Injury. 2025 Nov 21:112894. doi: 10.1016/j.injury.2025.112894. Online ahead of print.

ABSTRACT

Individuals experiencing homelessness are known to be at an increased risk of poor health outcomes compared to those of relatively higher socioeconomic statuses. Specifically, a major cause of morbidity for people experiencing homelessness is traumatic injury. While poor outcomes after a traumatic injury for people experiencing homelessness is well documented in the American context, such literature for the Canadian context remains sparse. In this retrospective cohort study of 4551 trauma patients admitted at a Level 1 trauma center in Montreal, Canada, from 2016-2019 (inclusive), we determined the trauma outcomes of patients experiencing homelessness. We found that the outcomes between homeless and non-homeless trauma patients to be similar, but experiencing homelessness was associated with a 71 % increase in the odds of intubation. Healthcare coverage may have the potential to mitigate some of the adverse effects of a low socioeconomic status.

PMID:41350142 | DOI:10.1016/j.injury.2025.112894

Injury. 2025 Dec 4;57(2):112915. doi: 10.1016/j.injury.2025.112915. Online ahead of print.

NO ABSTRACT

PMID:41349238 | DOI:10.1016/j.injury.2025.112915

Injury. 2025 Nov 26;57(2):112912. doi: 10.1016/j.injury.2025.112912. Online ahead of print.

ABSTRACT

INTRODUCTION: Open fractures are associated with soft tissue injury and may require reconstruction via delayed flap coverage. The timing of coverage is critical as prolonged time to coverage is associated with increased risk for wound complications. Few studies have included all lower extremity fractures when analyzing time from definitive fixation to coverage. We analyzed the effect of time to flap coverage from both admission and definitive fixation, on fracture-related infections (FRI) in patients admitted with open fractures of the lower extremity.

METHODS: The National Inpatient Sample was queried from 2015-2019 for open fractures of the tibia, fibula, and femur that required flap coverage. Patients who underwent simple skin grafts only or fixation prior to admission were excluded. The number of days to coverage and days from fixation to coverage was determined using the inpatient stay day on which the flap coverage procedure was conducted. The primary endpoint was FRI acquired during the inpatient stay. Multivariable regression was used to quantify the odds of FRI for every day of delayed coverage.

RESULTS: Between 2015-2019, 1970 patients underwent flap coverage for open fractures of the lower extremity. Isolated tibia fractures constituted the majority (33.7 %), followed by tibia and fibula (27.7 %), and isolated femur (26.1 %). The rate of FRI during the initial hospital stay was 9.9 %. The median times from admission to flap coverage (6 days, IQR 4-18, vs 3 days, IQR 1-8) and definitive fixation to flap coverage (2 days, IQR 1-10, vs 0 days, IQR 0-4) were significantly greater in the FRI group compared to the non-fracture related infection (nFRI) group (p < 0.001 and p < 0.001, respectively). After controlling for confounding variables, each day of delay from admission and from fixation was associated with 10.7 % and 9.1 % increased odds of acquiring inpatient FRI (OR: 1.107, 95 % C.I. 1.062-1.154, p < 0.001, and OR: 1.091, 95 % C.I. 1.047-1.138, p < 0.001, respectively).

CONCLUSION: Our study analyzed all open fractures and did not employ arbitrary endpoints for coverage such as "late" and "early" coverage. Instead, we provide more general evidence in support of early flap coverage. We found that every additional day definitive flap coverage was delayed, the risk of FRI developed during the initial inpatient stay was increased by approximately 10 %. Despite our findings, it is critical to note that we only evaluated FRIs acquired during the inpatient stay, and many of these infections occur following discharge. However, the temporal relationship described in our study suggests that definitive wound closure should be achieved in the shortest time possible. Additionally, fixation should be performed as close to the definitive coverage procedure as possible.

LEVEL OF EVIDENCE: Level III.

PMID:41344103 | DOI:10.1016/j.injury.2025.112912

Injury. 2025 Nov 26;57(2):112914. doi: 10.1016/j.injury.2025.112914. Online ahead of print.

ABSTRACT

INTRODUCTION: Musculoskeletal soft tissue injuries (MSKIs) impose a significant burden on the United States (US) healthcare system, constituting a large proportion of emergency department (ED) visits. Understanding the epidemiology of these injuries is critical for identifying at-risk populations, improving preventive measures, and optimizing resource allocation. This study aims to identify and describe trends in MSKIs presenting to US EDs from 2003 to 2023, using the National Electronic Injury Surveillance System (NEISS).

PATIENTS AND METHODS: A retrospective cross-sectional analysis of NEISS data from 2003 to 2023 was performed, focusing on low-energy mechanism injuries categorized as "Strain, Sprain" or "Avulsion." Avulsions were manually evaluated to exclude non-MSKI avulsion injuries. Demographic and injury data, including age, gender, race, injury severity (defined according to disposition), and affected body part, were analyzed using descriptive and inferential statistics as well as survey analysis techniques. Piecewise regression was employed to assess trends in injury incidence rates (IR100k), with significance set at α = 0.05.

RESULTS: The final dataset included n = 941,996 observed injuries, which was extrapolated to an estimated national total of 36,605,488 injuries over 21 years. Annual IR100k declined significantly, with breakpoints in 2010, 2019, and 2020 (for each, P < 0.001), coinciding with important national public health events such as initiation of the Affordable Care Act (ACA) and the COVID-19 pandemic. The IR100k of soft tissue injuries presenting to US EDs did not rebound in the three years following the pandemic (P = 0.388). Severe injuries accounted for 0.68 % of all injuries, with minimal change over time in terms of proportion of injuries. The most common injuries presented in the lower extremities (56.8 %) and occurred in males aged <18-44 years. While demographic distributions showed marginal, yet statistically significant, variation, effect sizes were weak.

CONCLUSION: This 21-year analysis revealed declining trends in soft tissue MSKIs presenting to EDs, potentially influenced by societal events such as the ACA and COVID-19 pandemic. These findings highlight the potential impact of healthcare policy and public health crises on ED utilization patterns. and can potentially inform the aims of preventive and rehabilitative measures.

PMID:41344102 | DOI:10.1016/j.injury.2025.112914

Injury. 2025 Nov 27;57(2):112909. doi: 10.1016/j.injury.2025.112909. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to investigate the association between frailty and osteoporosis in middle-aged and older adults, and to evaluate the discriminative value of different frailty assessment tools, including the Groningen Frailty Indicator (GFI), SARC-F questionnaire, and a combined GFI + SARC-F score, in identifying patients at risk for osteoporosis.

METHODS: A total of 36 patients aged 50 years or older with distal radius fractures were included. Sociodemographic and clinical data were recorded. Osteoporosis was defined as a T-score < -2.5. Participants were assessed for frailty using GFI (cutoff ≥4), and sarcopenia risk was defined via SARC-F. Comparisons were made between patients with and without osteoporosis. Logistic regression and ROC analyses were conducted to determine associations and predictive performance.

RESULTS: Frailty, as measured by GFI, was significantly more common among osteoporotic patients (83.3 % vs. 33.3 %, p = 0.007). Logistic regression analysis showed that both GFI (OR: 1.563, 95 % CI: 1.039-2.350, p = 0.032) and the GFI + SARC-F (OR: 4.000, 95 % CI: 1.128-14.184, p = 0.032) were independently associated with osteoporosis. ROC analysis revealed AUC values of 0.717 for GFI and 0.743 for GFI + SARC-F, indicating good discriminative performance, with the combined assessment showing improved accuracy.

CONCLUSION: Frailty is a significant predictor of osteoporosis in older adults. Combining frailty with the sarcopenia risk, such as GFI and SARC-F, enhances the identification of patients at risk of osteoporosis.

LEVEL OF EVIDENCE: II.

PMID:41344101 | DOI:10.1016/j.injury.2025.112909

Injury. 2025 Nov 26;57(2):112911. doi: 10.1016/j.injury.2025.112911. Online ahead of print.

ABSTRACT

OBJECTIVE: Distal femur shaft fractures are typically associated with high-energy trauma. Stress fractures involving the distal femur shaft are extremely limited. Therefore, epidemiological characteristics, diagnostic protocol, optimal management strategies, and prognosis of distal femoral shaft stress fractures (DFSSF) remain poorly understood. This study aims to report clinical experience with 10 cases of DFSSF in South Korean military.

METHODS: This retrospective case series included patients diagnosed with DFSSF at the single South Korean military hospital between January 2022 and December 2023. Demographic and epidemiologic data, including military rank and training context, were collected. Radiographic evaluation including AO classification and femoral bowing angles were assessed. Clinical outcomes assessed included time to union, treatment modality, return to military duty, and complications.

RESULTS: Nine patients were male, one female noncommissioned officer candidate with a mean age of 21.2 ± 1.8 years (range, 19-24). As military rank, six patients were recruits, two were privates, and one patient was a private first class. The mean anterior and lateral femoral bowing angle measured by the Sasaki method was 3.7 ± 1.8° and 12.7 ± 2.3° respectively. All fractures achieved successful union within an average of 16.3 ± 2.4 weeks. All patients successfully returned to full military duty at an average of 16.7 ± 2.8 weeks post-injury. No complications were observed.

CONCLUSION: This study provides valuable insight into the rare entity of DFSSF, emphasizing clinical awareness, and optimal management strategies.

LEVEL OF EVIDENCE: Case Series, IV.

PMID:41344100 | DOI:10.1016/j.injury.2025.112911

Injury. 2025 Nov 19;57(2):112897. doi: 10.1016/j.injury.2025.112897. Online ahead of print.

ABSTRACT

INTRODUCTION: As the number of older adults with hip fractures rises, improving strategies to prevent postoperative pneumonia is crucial in this vulnerable population. This study aims to evaluate the effect of implementing the ICOUGH protocol for the prevention of pneumonia on the incidence of postoperative hospital-acquired pneumonia in geriatric hip fracture patients.

METHODS: This retrospective cohort study included 1342 patients aged ≥ 70 years with operative treatment of a hip fracture between 2021 and 2024. In January 2023, the ICOUGH protocol was implemented, consisting of incentive spirometry, coughing and deep breathing, oral care, early mobilization, patient education, and head-of-bed elevation. A historical control cohort of 646 patients was compared to a post-implementation cohort of 696 patients. The primary outcome was the incidence of hospital-acquired pneumonia. Secondary outcomes included delirium, urinary tract infection, intensive care unit admission, length of stay, and 30-day mortality. Multivariable logistic regression analysis was performed with predetermined covariates.

RESULTS: The incidence of postoperative pneumonia was 8.0 % in the historical cohort, and 4.7 % in the intervention cohort (p = 0.013). Implementation of the ICOUGH protocol was independently associated with a lower risk of developing postoperative hospital-acquired pneumonia (aOR=0.551, 95 % CI=0.347-0.875, p = 0.012). Secondary outcomes showed that delirium was reduced with 7.9 % (p = 0.012) and 30-day mortality was reduced with 1.4 % (p = 0.022) in the intervention group.

CONCLUSION: Implementation of the ICOUGH protocol effectively reduces the incidence of postoperative hospital-acquired pneumonia among geriatric hip fracture patients. This protocol is a practical and minimally invasive strategy, and shows that multidisciplinary, proactive care is effective in preventing postoperative pneumonia.

LEVEL OF EVIDENCE: IIIb.

PMID:41337952 | DOI:10.1016/j.injury.2025.112897

Injury. 2025 Nov 27:112907. doi: 10.1016/j.injury.2025.112907. Online ahead of print.

ABSTRACT

OBJECTIVE: Helmets play a critical role in preventing and reducing the severity of head injuries in high-risk sports. Understanding the factors influencing equestrian helmet use and safety perceptions is needed to optimise injury prevention strategies.

METHODS: In this cross-sectional study of 596 equestrian participants aged ≥12 years, we assessed helmet use, factors influencing helmet purchase decisions, and perceptions of helmet safety. Chi square tests and regression models examined differences by age, professional status, jumping versus non-jumping disciplines and concussion history.

RESULTS: Helmet use whilst riding was high (96 % participants). A high proportion of helmets used for competition (97 %) met at least one safety standard, however this was lower for recreational use (65 %). Younger equestrians (aged 12-44 years) and those who had not experienced a concussion were more likely to rank price as the most important factor for helmet purchase decision making. There were no differences by jumping or non-jumping equestrian disciplines or professional status. Older age and being female were independently linked with higher perceptions of helmet safety in the regression model (p = 0.01).

CONCLUSION: Safety messages need to focus on improving understanding of helmet standards and the reasoning behind safety recommendations to help reduce the injury risk in equestrian sports, particularly targeting adolescents/young adults.

PMID:41330824 | DOI:10.1016/j.injury.2025.112907

Injury. 2025 Nov 20;57(2):112905. doi: 10.1016/j.injury.2025.112905. Online ahead of print.

NO ABSTRACT

PMID:41330087 | DOI:10.1016/j.injury.2025.112905

Injury. 2025 Nov 20:112904. doi: 10.1016/j.injury.2025.112904. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatically injured patients who are detained by law enforcement have variable disposition possibilities that may be unclear to providers. This creates difficulties in discharge planning, and may contribute to disparities in outpatient care. The objective of this study was to evaluate emergency department (ED) utilization, readmissions, and follow-up for traumatically injured patients discharged to jail compared to those discharged to home.

METHODS: This was a retrospective review of traumatically injured patients at a Level 1 trauma center from 2015 - 2022. All patients discharged to jail were propensity matched 1:1 to a subset of patients discharged to home. The match was based on age, gender, race, mechanism of injury, and Injury Severity Score. The primary outcome was ED utilization within 60 days. Secondary outcomes were unplanned readmissions and attendance at trauma-related follow-up appointments. Outcomes were compared between the two groups.

RESULTS: There were 392 matched pairs. Patients discharged to jail were more likely to visit the ED compared to home patients (25 % vs 18 %, OR 1.46, 95 % CI 1.02 - 2.10, p = 0.030). There were no differences in unplanned readmissions (6 % vs 7 %, OR 0.86, 95 % CI 0.48 - 1.53, p = 0.579) between the two groups. Patients discharged to jail were more likely to visit the ED with concerns regarding obtaining their discharge prescriptions (19 % vs 1 %, p < 0.001), and 30 % (n = 7) of these patient readmissions were due to the jail not being able to accommodate their medical cares. A total of 28 % of patients discharged to jail had no trauma-related ambulatory follow-up compared to 15 % of home patients (OR 2.33, 95 % CI 1.59 - 3.49, p < 0.001).

CONCLUSION: Patients discharging to jail face fragmented transitions of care which creates barriers in outpatient healthcare engagement. They are more likely to visit the emergency department, and are less likely to have appropriate trauma related follow-up care. Targeted interventions are necessary to support this patient population to improve outpatient care after injury.

PMID:41320616 | DOI:10.1016/j.injury.2025.112904

Injury. 2025 Nov 26:112910. doi: 10.1016/j.injury.2025.112910. Online ahead of print.

ABSTRACT

INTRODUCTION: The global trauma burden disproportionately affects low- and middle-income countries(LMICs), which lack robust emergency medical services(EMS). The Global Prehospital Consortium determined Tier-1 EMS response intervals are a priority for investigation. On-scene response intervals for professional ambulance-driven Tier-2 EMS vary by density of centralized ambulance dispatch sites per population, requiring costly infrastructure to improve response times. Community bystander-driven (Tier-1) systems are less costly with diffuse and non-centrally dispatched responders. Therefore, we hypothesized Tier-1 EMS response intervals to emergencies are not distance-related, due to the inherent diffusion of Tier-1 responders.

METHODS: In 2016, Tanzania Rural Health Movement launched a Tier-1 lay first responder(LFR) program in Tanzania integrated with Beacon, a mobile emergency medical dispatch(EMD) platform. LFRs were provided with a two-day training course. Chief complaints, diurnal emergency variation, and response/triage/encounter intervals were prospectively recorded for analysis. GIS software (ArcGIS Pro 2.8) evaluated encounter latitude/longitude and distance from Mwanza city center, compared with response interval, using a logarithmic distribution for correlational analysis.

RESULTS: 1273 entries were prospectively catalogued (2017-2024). 60 encounters lacked ≥67 % data compliance, 136 lacked GPS coordinates, and 89 geographic/time outliers were excluded, leaving 988 encounters for analysis (77.6 %). Of chief complaints, 81.0 % were road traffic injury-related. Median dispatch to on-scene arrival interval = 1 minute 4 seconds (IQR:36s-5m9s) and median on-scene arrival to triage decision interval = 1 minute 2 seconds (IQR:37s-2m32s) (n = 988). There was no correlation between log (response time interval) and log (distance from Mwanza center) (r = 0.028, p = 0.380) (n = 1012).

CONCLUSIONS: In this community-based EMS model, response times were rapid and not associated with geographic distance, highlighting the effectiveness of decentralized Tier-1 systems when combined with mobile dispatch technology. These findings support the scalability of low-cost, bystander-driven EMS networks in LMICs without reliance on traditional costly dispatch infrastructure, offering a promising strategy to address the global trauma burden.

PMID:41320615 | DOI:10.1016/j.injury.2025.112910

Injury. 2025 Nov 20;57(2):112902. doi: 10.1016/j.injury.2025.112902. Online ahead of print.

ABSTRACT

OBJECTIVES: Atypical femoral fractures are associated with high rates of non-union and reoperation due to their complex pathogenesis. There is no consensus in literature on the optimal treatment strategy of these difficult cases. This study demonstrates a standardized management protocol for atypical femoral fracture non-unions, with surgical mechanical alignment of the non-union, without bone grafting or use of biological adjuncts, and with immediate unrestricted weight bearing post operatively. The study aimed to examine whether comparable union and complications rates can be achieved to those published in literature.

METHODS: A retrospective analysis of a prospectively collected trauma database at a tertiary referral centre for non-union was conducted. Demographic data, serial radiographs, and clinical records were reviewed. The primary outcomes were union rate and time to union.

RESULTS: 13 consecutively treated patients with atypical femoral fracture non-union were included with a union rate 92 % (12 out of 13). The single ongoing non-union was in a patient who died shortly post-operatively and once excluded, the union rate was 100 %. 1 of the 12 patients who achieved union required two procedures. The average time to union of the 11 patients who underwent a single procedure for non-union was 8.3 months. The revision fixation methods were reconstruction intramedullary nail (n = 4), a reconstruction type nail with adjuvant plate (n = 5), or a 95-degree blade plate (n = 4). No bone graft or any other biological adjuncts were used in any cases.

CONCLUSIONS: This study demonstrated a comparable union rate for atypical femoral fracture non-unions to studies previously reported and achieved this without any form of bone grafting and no complications from immediate weight bearing. To our knowledge, this is the only case series where no bone grafting was used in the management of AFFNU.

PMID:41319409 | DOI:10.1016/j.injury.2025.112902

Injury. 2025 Nov 26;57(2):112913. doi: 10.1016/j.injury.2025.112913. Online ahead of print.

ABSTRACT

BACKGROUND: The global rise in obesity presents a complex challenge in trauma care, characterized by the "Obesity Paradox." This study aimed to evaluate the biomechanical protection hypothesis and its influence on initial injury severity and clinical outcome in severely injured patients.

METHODS: This retrospective study analyzed 1549 adult trauma patients (ISS≥9) divided into Non-Obese (NO, BMI<30) and Obese (OB, BMI≥30) cohorts. Primary endpoints included ISS, regional AIS scores, and mortality. Secondary endpoints included physiological burden (SAPS II) and resource utilization (LOS, ICU LOS). Group differences were analyzed and the independent effect of BMI on mortality, adjusting for Age, ISS, and ASA status assessed.

RESULTS: The OB cohort was significantly older and presented higher pre-existing comorbidity. Supporting the cushioning effect, OB patients exhibited a significantly lower overall ISS (p=0.035) and lower regional AIS scores for the Head/Neck (p=0.008) and Abdomen/Pelvis (p=0.036). OB patients suffered greater morbidity however, with higher SAPS II scores (p<0.001) and longer total LOS (p=0.005) and ICU LOS (p=0.021). Despite this morbidity and their lower ISS, in-hospital mortality was comparable between groups (p=0.728). Multivariate analysis confirmed that Age and ISS were strong, independent mortality predictors (OR>1.08, p<0.001), while BMI itself was not a significant independent predictor (OR1.036, p=0.119).

CONCLUSIONS: Our findings strongly suggest that the "Obesity Paradox" in major trauma is not a mere statistical anomaly, but a reproducible phenomenon with a distinct mechanistic explanation: Biomechanical protection which results in a lower ISS, neutralizes the increased physiological and comorbidity burden of the obese state.

PMID:41319408 | DOI:10.1016/j.injury.2025.112913

Injury. 2025 Nov 26;57(2):112908. doi: 10.1016/j.injury.2025.112908. Online ahead of print.

ABSTRACT

INTRODUCTION: Acute nerve injury (ANI) leads to significant neuropathic pain and functional impairment. Current treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs) like meloxicam, provide symptomatic relief but have limited neuroregenerative effects. Varenicline, a nicotinic acetylcholine receptor (nAChR) agonist, has demonstrated neuroprotective and anti-inflammatory properties.

AIM: This study evaluates the effects of varenicline as an add-on therapy to meloxicam in a rat model of ANI.

METHODS: Eighteen female Wistar rats were randomized into four groups: Control (CONT), Sham (SHAM), Acute Nerve Injury + Meloxicam (ANI+Melox), and Acute Nerve Injury + Meloxicam + Varenicline (ANI+Melox+VAR). Varenicline (2.5 mg/kg, s.c.) was administered alongside meloxicam (2 mg/kg, s.c.). Functional recovery, histopathological changes, and biochemical markers, including prostaglandins (PGE₂, PGI₂), substance P, IL-6, levels, were assessed after 30 days.

RESULTS: Varenicline and meloxicam co-treatment significantly reduced inflammatory and pain biomarkers including prostaglandins, interleukin-6 and substance P, compared to meloxicam alone. Histopathological evaluation revealed enhanced Schwann cell proliferation, reduced fibrosis, and increased Bands of Büngner formation, suggesting nerve regeneration.

CONCLUSION: Varenicline, as an adjunct to meloxicam, enhances neuroprotection, reduces inflammation, and promotes histological and biochemical indicators of regeneration in rats with acute sciatic nerve injury. Future studies should explore its long-term effects and potential as a monotherapy for peripheral nerve injuries.

PMID:41317660 | DOI:10.1016/j.injury.2025.112908

Injury. 2025 Nov 20;57(2):112900. doi: 10.1016/j.injury.2025.112900. Online ahead of print.

ABSTRACT

AIM: To analyze the spectrum of ocular injuries caused by pressure cooker explosions, evaluate visual outcomes, and highlight the need for increased safety awareness.

METHODS: This retrospective study reviewed medical records of 40 patients presenting with ocular trauma due to pressure cooker explosions between January 2010 and December 2022 across four tertiary eye care centers in South India. Data collected included demographics, injury type, clinical findings, imaging results, surgical interventions, and visual outcomes. Injuries were classified based on the Birmingham Eye Trauma Terminology (BETT) system and graded according to the presenting and final best-corrected visual acuity (BCVA).

RESULTS: The mean age at presentation was 40 ± 13.4 years, with a female predominance (65 %). Urban residents (62.5 %) were more frequently affected than rural individuals (37.5 %). Closed globe injuries comprised 80 % of cases, while open globe injuries accounted for 20 %. Blast injuries were the most common mechanism (57.5 %), followed by thermal injuries (40 %). Common ocular findings included hyphema (10 %), iridodialysis (7.5 %), traumatic cataract (12.5 %), and vitreous hemorrhage (7.5 %). Surgical intervention was required in 37.5 % of cases, with procedures ranging from conjunctival tear repair to evisceration. Poor visual prognosis was associated with open globe injuries and severe blast trauma.

CONCLUSION: Pressure cooker-related ocular trauma predominantly affects women in domestic settings and can lead to severe vision loss. Increased public awareness, manufacturer adherence to safety standards, and user education on proper handling may help reduce the incidence of such injuries.

PMID:41317659 | DOI:10.1016/j.injury.2025.112900

Injury. 2025 Nov 1:112859. doi: 10.1016/j.injury.2025.112859. Online ahead of print.

ABSTRACT

This letter evaluates the methodological shortcomings in the FEA research conducted by Ma et al. (2025) that contrasts hook plates with tension-band wiring for patellar fractures. Unresolved concerns consist of: uniform bone material characteristics simplifying biomechanics; static loads neglecting dynamic physiological forces; idealized fracture spaces missing clinical variation; and unverified interfaces exaggerating stability. These gaps may exaggerate the effectiveness of the implant. We suggest personalized modeling, simulations of dynamic loading, and studies on mesh convergence to enhance clinical significance. Tackling these issues would enhance forthcoming evaluations of orthopedic devices based on FEA.

PMID:41314893 | DOI:10.1016/j.injury.2025.112859

Injury. 2025 Oct 31:112874. doi: 10.1016/j.injury.2025.112874. Online ahead of print.

ABSTRACT

This letter addresses the research conducted by Lin et al. regarding the shock index (SI) as an indicator of compensated shock in normotensive trauma cases. We acknowledge the authors' efforts while highlighting significant limitations: overlooked confounding due to cardioactive drugs, survival bias from omitting early fatalities, influences of prehospital fluid resuscitation, and insufficient age-specific SI thresholds. We additionally challenge transfusion as a surrogate for shock and emphasize the variation in injury mechanisms. Suggestions consist of modifications in pharmacovigilance, incorporation of early mortality statistics, and multi-center confirmations with microcirculatory outcomes.

PMID:41314892 | DOI:10.1016/j.injury.2025.112874

Injury. 2025 Nov 20:112898. doi: 10.1016/j.injury.2025.112898. Online ahead of print.

ABSTRACT

BACKGROUND: Equestrian sports have been found to cause high rates of injuries. In clinical practise after such injuries, polytrauma protocol workups usually include whole-body computed tomography (WBCT), CT of the chest, abdomen and pelvis with intravenous iodine contrast medium, and CT of the cervical spine and brain without contrast. The purpose was to investigate the use of WBCT in equestrian-related accidents, to analyse demographics, mechanism of injury (MOI), therapy and severity of equine-related accidents, radiology, and the use of protecting equipment.

MATERIAL AND METHODS: This is a retrospective study including a cohort of patients who were admitted to trauma centres at Queen Silvia Children's Hospital (paediatric <16 years) and Sahlgrenska University Hospital (adult ≥16 years) in Gothenburg in the period 2010 - 2020 due to equestrian-related injuries. Medical records were studied concerning patient demographics, MOI, protective equipment, injuries suffered, Injury Severity Score (ISS), surgery, and hospital length of stay.

RESULTS: There were 1341 patients (97 % female, 43 % paediatric) with equestrian-related accidents who were admitted to the hospitals. Of these, 262 were assessed as polytrauma, of whom 77 % were adults with median age of 38 years and 23 % were paediatric with median age of 13 years. WBCT was performed in 54 % of adult and 52 % of paediatric patients. The MOI was mainly fall from a horse 241/262 (92 %), and in 27/241 (11 %) the horse also fell on the rider. In the 262 patients, spine injury was seen in 32 %, thoracic injury in 29 %, cerebral hemorrhages in 22 (8 %), tetraplegia in 2 (0.8 %), and paraplegia in 1 (0.4 %). Abdominal injury was mostly seen in liver 13/262 (5 %). The median ISS was 4 (IQR 1-9). There were 59 % of paediatric and 48 % of adult patients hospitalized for a median of 2 days (IQR 1-5), and 14 needed intensive care. Surgery was required in 33 patients. Wearing of helmets and vests was recorded in 146 (56 %) and 58 (22 %) of the individuals, respectively.

CONCLUSIONS: Only 54 % of adult and 52 % of paediatric patients underwent a WBCT after equestrian - related polytrauma indicating inadequate assessment. The documentation rate of safety equipment was low.

PMID:41309434 | DOI:10.1016/j.injury.2025.112898

Injury. 2025 Oct 31:112879. doi: 10.1016/j.injury.2025.112879. Online ahead of print.

NO ABSTRACT

PMID:41309433 | DOI:10.1016/j.injury.2025.112879

Injury. 2025 Nov 19;57(2):112895. doi: 10.1016/j.injury.2025.112895. Online ahead of print.

ABSTRACT

BACKGROUND: The objective of this study is to compare the clinical outcomes of robot-assisted percutaneous screw fixation with traditional ORIF for treating displaced intra-articular glenoid Ideberg Ia fractures.

METHODS: This retrospective study included all patients diagnosed with displaced intra-articular glenoid fractures between January 1, 2021, and December 31, 2024, at our Level 3 hospital who met the inclusion and exclusion criteria. Patient demographics and intraoperative parameters were meticulously documented. Clinical outcomes were measured using the Constant Murley Shoulder score, the Quick Disabilities of the Arm, Shoulder, and Hand score, and the Visual Analogue Scale for pain. Each patient was asked to assess their satisfaction with the appearance of their scars using a 10-point Likert scale. The range of motion and any complications were thoroughly documented for further analysis. In addition, the time taken to resume work, sports activities, and recover the previous range of motion in the shoulder was also recorded.

RESULTS: 18 patients were included in the final analysis-8 in the robot-assisted group and 9 in the ORIF group. The robot-assisted group required significantly less operative time (70.00 ± 16.04 vs. 108.22 ± 34.67minutes, P < 0.05), reduced blood loss (11.25 ± 7.44 vs. 120.00 ± 65.00 mL, P < 0.05), smaller incision length (1.18 ± 0.26 vs. 12.24 ± 2.74 cm, P < 0.05), faster resume work (13.13 ± 1.81 vs. 23.78 ± 15.57 weeks), quicker return to sports (17.00 ± 1.85 vs. 27.53 ± 13.63 weeks, P < 0.05), a shorter time to regain full range of motion (13.00 ± 1.85 vs. 29.00 ± 12.05 weeks, P < 0.05), and a higher scar cosmesis score (9.88 ± 0.35 vs. 5.17 ± 3.4, P < 0.05). The robot-assisted group achieved bone union substantially faster, with an average time of 8.12 ± 0.35weeks compared to 13.33 ± 2.46 weeks in the ORIF group (P < 0.05). In terms of active range of motion, patients in the robot-assisted group had a significantly better function in forward flexion, abduction, and internal rotation (150.00 ± 9.26 vs. 126.67 ± 21.94, 138.75 ± 12.46 vs. 106.25 ± 32.27, 84.38 ± 4.96 vs. 59.58 ± 15.73, respectively) (P < 0.05).

CONCLUSION: Robot-assisted percutaneous screw fixation offers a safe and minimally invasive treatment option for displaced intra-articular glenoid Ideberg Ia fractures. This technique not only promotes faster healing but also provides superior cosmetic results and excellent functional outcomes when compared to traditional ORIF.

PMID:41308429 | DOI:10.1016/j.injury.2025.112895