j.injury.2025.112771

Injury. 2025 Sep 15;56(11):112764. doi: 10.1016/j.injury.2025.112764. Online ahead of print.

ABSTRACT

BACKGROUND: A nonvascularized fibular graft (NVFG) is considered to be an alternative option in managing segmental bone loss of the tibia. Nevertheless, there has been no consensus on optimal graft position and graft fixation technique. The purposes of the present study were to mechanically test the influences of various NVFG fixation techniques on the overall stability of the fixation construct by use of finite element analysis.

METHODS: Seven FE models of tibias with segmental bone loss stabilized with various fixation techniques were developed including medial and lateral plate-screw, medial and lateral plate-screw with a NVGF on the opposite cortex, medial and lateral plate-screw with an additional locking screw inserting into a NVGF, and intramedullary nail. Single-legged loading with 388 N applying on the tibial plateau was under consideration.

RESULTS: A NVGF placed on opposite cortex to the plate played an important role in withstanding bending moment which could reduce implant stress. An additional locking screw inserted into the NVGF helped to keep the NVGF in position and was essential for maintaining fracture gap width.

CONCLUSION: A NVFG with locking screw fixation could be an effective modality in managing segmental bone loss of the tibia. A construct of lateral LCP with a NVFG stabilized by a locking screw was mechanically superior to the others.

PMID:41004973 | DOI:10.1016/j.injury.2025.112764

Injury. 2025 Sep 22;56(11):112769. doi: 10.1016/j.injury.2025.112769. Online ahead of print.

NO ABSTRACT

PMID:41004972 | DOI:10.1016/j.injury.2025.112769

Injury. 2025 Sep 19;56(11):112768. doi: 10.1016/j.injury.2025.112768. Online ahead of print.

ABSTRACT

INTRODUCTION: The osteosynthesis of supracondylar fractures (SC) using pins buried under the skin (PB) or externalized (PE) is a subject of debate. The aim of this study was to compare two treatment protocols, one using PB and the other using PE, in terms of clinical and radiographic outcomes, complication rates.

HYPOTHESIS: The hypothesis of the study was that both protocols are equivalent in terms of clinical, radiological outcomes, and complication rates.

MATERIALS AND METHODS: This was a retrospective bicentric comparative study analyzing 296 boys and 267 girls (mean age 6.2 ± 2.7 years) who underwent SC fracture surgery between 1/1/2010 and 31/12/2020 using two therapeutic protocols. The first protocol (group A; n = 210) involved osteosynthesis with PB, immobilization (6-7 weeks), and pin removal in the operating room under general anesthesia. The second protocol (group B; n = 353) was characterized by osteosynthesis with PE, immobilization (4-6 weeks), and pin removal in an outpatient setting. Functional outcomes were assessed using the QuickDASH questionnaire, radiographic outcomes [Baumann angle, lateral capitulum-humeral angle (LCHA), rotational disorders according to the Von Laer quotient], and postoperative complication rates (infection, recurrent fracture, stiffness, vasculo-nerve complications).

RESULTS: No patients were lost to follow-up (n = 563) and the mean follow-up was 6.6 ± 7.3 months (3-70). The mean immobilization duration was longer in group A (45.8 ± 7.4 vs 39.7 ± 12.0 days; p < 0.001). Clinical and functional outcomes were similar (p = 0.316), and the pre- and postoperative complication rates were comparable between the two groups (A-B = 8 %/8.6 %-6 %/7.1 %; p = 0.733 and p = 0.512), while the postoperative Baumann angle, LCHA, number of rotational disorders, and Von Laer quotient were significantly different [A-B = 71.5°-74° (p < 0.001); A-B = 32.8°-35.6° (p < 0.001); A-B = 32-10 (p < 0.001); A-B = 0.2-0.1 (p = 0.020)].

DISCUSSION: This retrospective study compared two surgical protocols for pediatric supracondylar (SC) fractures in 563 children. Functional and clinical outcomes were similar between groups, with no significant difference in complication rates. Group B had better radiographic results and a lower rate of postoperative rotational deformities. Pin buried (Group A) increased costs and required a second general anesthesia for removal. Group B's protocol allowed outpatient pin removal under nitrous oxide, reducing risks and costs. Infection rates were no significant different between both groups. Whereas the decrease of number of rotational disorsders, the increase of Baumann angle and decrease of LCHA in this patient show that decrease of rotational disorders is more likely related to osteolysis of rotational spur than bone remodeling. Despite limitations, this is the largest French series comparing these two protocols, showing equivalent functional outcomes but greater efficiency and safety in Group B.

CONCLUSION: Both therapeutic protocols have comparable clinical outcomes and complication rates. Leaving pins exposed does not increase the risk of infection.

LEVEL OF EVIDENCE: III comparative retrospective study.

PMID:41004971 | DOI:10.1016/j.injury.2025.112768

Injury. 2025 Sep 17;56(11):112763. doi: 10.1016/j.injury.2025.112763. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to assess the effect of an acute traumatic meniscus tear that required repair in association with a tibial plateau fracture repair on outcomes.

METHODS: Over a 17-year period, 843 patients presented with a tibial plateau fracture and were followed prospectively. 721 patients with Schatzker I-VI fractures were treated operatively via a standardized algorithm. 161 tibial plateau fractures (22.3 %) had an associated meniscus tear that underwent acute repair at the time of bony fixation. These patients were compared to operatively repaired tibial plateau fracture patients with no meniscus injury (NMR). Demographics were collected and outcomes including: radiographic healing, knee range of motion (ROM), and complication rates, were recorded. In addition, re-operation rates were compared and any reoperation for meniscus repair failure identified. All patients had a minimum of 1 year follow up.

RESULTS: A total of 524 patients with a mean of 21.4 (range: 12-120) months follow up met inclusion criteria. Patients in the meniscus repair (MR) cohort had poorer knee extension (1.01 degrees, range: 0-30 degrees) compared to the NMR cohort (0.07 degrees, range: 0-10 degrees) (p < 0.001), in addition to poorer knee flexion (123 degrees, range: 0-145 degrees, p = 0.024). Additionally, MR patients reported higher pain scores (mean: 3 and range: 0-8, p = 0.005) at latest follow up. Finally, MR patients had higher rates of infection (8.1 % vs. 3.3 %, p = 0.025) and lateral collapse of the joint (p = 0.032).

CONCLUSION: Patients who had a meniscus repair at the time of tibial plateau fracture repair were found to have poorer knee ROM, more patient reported pain at minimum 12 (mean 24) months post-operation. Additionally, these patients developed more post-operative complications than those patients who did not undergo a meniscus repair.

PMID:41004970 | DOI:10.1016/j.injury.2025.112763

Injury. 2025 Sep 17:112766. doi: 10.1016/j.injury.2025.112766. Online ahead of print.

ABSTRACT

Not applicable.

PMID:40992972 | DOI:10.1016/j.injury.2025.112766

Injury. 2025 Sep 17;56(11):112767. doi: 10.1016/j.injury.2025.112767. Online ahead of print.

ABSTRACT

Lower limb amputations have a prevalence of about 26 per 100,000 in the United Kingdom. A significant proportion of these patients suffer from chronic pain and/or phantom limb pain. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) have been found to help improve these symptoms, however these are usually used as a treatment as opposed to prevention. These techniques work on the principle of giving the nerves somewhere to go and something to do, but it is not yet standard practice. Central neural reorganisation and adaptation to chronic/phantom limb pain suggest that preventing the symptom in the first place could yield a superior result to treatment after the problem has arisen. We present a series of 24 cases of where TMR and/or RPNI were performed primarily at the time of initial amputation. Patients were followed up approximately one year after procedure and assessed their pain scores according to a numerical rating scale (NRS) and the PROMIS Pain Interference Short form 6b Significant improvements of pain scores were found for these patients when compared to patients without previous TMR or RPNI. PLP is a debilitating, life limiting and an economic burden on patients who have undergone limb amputations, and with no clear medical or surgical intervention yet widely accepted to offer a definitive management option for this problem, TMR and RPNI may be able to fill a void. This is a good proof of principle showing promising results, and suggests that further investigations with randomised control studies are warranted.

PMID:40992116 | DOI:10.1016/j.injury.2025.112767

Injury. 2025 Sep 18;56(11):112765. doi: 10.1016/j.injury.2025.112765. Online ahead of print.

ABSTRACT

PURPOSE: Tibial tuberosity fractures are rare physeal injuries in adolescents and are frequently overlooked on radiographs, despite a high risk of associated soft tissue injury. This study analyzed magnetic resonance imaging (MRI) findings and concurrent injuries in 63 cases to improve diagnostic accuracy and guide clinical management. This study aimed to investigate the MRI features and associated injury patterns of tibial tuberosity fractures in adolescents.

METHODS: A retrospective analysis was performed on 63 adolescent patients with tibial tuberosity fractures admitted to our hospital between June 2017 and January 2025. The cohort comprised 62 males and 1 female, with ages ranging from 11 to 16 years (mean: 13.9 years). Fractures occurred on the right side in 22 cases, the left side in 40 cases, and bilaterally in 1 case. Body mass index (BMI) ranged from 20.8 to 33.3 kg/m², with a mean of 26.8 kg/m². Upon admission, all patients underwent MRI examinations within 48 h (3.0 T, including T1-, T2-, and STIR-weighted sequences). Fracture types were classified according to the Ogden classification, and associated injuries involving ligaments and the meniscus were simultaneously documented.

RESULTS: MRI revealed patellar tendon injuries in all patients (patellar tendon rupture in 6 cases). Associated injuries included anterior cruciate ligament (ACL) injuries in 28 cases (44.4 %) and posterior cruciate ligament (PCL) injuries in 3 cases (4.8 %). Meniscal injuries were observed in 25 cases (39.7 %), comprising 9 cases of grade I, 12 cases of grade II, and 4 cases of grade III. Peripatellar retinacular injuries were present in 28 cases (44.4 %), and medial or lateral collateral ligament injuries of the knee were identified in 13 cases (20.6 %). Additional associated injuries included 1 case (1.6 %) of fibular fracture, 10 cases (15.9 %) of patellar fracture, and 5 cases (7.9 %) of patellar subluxation.

CONCLUSION: Plain radiography is the preferred imaging modality for diagnosing tibial tuberosity fractures in adolescents, while computed tomography (CT) can be useful for further classification of fracture types. In cases where concomitant soft tissue injuries-such as those involving the patellar ligament or meniscus-are suspected, MRI provides significant diagnostic value and plays a crucial role in surgical planning and complication prevention.

LEVEL OF EVIDENCE: Level III.

PMID:40992115 | DOI:10.1016/j.injury.2025.112765

Injury. 2025 Sep 11;56(11):112759. doi: 10.1016/j.injury.2025.112759. Online ahead of print.

ABSTRACT

PURPOSE: The disability and pain after a neglected scaphoid non-union fracture are well recorded in the literature. We aimed to compare and detect the short-term results of non-united scaphoid waist fracture treated by internal fixation and bone graft with the volar buttress plate utilization versus the Herbert screw.

METHODS: This is a therapeutic study. This randomized, prospective comparative an intervention study was carried out on 30 cases with non-union scaphoid waist fractures. They were randomly categorized into two equal groups, group (A) treated by volar buttress plate fixation with bone graft, and group (B) managed by Herbert screw fixation along with bone graft. Bone graft in both groups was taken from the distal radius. All cases underwent clinical examination and radiological evaluation.

RESULTS: With an average of 18 months, thirty cases were followed up. Both groups had similar baseline characteristics. The union rate and time were insignificant difference between both groups. Insignificant differences were determined across either intervention groups in terms of grip strength, the visual analogue pain scale (VAS), the Mayo wrist score, and the quick disabilities of arm, shoulder and hand score (quick DASH score) during the early interval of follow-up postoperatively (at 3, 6, 9 and 12 months). Group (A) demonstrated shorter operative time and lower numbers of image intensifier intraoperatively in contrast to group (B). Hardware removal after union was needed in 3 patients of group (A) in variance to group (B), in which no cases need implant removal. The Radio-scaphoid (RS) impingement and flexor carpi radialis (FCR) tenosynovitis exhibited a significant elevation in group (A) in contrast to group (B). Among the patients with scaphoid fracture non-union who underwent surgery, some cases did not achieve union after the initial procedure. We had to employ an alternative fixation method for these cases, and we followed them until union was achieved, and their function was restored. Specifically, three patients from group (A) (20%) [one case was fixed with a miniplate 2 mm, and two cases were fixed with a microplate 1.5 mm] and two patients from group (B) (13.3 %) required this approach.

CONCLUSIONS: The functional and radiological outcomes are comparable between volar buttress plate and Herbert screw in the treatment of non-united waist scaphoid fracture. The rate of removal of the implant is higher in the volar buttress plate.

PMID:40987252 | DOI:10.1016/j.injury.2025.112759

Injury. 2025 Sep 14;56(11):112760. doi: 10.1016/j.injury.2025.112760. Online ahead of print.

ABSTRACT

INTRODUCTION: Posterior sternoclavicular joint (SCJ) dislocations are rare, accounting for <1 % of all joint dislocations. Despite their rarity, these injuries warrant urgent recognition due to the SCJ's proximity to mediastinal structures, including the trachea, esophagus, and great vessels. While not always surgical emergencies, delayed or unstable cases can result in life-threatening complications if not managed in an appropriately equipped hospital setting.

CASE PRESENTATION: A 28-year-old male presented two weeks after sustaining a right SCJ injury while sliding during a softball game. He reported persistent pain, difficulty breathing, and limited shoulder function. Initial radiographs were unremarkable; however, CT imaging revealed a posterior dislocation of the medial clavicle. Given the delayed presentation and potential mediastinal involvement, the patient underwent open reduction and internal fixation (ORIF) with cardiothoracic surgical assistance. Fixation was achieved using unicortical screws in the sternum and bicortical screws in the clavicle. He recovered without complications and returned to full activity CONCLUSION: : Posterior SCJ dislocations are challenging to diagnose on radiographs and often require CT for accurate assessment. Although closed reduction is an option in acute cases, delayed presentations typically necessitate surgical stabilization. Plate fixation offers reliable alignment and secure fixation. This case underscores the importance of timely diagnosis, hospital-based care, and multidisciplinary surgical planning when managing posterior SCJ dislocations.

PMID:40982998 | DOI:10.1016/j.injury.2025.112760