Injury. 2026 May 4:113341. doi: 10.1016/j.injury.2026.113341. Online ahead of print.

NO ABSTRACT

PMID:42140809 | DOI:10.1016/j.injury.2026.113341

Injury. 2026 May 8:113350. doi: 10.1016/j.injury.2026.113350. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma is a leading cause of death and disability, both in Sweden and globally. Timely surgical intervention and level of care have been identified as important determinants of outcome, yet it is not known whether time to surgery differs between trauma centers and non-trauma centers in Sweden, or whether previously observed survival differences also apply to patients undergoing early operative management.

METHODS: This retrospective national cohort study included adult trauma patients (≥18 years) who underwent surgery within six hours of hospital arrival between 1 January 2019 and 21 March 2023. Data were obtained from Swedish national quality registries and administrative registers held by the National Board of Health and Welfare (Socialstyrelsen). The primary outcome was time from hospital arrival to initiation of surgery. Secondary outcomes were time to urgent surgery and 30-day mortality. Associations between trauma center status and outcomes were examined using regression models adjusted for demographic and injury-related factors.

RESULTS: A total of 1129 adult trauma patients who underwent surgery within six hours of hospital arrival were included, the majority presenting with moderate to severe injuries; of whom 659 (58.4%) were treated at trauma centers and 470 (41.6%) at non-trauma centers. Patients treated at trauma centers had higher injury severity and greater physiological compromise. Trauma center care was associated with shorter time to surgery; the fully adjusted mean difference was 0.68 h compared with non-trauma centers. Crude 30-day mortality was higher at trauma centers, but after full adjustment for case-mix, trauma center care was associated with lower mortality.

CONCLUSION: Among trauma patients undergoing early surgery, treatment at trauma centers was associated with shorter time to surgery and improved adjusted survival. Further research is needed to identify which patient groups may benefit most from direct transport to trauma centers.

PMID:42120216 | DOI:10.1016/j.injury.2026.113350

Injury. 2026 May 5;57(7):113340. doi: 10.1016/j.injury.2026.113340. Online ahead of print.

ABSTRACT

INTRODUCTION: The sinus tarsi approach (STA) has gained popularity as a minimally invasive alternative to the extensile lateral approach for displaced intra-articular calcaneal fractures (DIACFs), yet wound complications remain a concern. This study aimed to determine the incidence and predictors of wound complications following STA fixation.

METHODS: A retrospective multicenter cohort study was conducted across four tertiary referral hospitals, including all surgically treated DIACFs managed with STA between 2018 and 2022. Demographic, injury-related, and operative variables were extracted from medical records. The primary outcome was wound complications within eight postoperative weeks, defined as inflammation, necrosis, or persistent wound leakage >2 weeks. Secondary outcomes included reoperation and identification of risk factors.

RESULTS: 148 fractures in 143 patients were included. Wound complications occurred in 13 cases (9%), with only one requiring surgical revision; eight were treated with antibiotics. Reoperation within one year occurred in 10% of cases, with a higher, though not statistically significant, rate among patients with wound complications (21% vs. 7.5%). Significant risk factors for wound complications were psychiatric comorbidity (p = 0.012), open fractures (p = 0.032), and concomitant fractures (p = 0.021). Trends toward higher complication rates were observed with screw fixation and Sanders type III-IV fractures. No associations were found with smoking, diabetes, alcohol use, or time to surgery.

CONCLUSION: STA for DIACFs is associated with a low wound complication rate, with few cases requiring reoperation. Open fractures, psychiatric disorders, and concomitant injuries significantly increase the risk of wound complications, whereas traditional risk factors known from extensile approaches-such as smoking and diabetes-were not associated with adverse outcomes. These findings support the safety of STA and highlight the importance of recognizing patient- and injury-related risk factors in perioperative planning.

PMID:42119541 | DOI:10.1016/j.injury.2026.113340

Injury. 2026 May 4:113338. doi: 10.1016/j.injury.2026.113338. Online ahead of print.

NO ABSTRACT

PMID:42115112 | DOI:10.1016/j.injury.2026.113338

Injury. 2026 May 2:113337. doi: 10.1016/j.injury.2026.113337. Online ahead of print.

ABSTRACT

BACKGROUND: Turret trucks are widely used to handle cargo in Japanese wholesale markets. Under Japanese law, helmet use is not mandatory for turret truck operators, which potentially increases the risk of head and neck injuries. This study aimed to describe the clinical characteristics, risk factors, and outcomes of turret truck-related head and neck injuries as the first reported analysis of this injury mechanism.

METHODS: We conducted a retrospective observational study of patients with turret truck-related head and neck injuries who were transported to St. Luke's International Hospital between January 2011 and June 2024. Demographic data, injury characteristics, and outcomes were collected. The primary outcome was the necessity for hospital admission, and the secondary outcome was functional status at discharge, measured using the modified Rankin Scale (mRS).

RESULTS: Of the 67 patients analyzed, 48 (72%) were turret drivers and 19 (28%) were non-drivers. The cohort was predominantly male (97%) with a median age of 64 years. Twenty-four patients (36%) required hospital admission, with a higher proportion among turret drivers (44%) than among non-drivers (16%). Among turret drivers, all patients with severe injuries (Injury Severity Score ≥16) and those with significant head and neck injuries (Abbreviated Injury Scale ≥3) required hospitalization. Despite injury severity, most patients achieved favorable functional outcomes, with 97% having an mRS score of 0-2 at discharge. One fatality occurred in a 70-year-old female passenger without helmet who fell from a turret truck.

CONCLUSIONS: Although most turret truck-related head and neck injuries result in favorable outcomes, a substantial proportion of patients require hospitalization. Given the predominantly older male population and the occurrence of fatal outcomes even at low speeds without helmet protection, mandatory helmet use and comprehensive safety measures should be considered to reduce injury severity in this population.

PMID:42115111 | DOI:10.1016/j.injury.2026.113337

Injury. 2026 Apr 10:113216. doi: 10.1016/j.injury.2026.113216. Online ahead of print.

NO ABSTRACT

PMID:42108111 | DOI:10.1016/j.injury.2026.113216

Injury. 2026 May 7;57(7):113348. doi: 10.1016/j.injury.2026.113348. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures represent a major public health concern in the aging population, contributing substantially to morbidity, functional decline, and mortality. Although hip fractures are widely recognized for their high early mortality risk, less is known about the comparative one-year mortality associated with first-time long bone fractures at other anatomical sites. This study evaluates one-year all-cause mortality across multiple fracture types in older adults using a large, multicenter research network.

METHODS: We performed a retrospective cohort study using the TriNetX US Collaborative Network, identifying patients ≥ 65 years with a first-time long bone fracture between 2004 and 2024. Fracture types included hip, pertrochanteric, subtrochanteric, distal femur, proximal tibia, distal tibia, proximal humerus, and distal humerus fractures. Patients with pathologic, metastatic, or multiple fractures were excluded. A non-fracture cohort of age-matched older adults served as the comparison group. The primary outcome was one-year all-cause mortality. Propensity score matching (1:1) was used to balance demographics. Relative risks (RR) with 95% confidence intervals (CIs) and Kaplan-Meier survival analyses were performed.

RESULTS: A total of 165,017 fracture patients and 4.55 million non-fracture controls were identified; 162,469 patients remained after matching per cohort. All fracture types were associated with significantly increased one-year mortality compared with matched controls (2.77%). Hip fractures demonstrated the highest risk (27.9%; RR 4.86, 95% CI 4.65-5.08), followed by pertrochanteric (23.9%; RR 4.14) and subtrochanteric fractures (15.2%; RR 2.98). Distal femur fractures carried a 9.4% mortality risk (RR 2.71). Mortality for distal humerus, distal tibia, proximal tibia, and proximal humerus fractures ranged from 5.6 to 7.1% (RR 1.63-1.97).

CONCLUSION: First-time long bone fractures in older adults are associated with significantly elevated one-year mortality, with hip and proximal femur fractures conferring the greatest risk. These findings underscore the need for early risk stratification, targeted postoperative care, fall-prevention strategies, and multidisciplinary management to reduce fracture-related mortality in the geriatric population.

PMID:42107204 | DOI:10.1016/j.injury.2026.113348

Injury. 2026 Apr 10;57(7):113278. doi: 10.1016/j.injury.2026.113278. Online ahead of print.

ABSTRACT

PURPOSE: Primary bipolar hip arthroplasty is commonly used to manage displaced femoral neck fractures in elderly patients, offering early mobilization and reduced surgical burden compared with total hip arthroplasty. However, long-term functional outcomes and predictors of recovery remain variable. This study aimed to prospectively evaluate the clinical and functional outcomes of primary bipolar hip arthroplasty.

METHODS: This prospective observational study included 196 patients who underwent primary bipolar hip arthroplasty between January 2016 and September 2024 in three university-affiliated teaching hospitals. Functional outcomes were assessed using the Harris Hip Score (HHS), while postoperative complications were recorded for one year. Patients were stratified by age (<60 vs. ≥60 years) to examine the impact of demographic factors on outcomes. Statistical analysis included correlation and subgroup comparisons with significance set at p < 0.05.

RESULTS: The mean age of participants was 68.7 ± 11.9 years, and the mean follow-up was 46.97 ± 25.21 months. No major complications or revision surgeries occurred; 4.0% of patients developed superficial wound infections. Overall, the mean HHS was 50.51 ± 18.59, with 79.6% of patients achieving poor scores. Younger patients (<60 years) demonstrated better functional outcomes, particularly in mobility-related domains (p = 0.06), while most older patients (≥60 years) had poor long-term functional results. A significant negative correlation was observed between age and HHS (r = -0.379, p = 0.007).

CONCLUSIONS: Bipolar hemiarthroplasty is a safe procedure with low complication and revision rates. However, long-term functional outcomes are modest, especially in elderly patients, likely influenced by age, comorbidities, preoperative status, and acetabular erosion. Individualized patient selection and long-term monitoring of hip function are recommended to optimize recovery.

PMID:42105687 | DOI:10.1016/j.injury.2026.113278

Injury. 2026 May 4;57(7):113339. doi: 10.1016/j.injury.2026.113339. Online ahead of print.

ABSTRACT

Being established as an important natural component for wound healing, acacia honey (AH) in combination with ascorbic acid (AA) was evaluated for its tissue regenerative properties to establish a synergistic effect. A thermosensitive hydrogel formulation was developed and characterized for viscosity, mucoadhesion, moisture retention, pH, and morphology, where the parameters were found to be favourable for topical application and longer retention. The porosity and swelling of the hydrogel matrix allow for prolonged and sustained release of AH and AA. The release patterns of AH and AA from the gel matrix followed the Korsmeyer-Peppas and Michaelis-Menten patterns, respectively, indicating sustained release. The optimized formulation revealed antimicrobial properties, as evidenced by the significant increase (p < 0.05) in the diameter of the zone of inhibition. Scratch wound assay using HaCaT cell line showed wound healing potential of 90.6±4.5% for the co-loaded formulation. Furthermore, the wound healing potential of the co-loaded hydrogel in the excision wound model in experimental rats could be linked to increased vascularization due to the daily application of the formulation at the wound site. The antioxidant capacity was demonstrated by decreased IC50 values of 53.75±5.9 and 72.71±6.63 µg/mL against ABTS and DPPH, respectively, which additionally supported the wound healing potential. Lastly, the synergistic role of AH and AA facilitates fibroblast proliferation, collagen production, and glycosaminoglycan deposition, which could be correlated with a significant increase in hexosamine and hexuronic acid to 153.3±9.49 and 48.91±6.84 µg/40 mg of wound tissue, respectively. Overall, the co-loaded hydrogel could be an effective alternative for the treatment of acute dermal injuries.

PMID:42105686 | DOI:10.1016/j.injury.2026.113339

Injury. 2026 May 4;57(7):113336. doi: 10.1016/j.injury.2026.113336. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple rib fractures cause substantial morbidity through severe pain, impaired ventilation, and pulmonary complications. While open rib fixation is well established, thoracoscopic fixation may reduce soft-tissue trauma and enhance recovery, but comparative evidence remains unclear. This systematic review and meta-analysis aimed to compare thoracoscopic versus open fixation for multiple rib fractures in terms of effectiveness and safety outcomes.

METHODS: We conducted a systematic literature search across PubMed, Scopus and Web of Science to retrieve comparative studies comparing thoracoscopic fixation versus traditional open fixation for multiple rib fractures regarding pain, perioperative outcomes and safety outcomes. Risk of bias of included studies was assessed using the ROBINS-I tool. A meta-analysis was conducted using a random-effects model in R (version 4.5.0).

RESULTS: Nine comparative studies were identified (total participants = 751). Meta-analysis revealed that thoracoscopic fixation was associated with improved postoperative pain compared with open fixation. Pain was significantly lower with thoracoscopy on postoperative day (POD) 1 (SMD= -1.12, 95% CI -1.64 to -0.61) and POD7 (SMD= -1.90, 95% CI -3.08 to -0.73), while POD3 was not significant (SMD= -1.49, 95% CI -3.52-0.54). Thoracoscopy reduced incision length (MD= -4.19 cm) and blood loss (MD= -18.56 mL) and shortened hospital stay (MD= -2.05 days), with no difference in operative time (MD= 9.66 min). Pleural effusion was less frequent (OR 0.32, 95% CI 0.10-1.00) on thoracoscopic fixation.

CONCLUSION: There may be clinically significant benefits of thoracoscopic rib fixation over open fixation for multiple rib fractures. These benefits may include less early postoperative pain, smaller incisions, less blood loss, shorter hospital stays, and no increase in operative time. Overall complication rates were similar, but thoracoscopic fixation was associated with fewer pleural effusions. Due to significant heterogeneity and the predominance of observational studies, there is a need for more rigorous prospective trials.

PMID:42102768 | DOI:10.1016/j.injury.2026.113336

Injury. 2026 Apr 10;57(7):113270. doi: 10.1016/j.injury.2026.113270. Online ahead of print.

ABSTRACT

BACKGROUND: Increased frailty is associated with higher rates of adverse events after hip fracture surgery. Unfortunately, considerable uncertainty remains about which tool or index best quantifies frailty and therefore the associated risk of complications following hip fracture surgery. This study tried to evaluate whether a Comprehensive Geriatric Assessment-Frailty Index could predict in-hospital complications following hip fracture surgery.

METHODS: A retrospective cohort study was conducted among 1469 patients aged 70 years and older with an operatively managed hip fracture. Patients grouped according to their Comprehensive Geriatric Assessment-based Frailty Index: pre-frail to mildly frail and moderately to severely frail. The primary outcome was the occurrence of one or more complications. Secondary outcomes included specific complications, intensive care unit admission, length of stay and in-hospital mortality. Multivariable regression was used to adjust for confounders and presented as adjusted Odds Ratios (aOR).

RESULTS: Moderately to severely frail was independently associated with an increased risk of having one or more complications (aOR 1.70, 95% CI=1.28-2.26, p < 0.001), urinary tract infection (aOR 2.12, 95% CI=1.01-4.47, p < 0.05), delirium (aOR 2.05, 95% CI=1.43-2.93, p < 0.001), in-hospital death (aOR 3.35, 95% CI=1.00-11.26, p = 0.05) and 1-year mortality (aOR 1.75, 95% CI=1.23-2.51, p = 0.002).

CONCLUSION: A Comprehensive Geriatric Assessment-based Frailty Index is a useful tool to predict in-hospital complications, in-hospital mortality and 1-year mortality in geriatric hip fracture patients. This tool provides useful information about a patient's frailty, enables early risk stratification, and has the potential to support physicians, patients and healthcare proxies in shared decision-making and setting individualized postoperative expectations.

LEVEL OF EVIDENCE: Prognostic, level III.

PMID:42085909 | DOI:10.1016/j.injury.2026.113270

Injury. 2026 Apr 23:113300. doi: 10.1016/j.injury.2026.113300. Online ahead of print.

ABSTRACT

INTRODUCTION: The timing of Emergency Medical Services (EMS) notification, crash scene arrival, and hospital arrival may impact motor vehicle fatalities. We examined EMS response time intervals over the past three decades, considering the effects of weather, vehicles involved, time of day, and location.

METHODS: We used the Fatal Accident Reporting System to compute and describe annual (1987-2020) EMS response time intervals. This included total time (i.e., crash-to-hospital), as well as the intervals between four key timepoints: crash, crash notification, crash scene arrival, and hospital arrival. We examined the proportion of fatal crashes with total intervals under 60 min (i.e., the "golden hour"), and where the crash arrival-to-hospital interval was under 30 min (the "beneficial timeframe"). Additionally, analyses were stratified by crash factors including weather (poor/clear) number of vehicles involved (single/multiple), time of day (early morning/rest of the day), and location (urban/rural).

RESULTS: A total of 310,001 fatal crashes were analyzed. Between 1987-1994 total median response times ranged between 40 and 42 min. By 1999, intervals had increased to 45 min; elevated intervals were evident through 2009. By 2020, observed intervals had returned to 41 min. Paralleling this pattern, crashes with "golden hour" intervals decreased from 77.0% in 1987 to 72.4% in 2009 and increased to 78.0% by 2020. Similarly, crashes with a "beneficial timeframe" decreased from 60% in 1987 to 52% in 2009 and increased to 56.0% by 2020. The largest discrepancies for crash strata were evident for location: rural crash total response time intervals were 15-23 min longer than urban.

CONCLUSIONS: From 1987-2020, the total time response interval following a fatal crash remained relatively stable. However, steady increases in intervals between crash notification and both crash scene and hospital arrival are evident.

PRACTICAL APPLICATIONS: Future research should focus on approaches to reduce response time intervals.

PMID:42069492 | DOI:10.1016/j.injury.2026.113300

Injury. 2026 Apr 28;57(7):113301. doi: 10.1016/j.injury.2026.113301. Online ahead of print.

ABSTRACT

INTRODUCTION: Non-home discharge after orthopedic trauma is associated with worse outcomes, increased costs, and greater resource utilization. Existing prediction tools often rely on hospital course variables unavailable at presentation or are limited to specific fracture populations. This study aimed to develop and validate the Fracture Orthopedic Risk of Non-Home Discharge (FORD) Score, a bedside tool using only emergency department-available variables to predict non-home discharge in adult fracture patients.

METHODS: A retrospective cohort study was conducted of adult fracture patients treated at an ACS-verified Level I trauma center from 2015 to 2023. Patients were randomly split into derivation (67%) and validation (33%) cohorts. Candidate predictors available immediately upon patient arrival were evaluated using univariate logistic regression, followed by multivariate logistic regression after collinearity assessment. Independent predictors were converted into an integer-based point system to construct the FORD Score. Model discrimination, calibration, and classification performance were assessed in the validation cohort and compared with established trauma severity measures.

RESULTS: The final cohort included 8422 patients, of whom 8.1% had non-home discharge. Fifteen independent predictors comprised the FORD Score, including age, physiologic abnormalities, fracture characteristics, and transport mode. In the validation cohort, FORD demonstrated good discrimination (AUROC 0.818, 95% CI 0.791-0.846) and excellent calibration. At the optimal threshold (score ≥4), sensitivity was 74.1%, specificity 75.8%, PPV 21.3%, and NPV 97.1%. FORD outperformed GTOS-II (AUROC 0.777; DeLong p = 0.018) and TRIAGES (AUROC 0.746; p < 0.001). Non-home discharge rates ranged from 1.7% in the lowest risk group to 34.1% in the highest, a 20-fold gradient.

CONCLUSION: The FORD Score is a validated bedside tool that accurately predicts non-home discharge in adult orthopedic trauma patients using only admission data, enabling early discharge planning and optimized resource allocation.

PMID:42068850 | DOI:10.1016/j.injury.2026.113301

Injury. 2026 Apr 24:113294. doi: 10.1016/j.injury.2026.113294. Online ahead of print.

ABSTRACT

BACKGROUND: U.S. Consumer Product Safety Commission reported that from 2018 to 2020 there were 94,700 off-highway vehicle accidents with 92% of those injuries related to all-terrain vehicles (ATV). An estimated 300 deaths were in children less than age 16. There has not been any previous evaluation of urethral injuries resulting from ATV accidents. We sought to define the volume and demographics of ATV-related urethral injuries.

METHODS: Data was obtained from the National Trauma Database (NTDB) Trauma Quality Program over a 7-year period (2016-2022). ICD-10 codes were used to identify patients who sustained urethral injury in ATV-related accidents. Injury and patient related demographic data was reviewed. R: A Language and Environment for Statistical Computing was used for data review and statistical analysis. Data were presented and analyzed using standard statistical methods RESULTS: During this time frame, there was a total of 7679,101 injuries recorded in the NTDB. There was a total of 7398 urethral injuries (0.1%), with 181 (2.5%) of those being related to ATV-accidents. 90.6% of patients were male, and there was a median age of 30 (range 5-76, IQR 29). The median injury severity score (ISS) was 17 (range 4-50, IQR 15). There was no association between age and higher ISS (r = 0.07, p = 0.36). Passengers were more likely to be less than age 16 (p = 0.001). Interestingly, 17% (26/153) of drivers were less than age 16. Non-traffic ATV accidents were associated with higher ISS (medians 21.5 versus 17, p = 0.003).

CONCLUSIONS: Urethral injuries are uncommon, however over 2% of these are related to ATV accidents alone. A high proportion of these injuries are severe, involving young patients, speaking to significant potential long-term morbidity.

PMID:42062182 | DOI:10.1016/j.injury.2026.113294

Injury. 2026 Apr 24:113304. doi: 10.1016/j.injury.2026.113304. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to assess the learning curve of REBOA from the first case in trauma centers using cumulative sum (CUSUM) analysis.

MATERIALS AND METHODS: This study enrolled consecutive trauma patients who visited five trauma centers from December 2015 to December 2021. To monitor the effectiveness of REBOA, we performed risk-adjusted cumulative sum (RA-CUSUM) analysis for mortality due to exsanguination. For individual risk adjustment, we implemented the least absolute shrinkage and selection operator (LASSO) logistic regression model. We then calculated the CUSUM for: (1) the time from common femoral artery (CFA) access to confirmation of REBOA placement (RP-CUSUM), (2) the total occlusion time (OT-CUSUM), (3) door-to-balloon time (DB-CUSUM), and (4) the time from injury to admission (IA-CUSUM). To determine whether observed deviations were statistically significant, a V-mask was superimposed on the CUSUM curve.

RESULTS: A total of 251 patients were enrolled. The overall mortality rate was 67.7% (170/251), and the mortality rate due to exsanguination was 49.0% (123/251). The RA-CUSUM model was developed using a LASSO logistic regression approach. In three hospitals, the RA-CUSUM showed an improvement after 5-34 procedures. However, the RA-CUSUM showed fluctuations with deterioration in the other two hospitals. The RA-CUSUM fluctuations exceeded the V-mask control limits. RA-CUSUM charts for five hospitals deviated beyond the V-mask boundaries, indicating that the processes were out of control. Other CUSUM charts-such as RP-, OT-, DB-, and IA-CUSUM-exhibited fluctuations limited within V-mask boundaries, which suggests no significant change.

CONCLUSION: CUSUM analysis demonstrated that a reduction in risk-adjusted mortality may be achieved with experience. Nevertheless, trauma surgeons should exercise caution due to a potential decline in the performance of REBOA, particularly the rate of mortality due to exsanguination.

PMID:42055837 | DOI:10.1016/j.injury.2026.113304

Injury. 2026 Apr 11:113285. doi: 10.1016/j.injury.2026.113285. Online ahead of print.

ABSTRACT

INTRODUCTION: Venous thromboembolism (VTE) is a common complication in trauma patients; however, there have been limited studies on VTEs and the prevention thereof in patients with inferior vena cava (IVC) injuries. This study aimed to examine VTE incidence and the preventative efficacy of VTE prophylaxis regimens after operative IVC repair.

METHODS: A 12-year retrospective review was performed of all patients who presented with IVC injuries to an urban level 1 trauma center. A subgroup analysis of VTE incidence, prophylaxis regimen (i.e., prophylactic anticoagulation [PAC] and/or antiplatelet [AP]) efficacy, and other clinical variables was performed on patients who underwent a primary or patch IVC repair and survived > 72 h.

RESULTS: A total of 132 patients presented with IVC injuries requiring operative management, with 56% overall survival. Among the 66 patients who received primary or patch repair and survived > 72 h, 27% had a VTE during index hospitalization and/or readmission. VTEs occurred a median of 9 days post-injury, and the most common type of VTE was deep vein thrombosis, followed by IVC thrombosis and pulmonary embolism. There were no significant differences in any clinical variables compared between patients who developed VTEs during index hospitalization and those who did not, including VTE prophylaxis timing, hospital or ICU length-of-stay, and injury severity score. Index hospitalization VTE rates differed significantly based on prophylaxis strategy (p = 0.018), with a 100% (2/2) VTE rate among patients who received no prophylaxis, a 22% (11/50) rate among patients who received a single modality (AP or PAC), and a 7% (1/14) rate among patients who received dual strategies (AP+PAC). However, VTE rates did not differ between single- and dual-prophylaxis strategies when compared directly.

CONCLUSION: Patients undergoing primary or patch IVC repair experienced high rates of VTEs, but these rates differed by prophylaxis strategies. While we observed trends toward reduction in the incidence of VTE with dual (PAC + AP) modalities versus single modality therapy, this study was underpowered to observe an actual effect given the small sample size. Further research or prospective trials are warranted to determine optimal prophylaxis strategies, especially given the markedly elevated VTE risk in patients with IVC injuries.

PMID:42055836 | DOI:10.1016/j.injury.2026.113285

Injury. 2026 Apr 22;57(6):113299. doi: 10.1016/j.injury.2026.113299. Online ahead of print.

ABSTRACT

BACKGROUND: Hip fracture care requires timely diagnosis, expedited surgery, and high-risk inpatient management. Failures along this pathway can result in patient harm and malpractice exposure. This review synthesized cross-jurisdiction malpractice trends and inflation-adjusted liability payments associated with adult hip fracture care.

METHODS: A PRISMA-guided systematic review was conducted. PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched from January 2000 through January 2026. Eligible studies reported malpractice claims and outcomes specific to adult hip fracture care. Monetary values were converted to 2026 United States dollars (USD) using the Consumer Price Index. British pound values were converted using 1 GBP = 1.30 USD. Results were synthesized descriptively owing to heterogeneity in medicolegal frameworks.

RESULTS: Six studies met the inclusion criteria, representing 1192 hip fracture-related claims from the United States (U.S.), United Kingdom (U.K.), and Norway. Hip fractures accounted for 7%-17% of fracture-related claims in tort-based systems. Among 445 National Health Service Litigation Authority (NHSLA) claims, plaintiff success rates ranged from 56% to 69%, compared with 31% in 80 U.S. jury-based cases. Diagnostic delay or missed diagnosis was the most frequent allegation (28%-40%) and the only independent predictor of plaintiff success in U.S. data (odds ratio, 12.57). U.K. datasets reported total indemnities exceeding $25 million (2026 USD), with pressure injuries demonstrating the highest mean payouts. In Norway's no-fault system, 616 claims were filed following 90,601 hip fracture surgeries (0.7% claim rate), with 36% accepted, most commonly for hospital-acquired infection.

CONCLUSIONS: Medicolegal risk after hip fracture care clusters around process-driven failure points, particularly diagnostic delay and ward-based care breakdowns, rather than isolated technical errors. Missed diagnosis was the only independent predictor of plaintiff success in the U.S.

DATA: Findings suggest that pathway-level interventions targeting diagnostic accuracy, operative timeliness, and inpatient surveillance may reduce both patient harm and medicolegal exposure.

PMID:42054931 | DOI:10.1016/j.injury.2026.113299

Injury. 2026 Apr 22;57(6):113302. doi: 10.1016/j.injury.2026.113302. Online ahead of print.

ABSTRACT

INTRODUCTION: Various factors can influence the survival of patients with severe burns. One of these factors could be the day or time of the burn injury. There are studies describing worse outcomes and higher mortality, as well as longer hospital stays, for emergency presentations at night and weekends for certain conditions. This study evaluates data from multiple burn centers, to analyse whether the day of the week, time of day or season of the year when a severe burn injury occurs has an impact on patient survival in a single patient cohort.

METHODS: Only primary admitted adult patients with documented date and time of admission to hospital and existing Burn mortality prediction (BumP)-Score were eligible for this study. The BumP score is used to calculate mortality using the variables age, burn area, presence of full-thickness burns, presence of inhalation trauma, circumstances of the burn and presence of pre-existing conditions. In the analyzed period 6152 patients were included. For the following subgroups burn trauma frequencies and characteristics of patients were analysed: Time of day, weekdays versus weekends, month and season. For outcome analysis the standardised mortality ratio (SMR) was calculated.

RESULTS: The SMR calculation revealed no significant difference between daytime and nighttime (0.939 [95% CI 0.831 - 1.046] vs. 0.985 [95% CI 0.863 - 1.106], p = 0.556). There was also no difference in the SMR between weekdays and weekends (0.932 [95% CI 0.836-1.027] vs. 1.027 [95% CI 0.875-1.179], p = 0.375), nor between time of day (p = 0.873), or season (p = 0.197).

DISCUSSION: The timing of burn injury does not significantly affect overall patient survival in relation to the time of day and between weekends and weekdays, or season although temporal trends and variations in SMR suggest that structural or logistical factors may play a role. The quality of care is consistently high regardless of the time of the burn admission.

PMID:42054930 | DOI:10.1016/j.injury.2026.113302

Injury. 2026 Apr 21;57(6):113258. doi: 10.1016/j.injury.2026.113258. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic spine fractures often occur with multisystem injuries. Pelvic and transverse process (TP) fractures have been linked to visceral trauma, but whether the pelvis behaves as an "organ protective" structure in spine injury is unclear.

OBJECTIVE: To determine how concomitant pelvic fractures and TP fracture burden influence visceral injury patterns in patients with spinal fractures.

METHODS: This retrospective cohort included adult trauma patients with CT-confirmed spinal fractures at a single Level I trauma center (2015-2023). Patients were grouped into spine-only or spine-plus-pelvic fracture groups. Demographics, mechanism, TP characteristics, and visceral injuries (thoracic, abdominal, neurologic) were recorded. Liver, spleen, and kidney injuries were graded using the American Association for the Surgery of Trauma criteria, and a Visceral Injury Complexity Score (VICS) was calculated. Bivariate analyses and multivariable Poisson regression assessed associations between pelvic injury and TP fracture count with visceral injury burden and organ-specific severity.

RESULTS: Among 154 patients (86 spine only, 68 spine plus pelvic), overall visceral (92.5% vs 70.9%) and abdominal injuries (85.1% vs 50.9%) were more common in spine only trauma, which also showed higher VICS and spleen injury grades. Pelvic injury independently predicted fewer abdominal injuries and lower liver, spleen, and composite organ injury severity, whereas increasing TP fracture count predicted higher total visceral, thoracic, and neurologic injury counts and greater spleen, kidney, and composite organ injury severity.

CONCLUSIONS: In spine trauma, pelvic fractures were associated with reduced abdominal organ injury burden, while greater TP fracture burden identified patients with more extensive multisystem trauma, supporting a dual role of the pelvis as both an injury marker and a potential organ protective structure.

PMID:42054929 | DOI:10.1016/j.injury.2026.113258

Injury. 2026 Apr 23:113303. doi: 10.1016/j.injury.2026.113303. Online ahead of print.

ABSTRACT

BACKGROUND: Motor vehicle crashes (MVCs) are a leading cause of injury and death in the United States. Community-level factors, such as social vulnerability and urbanicity, have been associated with risk of death; less is known about how these factors impact nonfatal, post-injury outcomes. This study examined the association between social vulnerability and urbanicity with hospital length of stay (LOS) and hospital discharge disposition among MVC patients.

METHODS: Patients aged 18 years and older who were admitted to a Montana regional trauma center with a non-fatal injury following an MVC from 2016 to 2024 were included in the study. The CDC Social Vulnerability Index (SVI) was used to quantify social vulnerability at the census tract level and scores were divided into tertiles representing low, medium, and high vulnerability. Urbanicity was defined using RUCA codes based on patient residence. Generalized estimating equations with a binomial distribution were used to estimate the joint association between SVI and urbanicity with discharge disposition (home vs. facility) and prolonged LOS (≥7 days), controlling for injury severity, patient demographics, and comorbidities.

RESULTS: Of the 668 patients, 529 (79%) were discharged home and 179 (27%) had a prolonged LOS. Among metropolitan patients, higher SVI rankings were associated with increased odds of discharge home; patients with medium and high SVI had respectively 2.6 and over 3 times greater odds of being discharged home than low SVI (medium aOR: 2.64; 95% CI: 1.96, 3.57; high aOR: 3.26; 95% CI: 2.52, 4.23). This association was not observed for non-metropolitan patients; however, patients from non-metropolitan had 2 times the odds of a prolonged LOS than those from metropolitan areas regardless of SVI (aOR: 2.03; 95% CI: 1.38, 2.98).

CONCLUSION: The association between social vulnerability and discharge disposition following a MVC differed by urbanicity, and urbanicity was also associated with prolonged LOS. Further research to better understand how sociodemographic factors impact nonfatal injury outcomes can help reduce disparities in care.

PMID:42034518 | DOI:10.1016/j.injury.2026.113303