Injury. 2026 Apr 15:113292. doi: 10.1016/j.injury.2026.113292. Online ahead of print.

ABSTRACT

Concomitant ipsilateral fractures of the clavicle, scapula, and ribs, termed forequarter lateral implosion injury, represent a severe but underrecognized injury pattern resulting from high-energy lateral shoulder trauma. While the surgical indications for isolated chest wall and shoulder girdle injuries are well described, guidance on the integrated management of this combined injury complex remains limited. We describe a reproducible multidisciplinary approach for the concurrent surgical fixation of clavicle, scapula, and rib fractures, illustrated through two cases of forequarter lateral implosion injury resulting from high-energy road traffic accidents. Preoperative planning incorporated CT three-dimensional (3D) reconstructions and patient-specific 3D printed models to facilitate pre-operative planning, with a multidisciplinary team involved for incision planning and fixation sequencing. Surgery was performed in a single setting with the patient in the lateral position, utilizing muscle-sparing approaches and a staged fixation strategy to address the clavicle, scapula, and ribs through coordinated exposures. Simultaneous osseous stabilization allowed restoration of the superior shoulder suspensory complex integrity and chest wall mechanics, enabling immediate postoperative shoulder mobilization and aggressive pulmonary rehabilitation. Both patients demonstrated early pain resolution, functional shoulder range of motion, radiographic union, and return to work within months and without major complications. In the setting of combined chest wall and shoulder girdle disruption, the cumulative biomechanical instability may justify a judicious relaxation of traditional surgical thresholds to permit concurrent surgical stabilization to facilitate earlier rehabilitation and recovery. This study characterizes the underrecognized entity of a forequarter lateral implosion injury, highlights practical management considerations, and supports an integrated surgical strategy to optimize functional recovery.

PMID:42034517 | DOI:10.1016/j.injury.2026.113292

Injury. 2026 Apr 22;57(6):113297. doi: 10.1016/j.injury.2026.113297. Online ahead of print.

ABSTRACT

BACKGROUND: Septic tibial nonunion regarding proximal metaphysis is a rare complication with devastating results.

METHODS: Due to scarce literature about this condition, a prospective interventional study using Ilizarov External Frame was conducting with participants recruitment from December 2020 till January 2022. Primary outcomes were bone healing and infection eradication while side-effects were reported. Secondary outcomes were the final leg length discrepancy (LLD) more than 2.5 cm, external fixation time, the Association for the Advancement of Methods of Ilizarov (ASAMI) bone and functional classification scores, the Knee Outcome Survey-Activity of Daily Living Scale (KOS-ADSL) score, the American Academy of Orthopedic Surgeons (AAOS) Lower Limb Scale, the quality-adjusted life year (QALY) Time Trade-Off and the Short-Form 12 (SF-12) physical and mental score.

RESULTS: 17 patients (16 males) with infected proximal tibial nonunions were treated with an Ilizarov external fixator at the Orthopedic Department of Serres General Hospital in Serres, Greece. Fracture healing and infection eradication were achieved in all patients with minimum follow-up of 30 months. Tibia deformity was present in four cases (23.5%), and length discrepancies were observed in one patient (3 cm). Limping was recorded in three patients. Stiffness of the knee or ankle was reported in six patients but all patients except one were pain-free. Everyone resumed their work or daily activities. According to ASAMI, the bone results were excellent in 13 patients, good in three patients, and fair in one. Analogously, the functional results were excellent in 11 patients, good in two and fair in 4 patients. Patient Reported Outcome Measures (PROMs) display an impressive improvement over the observation period.

CONCLUSION: The Ilizarov method is a reliable technique for managing septic proximal tibial metaphyseal nonunions, particularly in cases involving extensive bone loss and existing deformities. Of vital importance is the assembling of an experienced multidisciplinary team to manage these rare and complex clinical conditions.

TRIAL REGISTRATION: ISRCTN30905788 (SePseT Ilizarov).

PMID:42034023 | DOI:10.1016/j.injury.2026.113297

Injury. 2026 Apr 20;57(6):113298. doi: 10.1016/j.injury.2026.113298. Online ahead of print.

ABSTRACT

AIM: To investigate the appropriateness of lower doses of loxoprofen in patients with type two diabetes (T2D) with bone fractures/surgeries in comparison to common NSAIDs.

METHODS: The current study is a prospective cross-sectional study. A total of 174 patients treated for bone fractures/orthopedic surgeries were recruited from orthopedic outpatient clinics in Amman, Madaba, and University of Jordan Hospital. Risk stratifications were performed for cardiovascular (CV), gastrointestinal (GI), renal, and hepatic complications. We created in-depth comparisons of safety and effectiveness of common NSAIDs in alleviating postoperative/ fracture pain.

RESULTS: All NSAIDs showed variable reductions in the numerical pain score (NPS) after four weeks. Loxoprofen was the only NSAID prescribed at lower daily doses of 60-120 mg. Loxoprofen resulted in the most reduction in NPS; the fastest onset of action; the least time to reach peak analgesia; decrease in nocturia and the strongest overall pain relief in bone fractures and postoperative pain, p < 0.05. Celecoxib had the highest variability in pain relief among the agents.

CONCLUSION: Lower doses of loxoprofen provide an effective strategy to alleviate postoperative and bone fracture pain and increase patient satisfactions among T2D at lower systemic risks compared to other NSAIDs. Such low dosing approach provides a plausible balanced triad of safety, effectiveness and maximum bone healing which lead to maximum patient satisfaction.

PMID:42034022 | DOI:10.1016/j.injury.2026.113298

Injury. 2026 Apr 21;57(6):113289. doi: 10.1016/j.injury.2026.113289. Online ahead of print.

ABSTRACT

INTRODUCTION: Antibiotic-laden beads provide high, local concentrations of antibiotics and are used to prevent infections in open fractures. This study aimed to determine if wound management with antibiotic beads was associated with fewer surgical site infections (SSI) and unplanned fracture-related operations in patients with severe lower extremity open fractures.

MATERIALS AND METHODS: This cohort study included patients enrolled in the Aqueous-PREP and PREPARE Open trials with a single Gustilo-Anderson (GA) type III open fracture of the lower extremity. Our primary outcome was SSI within 90 days of initial surgery. The secondary outcomes included both SSI and unplanned reoperation for infection within one year of injury and adverse renal events. We used propensity score matching to reduce bias related to several factors, including wound contamination and number of surgeries that may influence the use of antibiotic beads. We used conditional logistic regression to estimate odds ratios (ORs) for the association between antibiotic bead use and the study outcomes.

RESULTS: Of 1039 included patients, 106 (10%) received antibiotic beads comprised primarily of vancomycin (95%) and tobramycin (77%). After propensity score matching, the association of antibiotic beads and SSI within 90 days of initial surgery did not reach statistical significance (OR = 1.9, 95% CI 1.0 - 3.8, p = 0.06). Bead use was associated with an increased odds of SSI within the year following injury (OR = 2.0, 95% CI 1.1 - 3.6, p = 0.02) and an increased odds of unplanned reoperation for infection (OR = 2.0, 95% CI 1.1 - 3.8, p = 0.03). Bead use was not associated with renal serious adverse events.

DISCUSSION: Patients with severe lower extremity open fractures treated with antibiotic beads had greater odds of SSI and unplanned reoperation for infection in the year following injury; however, antibiotic bead formulation was not standardized and could potentially influence the results of this study. These findings challenge the previously reported effectiveness of antibiotic-laden beads from retrospective studies. A randomized trial examining this treatment strategy is warranted.

PMID:42034021 | DOI:10.1016/j.injury.2026.113289

Injury. 2026 Apr 15:113199. doi: 10.1016/j.injury.2026.113199. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic injury in older people is a significant health burden with higher mortality rates than younger cohorts. Survival following older trauma may be complicated by the patients pre-injury state and clinical uncertainty. Timely identification of palliative and end-of-life care needs may be challenging for acute clinical teams, and treatment escalation planning is not routinely embedded in trauma care. This point prevalence snap-shot aimed to evaluate treatment escalation discussions and palliative/end of life care (EoLC) practice in older major trauma patients at a national level.

METHODS: A one-day point prevalence "flash-mob" audit was conducted across Major Trauma Centres (MTCs) and Trauma Units (TUs) in England, Wales and Scotland. All trauma patients aged ≥ 65 years in hospital were eligible for inclusion. Patients with and without treatment escalation plans (TEPs) and those on care pathways were analysed.

RESULTS: Data from 957 patients in 49 hospitals were included and median time from injury was 11 days (interquartile range 4-24). A TEP or equivalent was documented in 393 patients (41.0%). Among patients with a TEP, there were more aged > 85 years (165/393 (41.9%), than in those without a TEP (167/564 (29.6%), p < 0.001). Clinical frailty scoring was performed in 657 patients (68.6%), and where recorded, TEPs were associated with increased frailty (CFS ≥5 TEP: 68% [207/304] vs. No TEP: 46.4% [164/353], p < 0.001). Polytrauma predominated over any single site injury (TEP: 140/393, 35.6% vs. No TEP: 197/564, 34.9%). Admitting specialty teams differed between groups and those with a TEP were more likely to be under the care of a medical consultant (92/393, 23.4%) compared to only 60/564, 10.6% of the no-TEP patients (p < 0.001). A fifth of those with a TEP were on a documented palliative, time-limited or end-of-life care pathway (20.3%). Care pathways were more likely in those with older age (p < 0.001) and severe frailty (CFS≥7) (p = 0.03) rather than injury type, clinical specialty or advance care plans.

CONCLUSION: This national snapshot demonstrates limited and variable use of treatment escalation planning with low rates of recorded palliative and EoLC need discussions in older major trauma patients. Greater integration of frailty assessment and early goals-of-care discussions are required to improve care for this growing population.

PMID:42031637 | DOI:10.1016/j.injury.2026.113199

Injury. 2026 Apr 19;57(6):113184. doi: 10.1016/j.injury.2026.113184. Online ahead of print.

ABSTRACT

Femoral neck fractures (FNFs) represent a critical challenge in orthopedic trauma, characterized by high incidences of postoperative osteonecrosis of the femoral head (ONFH) and nonunion. For young patients and active elderly individuals, anatomic reduction and stable internal fixation remain the primary therapeutic goals. However, conventional assessment of reduction quality relies on two-dimensional (2D) fluoroscopic indices, which often lack the sensitivity to detect complex rotational or translational malalignment. Emerging three-dimensional (3D) digital techniques and robotic assistance offer superior spatial visualization and objective measurement frameworks. This review evaluates the evolution from classic 2D radiographic criteria to contemporary 3D digital assessment tools, discussing their clinical efficacy and potential for enhancing robotic-assisted surgical precision.

PMID:42030599 | DOI:10.1016/j.injury.2026.113184

Injury. 2026 Apr 9;57(6):113263. doi: 10.1016/j.injury.2026.113263. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the frequency, laterality, diameter, and arterial origin of the corona mortis (CM) using computed tomography angiography (CTA) in a large consecutive cohort from two affiliated academic hospitals. A secondary objective was to assess demographic associations with CM, including age, sex, body mass index (BMI), and race or ethnicity.

METHODS: This retrospective study evaluated 988 consecutive abdominal and pelvic CTAs performed between 2020 and 2022 at Parkland Hospital and Clements University Hospital, representing 1976 hemipelvises. All patients aged be ≥ 18 years with diagnostic-quality CTA were included. Studies were not excluded for trauma indications or prior pelvic surgery, ensuring an inclusive, real-world imaging population. CM presence, laterality, vessel diameter, and arterial origin were recorded. Demographic variables were collected, and analyses were performed using the Wilcoxon rank-sum test, paired t-test, and sign test.

RESULTS: Arterial CM was identified in 318 of 988 patients (32.2%). Among CM-positive cases, 53% were unilateral and 47% bilateral, with laterality distributed as 25% right-sided, 27% left-sided, and 47% bilateral. The median vessel diameter measured 2.40 mm (IQR, 2.00-2.50 mm). Most CMs originated from the inferior epigastric artery (98%), while 2.3% arose directly from the external iliac artery. CM was more common in females and in non-Hispanic Black individuals. Patients with CM were significantly older than those without (p = 0.035). Vessel diameter differed significantly between sexes (paired t-test, p = 0.004; sign test, p = 0.006).

CONCLUSIONS: Across two major academic hospitals, this large consecutive CTA cohort-the largest reported to date-identified arterial CM in nearly one-third of patients and demonstrated meaningful demographic variability. Given its potential for clinically significant bleeding, systematic evaluation of CM on preoperative or preprocedural CTA may help reduce iatrogenic vascular injury during pelvic and acetabular surgery.

PMID:42030598 | DOI:10.1016/j.injury.2026.113263

Injury. 2026 Apr 17:113295. doi: 10.1016/j.injury.2026.113295. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma team activation protocols are critical for mobilizing resources in the care of severely injured patients. In the US, the American College of Surgeons (ACS) specifies minimum criteria for the highest-level (full) trauma activation (fTA), but hospitals retain discretion to add criteria, potentially leading to variability in activation practices and resource utilization. The extent of this variation and its impact on patient outcomes is unknown. The aim of this study was to quantify inter-hospital variability in fTA use and its relationship to mortality.

METHODS: We conducted a multicenter, retrospective cohort study of adult trauma patients treated at 37 Level I and II trauma centers across the United States from 2017 to 2019; transfers were excluded. Mixed-effects logistic regression models were used to quantify inter-hospital variability in fTA utilization and total mortality (death+hospice), adjusting for 12 patient and hospital-level characteristics. Correlation analyses assessed the relationship between adjusted hospital-specific fTA rates and adjusted total mortality.

RESULTS: Overall, 158,696 patients were included, with 34,374 (21.7%) receiving a fTA. The median age was 53 yrs, with 59% male, 71% White, 88% blunt, and a median Injury Severity Score of 9. Use of fTA varied widely (3.3% to 54.1%, median [IQR]=19.3% [13.6-27.3%]) and the adjusted odds of fTA varied significantly across hospitals (SD=0.88; coefficient of variation [CV]=0.53), with 83.7% of hospitals differing significantly from the average hospital. In contrast, adjusted odds of total mortality showed lower inter-hospital variation (SD=0.31; CV=0.22), with 35% of hospitals differing significantly from the average hospital. Overall, no statistically significant correlation was found between adjusted hospital-level fTA rates and total mortality (r = 0.07, b=0.01, p = 0.69). Age-stratified sensitivity analyses also confirmed substantially greater inter-hospital variability in fTA rates compared to mortality rates.

CONCLUSIONS: Substantial variation in fTA utilization exists across this sample of U.S. trauma centers. Importantly, higher fTA rates were not associated with improved mortality outcomes. These findings suggest that discretionary activation practices may lead to inconsistent resource utilization without measurable benefit on total mortality. Standardized evidence-based criteria for fTA may improve resource stewardship and trauma system efficiency.

PMID:42025512 | DOI:10.1016/j.injury.2026.113295

Injury. 2026 Apr 10;57(6):113274. doi: 10.1016/j.injury.2026.113274. Online ahead of print.

ABSTRACT

BACKGROUND: Hip fractures and vertebral fractures are significant public health concerns, causing substantial morbidity, mortality, and economic costs. Hip fractures often lead to mobility loss, while vertebral fractures, frequently underdiagnosed, can result in spinal deformities and recurrent fractures or subsequent injuries.

METHODS: This study identified hip and vertebral fractures using ICD-9 and ICD-10 codes in Taiwan's National Health Insurance Research Database (NHIRD). It applied Kaplan-Meier and Monte Carlo methods to estimate survival functions, comparing outcomes with a reference population. Extrapolation beyond the follow-up period was done to calculate lifetime life expectancy.

RESULTS: The study included 214,077 hip fracture patients and 101,731 vertebral fracture patients. The average age was 77.1 for hip fractures and 73.4 for vertebral fractures, with women comprising the majority. For hip fractures, the estimated life expectancy (LE) was 7.9 years, while for vertebral fractures, it was 11.9 years. Patients with a history of stroke exhibited the greatest loss of life expectancy in both fracture cohorts.

CONCLUSION: This study highlights the significant loss of life expectancy in stroke patients with hip fractures. It urges policymakers to prioritize prevention strategies and resource allocation to improve outcomes for high-risk populations.

PMID:42025401 | DOI:10.1016/j.injury.2026.113274

Injury. 2026 Apr 16;57(6):113296. doi: 10.1016/j.injury.2026.113296. Online ahead of print.

ABSTRACT

INTRODUCTION: Periprosthetic distal femur fractures are deleterious injuries, found commonly in the elderly osteoporotic population, typically addressed with open reduction internal fixation (ORIF). Fractures that are very distal (Su type III) require special considerations due to limited distal bone stock for fixation. The utilization of the nail-plate combination (NPC) technique for these patients aims for an early return to ambulation by maximizing distal fixation and stability while allowing for immediate postoperative weight-bearing.

METHODS: The technical steps for NPC in very distal periprosthetic femur fractures are outlined in addition to a comparative case series of these injuries treated with NPC, retrograde intramedullary nail (rIMN), lateral locking plate (LLP), and dual plate contruct (DPC). Primary outcomes included postoperative weight-bearing status, ambulatory recovery using Koval scores, radiographic union (mRUST and documented union), reoperation, and mortality.

RESULTS AND CONCLUSIONS: All NPC patients were permitted immediate weight-bearing as tolerated (WBAT) on postoperative day 1, significantly more frequently than other constructs (p < 0.001), with maintained significance versus rIMN after correction (p = 0.012). There were no significant differences in Koval mobility scores at any postoperative time point. One-year mortality was 15.9%, and reoperation occurred in 20%, with no significant differences between constructs. Union outcomes were limited due to sparse data. Therefore, the NPC is a useful method that allows immediate and consistent functional recovery and stability for very distal periprosthetic femur fractures.

PMID:42025400 | DOI:10.1016/j.injury.2026.113296

Injury. 2026 Apr 15;57(6):113291. doi: 10.1016/j.injury.2026.113291. Online ahead of print.

ABSTRACT

INTRODUCTION: A lag screw, or a lag screw combined with a neutralization plate, is commonly used for compressive fixation of simple fracture patterns. There are several surgical variables that potentially affect fixation stability including lag screw angle, fracture gap, screw countersinking, screw diameter, and neutralization plate configuration.

METHODS: This study involved finite element modeling of these biomechanics in a diaphyseal bicortical oblique fracture model of (1) lag screw application under controlled torque; and (2) postoperative stability with 4.5 mm diameter lag screw and corresponding neutralization plate combinations, subject to external compression, bending, and torsion.

RESULTS: In models of lag screw application, predicted interfragmentary misalignment had good agreement with corresponding validation experiments. When the screw was applied perpendicular to the fracture, with moderate countersinking and no initial fracture gap, fracture compression was maximized and interfragmentary misalignment minimized. A 30° deviation from perpendicular screw placement reduced fracture compression by 19% and produced 0.7 mm of interfragmentary misalignment, while screw deviation at 15° had negligible effects. Not countersinking the screw head also decreased fracture compression and increased lag screw stress at the head-shaft junction, with the model predicting larger effects on compression than observed in the experiment. During postoperative loading, the addition of a neutralization plate limited shear interfragmentary motion to < 0.4 mm under all loadings, and reduced lag screw stress and bone strains, particularly under torsion.

CONCLUSION: The study quantifies the decreases in fracture compression in lag screw fixation due to screw angular deviation and not countersinking the screw head, and characterizes the biomechanical benefits of combining lag screw fixation with a neutralization plate.

PMID:42019156 | DOI:10.1016/j.injury.2026.113291

Injury. 2026 Apr 16;57(6):113266. doi: 10.1016/j.injury.2026.113266. Online ahead of print.

ABSTRACT

INTRODUCTION: Individuals with psychiatric disorders and substance use are at greater risk of sustaining severe injuries due to behavioral impulsivity, impaired judgment, and medication effects. The influence of psychiatric comorbidities on the hospitalization of patients with pelvic fractures remains underexplored. This study investigates the impact of psychiatric disorders and substance abuse on hospitalization outcomes for these patients.

MATERIALS AND METHODS: This retrospective, single-center cohort study was conducted from 2014 to 2023, including patients aged ≥ 18 years with high-energy pelvic and acetabular fractures and documented psychiatric disorders or substance abuse history. Exclusion criteria included subjects with incomplete or missing data, pathological pelvic fractures, patients younger than 18 years, non-trauma admissions, conservative fractures. Patients were divided into two groups: the mental group (with psychiatric comorbidities and/or substance abuse) and the control group. We analyzed factors such as emergency department length of stay, Injury-to-surgery interval, surgery-to-discharge readiness interval, discharge readiness-to-discharge interval and the necessity of discharge support service.

RESULTS: A total of 208 patients were included, of whom 22 (10.6%) had psychiatric comorbidities. Patients with psychiatric disorders were significantly younger and had more severe injuries than control group. Despite a shorter injury-to-surgery interval (3.5 vs. 6.1 days, p = 0.007), psychiatric patients had significantly longer hospital stays (44.7 vs. 18.5 days, p = 0.050). There was no significant difference in the surgery-to discharge readiness interval, but psychiatric patients experiencing a prolonged discharge readiness-to-discharge interval (19.2 vs. 3.4 days, p = 0.032).

DISCUSSION: Psychiatric comorbidities significantly influence hospitalization dynamics in pelvic fracture patients. Although psychiatric patients undergo surgery more quickly and achieved clinical recovery at similar times, compared to controls, their hospital stays are prolonged due to psycho-social and organizational barriers rather than ongoing medical needs. A higher proportion of psychiatric patients required discharge support services, emphasizing the role of non-medical factors in discharge delays.

CONCLUSIONS: Our findings indicate that the higher proportion of patients in the mental health group requiring discharge support services suggests that non-medical factors are major contributors to discharge delays. The higher rate of discharge-support activation further confirms the greater dependence of this population on structured continuity-of-care pathways.

PMID:42013718 | DOI:10.1016/j.injury.2026.113266

Injury. 2026 Apr 10;57(6):113267. doi: 10.1016/j.injury.2026.113267. Online ahead of print.

ABSTRACT

BACKGROUND: Even though the radiological and functional outcomes following femoral head fractures have been reported earlier, Quality Adjusted Life Years (QALY) after fixation of these fractures has not yet been studied. This study aims at a subgroup analysis of the Pipkins classification of fractures, radiological and functional outcomes, and the burden of femoral head fractures by QALY.

METHODS: A retrospective analysis of 101 patients with femoral head fractures was performed between 2008 and 2022 with a minimum follow-up of 2 years and maximum of 15 years. Serial radiographs were studied from PACS (radiological outcome) and the patients were interviewed using Harris Hip Score (functional outcome) and the EuroQoL EQ-5D-3L questionnaires to assess the Quality Adjusted Life Years (QALY).

RESULTS: Patients who underwent immediate reduction of the hip joint (<6 h) demonstrated better QALY in the long term follow up. Those with Pipkins type 3 (n = 10) fractures who had to undergo Primary THR showed the best functional outcomes, followed by types 4,1, and 2. Infra foveal fractures gave a better outcome than supra foveal fractures. Heterotopic ossification (7%), AVN (4%), and the need for conversion to secondary THR (3%) was more common in patients who had a prolonged injury to reduction interval or a comminuted fracture of the femoral head. Despite a 2% incidence of infection, short-term functional outcomes remained positive in these patients.

CONCLUSION: In this cohort, well-fixed femoral head fractures across Pipkin subtypes showed satisfactory radiological and functional outcomes with acceptable long-term health utility. Pipkin type II fractures with extensive comminution and Pipkin type III fractures appeared to have better outcomes with primary total hip replacement, potentially reducing the need for secondary surgery.

PMID:42000478 | DOI:10.1016/j.injury.2026.113267

Injury. 2026 Apr 15;57(6):113286. doi: 10.1016/j.injury.2026.113286. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the prevalence of barriers to care and IPV risk and assessed associations between economic hardship and violence.

METHODS: A prospective, cross-sectional survey was performed recruiting adult orthopedic trauma patients presenting for clinical follow up at one Level 1 orthopaedic trauma center. Primary outcomes were SDoH domains and IPV risk. Associations between patient characteristics, barriers to care, and IPV risk were analyzed using Fisher's exact tests with false discovery rate control.

RESULTS: Among 261 respondents, 50.6% reported difficulty paying for basic needs, while 26.2% reported food insecurity and 25.2% transportation barriers. Positive IPV screens were driven largely by emotional abuse (17.7%), compared with physical hurt (3.3%). Financial hardship was the strongest predictor of barriers to care (OR 48.8, p < 0.001) and was associated with overall IPV risk (OR 3.31, p < 0.001), increasing the odds of threats of harm by over 28-fold. Tobacco use (OR 3.35, p < 0.001) and monthly alcohol use (OR 3.26, p = 0.01) were also associated with IPV risk. Nearly one-third of patients (28.8%) requested connection to supportive resources.

CONCLUSIONS: Orthopaedic trauma patients experience a substantial burden of unmet social needs and IPV risk. Financial hardship and substance use are associated with barriers to care and IPV exposure, and many patients desired connection to resources. Trauma clinics represent a critical point for identification, but screening alone is insufficient without embedded referral pathways to provide timely support.

LEVEL OF EVIDENCE: Level II; survey study.

PMID:42000477 | DOI:10.1016/j.injury.2026.113286

Injury. 2026 Apr 15;57(6):113293. doi: 10.1016/j.injury.2026.113293. Online ahead of print.

NO ABSTRACT

PMID:42000476 | DOI:10.1016/j.injury.2026.113293

Injury. 2026 Apr 15;57(6):113260. doi: 10.1016/j.injury.2026.113260. Online ahead of print.

ABSTRACT

PURPOSE: This study investigates the pathophysiological mechanisms, risk factors, and conditions contributing to the occurrence of paralyzing disc herniation (PDH) following L4-L5 disc herniation surgery. Despite the significance of PDH, comprehensive understanding remains limited due to the inherent challenges in recruiting patients with neurologic deficits and the variability in research methodologies.

METHODS: Our retrospective analysis includes 1285 patients who underwent surgery for disc herniation over a decade, identifying an incidence rate of 7.69% for PDH among the cohort. Notable risk factors include age, obesity, diabetes mellitus, a narrow lumbar canal, and trauma.

RESULTS: The recovery rate of 66.66% observed in our study aligns with existing literature, indicating a comparable average age of participants (48.64 years).

CONCLUSIONS: The restricted volume of research focusing on postoperative outcomes has resulted in a lack of consensus on optimal management strategies for PDH. Consequently, the timing of intervention remains ambiguous, aside from recognized emergency situations. Our study underscores the need for further prospective research to enhance understanding and establish definitive management protocols for PDH.

PMID:42000475 | DOI:10.1016/j.injury.2026.113260

Injury. 2026 Apr 15:113287. doi: 10.1016/j.injury.2026.113287. Online ahead of print.

ABSTRACT

BACKGROUNDS: The objective of this study is to closely examine the preferred anastomoses of the superior thyroid artery, facial artery, lingual artery, maxillary artery, and superficial temporal artery anastomoses for the reconstruction of maxillomandibular defects caused by firearm injuries. The study will also examine the reasons for choosing these arteries, their advantages and disadvantages, surgical techniques, complications, and their postoperatively clinically and scintigraphically assessable viability.

METHODS: The present study encompasses a cohort of ten patients who sustained maxillomandibular injuries and underwent surgical intervention employing a multisegment fibular flap. In all cases, following bone fixation, microvascular anastomoses were sutured under a microscope using 9-0 nylon sutures. Flap viability was initially assessed clinically; in addition, all patients underwent a bone scan on the fifth day after surgery using an intravenous infusion of Tc-99m methylene diphosphonate (MDP).

RESULTS: In the study, 10 patients who underwent maxillomandibular multisegment flap surgery received the most appropriate microvascular anastomosis for their pathology. Of these patients, the six most demonstrative cases, which best represent the relevant artery used for anastomosis, have been detailed.

CONCLUSIONS: Although the aim of this study was not to establish a definitive algorithm based on the 10 cases presented, it is hypothesised that the findings may provide some guidance to surgeons working in this field.

PMID:42000208 | DOI:10.1016/j.injury.2026.113287

Injury. 2026 Apr 11:113271. doi: 10.1016/j.injury.2026.113271. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma is the leading cause of death in younger adults and children. Severe polytrauma predisposes patients to the failure of multiple organ systems, including the cardiovascular and respiratory systems, at times necessitating extracorporeal membrane oxygenation (ECMO). ECMO use in the setting of trauma is increasing, yet little data exists describing current practice patterns. We performed an epidemiological analysis of ECMO use and outcomes in trauma patients.

STUDY DESIGN AND METHODS: We analyzed data from the Trauma Quality Improvement Program Registry from 2017 to 2023. Procedure codes were used to identify the application of ECMO. Pediatric patients were those < 18 years of age. We analyzed two groups from this data set: one including all patients who required ECMO and a separate group including only pediatric cases. We used descriptive and inferential statistical methods.

RESULTS: There were 8,014,737 encounters of which 1919 had documented ECMO use. Within that group, 224 were < 18 years of age. The median time from hospital arrival to the first initiation of ECMO was 44 h (interquartile range [IQR] 5-147). The incidence per year ranged from 1.9 to 2.9 events per 10,000 encounters. Survival ranged from 59% to 68% per year. The number of facilities with documented ECMO use annually ranged from 103 to 158 and overall increased during the time of the study. Interfacility transfer was common but was not related to survival.

DISCUSSION: ECMO use demonstrated steady growth in the number of performing facilities throughout the study period. Survival was similar to previous reports. Our findings will help inform targeted clinical guidelines for the use of ECMO in adult and pediatric trauma populations.

PMID:42000207 | DOI:10.1016/j.injury.2026.113271

Injury. 2026 Apr 15;57(6):113280. doi: 10.1016/j.injury.2026.113280. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate fixation failure following femoral neck system fixation (FNS) for intracapsular femoral neck fractures (FNF) and to determine whether fracture characteristics, particularly fracture orientation, were associated with fixation failure.

METHODS: A retrospective cohort study was performed at a Level I trauma center. 82 patients with intracapsular femoral neck fractures treated with FNS fixation were included. Fixation failure was defined as implant cut-out, loss of fixation, nonunion, or revision surgery. Associations between fracture characteristics and fixation failure were evaluated.

RESULTS: The mean age was 70.1 ± 12.7 years, with a mean follow-up of 22.2 ± 10.2 months. Eight fixation failures occurred (9.8%). Pauwels classification was significantly associated with fixation failure (p < 0.001), with higher-angle fractures demonstrating increased risk of failure. No failures occurred in Pauwels type I fractures, whereas failures occurred in Pauwels type II and III fractures. Fracture morphology (subcapital, including valgus impacted vs transcervical) and Garden classification were not associated with fixation failure (p = 1.000 and p = 1.000, respectively). One case of distal locking screw breakage was observed; however, most fixation failures were associated with fracture orientation rather than implant-related mechanical failure.

CONCLUSION: Fixation failure following femoral neck system fixation appears to be primarily associated with fracture orientation rather than implant-related mechanical failure. The low rate of implant-related mechanical complications suggests that the FNS provides adequate biomechanical stability for intracapsular femoral neck fracture fixation, whereas vertical fracture patterns remain a major determinant of fixation failure.

PMID:41997098 | DOI:10.1016/j.injury.2026.113280

Injury. 2026 Apr 11;57(6):113288. doi: 10.1016/j.injury.2026.113288. Online ahead of print.

ABSTRACT

BACKGROUND: Blunt cerebrovascular injury (BCVI) poses significant risk of devastating neurologic injury following blunt trauma. Selective screening criteria miss numerous clinically relevant injuries. Early diagnosis and treatment reduce these negative sequelae. Emerging data have prompted expanded interest in universal screening; however, no consensus screening strategy exists. This review evaluates the current state of BCVI screening.

METHODS: A narrative literature review was performed evaluating universal and liberalized BCVI screening criteria. A structured PubMed search was supplemented by manual review of references, trauma society abstracts, and other grey literature. Eligible studies included peer reviewed literature examining universal or liberalized BCVI screening among adult blunt trauma patients. Given the paucity of available data and relative heterogeneity in study design, findings were synthesized qualitatively.

RESULTS: Eight studies were included for evaluation. Across contemporary cohorts, various screening criteria including extended Denver, Memphis, and Western Trauma Association, miss 16-79% of BCVI identified under universal or liberalized screening protocols. Universal screening studies report BCVI incidence ranging from 2.7% to 7.6%. Reported rates of contrast-associated acute kidney injury and major bleeding were low, though rarely examined. Cost-modeling suggests universal screening may be economically favorable, particularly if BCVI incidence is greater than 6%.

CONCLUSIONS: Selective screening guidelines lack sufficient sensitivity to detect all clinically significant BCVI, including those of high grade. Universal or liberalized CTA screening increases detection and facilitates treatment in a timely manner, potentially reducing BCVI-associated stroke rates. Although current literature is limited and prospective studies are needed, current evidence supports strong consideration of universal or liberalized BCVI screening protocols for blunt trauma patients.

PMID:41997097 | DOI:10.1016/j.injury.2026.113288