Injury. 2026 Mar 15;57(4):113161. doi: 10.1016/j.injury.2026.113161. Online ahead of print.

ABSTRACT

BACKGROUND: Extra-articular distal tibial fractures treated with locked intramedullary nails present a high rate of malunion, particularly rotational deformities. Concomitant fibular fixation has been associated with a reduction in malalignment; however, some studies suggest it may increase nonunion and complication rates, including infection. There is currently no consensus regarding the influence of fibular stabilization in these fractures.

OBJECTIVE: To compare radiographic outcomes, functional results, and complication rates of extra-articular distal tibial fractures treated with locked intramedullary nails, with or without concomitant fibular fixation.

METHODS: A randomized prospective study was conducted including patients aged 18-60 years with displaced extra-articular distal tibial fractures, including open fractures up to Gustilo type IIIA, associated with fibular fractures located below the middle third. Patients lost to follow-up or who did not complete all radiographic or functional assessments were excluded. Primary outcomes included fracture union assessed by a modified RUST score ≥ 11 at 12 months, malalignment assessed by postoperative radiographs and CT scan at one year, functional evaluation of the knee and ankle using the Lysholm and AOFAS scores, respectively, and complication rates.

RESULTS: At the end of follow-up, 43 patients without fibular fixation (HIMB group) and 34 with fixation (HIMBF group) were analyzed. The nonunion rate was 4.7 % in the HIMB group and 5.9 % in the HIMBF group, with no significant difference. Fracture healing progression was similar between groups. Malunion occurred in 18.6 % of the HIMB group and 11.8 % of the HIMBF group, without statistical significance. There were no significant differences in complication rates or in knee and ankle functional outcomes at one year.

CONCLUSION: Concomitant fibular fixation does not influence nonunion or malunion rates, does not increase complication rates, and does not affect knee or ankle function in the treatment of extra-articular distal tibial fractures stabilized with locked intramedullary nails.

PMID:41861501 | DOI:10.1016/j.injury.2026.113161

Injury. 2026 Mar 13;57(4):113156. doi: 10.1016/j.injury.2026.113156. Online ahead of print.

ABSTRACT

BACKGROUND: Appropriate triage is essential to reducing preventable deaths and optimizing the allocation of limited medical resources in trauma care. Although the mechanism of injury (MOI) has been incorporated into prehospital triage protocols, its predictive accuracy remains controversial. This study aimed to investigate the association of MOI and anatomical injury sites with the need for emergency procedures and in-hospital outcomes using a nationwide trauma registry in Japan.

METHODS: This retrospective cohort study analyzed data from the Japan Trauma Data Bank (JTDB) between 2019 and 2021. Adult trauma patients (age ≥18 years) directly transported from the scene were included. The primary outcome was the implementation of emergency procedures upon hospital arrival, and the secondary outcome was in-hospital mortality. Multivariable logistic regression was performed to calculate odds ratios (OR) with 95% confidence intervals (CI). Discriminatory ability was evaluated using the area under the receiver operating characteristic curve (AUC).

RESULTS: Among 42,124 eligible patients, 16,580 (39.3%) underwent emergency procedures. Railway-related trauma (OR, 95% CI: 5.50, 3.73-8.11), crush injuries (2.03, 1.50-2.75), head injuries (4.35, 4.12-4.59), and abdominal injuries (20.06, 16.66-24.16) were significantly associated with emergency procedures. The AUCs for predicting emergency procedures were 0.57 for MOI and 0.72 for injury sites, and 0.53 and 0.77, respectively, for in-hospital mortality.

CONCLUSIONS: Anatomical injury sites demonstrated greater discriminative performance than MOI in predicting the need for emergency procedures and in-hospital mortality. These findings highlight the limitations of mechanism-based triage and suggest that incorporating anatomical assessment may improve triage accuracy and resource utilization.

PMID:41861500 | DOI:10.1016/j.injury.2026.113156

Injury. 2026 Feb 16;57(4):113121. doi: 10.1016/j.injury.2026.113121. Online ahead of print.

ABSTRACT

PURPOSE: Tibial plateau fractures are often surgically treated to restore native joint congruity and articular alignment. While these injuries portend an increased risk for end stage knee osteoarthritis, it is unknown whether the fixation constructs contribute to the development of osteoarthritis by influencing articular stress distribution following instrumentation.

METHODS: We conducted a cadaver study measuring resultant intra-articular stresses of the native knee due to physiological levels of ex-vivo loading, after instrumentation with plate and screw fixation, and after implant removal. To account for variable subchondral bone density, we used 3D printed bone with osteoporotic and normal cancellous bone volume fraction, and SawBones where there is no appreciable cancellous bone.

RESULTS: There was no statistical difference in peak, average, or total contact pressures following implant fixation and removal from the preimplantation articular pressure states in all loads and all models (p > 0.05). There was also no difference between the pressure changes of the cadaveric and Sawbones models. There were statistically significant pressure changes between cadaveric and 3D printed models following fixation, however these changes were within previously described physiologic loads (<10 MPa).

CONCLUSIONS: Subchondral instrumentation of tibial plateau fractures did not materially alter articular pressures. These findings suggest that the development of end-stage knee osteoarthritis may not be a result of altered biomechancial stresses from the instrumentation. Further, elective removal of implants is not supported by biomechanical reasons alone to reduce future risk. Supplementing cadaveric studies with patient-specific models while tuning variables can enhance the fidelity of these investigations.

STATEMENT OF CLINICAL RELEVANCE: The findings may guide surgeons in their operative indications and clinical decision making as well as guide future biomechanical research on periarticular implant effects.

PMID:41855643 | DOI:10.1016/j.injury.2026.113121

Injury. 2026 Mar 13:113151. doi: 10.1016/j.injury.2026.113151. Online ahead of print.

ABSTRACT

BACKGROUND: Severe hand injuries with extensive soft-tissue loss present a significant reconstructive challenge. Achieving stable coverage while preserving hand function often necessitates the combined use of regional and local flaps. The posterior interosseous artery (PIA) flap, in combination with regional flaps harvested from non-salvageable digits, may offer an effective solution.

METHODS: A retrospective analysis was performed on patients with severe hand injuries who underwent reconstruction using a PIA flap between 2022 and 2025. Patients were treated with either an isolated PIA flap or a PIA flap combined with local flaps, including fillet flaps harvested from non-salvageable digits or rotational flaps, depending on the extent and location of the defect. Demographic characteristics, injury mechanisms, defect locations, and surgical details were recorded. Postoperative complications and functional outcomes were assessed using fingertip-to-palm distance, Quick DASH score, and VAS for pain.

RESULTS: Fourteen patients with severe hand injuries were included in the study. The mean age was 39.4 years, and the mean follow-up period was 19.7 months. Five patients with complex, multi-site defects underwent combined reconstruction using a PIA flap with local flaps (four with fillet flaps, one with a rotational flap), while nine patients were treated with an isolated PIA flap. Successful soft-tissue coverage was achieved in all patients without total flap loss. Partial distal flap necrosis occurred in two patients due to venous congestion and was managed with wound care followed by split-thickness skin grafting. At final follow-up, the mean fingertip-to-palm distance was 2.07 cm, the mean Quick DASH score was 21.89, and the mean VAS pain score was 2.07. All patients achieved stable wound healing and were able to perform daily activities without the need for further reconstructive procedures.

CONCLUSION: The PIA flap, either alone or in combination with local flaps, provides reliable soft-tissue coverage and favorable functional outcomes in patients with severe hand injuries. Combined reconstruction strategies should be considered based on defect characteristics, with acceptable complication rates and good functional recovery. This technique represents a valuable option in complex hand trauma reconstruction.

LEVEL OF EVIDENCE: IV.

PMID:41850965 | DOI:10.1016/j.injury.2026.113151

Injury. 2026 Mar 12;57(4):113152. doi: 10.1016/j.injury.2026.113152. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency Spinal Stabilization (ESS) represents a cornerstone of contemporary polytrauma management, yet its independent impact on respiratory outcomes remains a subject of ongoing debate. This study investigates whether tracheostomy (TS) rates and duration of mechanical ventilation (DMV) are primarily driven by the surgical intervention itself, neurological impairment, or overall injury severity.

METHODS: We retrospectively analyzed 914 severely injured patients (ISS≥16) admitted to a Level I trauma center. Primary outcomes were TS rate and DMV. Multivariate logistic and linear regression models were employed to isolate the independent effects of ESS, injury severity (ISS, AIS), and neurological status. A dedicated subgroup analysis of operated patients (n = 85) evaluated surgical technique (e.g., ventral stabilization) and physiological severity scores (SAPS2, TISS-10).

RESULTS: ESS patients demonstrated a significantly elevated TS rate (39.5% vs. 20.6%, p < 0.001) despite being younger and exhibiting lower physiological severity at admission (SAPS2 28.0 vs. 33.5, p = 0.013). In the total cohort, thoracic injury (OR 1.99, p < 0.001) and ISS (OR 1.04, p = 0.002) independently predicted TS; ESS was not an independent predictor (p = 0.27). Within the ESS subgroup, spinal cord injury (SCI) emerged as the strongest predictor for TS (OR 3.33, p = 0.032), whereas surgical invasiveness (ventral stabilization) exerted no independent impact (p = 0.520). DMV was exclusively determined by ISS (p < 0.001); neither neurological status nor surgical technique independently influenced ventilation duration.

CONCLUSIONS: ESS serves as a reliable clinical marker for increased TS requirements but does not independently prolong mechanical ventilation. TS necessity is primarily dictated by SCI and overall injury burden rather than surgical invasiveness. Early TS in ESS patients with SCI appears to effectively compensate for physiological deficits, aligning ventilation durations with those of non-neurologically impaired patients. ESS should therefore be recognized as a clinical "red flag" prompting proactive multidisciplinary airway management to optimize respiratory weaning strategies.

PMID:41850132 | DOI:10.1016/j.injury.2026.113152

Injury. 2026 Mar 17;57(4):113162. doi: 10.1016/j.injury.2026.113162. Online ahead of print.

NO ABSTRACT

PMID:41850131 | DOI:10.1016/j.injury.2026.113162

Injury. 2026 Mar 13:113153. doi: 10.1016/j.injury.2026.113153. Online ahead of print.

ABSTRACT

BACKGROUND: The role of diagnostic laparoscopy in adults with blunt abdominal trauma and the effect of negative laparoscopy on mortality is not well delineated.

METHODS: We reviewed the National Trauma Data Bank (2007-2019) for adults sustaining blunt abdominal trauma who underwent operative intervention. We performed a doubly robust, augmented inverse propensity weighted multivariable logistic regression to estimate the effect of a negative diagnostic laparoscopy on mortality in adults with operative blunt abdominal trauma.

RESULTS: 87,864 patients met the inclusion criteria. Diagnostic laparoscopy occurred in 6.6% (n = 5816) of patients, with a 21.1% (n = 1226) conversion to laparotomy rate. The rate of negative diagnostic laparoscopy was 28.6% (n = 1665). Negative laparoscopy patients had a 49% reduction in odds of mortality (OR 0.51, 95%CI 0.47 - 0.56, p < 0.001) compared to negative laparotomy patients. Patient's that underwent laparoscopy, found to have intra-abdominal injury, had a similar reduction in odds of mortality compared to negative laparotomy patients (OR 0.54, 95% CI 0.51 - 0.57, p < 0.001).

CONCLUSION: Diagnostic laparoscopy may be safe for adults with blunt abdominal trauma and prevent significant morbidity and mortality from a negative laparotomy.

PMID:41846201 | DOI:10.1016/j.injury.2026.113153

Injury. 2026 Mar 9;57(4):113148. doi: 10.1016/j.injury.2026.113148. Online ahead of print.

NO ABSTRACT

PMID:41843999 | DOI:10.1016/j.injury.2026.113148

Injury. 2026 Mar 11;57(4):113096. doi: 10.1016/j.injury.2026.113096. Online ahead of print.

NO ABSTRACT

PMID:41818861 | DOI:10.1016/j.injury.2026.113096

Injury. 2026 Feb 27;57(4):113138. doi: 10.1016/j.injury.2026.113138. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate intraoperative assessment of fracture reduction is essential in trochanteric fracture surgery to prevent mechanical failure. Although restoration of anteromedial cortical support, particularly in the sagittal plane, has been recognized as a critical factor, standard lateral views may fail to detect malreduction because the shadow of the greater trochanter overlaps and obscures the anteromedial cortical line. This study aimed to evaluate the clinical utility of a novel intraoperative anteromedial cortex (AMC) view for assessing fracture reduction.

METHODS: This prospective multicenter observational study included 135 trochanteric fractures (AO/OTA 31A1.2, 31A1.3, and 31A2) surgically treated between June 2022 and December 2023. In addition to standard AP and lateral fluoroscopic views, an AMC view was obtained intraoperatively. Reduction on the lateral and AMC views was categorized as anterior malreduction, anatomic reduction, or posterior malreduction. The primary outcome was the concordance rate between the lateral and AMC views.

RESULTS: Discordances between lateral and AMC views were observed in 26 of 135 cases (19.3%). Notably, among fractures classified as anatomic reduction on the lateral view, 12 cases (19.4%) were reclassified as anterior malreduction on the AMC view, representing "hidden" anterior malreduction. In 7 of these 12 cases (5.2% of the total cohort), the AMC view findings directly led to a change in the surgical strategy, requiring direct reduction through a small incision.

CONCLUSIONS: Approximately one-fifth of trochanteric fractures showed inconsistent reduction patterns between the standard lateral the AMC views. The AMC view provides a more precise intraoperative assessment of the anteromedial cortex and is particularly effective in identifying hidden anterior malreduction that may be overlooked on standard fluoroscopy.

PMID:41818860 | DOI:10.1016/j.injury.2026.113138

Injury. 2026 Mar 11;57(4):113137. doi: 10.1016/j.injury.2026.113137. Online ahead of print.

NO ABSTRACT

PMID:41818859 | DOI:10.1016/j.injury.2026.113137

Injury. 2026 Feb 28;57(4):113144. doi: 10.1016/j.injury.2026.113144. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate outcomes of a series of consecutive, atypical femur fractures (AFFs) treated exclusively with closed reduction and reamed, statically locked intramedullary nailing.

METHODS: Design: Retrospective review.

SETTING: Single North American Level I trauma center. Patient Selection Criteria: All skeletally mature patients treated between 2012 and 2024 with closed reduction and reamed, statically locked IMN of a complete AFFs (OTA/AO 32) with > 6 months follow-up were eligible. Radiographic inclusion required fractures distal to the lesser trochanter and proximal to the supracondylar flare that met ≥4 of 5 American Society for Bone and Mineral Research (ASBMR) major criteria Outcome Measures and Comparisons: Primary outcome was radiographic and clinical union. Secondary measures included time to union, alignment quality, implant failure, and the relationship of neck-shaft angle (NSA) restoration with union.

RESULTS: There was a total of 52 AFFs with a mean age of 68 years (52-89 years). Overall, 46 (88%) patients were female and 6 (12%) were male. The mean BMI was 25.6 ± 4.51 kg/m2 and 52 (100%) patients reported bisphosphonate use. The mean follow-up was 21 months (range, 6-102). Thirty-nine (75%) were subtrochanteric and 13 (25%) were diaphyseal femur fractures. Overall, fracture union occurred in 49 AFFs (94%) at a mean of 6 months (range, 3-14). Three fractures (6%) progressed to nonunion. Notably, 7 AFFs were incompletely healed at 6 months, but 6 of 7 united by 12 months. Reduction quality was excellent in 98% of cases. Restoration of native NSA was significantly associated with union; nonunion cases demonstrated greater deviation from the contralateral NSA (p = 0.034). Implant-related variables (nail type, diameter, interlocking configuration) were not associated with union. Complications were limited to two cases of broken distal interlocking screws and one superficial surgical site infection.

CONCLUSIONS: Treatment of atypical femur fractures with solely closed reduction and reamed, statically locked intramedullary nailing provides reliable healing, with a 94% union rate.

PMID:41795353 | DOI:10.1016/j.injury.2026.113144

Injury. 2026 Feb 27;57(4):113141. doi: 10.1016/j.injury.2026.113141. Online ahead of print.

ABSTRACT

Taylor Spatial Frame (TSF) is a hexapod circular external fixator, i.e. built with six struts connecting two rings to support bone fragments by fixating them to the rings by wires or pins. Struts are length adjustable and have universal joints (U-joints) at both ends which attach to the rings. Behaviour of struts is crucial to the biomechanics of the TSF. However, no study on struts' mechanical characteristics has been reported. In this work, TSF struts and their components and pieces of materials were tested and their mechanical properties are reported. For doing so, the followings tests were conducted: 1) three sizes of TSF Fast-FX struts at different lengths in axial compression, 2) three short struts in oblique compression, 3) two long struts, gripped at and after their U-joints, in axial tension, and 4) two pairs of separated U-joints in compression. Pieces of the strut body and threaded rod were also machined out and tested for material properties. All tests continued till failure and their load-deflection data are plotted. Curve-fitting was applied to the plot of the average load-deflections (of strut sizes at their minimum length). The stiffness characteristics, buckling failure loads and failure load of the universal joints are also reported. Results show that the preponderance of deflections occurs in universal joints, which makes the results relevant to all strut types using the same U-joints.

PMID:41795352 | DOI:10.1016/j.injury.2026.113141

Injury. 2026 Feb 20;57(4):113128. doi: 10.1016/j.injury.2026.113128. Online ahead of print.

ABSTRACT

BACKGROUND: The period following orthopedic trauma is a critical window for developing psychological burden, prolonged opioid use, and opioid-related stigma. Stigma refers to shame or perceived judgment related to opioid use, which may impair postoperative pain management and patient-provider trust. Although stigma is increasingly recognized as a recovery barrier, its relationship to pain, psychological factors, and opioid use duration remains poorly understood.

OBJECTIVE: To characterize patterns of psychological factors, substance use, concerning opioid use (opioid misuse), and stigma by opioid use duration (0-29 days, 30 -59 days, and ≥ 60 days) during the three-month period following hospitalization for musculoskeletal trauma.

METHODS: In this prospective observational cohort study, 170 adults hospitalized for orthopedic traumatic injuries were enrolled and followed for three months post-discharge. Clinical data were obtained from electronic health records and the state prescription drug monitoring program, and participants completed validated assessments of pain, psychological symptoms, opioid misuse, and stigma. Participants were categorized by opioid use duration into 0-29 days, 30-59 days, and ≥ 60 days.

RESULTS: Of the 170 participants, 135 (79 %) completed follow-up. Longer opioid use duration was significantly associated with greater inpatient pain intensity, depression, anxiety, pain-related anxiety, and traumatic distress. These trends persisted at follow-up, where participants with longer use demonstrated higher pain intensity, greater opioid exposure, and worse psychological and functional outcomes. Indicators concerning opioid use (opioid misuse) were common; the most frequently endorsed behaviors included running out of medication early (33 %) and anxiety when medication ran out (36 %). Experiences of stigma were reported by 17 % of participants and increased to 52 % among those using opioids for ≥ 60 days (p < .001). Internalized stigma (31 %) and stigma-related behaviors, including taking less medication than needed (24 %), also increased with longer opioid use duration.

CONCLUSIONS: Prolonged opioid use after traumatic musculoskeletal injury was associated with greater pain, psychological burden, concerning opioid use, and experiences of stigma. Findings underscore the interrelated nature of pain, mental health, and stigma in post-injury recovery and highlight the need for integrated interventions targeting pain-related distress, effective coping, and stigma reduction to support safer opioid use and improved functional outcomes.

PMID:41785541 | DOI:10.1016/j.injury.2026.113128

Injury. 2026 Feb 28;57(4):113140. doi: 10.1016/j.injury.2026.113140. Online ahead of print.

ABSTRACT

STUDY TYPE: Retrospective cohort.

PURPOSE: Complex regional pain syndrome (CRPS) is a rare but debilitating complication that may develop following distal radius fracture (DRF). Concomitant nerve-related injury may increase risk. The current study aimed to evaluate the incidence and odds of developing CRPS following DRF with or without need for open reduction and internal fixation (ORIF) and/or carpel tunnel release (CTR).

METHODS: Unilateral DRF patients between 2010-2022 were abstracted from the PearlDiver M170 Ortho database. Cohorts were defined as: (1) DRF managed non-operatively, (2) DRF treated with ORIF without same-day CTR, and (3) DRF treated operatively with ORIF and same-day CTR. ICD-10 laterality coding was used to ensure side-specific matching of DRF and CRPS diagnoses. Management cohorts were matched 1:1:1 based on patient age, sex, and Elixhauser Comorbidity Index (ECI). Monthly incidence of CRPS diagnosis through 1-year post-injury was determined for each matched cohort. Multivariable regression was performed to identify factors independently associated with CRPS.

RESULTS: After matching, there were 7656 patients in each management cohort. At 1 year, the incidence of CRPS was 24 (0.31 %) in the non-operative group, 44 (0.57 %) in the ORIF-only group, and 110 (1.44 %) in the ORIF+CTR group. Compared with non-operative management, ORIF-only was associated with an odds ratio for CRPS of 2.19 at 3 months and 1.84 at 1 year, while ORIF+CTR demonstrated an odds ratio for CRPS of 6.42 at 3 months and 4.60 at 1 year. A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73).

CONCLUSIONS: Patients undergoing ORIF with concomitant CTR demonstrated the highest odds of CRPS at both early and late timepoints, likely related to median nerve injury or irritation at the time of injury in cases requiring acute CTR.

LEVEL OF EVIDENCE: III.

PMID:41785540 | DOI:10.1016/j.injury.2026.113140

Injury. 2026 Feb 27;57(4):113143. doi: 10.1016/j.injury.2026.113143. Online ahead of print.

NO ABSTRACT

PMID:41780467 | DOI:10.1016/j.injury.2026.113143

Injury. 2026 Feb 27;57(4):113142. doi: 10.1016/j.injury.2026.113142. Online ahead of print.

ABSTRACT

INTRODUCTION: Fragility fractures of the pelvis (FFP) from low-energy trauma are increasingly frequent in older patients. FFP type IIIa, with displaced posterior ilium fracture, usually needs surgical treatment and its optimal fixation technique is unclear. Here, construct stiffness and failure load after fixation of an FFP type IIIa with anterior plate osteosynthesis (PO) with an additional lateral compression 2 (LC2) screw, was compared with PO alone under weight-bearing conditions.

MATERIALS AND METHODS: Twelve artificial left hemipelvises with simulated FFP type IIIa fractures were assigned into the PO (for fixation with an anteriorly fixed 3.5-mm plate) or PO with a 7.3-mm fully threaded antegrade LC2 screw (POLC2) groups (n = 6 per group). All specimens underwent ramped loading (at 18 N/s) from 20 N (preload) to 200 N, followed by progressively increasing cyclic testing at 2 Hz until failure, performed at 0.05 N/cycle on a servohydraulic material test system. Relative displacements and bone fragment angles were monitored using motion tracking.

RESULTS: Initial stiffness (N/mm) did not differ significantly in the PO vs POLC2 group (139.8 ± 31.7 vs 140.1 ± 27.0). After 5000 cycles, dynamic stiffness was significantly higher in the POLC2 group than in the PO group (199.0 ± 20.4 vs 163.8 ± 25.2, p = 0.041) while fracture displacement, torsional fracture displacement, and gap angle were significantly increased in the PO group than in the POLC2 group (p < 0.0001). Cycles to failure and load to failure were higher in the POLC2 group (6922 ± 1133 and 892.2 ± 113.3 N, respectively) when compared with the PO group (4979 ± 943 and 697.9 ± 94.3 N, respectively) (p = 0.015).

CONCLUSION: Compared with plate osteosynthesis alone in an FFP type IIIa model, antegrade LC2 screw augmentation demonstrated significantly increased stability against axial and torsional loading. The combined plate-LC2 screw construct might be an ideal fixation option for posterior iliac fracture of FFP, safely allowing early weight bearing and rehabilitation.

PMID:41780466 | DOI:10.1016/j.injury.2026.113142

Injury. 2026 Feb 27;57(4):113139. doi: 10.1016/j.injury.2026.113139. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal femoral periprosthetic fractures following TKA are increasingly common in elderly patients. Surgical management most commonly involves either open reduction and internal fixation (ORIF) or distal femoral replacement (DFR); however, comparative data regarding short-term and long-term complications remain limited. As such, this study compared complications between ORIF and DFR in elderly patients with distal femoral periprosthetic fractures following TKA.

METHODS: A retrospective cohort study was performed using the TriNetX Research Network. Patients aged ≥65 years with distal femoral periprosthetic fractures were identified and categorized by operative treatment. Propensity score matching was performed to balance cohorts. Short-term complications were assessed at 90 days, and long-term complications were evaluated at 1 and 5 years. Complications were compared using risk differences and risk ratios with 95% confidence intervals, and Kaplan-Meier survival methods.

RESULTS: After matching, 698 patients remained in each cohort. Most 90-day complications were similar between groups. However, DFR was associated with higher rates of wound disruption (7.6% vs 2.7%, RR 2.79 [95% CI 1.67-4.66], p<0.001) and transfusion (17.5% vs 13.0%, RR 1.34 [1.04-1.72], p=0.021). At 5-year follow-up, DFR demonstrated higher risks of periprosthetic joint infection (22.5% vs 5.3%, RR 4.24 [3.01-5.98], p<0.001), revision TKA (15.5% vs 3.3%, RR 4.70 [3.03-7.27], p<0.001), and subsequent knee procedures (24.4% vs 14.9%, RR 1.64 [1.31-2.04], p<0.001). Conversely, repeat periprosthetic fractures were more frequent following ORIF (55.3% vs 44.8%), with DFR demonstrating a lower relative risk (RR 0.81 [0.73-0.90], p<0.001). Similarly, additional fixation procedures occurred more often after ORIF (4.9% vs 1.6%), while DFR was associated with a reduced relative risk (RR 0.32 [0.17-0.63], p<0.001). Mortality was similar between approaches at both 30 days (2.2% vs 2.2%, RR 1.00 [0.48-2.08], p=1.00) and 5 years (16.0% vs 15.4%, RR 1.04 [0.81-1.33], p=0.764).

CONCLUSION: Short-term systemic complication rates were comparable between approaches, although DFR was associated with greater perioperative morbidity. Over longer follow-up, DFR demonstrated higher implant-related infection and revision risks, whereas ORIF carried higher risks of refracture and secondary fixation. These findings highlight a tradeoff between the immediate stability and mobilization of DFR and longer-term implant-related complications, supporting individualized treatment selection based on patient-specific risk factors.

PMID:41780465 | DOI:10.1016/j.injury.2026.113139

Injury. 2026 Feb 23;57(4):113119. doi: 10.1016/j.injury.2026.113119. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric supracondylar humeral fractures (SCHFs) with coronal obliquity pose unique intraoperative challenges and are believed to carry a higher risk of postoperative loss of reduction and delayed functional recovery. However, high-quality evidence supporting this association remains limited.

METHODS: This retrospective comparative study analyzed pediatric patients under 16 years of age who underwent closed reduction and percutaneous pinning for Gartland type III or IV SCHFs between 2016 and 2022. Based on preoperative radiographs, patients were classified into transverse or coronal oblique groups, with coronal obliquity defined as >10° on the anterior-posterior view. Postoperative radiographic parameters, complications, and recovery of elbow range of motion (ROM) were compared between groups.

RESULTS: Among 88 patients, 52 had transverse and 36 had coronal oblique fractures. The coronal oblique group showed significantly higher rates of reduction outliers (anterior humeral line non-intersection: 36.1 % vs. 13.5 %, p = 0.013; malrotation: 22.2 % vs. 3.8 %, p = 0.008), loss of reduction (LOR) requiring reoperation (13.9 % vs. 0 %, p = 0.006), and delayed ROM recovery (19.4 % vs. 1.9 %, p = 0.011). No significant differences were observed in cosmetic or functional outcomes at six months (p = 0.311).

CONCLUSIONS: Coronal obliquity in pediatric SCHFs is significantly associated with a higher incidence of reduction outliers and postoperative LOR. Consequently, these fractures are more likely to require revision surgery and demonstrate slower functional recovery of elbow motion during the early postoperative period compared with transverse-type fractures.

PMID:41780464 | DOI:10.1016/j.injury.2026.113119

Injury. 2026 Feb 23;57(4):113127. doi: 10.1016/j.injury.2026.113127. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate whether preoperative use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) is associated with increased risk of reoperation, nonunion, infection, hospital readmission, or emergency department (ED) visits following operative fixation of isolated long bone fractures.

METHODS: This retrospective, multicenter cohort study was conducted using the TriNetX Research Network. Adults (≥18 years) who underwent operative fixation of isolated tibial, femoral, or humeral shaft fractures between 2012 and 2024 were included. Patients prescribed an SSRI or SNRI within 180 days prior to fracture and within 12 months after surgery were compared with controls without antidepressant prescriptions before or within 12 months after fracture. Polytrauma, pathologic fractures, and prior surgery at the same site were excluded. Propensity score matching (1:1) was performed for demographics, fracture location, and relevant medical and psychiatric comorbidities. The primary outcome was reoperation within 12 months. Secondary outcomes included nonunion, infection, hospital readmission, and ED visits. Analyses were stratified by fracture type (open vs closed) and location.

RESULTS: A total of 5293 SSRI/SNRI users were matched to 5293 controls. In closed fractures, antidepressant use was associated with higher rates of nonunion (5.2% vs 4.0%; RR 1.29, 95% CI 1.06-1.56). Open fractures demonstrated a trend towards greater rates of nonunion (4.8% vs 3.1%) and reoperation (15.2% vs 13.9%); however, this was not significant. 30-day ED visits, 30-day surgical site infection, and 90-day readmissions were comparable between groups.

CONCLUSIONS: Preoperative SSRI or SNRI use was associated with increased risk of nonunion following operative fixation of closed long bone fractures. Outcomes following open fractures were largely unaffected, likely due to the dominant biological and mechanical risks inherent to open injuries. These findings suggest the need for increased clinical vigilance in patients with closed fractures receiving serotonergic antidepressants and highlight the importance of prospective studies to further clarify causality and guide management strategies.

PMID:41775053 | DOI:10.1016/j.injury.2026.113127