Injury. 2025 Aug 8;56(10):112658. doi: 10.1016/j.injury.2025.112658. Online ahead of print.

ABSTRACT

INTRODUCTION: Open pelvic fractures, though rare, are associated with high morbidity and mortality due to severe soft tissue damage, hemorrhage, and associated injuries. This retrospective study aimed to assess injury patterns, management strategies, complications, and outcomes of open pelvic fractures at a Level 1 trauma center MATERIALS AND METHODS: A retrospective analysis of 30 patients with open pelvic fractures treated between 2014 and 2021 was conducted. Data included demographics, injury mechanism, fracture pattern (Jones-Powell classification), soft tissue injury (Faringer classification), hemodynamic status, transfusion requirements, associated injuries, surgical interventions, and functional outcomes (Merle de Au Binge score) RESULTS: The mean age was 35.7 years, with a male predominance (28 males, 2 females). Road traffic accidents were the most common injury mechanism. Most patients (n = 28) sustained multiple injuries. Fracture patterns were: Class 1 (n = 2), Class 2 (n = 7), and Class 3 (n = 21). Faringer classification revealed 22 Zone 1, 4 Zone 2, and 4 Zone 3 injuries. The mean transfusion requirement was 5.63 units within 24 h. Emergency external fixation was performed in 15 patients. Definitive fixation (internal or external) was performed at a mean of 11.27 days post-injury. Complications included urinary incontinence (n = 5), rectal incontinence (n = 2), and infections. The mortality rate was 20 % (n = 6). Functional outcomes showed 3 excellent, 8 good, 8 fair, and 5 poor results CONCLUSION: Open pelvic fractures are complex injuries requiring multidisciplinary management. Early haemorrhage control, aggressive soft tissue management, and appropriate fracture stabilization are crucial for improving outcomes. Delayed internal fixation after thorough debridement and soft tissue healing may reduce infection risk. High transfusion requirements and unstable fractures were associated with increased mortality.

LEVEL OF EVIDENCE: III.

PMID:40840317 | DOI:10.1016/j.injury.2025.112658

Injury. 2025 Aug 6;56(10):112662. doi: 10.1016/j.injury.2025.112662. Online ahead of print.

ABSTRACT

INTRODUCTION: The primary objective was to analyze the trends in hemiarthroplasty (HA) and total hip arthroplasty (THA) for adult patients with fractures (FNFs), with a focus on geriatric population, over the past two decades. The secondary objectives were to compare outcomes between HA and THA and evaluate its association with patient- and surgeon- specific factors.

METHODS AND MATERIALS: Design: Retrospective cohort.

SETTING: Two Level 1 Trauma Centers. Patient Selection Criteria: Adult patients with FNFs between 2001 and 2023.

RESULTS: A total of 3180 cases of FNF treated with arthroplasty were included in the study, comprising 2497 patients who received HA and 683 patients who received THA. There was an overall increase in both THA and HA performed for geriatric FNFs with THA increasing at a faster rate (223 % vs. 172 %, respectively). Patients receiving THA were younger (70.8 vs. 81.4 years, p < 0.001) and more likely to be female (70.9 % vs. 65.1 %, p = 0.006). Patients receiving HA had lower BMI (24.6 vs. 25.4kg/m2, p = 0.002), higher Charlson Comorbidity Index (7.5 vs. 4.6, p < 0.001), and higher rates of dementia (29.9 % vs. 7.8 %, p < 0.001).Factors associated with selection of THA over HA included arthroplasty fellowship training (21.5 % vs. 10.4 %, p < 0.001) and greater surgical experience, as measured by years in practice (15.1 vs. 12.5 years, p < 0.001).. Patients receiving THA had shorter hospitalizations (6.3 vs. 7.9 days, p < 0.001) and were more likely to be discharged home (24.3 % vs. 5.5 %, p < 0.001). Despite similar reoperation rates (4.5 % vs. 5.1 %, p = 0.58), THA resulted in a higher complication rate (9.2 % vs. 6.1 %, p = 0.006). HA had higher 90-day (11.1 % vs. 1.6 %, p < 0.001) and 1 year (21.1 % vs. 3.8 %, p < 0.001) mortality rates.

CONCLUSIONS: There has been a rising trend in THA for the treatment of FNFs over the past two decades, and factors affecting treatment decision are both patient and surgeon driven.

PMID:40840316 | DOI:10.1016/j.injury.2025.112662

Injury. 2025 Aug 13;56(10):112681. doi: 10.1016/j.injury.2025.112681. Online ahead of print.

NO ABSTRACT

PMID:40840315 | DOI:10.1016/j.injury.2025.112681

Injury. 2025 Aug 7;56(10):112654. doi: 10.1016/j.injury.2025.112654. Online ahead of print.

ABSTRACT

BACKGROUND: Determine whether native acetabular anteversion angle increased the risk of ipsilateral limb injuries in patients with traumatic hip dislocations.

METHODS: Retrospective clinical series completed at a large, tertiary health care system between February 2016-November 2021. Patients with a native traumatic hip dislocation requiring a closed reduction in the operating room or open reduction internal fixation (ORIF) of an associated fracture were included, identified using current provider terminology (CPT) codes 27,250 and 27,252. Standard acetabular version angles were measured on CT images.

RESULTS: 121 cases were included in the analysis. The average age of our population was 37.5 years and 72 % were male. The median acetabular version was 14.7° (2-27°). Of the 121 cases of dislocations, 28 experienced a knee injury (23 %, p = 0.89) and 40 had a femoral head injury (33 %, p = 0.88). The most common knee injuries were patellar fractures (29 %, n = 8), tibial plateau fractures (29 %, n = 8), meniscal injuries (25 %, n = 7) and ligamentous knee injuries 21 %, n = 6). Median version angle was not associated with an increase in predisposition to femoral head injury or knee injury for patients with a native hip dislocation (p = 0.13).

CONCLUSION: These findings demonstrate that native acetabular anteversion does not predispose, nor protect, patients from experiencing an ipsilateral limb injury in the setting of a traumatic hip dislocation. Future studies should investigate other factors that may influence the occurrence of ipsilateral limb injuries in these settings.

LEVEL OF EVIDENCE: Level IV - Therapeutic (Retrospective Clinical Series).

PMID:40834614 | DOI:10.1016/j.injury.2025.112654

Injury. 2025 Aug 6;56(10):112675. doi: 10.1016/j.injury.2025.112675. Online ahead of print.

ABSTRACT

OBJECTIVE: External chest wall fixators may provide a new approach as part of multimodal treatment. This study aimed to investigate the effect of external chest wall fixator on patients' pain level, complication development and hospital stay in patients with rib fractures.

MATERIAL AND METHOD: Patients who were admitted due to trauma and had serial rib fractures between December 2020 and December 2021 were evaluated. There were 14 patients in case group and 20 in control group. External chest wall fixator was applied to the case group in addition to standard treatment. Pain levels, development of complications and duration of hospitalization were recorded.

RESULTS: Pain levels in first and third months were lower in case group than control group. Mean pain levels in the first month were 1.79 (SD 0.80) in case group and 2.85 (SD 1.53) in control group, in the third-month were 0.43 (SD 0.64) in case group and 1.34 (SD 1.59) in control group, and the difference was significant (p = 0.022 and 0.032, respectively). Complications were more common in patients with more rib fractures (p = 0.002). While complications developed in 2 patients in the case group and 8 patients in the control group, the difference was not statistically significant (p = 0.216). Duration of hospital stay was shorter in the case group and the difference was significant (2.7 (SD 0.9) days versus 2.0 (SD 0.7) days, p = 0.049).

CONCLUSION: It has been shown in our study that external fixator can be an effective method in reducing patients' pain and hospital stay. This method can be included as part of multimodal treatment in patients with rib fractures.

PMID:40829526 | DOI:10.1016/j.injury.2025.112675

Injury. 2025 Aug 10:112678. doi: 10.1016/j.injury.2025.112678. Online ahead of print.

ABSTRACT

BACKGROUND: High-quality, granular, accessible, and timely data are essential for evaluating regional trauma ecosystems and implementing programs to improve trauma care. State trauma registries play a crucial role in collecting, disseminating, and sharing data for clinicians, researchers, implementation scientists, and policymakers. This study aimed to assess the status and progress of statewide trauma registries in the United States over the past 20 years.

METHODS: A structured electronic survey was administered to eligible and consenting state trauma registry managers or emergency medical services personnel between July 2024 and November 2024. The survey gathered information on registry infrastructure, data collection and reporting processes, and data quality assurance measures. Findings were compared with those from a similar survey conducted in 2004.

RESULTS: All 50 states and the District of Columbia participated in the survey. Forty-seven states (92 %) reported an active trauma registry, an increase of 15 since 2004. Four states have never had a statewide registry, though two are planning to develop one. Among states with registries, only 18 (38 %) mandate data submission from all hospitals. While many registries have transitioned to web-based systems and updated software over the last two decades, 34 registries (72 %) still rely on manual data abstraction, and 28 (60 %) lack integration with electronic health records. Additionally, only 20 (43 %) state registries contribute data to national collection efforts.

CONCLUSIONS: Although progress has been made in establishing and modernizing state trauma registries since 2004, significant gaps remain, particularly in the absence of comprehensive mandatory reporting, the reliance on manual data entry, and the lack of integration with electronic health records and national databases. Addressing these challenges is essential for reducing the burden on registry teams and providing accurate, actionable, and timely data for improving trauma care.

PMID:40825754 | DOI:10.1016/j.injury.2025.112678

Injury. 2025 Aug 7:112661. doi: 10.1016/j.injury.2025.112661. Online ahead of print.

NO ABSTRACT

PMID:40820076 | DOI:10.1016/j.injury.2025.112661

Injury. 2025 Aug 7;56(10):112676. doi: 10.1016/j.injury.2025.112676. Online ahead of print.

ABSTRACT

INTRODUCTION: Equestrian activities are popular in Australia for both work and recreation. However, these activities are associated with high rates of injury [including major trauma] when compared to other physical activities and sports. Research assessing equestrian-related major trauma is limited. This study analyses the characteristics of equestrian-related major trauma in New South Wales, Australia, to guide injury prevention initiatives.

METHODS: A retrospective analysis was conducted using data from the New South Wales Trauma Registry on equestrian-related major trauma cases over an 11-year period from 2012 to 2022. Major trauma was defined as patients with an Injury Severity Score (ISS) greater than 12, as well as those admitted to the Intensive Care Unit or those who died in hospital, regardless of ISS. Incidence rates per 100,000 NSW population were analysed using Poisson regression.

RESULTS: A total of 624 equestrian-related major trauma cases were identified over the study period. The median age was 49 years (IQR 29-60), and the median ISS was 17 (IQR: 13-50). Females comprised 56.74 % of cases, with a significantly higher incidence rate than males (IRR 1.24, 95 % CI: 1.19-1.45, p = 0.007). Older individuals were at greater risk, with the highest incidence in the group aged between 40 to 59 (IRR 2.64, 95 % CI: 2.04-3.42). Most injuries occurred on farms (55.93 %), during leisure riding (28.21%) and were a result of a fall or being thrown from a horse (60.90 %). The most frequently injured anatomical regions included the thorax (25.40 %), spine (20.29 %), and head (18.73 %). Severe-to-critical injuries were proportionally highest in the thorax (65.08 %), head (46.97 %), and lower extremities (43.97 %). The incidence rate of major trauma increased steadily during the study period (IRR 1.027, 95 % CI: 1.002-1.053, p = 0.036).

CONCLUSION: The data presented in this paper provides an overview of the characteristics of equestrian-related major trauma. Salient points are that major equestrian-related trauma predominantly affects females and older individuals, with the thorax, spine, and head the most frequently injured anatomical regions. Farms are identified as the primary location of injuries across all age groups. These findings can guide future injury prevention initiatives.

PMID:40818164 | DOI:10.1016/j.injury.2025.112676

Injury. 2025 Jul 19;56(10):112620. doi: 10.1016/j.injury.2025.112620. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: The best treatment of comminuted, proximal humeral fractures in the elderly population is an unresolved clinical problem. This study aimed to compare the outcome of hemiarthroplasty (HA) and nonoperative treatment in the elderly population patients with a comminuted proximal humeral fracture.

METHOD: From October 6, 2009 to April 26, 2017, 57 elderly patients with a comminuted proximal humeral fracture were enrolled in the multicenter randomized controlled trial (RCT). Patients were randomized to HA or nonoperative treatment. Outcome measures were the Constant-Murley score (primary outcome), Disabilities of the Arm, Shoulder, and Hand, pain (Visual Analog Score), quality of life (Short Form-36 and EuroQoL-5D-3 L), complications, revision operation, health care consumption, and costs. Patients were followed for two years.

RESULT: Of the 57 patients included, 30 underwent treatment with HA and 27 were treated nonoperatively. Patients had a median age of 77 years, and 89 % was female. According to the Hertel classification, most fractures were type 7 (47 %) or type 12 (42 %). The median Constant-Murley score increased from 23 (95 % CI 17-29) at six weeks to 48 (95 % CI 41-53) at 24 months in the HA group, and from 24 (95 % CI 17-31) to 59 (95 % CI 52-65) in the nonoperative group. Throughout follow-up, scores were similar in both groups. The DASH score consistently decreased over time in both groups. At 24 months, median DASH scores were 24.0 (95 % CI 17.4-30.8) and 23.4 (95 % CI 16.5-30.4) in the HA and nonoperative group, respectively. Pain levels, SF-36, and EQ-5D were similar in both groups throughout follow-up. Eleven patients, of which seven in the HA group, developed one or more complications, of which six patients required surgical interventions. Total costs were higher for HA, although not statistically significant.

CONCLUSION: Based on results of this RCT, primary hemiarthroplasty cannot be considered superior to nonoperative treatment for comminuted proximal humeral fractures in the elderly population. A trend favoring nonoperative treatment is observed in outcomes and in costs.

PMID:40818163 | DOI:10.1016/j.injury.2025.112620

Injury. 2025 Aug 8;56(10):112669. doi: 10.1016/j.injury.2025.112669. Online ahead of print.

ABSTRACT

INTRODUCTION: The success rate of antegrade insertion of a full-length ramus osseous fixation pathway (OFP) screw remains unreported. The objective of this study was to assess the safety, feasibility, and effectiveness of a novel antegrade technique for inserting full-length ramus screws, as well as to determine the parameters of the ramus OFP based on screw placement.

PATIENTS AND METHODS: From January 2022 to September 2024, patients with fractures of the superior pubic ramus or the anterior acetabular column treated with a novel technique of an antegrade insertion of a superior ramus OFP screw were recruited into this study. Peri- and postoperative complications were documented. Parameters of the OFP were measured based on the position of the inserted full-length screws on postoperative CT scans.

RESULTS: Thirty-eight fully threaded, large-diameter (7 mm) antegrade full-length screws were successfully inserted in 32 patients with no intraoperative screw insertion failures occurring. The procedure was performed without any noted wound infections or associated neurological, urological, and visceral complications. Postoperative CT images confirmed that all 38 ramus screws were correctly positioned within the bony corridors, with no evidence of screw breaching the hip joint. The OFP measures 118.9 ± 5.6 mm in length, with an angle projection of 38.7 ± 3.8 degrees to the horizontal plane and 15.8 ± 4.9 degrees to the coronal plane. All patients were followed for an average duration of 16.1 months (range, 6.2-31 months). Bone union was achieved in all cases with a union time of 3 months (range, 2.5 to 5 months), and no complications such as loss of reduction, screw loosening, breakage, or bone delayed union were noted.

CONCLUSIONS: Our novel antegrade technique for inserting a full-length large ramus screw has been validated for its safety, feasibility, and effectiveness. The parameters obtained through the insertion of a full-length screw in this study accurately represent those of our new ramus OFP and serve as a guide for the placement of full-length screws.

PMID:40816064 | DOI:10.1016/j.injury.2025.112669

Injury. 2025 Aug 10;56(10):112679. doi: 10.1016/j.injury.2025.112679. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the rate of unplanned reoperation to address fracture-related complications between extraarticular floating knee fracture patterns and those involving the articular surface of the knee, and to assess the impact of concomitant patella fracture on outcomes.

METHODS: Design: Retrospective study of patients with a floating knee injury treated at a single level 1 trauma center from 2012-2022.

SETTING: Single, urban, level 1 trauma center. Patient selection criteria: Patients ≥18 years old with a floating knee injury treated at a single urban level 1 trauma center from 2012-2022, with at least 3 months of followup. Outcome measures and comparisons: The primary outcome measure was the rate of unplanned reoperation to treat infection, obtain union, or surgically address knee stiffness.

RESULTS: Reoperation to address fracture-related complications was high in both extra and intraarticular floating knee patterns, with a trend toward more surgery to address knee stiffness in those with articular involvement (p = 0.078). Concomitant patella fracture and open fracture were present in 12 and 46 of the 64 patients, respectively; the presence of open fracture was significantly associated with reoperation to address either nonunion or infection (p < 0.001). An associated patella fracture was significantly associated with requiring surgery to address knee stiffness (p = 0.009).

CONCLUSIONS: Floating knee injuries with at least one articular fracture, especially when the patella is involved, had higher rates of surgery for knee stiffness. Intraarticular floating knee injuries are challenging, often requiring reoperation for infection, nonunion, or stiffness. Surgeons should be proactive with early motion protocols, supervised therapy, and tools like continuous passive motion to reduce knee stiffness risk.

LEVEL OF EVIDENCE: III.

PMID:40816063 | DOI:10.1016/j.injury.2025.112679

Injury. 2025 Aug 5;56(10):112649. doi: 10.1016/j.injury.2025.112649. Online ahead of print.

ABSTRACT

INTRODUCTION: Occult hip fractures are femoral neck fractures diagnosed by MRI or CT scan following negative plain radiographs. Incomplete intertrochanteric occult hip fractures (IIOHFs) do not involve the medial cortex. These fractures can be isolated but can also occur in the presence of greater trochanter (GT) fractures. Many authors recommend further imaging to exclude IIOHFs in cases where a GT fracture is present on plain radiograph, in order to evaluate the intertrochanteric region fracture extension. There is no consensus on the optimal treatment for IIOHFs, with approaches ranging from surgical fixation to full weight bearing. At our institution a protocol of immediate full weight bearing for patients diagnosed with IIOHFs was implemented. This study retrospectively evaluates the outcomes of this treatment protocol.

METHODS: The medical records of patients who underwent MRI for suspected occult hip fractures were retrospectively analyzed. Inclusion criteria included: (1) patients with no findings on plain radiographs who were diagnosed by MRI with intertrochanteric fractures not involving the medial cortex, and (2) patients with isolated GT fractures diagnosed by plain radiographs and fracture extension greater than one-third of the intertrochanteric width seen on MRI. Data regarding initial hospitalization, diagnostic timing and findings, and follow-up outcomes were collected.

RESULTS: Of 196 MRI scans performed during the study period, 45 patients met the inclusion criteria. None of these patients experienced secondary displacement of the fracture despite immediate full weight bearing. The average age was 81.1 years, and 21(10.7%) patients were male. The mean time from admission to MRI was 30 h, and the average length of hospitalization was 6.3 days. The 45 intertrochanteric fractures that were included in this study include nine isolated incomplete intertrochanteric fractures and 36 GT fractures with extension greater than one third of the intertrochanteric width. None of the GT fractures had involvement of the medial cortex.

CONCLUSION: Our findings suggest that immediate full weight bearing is a safe treatment approach for IIOHFs. Operative fixation or immobilization may be unnecessary for these fractures. Our findings also challenge the clinical necessity of routine MRI scans in patients with GT fractures to assess for fracture progression.

PMID:40816062 | DOI:10.1016/j.injury.2025.112649

Injury. 2025 Aug 7;56(10):112653. doi: 10.1016/j.injury.2025.112653. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to compare demographics, treatments, and outcomes of interprosthetic (IPFFs) and periprosthetic femur fractures (PPFFs). IPFFs were hypothesized to occur in older patients and have higher rates of reoperation, implant failure, and mortality.

METHODS: This was a retrospective cohort at a Level 1 trauma center analyzing adults with PPFFs/IPFFs from 2012-2024. Patients with < 30 days follow-up were excluded. Patient characteristics, treatments, and complications were compared between IPFFs and PPFFs.

RESULTS: 276 patients with 30 IPFFs and 246 PPFFs were included. IPFFs were older (74y v 69y p=.035), more commonly osteoporotic (33% v 11% p<.001), and more commonly current (17% v 14%) or former smokers (7% v 0% p<.001). IPFFs presented with 29 total hip (THA) and knee (TKA) arthroplasties and one THA and unicompartmental knee arthroplasty. PPFFs presented with 130 fractures around THAs and 116 fractures around TKAs. IPFFs more commonly presented with unstable prostheses (40% v 21% p=.017). Of the seven IPFFs treated with nail-plate hybrid constructs (NPCs), six (86%) were immediately weightbearing as tolerated (WBAT). Of the 23 IPFFs not treated with NPCs, 9 (39%) were immediately WBAT (p=.031). IPFFs had more blood loss (811mL v 513mL p=.016). The mortality rate was 15% in IPFFs and 4% in PPFFs (p=.02). IPFFs had higher rates of implant failure (23% v 7% p=.004) and superficial infection (15% v 4% p=.013). Of the seven IPFFs treated with NPCs, there were no implant failures, while 7/23 (30%) IPFFs treated with other techniques failed (p=.09).

CONCLUSIONS: IPFFs were older, more commonly osteoporotic, more likely to be smokers, and more often had unstable prostheses at presentation than PPFFs. While treatments were similar, the rate of mortality, implant failure and superficial infection was higher in IPFFs. NPCs may allow for earlier weightbearing but their long-term effects regarding outcomes and stability require further investigation in prospective studies.

LEVEL OF EVIDENCE: III.

PMID:40812247 | DOI:10.1016/j.injury.2025.112653

Injury. 2025 Aug 8;56(10):112672. doi: 10.1016/j.injury.2025.112672. Online ahead of print.

ABSTRACT

Mountain accidents have increased over the last decade all around the globe mostly due to a raise of mountain activity practitioners. Outcomes of accidents usually imply evacuation, traumatic injuries or even cardiovascular events. Sex, age, activity, altitude, experience, and equipment adequacy relate to accidents as direct causes or moderators of accident severity. This study focuses on the mountain accidents in Catalonia with descriptive and ordinal regression analysis aiming to characterize a victim vulnerability profile, which remains largely unexplored. The current sample includes 3257 mountain rescue operations from the Catalan Fire Department records between 2011 and 2021. Descriptive analysis showed that the most common profile was being hiker (63 %), climber (11.6 %), mountain biker (10.2 %), man (60.3 %), going in group (84.3 %), occurring in weekends (53.7 %), and suffering traumatic events (61.4 %) or needing technical support (20.4 %). Moreover, the main causes of fatality were falls and cardiovascular issues with the latter showing the higher fatality rate (55.5 %). Ordinal regression analysis explained a modest amount of variance (Nagelkerke R2 = 0.12), suggesting that predictors of higher severity were Group, Altitude, Male, Gathering, Mountain Biking and other practices such as Hunting. Recommendation to rescue teams comprise standardizing and potentiate data collection, conducting awareness campaigns targeted mainly to hikers, mountain bikers and elderly men, and to reinforce awareness campaigns and rescue teams during weekends.

PMID:40812246 | DOI:10.1016/j.injury.2025.112672

Injury. 2025 Aug 8;56(10):112668. doi: 10.1016/j.injury.2025.112668. Online ahead of print.

ABSTRACT

This study explores the effects of some of the key factors, including emergency response measures, roadway and environment, traffic-related attributes, and crash-specific factors, on the Injury Severity Score (ISS) of Road Traffic Crashes' (RTCs) victims, both directly and through pre-hospital time (PHT), using rigorous path analysis. Data for 298,654 crashes, compiled by the Road Traffic Injury Research and Prevention Center (RTIRPC) in Karachi (Pakistan), were used for analyses. Owing to the corner-solution distribution of the response variables (PHT and ISS), two Tobit regression models are estimated after accounting for missing values through synthetic data generation. Marginal effects from these models are used in the path analysis. The findings suggest that ISS increases by 0.01 units with a unit increase in PHT, highlighting the critical need for rapid evacuation of crash victims to medical facilities. The mode of evacuation emerged as a crucial factor, with ambulances resulting in increased PHT and ISS compared to private or public transport, underscoring the improvement needed in the dedicated ambulance-based emergency response. PHT and ISS were found to be higher in nighttime crashes, necessitating better emergency medical services (EMS) response during the night. Intersection crashes were associated with lower PHT and ISS; whereas, crashes on undivided roads and those involving multiple or large vehicles increased PHT and ISS. The path analysis revealed that the overall effects of some of the key variables on ISS were higher than their direct effects - something that could not be explored without the path analysis. These insights can help policymakers develop strategies to improve emergency response and road safety, ultimately reducing the number of RTC-related injuries and fatalities.

PMID:40812245 | DOI:10.1016/j.injury.2025.112668

Injury. 2025 Aug 6;56(10):112673. doi: 10.1016/j.injury.2025.112673. Online ahead of print.

ABSTRACT

BACKGROUND: Resuscitative thoracotomies (RTs) are controversial interventions that heavily consume resources and can pose risks for the surgical team. Increasingly limited resources and risk to healthcare teams have encouraged the continued refinement of RT guidelines. We evaluated RT futility indicators amid institutional RT practice guideline changes.

METHODS: Thoracotomies conducted at our Level 1 Trauma Center from January 2017 to July 2023 were reviewed and classified as either RT or non-resuscitative (non-RT). Injury characteristics, patient demographics, procedure details, and mortality outcomes were collected through chart review.

RESULTS: Of 78 thoracotomies, 56 (71.8 %) were RTs, predominantly on patients with penetrating injuries (55.4 %), specifically gunshot wounds (46.4 %). Most RTs (87.5 %) complied with Eastern Association for the Surgery of Trauma guidelines. The procedure mortality rate was 4.6 % for non-RT and 67.9 % for RT, and hospital mortality was 13.6 % for non-RT and 89.3 % for RT. Thus, 10.7 % of RT patients survived to discharge, including 5 (16.2 %) with penetrating injuries and 1 (4.0 %) with blunt injuries. Ten (17.8 %) RT patients arrived with fixed and dilated pupils, 11 (19.6 %) arrived with no signs of life, and 4 (10.7 %) received pre-hospital CPR, all of whom did not survive to discharge. Changes in institutional practice guidelines decreased the frequency of total thoracotomies, but not RT numbers.

DISCUSSION: RT utilization and mortality rates remained consistent after implementing stricter institutional guideline policies. Improving odds of survival may require further refinement to RT practice guidelines regarding patient selection criteria. We recommend adding witnessed cardiac arrest and prioritizing pupillary response to RT futility guidelines regardless of injury pattern.

PMID:40812244 | DOI:10.1016/j.injury.2025.112673

Injury. 2025 Aug 5:112627. doi: 10.1016/j.injury.2025.112627. Online ahead of print.

ABSTRACT

BACKGROUND: The role for routine follow-up imaging in nonoperative management (NOM) of blunt splenic injury (BSI) remains controversial. Delayed complications, specifically vascular abnormalities such as pseudoaneurysms are associated with failure of NOM (FNOM). This study examined a ten-year experience with NOM of BSI and the influence of repeat imaging. Our centers have no guidelines for follow-up imaging.

METHODS: A retrospective cohort study was conducted including all trauma patients with BSI admitted within a regional trauma system (two Level III and one Level I ACS-verified trauma centers) between 2013 and 2022. Patient demographics, injury features, imaging and outcomes were obtained from trauma registry data and chart review. Patients undergoing splenectomy 6 hours or more after presentation were categorized as FNOM.

RESULTS: A total of 1815 patients presented with BSI during the study period. Urgent splenectomy was performed in 15.6 % (N=283). The rate of FNOM was 3.4 % (N=62). Among the 1532 patients initially managed nonoperatively, 139 (9.1 %) underwent a follow-up CT scan. Most scans were obtained in response to clinical changes, while 13.7 % (N= 19) were obtained for splenic surveillance. Follow-up scans were followed by 8 splenectomies and 9 embolizations. Among the 19 scans performed for surveillance, two revealed a pseudoaneurysm; one of which underwent embolization. Results are limited by a low rate of screening imaging and a lack of long-term outcome information.

CONCLUSION: A low rate of FNOM was achieved despite less than 2 % (19/1532) of patients undergoing screening follow-up imaging. These findings suggest that there is limited opportunity for routine surveillance imaging to improve outcomes in BSI. Reimaging in response to clinical changes is a cost-effective alternative.

PMID:40803925 | DOI:10.1016/j.injury.2025.112627

Injury. 2025 Aug 7;56(10):112664. doi: 10.1016/j.injury.2025.112664. Online ahead of print.

ABSTRACT

OBJECTIVES: We conducted a sex-stratified analysis to assess the prevalence and predictors of violence and non-fatal injury among adolescents attending school in Thailand.

METHODS: The data for this study were obtained from the Thailand Global School-based Student Health Survey (GSHS), a nationally representative survey conducted in 2021 with a sample size of 5661 students aged 13-17 years. Multiple logistic regression analyses were used to examine the protective factors and risk factors that influence non-fatal injury and violence. The regression analysis was reported using adjusted odds ratios (AORs) and 95 % confidence intervals (CIs), with a p-value < 0.05.

RESULTS: The national prevalence of violence and non-fatal injury among school-going adolescents was 11.6 % and 52.6 %, respectively. Boys had a substantially higher prevalence of violence (7.6 %) and non-fatal injury (26.4 %) compared to girls (3.6 % and 24.1 %, respectively). Stratifying by sex, school truancy, and bullying were associated with violence and non-fatal injuries in girls, as well as suicidal ideation, anxiety, hunger, and various health risk behaviors, like tobacco, alcohol, and cigarette use, were found to be associated with violence and non-fatal injuries in boys. In contrast, parental supervision, peer support, and sedentary behavior were found to be protective factors for Thai adolescents.

CONCLUSIONS: Future policies should consider individual risk factors and parent-child-teacher bonding to mitigate the burden of violence and injury among in-school adolescents in Thailand.

PMID:40803265 | DOI:10.1016/j.injury.2025.112664

Injury. 2025 Aug 6;56(10):112674. doi: 10.1016/j.injury.2025.112674. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric extremity fractures represent a frequent cause of emergency department visits, with inequity in care linked to socioeconomic status, race, and insurance type. Despite standardized treatment algorithms, currently available evidence indicates that socially disadvantaged children experience delays in surgical fixation and pain management. This scoping review aims to evaluate the impact of socioeconomic factors on multiple elements of pediatric extremity fracture management.

METHODS: This scoping review followed PRISMA standards. Eligible studies included pediatric patients (<18 years) with extremity fractures, incorporated measures of social or economic status, and evaluated pre-defined management outcomes. Studies conducted before 2010 or outside of the United States were excluded. Abstracts and full texts were screened independently by multiple reviewers using Covidence software.

RESULTS: After duplicate removal, 9,671 articles were screened, with 78 undergoing full-text review; 33 articles met all inclusion criteria. The 33 eligible studies predominantly consisted of retrospective cohort analyses, with sample sizes ranging from fewer than 500 to over 9 million patients. Major outcomes evaluated included type of treatment offered (n=10), pain management (n=10), time to care (n=8), post-discharge care (n=4), imaging (n=3), and pre-hospital care (n=1). Inequities were identified across multiple domains, commonly associated with insurance status, race, family income, and primary language. Children with public insurance consistently experienced higher rates of nonoperative management and longer delays to definitive treatment. Racial/ethnic minority children had lower odds of receiving opioid analgesics despite equivalent pain levels.

DISCUSSION AND CONCLUSION: Socioeconomic disadvantage, measured at both the individual and regional level, is strongly associated with differences in pediatric extremity fracture management, including inequitable access to timely imaging, operative care, and adequate pain control. These findings underscore the critical need for targeted policy interventions, standardized clinical protocols, and improved care coordination to reduce disparities and ensure equitable pediatric fracture care for all children.

PMID:40803264 | DOI:10.1016/j.injury.2025.112674

Injury. 2025 Aug 9;56(10):112656. doi: 10.1016/j.injury.2025.112656. Online ahead of print.

ABSTRACT

BACKGROUND: Portugal's favourable conditions for water-based recreational activities (WRA) often lead to incidents requiring intervention by the National Maritime Authority (AMN). Despite being documented in the SEGMAR database, participant profiles and severity factors, particularly for water-board-related incidents (BRIs), remain underexplored. This study aims to profile individuals involved in BRIs, identify determinants of severe incidents, and examine key clusters within the AMN's jurisdiction from 2020 to 2023.

METHODS: A cross-sectional observational study analysed 14,456 WRA incidents from the SEGMAR database. BRIs included activities involving water-boards (e.g., surfing, bodyboarding, kitesurfing) and collisions with water-boards. Severe BRIs were defined as incidents causing injuries, fatalities, or disappearances. Sociodemographic, temporal, and spatial factors were analysed using descriptive analysis and Quasi-Poisson regression to estimate frequency ratios (FR). Cluster analysis identified at-risk groups, and the severe to non-severe BRIs ratio was mapped by captaincy and municipality. Statistical significance was set at p<0.05.

RESULTS: BRIs made up 11.9% of all incidents, occurring more often among men, individuals aged 15-55, and foreigners, especially outside the bathing season and in unsupervised areas (p<0.001). Severe BRIs were linked to winter (FR 1.92; 95% CI 1.15-3.19), nighttime (FR 2.0; 95% CI 1.6-2.6), dawn (FR 1.6; 95% CI 1.3-2.0), and the bathing season (FR 1.9; 95% CI 1.3-2.7). Clusters revealed at-risk groups: children under 14 at patrolled beaches in summer evenings, men over 55 at unpatrolled areas in autumn, and young females at unpatrolled beaches in winter. Seven captaincies and 20 municipalities had a severe to non-severe BRIs ratio above 1.

CONCLUSION: BRIs predominantly affect men, young adults, and foreigners. Key risk factors include extreme ages, non-summer seasons, unsupervised areas, and low-light conditions. Targeted interventions, such as adjusting lifeguard schedules to cover high-risk times, promoting safety campaigns for children and older adults, and reinforcing safety infrastructure at unpatrolled beaches, might be important to mitigate risks and reduce incident severity.

PMID:40803263 | DOI:10.1016/j.injury.2025.112656