Injury. 2025 Aug 6:112652. doi: 10.1016/j.injury.2025.112652. Online ahead of print.

NO ABSTRACT

PMID:40796423 | DOI:10.1016/j.injury.2025.112652

Injury. 2025 Aug 7;56(10):112671. doi: 10.1016/j.injury.2025.112671. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Medial column disruption in proximal humeral fractures (PHFs) is associated with poor outcomes following reduction and internal fixation. Current assessments of unstable medial columns rely on qualitative descriptors such as disrupted hinges and insufficient osseous contact, often overlooking the quantification of bone defects. This study aims to quantitatively analyze bone defect characteristics in varus PHFs using advanced computer image processing techniques.

METHODS: A retrospective cohort study was conducted on 202 patients diagnosed with varus proximal humeral fractures who received treatment at two tertiary hospitals between January 2017 and December 2022. Three-dimensional (3D) fracture models were reconstructed using Mimics software based on preoperative computed tomography (CT) scans, followed by virtual reduction procedures performed in 3-matic software. Comprehensive demographic and morphological data were collected, including patient age, gender distribution, fracture classification, and quantitative parameters of bone defects the volume of bone defect (VBD), extent of bone defect area (EBDA), main defect region (MDR), and maximal defect height (MDH).

RESULTS: Quantile regression demonstrated that age exhibited strong positive associations with VBD across all quantiles (P < 0.001). EBDA and MDH showed consistently significant positive associations with VBD at every quantile level (all P < 0.001). For Sex, males showed no statistically significant differences compared to females (all P > 0.05). Among fracture classifications, 2-part fracture and 3-part fracture had comparable VBD values to 4-part fracture in most quantiles (all P > 0.05), except for 2-part fracture at Q90 (P = 0.017).

CONCLUSION: This study demonstrates that all varus PHFs with significant displacement are associated with bone defects. Age, EBDA, and MDH are positively correlated with VBD, highlighting the importance of considering these factors in surgical planning.

PMID:40795797 | DOI:10.1016/j.injury.2025.112671

Injury. 2025 Aug 5;56(10):112648. doi: 10.1016/j.injury.2025.112648. Online ahead of print.

ABSTRACT

INTRODUCTION: Fragility ankle and distal tibia fractures in the elderly population present a complex clinical situation, due to the poor bone quality, soft tissue condition and medical comorbidities in this age group. This study aims to assess the outcome of long hindfoot nail fixation using standard tibial nails in managing these injuries. This is the largest and possibly first study to date of this implant used in ankle trauma hindfoot fixation.

METHODS: This was a retrospective observational study across two level 1 major trauma centres in the United Kingdom, from January 2019 to December 2024. Patients included were above the age of 60 years, with acute ankle or distal tibia fractures and underwent long hindfoot nail fixation with standard tibial nails. Postoperative complications, early weightbearing and mortality rates were assessed.

RESULTS: A total of 36 patients were included, of which 44.4 % were malleolar fractures, 38.9 % distal tibia extra-articular fractures, and 16.7 % distal tibia intra-articular fractures. Half of the cases were open fractures. There were no cases of periprosthetic fracture, re-fracture, fixation or implant failure. There were six (16.7 %) postoperative complication cases, of which only one (2.8 %) was deemed a major complication; re-operation for removal of proximal locking bolt due to infection. 88.9 % were able to full weightbear within 30 days after surgery. The mortality rate was 8.3 % at 30 days and 16.7 % at 1 year.

CONCLUSION: The use of standard tibial nails, a universally available and feasible implant, for long hindfoot nail fixation in fragility ankle and distal tibia fractures is a safe and reliable treatment option, with a success rate of 97.2 % without major complications. They permit early weightbearing and provide a stable construct with reduced risk of periprosthetic fractures and fixation failure. The mortality rate was comparable to fragility hip fractures, highlighting the medical complexity of patients with these injuries.

PMID:40795796 | DOI:10.1016/j.injury.2025.112648

Injury. 2025 Aug 6;56(10):112670. doi: 10.1016/j.injury.2025.112670. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify risk factors and develop a scoring system based on static x-rays that can predict late displacement and deformity of non-operatively treated Young-Burgess lateral compression type 1 (LC1) pelvic ring injuries METHODS: A retrospective review of all non-operatively treated low-energy LC1 (AO/OTA 61-B2/B3) pelvic ring injuries in patients aged ≥50 associated with incomplete zone 1 sacral fractures and minimum three-month follow-up between January 2019 through January 2024 from two academic level 1 trauma centers. Exclusion criteria were non-acute presentations, nonunions, pathological fractures and non-ambulatory patients. Anterior-posterior, inlet and outlet radiographic imaging at initial, post-operative and final follow-up were assessed.The primary outcome measure was greater than 1 cm of pelvic ring displacement from initial to final radiographs showing fracture healing. Patient demographic and radiographic factors were described with univariate analyses. Statistically significant variables (P < 0.05) entered a multivariable logarithmic regression to develop a scoring system through stepwise elimination, which was assessed via receiver operator characteristic (ROC) curve analysis.

RESULTS: A total of 197 LC1 injuries in patients managed non-operatively (mean age 75.6 (50-103) years, n= 147 (74.6 %) female) were included for analyses. Variables correlated with pelvic deformity development on univariate analysis included, increasing age (p = 0.038), whether the anterior ring had initial displacement present (p < 0.001), bilateral anterior ring involvement (p = 0.027), unstable superior ramus fracture angle (p < 0.001), superior ramus comminution (p < 0.001), Nakatani zone 1 of ipsilateral fracture (p < 0.001), and Nakatani zone 1 of contralateral fracture (if bilateral) (p = 0.031). After multivariate analysis with stepwise elimination, only superior ramus fracture angle (oblique OR 4.88, 95 % CI 2.09-12.25; longitudinal OR 15.55, 95 % CI 4.81-56.42), anterior ring initial displacement present (OR 5.05, 95 % CI 1.93-14.29) and superior ramus comminution (OR 4.43 95 % CI 1.99-10.15) remained significant as variables correlating with the development of pelvic deformity (all p ≤ 0.001).

CONCLUSIONS: The statistically significant variables that correlated with late displacement and deformity of LC1 fracture patterns were superior ramus fracture angle, comminution, and initial anterior ring displacement. A combination of these factors increased the risk of displacement.

PMID:40795795 | DOI:10.1016/j.injury.2025.112670

Injury. 2025 Aug 7;56(10):112666. doi: 10.1016/j.injury.2025.112666. Online ahead of print.

ABSTRACT

BACKGROUND: Severe thoracic trauma is a leading contributor to mortality in critically injured patients, particularly when complicated by concomitant severe traumatic brain injury (TBI), which may independently impair neurological and respiratory function. Accurate assessment and timely intervention play a crucial role in these patients. However, risk factors for severe thoracic trauma remain unclear, and a prediction rule remains to be established. We developed and internally validated a nomogram that allows clinicians to quantify the risk of severe thoracic trauma.

METHODS: Clinical data from the MIMIC-IV database were retrospectively searched to identify a study cohort comprising patients with severe thoracic trauma. Using LASSO regression analysis, We screened out independent risk factors associated with 28-day mortality and incorporated them into nomogram model. The performance of each model was assessed by calculating receiver operating characteristic (ROC) curves, calibration plots and decision curve analysis (DCA).

RESULTS: The final analysis incorporated 2159 patients, with 192 deaths (8.9 %) occurring within 28-day of ICU admission. we constructed a nomogram that incorporates risk factors including heart rate (HR), traumatic brain injury (TBI), oxygen saturation (SpO2), systolic blood pressure (SBP), ventilation, and Sequential Organ Failure Assessment (SOFA) score on the first day of admission to ICU. The nomogram outperformed SOFA and Model 1 (risk factors including SBP, SpO2, TBI and ventilation) with an area under the receiver operating characteristic curve (ROC) of 0.854 (95 %CI 0.736-0.791, P < 0.001) in the training cohort and 0.859 (95 %CI 0.713-0.794, P < 0.001) in the validation cohort. The analysis of the calibration curve demonstrated that the nomogram exhibited a strong alignment with the observed 28-day mortality rates in severe thoracic trauma patients.

CONCLUSIONS: The study identified independent risk factors associated with the 28-day mortality risk and developed predictive nomogram models for ICU patients suffering from severe thoracic trauma. The nomogram shows promise in guiding strategies aimed at improving prognosis for patients with such injuries.

PMID:40789237 | DOI:10.1016/j.injury.2025.112666

Injury. 2025 Jul 15;56(10):112616. doi: 10.1016/j.injury.2025.112616. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic posttraumatic sequelae, such as chronic ankle joint infection with loss of the articular cartilage, significant ankle deformities with advanced osteoarthritis, or significant bone loss of the distal tibia or talus, cause chronic ankle pain and functional impairment. Arthrodesis is usually required to relieve pain and improve function. These disabling conditions cannot be treated with ordinary arthrodesis methods, particularly if they are associated with severe osteoporosis and/or poor soft-tissue coverage. The present study aimed to report the outcomes and complications of ankle arthrodesis with circular external fixators in patients with end-stage, posttraumatic ankle arthritis, infection, and/or bone loss.

METHODS: Patients treated with tibiotalar and tibiocalcaneal fusion for posttraumatic sequelae using the circular external fixator between January 2001 and January 2022 were retrospectively reviewed. The outcomes were evaluated using the Catagni tibiotarsal fusion score, and the complications were recorded.

RESULTS: The study included 81 consecutive patients; 58 were males, and 23 were females. The mean age of the patients was 41.52 years (range, 18-75). Successful arthrodesis was obtained in 73 patients (90.1 %). Twenty-four patients (29.6 %) developed complications. Most complications were minor except for unacceptable deformity in four patients, refracture of the arthrodesis site in one patient, and failure of arthrodesis in seven patients. At the final evaluation, the mean Catagni Score was 85.4 (range, 52-96). Fifty-eight patients achieved excellent results, 13 patients achieved good results, two patients achieved fair results, and eight patients achieved poor results. Higher Catagni scores were associated with patients without pre-operative infection, with union, without unplanned additional surgical procedures, without complications, and with better final results (all p < 0.001). In the multivariate regression analyses, we observed that the Catagni score tends to decrease as patient age increases (p = 0.010). Catagni scores of the anterior arthrodesis position were higher than the cases of the sinus tarsi position (p < 0.001).

CONCLUSION: Tibiotarsal arthrodesis with the circular external fixator can effectively treat complex ankle joint problems resulting from severe injuries. The Catagni score is a simple and reliable evaluation score after tibiotarsal arthrodesis surgeries.

PMID:40784318 | DOI:10.1016/j.injury.2025.112616

Injury. 2025 Jul 27:112631. doi: 10.1016/j.injury.2025.112631. Online ahead of print.

ABSTRACT

BACKGROUND: The reverse sural artery flap (RSAF) was reported to be a less technically demanding method for the coverage of defects in the distal lower leg, which can be elevated with short operative times. However, several studies pointed out the high frequency of partial necrosis in patients with comorbidities, which was primarily attributed to inadequate venous drainage. To overcome this challenge, we hypothesized that venous supercharging could effectively alleviate congestion of RSAF, potentially minimizing partial necrosis and related complications not only in healthy patients but also in comorbid patients.

METHODS: A single-center retrospective observational study was conducted. We reviewed patients with severe limb trauma who underwent RSAF for soft tissue defects on the distal lower legs, ankles, and feet from 2009 to 2022. All flaps were performed within 2 months of the injuries. Patients were divided into the Supercharge group and the Control group based on the presence of supercharge. The flap necrosis, major and minor complications, and nonunion were compared between the two groups. Additionally, these outcomes were also evaluated among high-risk patients with at least one comorbidity, including diabetes mellitus, peripheral arterial disease, venous insufficiency, advanced age over 50 years, or history of smoking.

RESULTS: A total of 30 patients including 16 males met the criteria, with 9 cases in the Supercharge group and 21 cases in the Control group. The Supercharge group decreased the frequencies of overall necrosis (11 % vs 71 %) as well as wound dehiscence (22 % vs 67 %). The Supercharge group also exhibited a relatively lower frequency of major complications (0 % vs 29 %) and minor complications (0 % vs 33 %) compared to the Control group. Among 21 high-risk patients with 7 supercharged cases and 14 control cases, supercharging decreased overall necrosis (14 % vs 71 %) and relatively suppressed major and minor complications (both of them: 0 % vs 36 %).

CONCLUSION: Venous supercharging of RSAF decreased the overall necrosis, potentially enhancing its clinical utility even in high-risk patients. Supercharged RSAF can be a valuable option as initial flap reconstruction for traumatic distal limb defects.

PMID:40783329 | DOI:10.1016/j.injury.2025.112631

Injury. 2025 Jul 27:112632. doi: 10.1016/j.injury.2025.112632. Online ahead of print.

NO ABSTRACT

PMID:40783328 | DOI:10.1016/j.injury.2025.112632

Injury. 2025 Aug 7:112651. doi: 10.1016/j.injury.2025.112651. Online ahead of print.

ABSTRACT

INTRODUCTION: The delivery of optimal trauma care requires an interdisciplinary team approach. However, the composition of these teams often varies across health services and systems. Moreover, different models of care exist which impact the way trauma teams operate, including consultative models and admitting models. This study aimed to explore contextual factors (e.g., barriers and facilitators) influencing trauma service model optimisation, propose strategies to address the factors, and understand implementation outcomes of the model.

METHODS: Staff and patients within a large public, major trauma referral centre with statewide outreach were interviewed, and data were analysed using a hybrid qualitative inductive and deductive design. The predominantly inductive approach used interpretive description methodology to produce a narrative and themes related to the interviews. The deductive approach used the Consolidated Framework for Implementation Research (CFIR 2.0) to understanding the influence of multi-level factors on implementation, and mapped data to five implementation outcomes. Finally, strategies addressing the factors were mapped to the nine domains of Expert Recommendations for Implementing Change (ERIC) to inform future research and service redesign.

RESULTS: Twelve staff and six patient interviews were conducted. 'Connecting with people' was a concept that underpinned all three themes of caring for the patient as a whole person; coming together to create a cohesive team identity; and securing a place in the bigger health system. The findings suggest that the Trauma Service improved continuity and enabled patient-centred care, but its perceived effectiveness was hindered by hospital attitudes, leadership changes, staff shortages, and dependence on key individuals. Participants highlighted acceptability and sustainability as key implementation outcomes, with patients viewing the Trauma Service positively while staff had mixed opinions. Fourteen implementation strategies were identified, including restructuring the Trauma Service for continuity of care, pre-planning with stakeholders, using cohorted trauma wards and advocating for funding to ensure sustainability.

CONCLUSIONS: The themes highlighted that optimal trauma care delivery is focussed on connecting with people; recognising and caring for the trauma patient as a whole person; and knowing individual and collective strengths. The findings may have implications for designing or redesigning similar trauma services in the future by ensuring external and internal risks to service provision are mitigated.

PMID:40783327 | DOI:10.1016/j.injury.2025.112651

Injury. 2025 Aug 7;56(10):112647. doi: 10.1016/j.injury.2025.112647. Online ahead of print.

ABSTRACT

BACKGROUND: Acute extensor tendon injuries of the hand, commonly managed by plastic surgeons, require timely repair to optimize outcomes. This study evaluates the functional results, complications, and patient-reported outcomes of acute extensor tendon repairs performed in an outpatient setting using the Wide Awake Local Anaesthetic No Tourniquet (WALANT) technique in Northern Ireland.

METHODS: A retrospective service evaluation analyzed 222 patients undergoing extensor tendon repair between 2018 and 2023. Inclusion criteria were adults (>18 years) with open injuries repaired via sutures. Exclusions included partial tears, fractures, and chronic injuries. Primary outcomes included Total Active Motion (TAM) and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores. Secondary outcomes were infection, rupture rates, and grip strength.

RESULTS: Mean age was 41 years, with 72.5 % males and 54.1 % non-dominant hand injuries. Mechanisms included lacerations (64 %), crush injuries (22 %), and avulsions (14 %). TAM was comparable across injury zones (Verdan classification), though distal zones (e.g., Zone 1) showed ∼30° lower TAM. PRWHE scores (mean: 8.2/50) indicated minimal pain/functional disability. Complications included two superficial infections (0.82 %) and one re-rupture (0.41 %). Grip strength matched normative values. Controlled Active Motion (CAM) rehabilitation yielded satisfactory outcomes, with proximal zones (Zones 7-8) associated with poorer PROMs.

CONCLUSION: Outpatient extensor tendon repair under WALANT is safe and effective, with low complication rates and favorable functional outcomes. Timely repair (<3 days), meticulous technique, and CAM rehabilitation contributed to success, supporting cost-effective management outside main operating theatres. Proximal injuries and rehabilitation protocols warrant further optimization. This study addresses a regional literature gap, advocating for prospective research to refine surgical and therapeutic strategies.

THERAPEUTIC LEVEL: IV.

PMID:40782631 | DOI:10.1016/j.injury.2025.112647

Injury. 2025 Jul 29;56(10):112634. doi: 10.1016/j.injury.2025.112634. Online ahead of print.

ABSTRACT

PURPOSE: Malrotation of the radius following a shaft fracture can lead to persistent pain, limited motion, and adjacent joint instability. This study aimed to evaluate radial torsion patterns by specific location.

METHODS: We included 50 patients with uninjured radii on computed tomography (CT). The torsion measuring zone (TMZ), defined along the longitudinal axis from just proximal to the watershed line to the distal end of the radial tuberosity, was divided into 3 mm intervals, generating cross-sectional images for torsion evaluation. Distal and proximal 30 mm segments were defined as distal end zone (DEZ) and proximal end zone (PEZ), respectively. The area with the largest 30 mm angular difference in distal half was designated the distal shaft torsion zone (DSTZ). The area between the proximal end of DSTZ and distal end of PEZ was the mid-shaft zone (MSZ). Angle change rate was evaluated in each zone, with the DSTZ compared to DEZ, MSZ, and PEZ.

RESULTS: The cohort included 27 men and 23 women, mean age of 54.8 ± 19.6 years. TMZ length was 160.5 ± 16.3 mm, with torsion angle of 49.8 ± 13.3° The angle change rate was 4.6 ± 1.9°/cm in the DEZ and 5.1 ± 3.3°/cm in the PEZ. The centre of the DSTZ was 4.8 ± 1.4 cm from distal end, with an angle change rate of 6.5 ± 1.8°/cm. The MSZ length was 6.7 ± 1.7 cm, with angle change rate of 0.3 ± 1.6°/cm. DSTZ showed significantly higher angle change rates compared to DEZ (P < 0.001) and MSZ (P < 0.001).

CONCLUSION: The DSTZ, located about 5 cm from the distal end, exhibited the most significant torsion, while the MSZ showed minimal torsion. Recognising these torsion patterns will guide proper plate positioning and prevent iatrogenic malrotation during plate osteosynthesis for radius shaft fracture.

PMID:40774028 | DOI:10.1016/j.injury.2025.112634

Injury. 2025 Jul 28;56(10):112624. doi: 10.1016/j.injury.2025.112624. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to utilize a large national database to evaluate short- and long-term outcomes of acute management of proximal humerus fractures (PHF) with reverse total shoulder arthroplasty (RSA) compared to open reduction internal fixation (ORIF).

METHODS: The TriNetX platform was utilized to perform a retrospective review of patients who sustained PHFs treated within three weeks of injury. Patients were identified using Current Procedural Terminology codes and the International Classification of Disease diagnosis codes. The cohorts were 1:1 propensity matched. Patients who received RSA were propensity matched to patients who underwent ORIF. Short-term and long-term outcomes were compared across the cohorts across various post operative periods. Kaplan Meier survival analysis was used to analyze implant survival rate and Cox hazard ratio was used to identify risk factors of re-operation.

RESULTS: Following propensity matching, each cohort included 2733 patients with an average age of 71±9.5. Patients treated with ORIF were more likely to have a re-operation or hospital admission than patients who underwent RSA at both 1 and 2 year follow up (5.5 % vs 2.1 %; p < 0.001; 6.9 % vs 2.6 %, p < 0.001 and 13.7 % vs 11.3 %, p = 0.01; 19.6 % vs 16.4 %, p = 0.003). At two year follow up, 173 patients treated with ORIF had a re-operation of which 60 (35 %) were converted to arthroplasty. On Kaplan Meier survival analysis for re-operation, both implants had satisfactory survival rates at both one and two year time point with survival rates over 90 %. However, there was a difference between survival rates at both one and two years between the ORIF and RSA groups (94 % vs 98 %, p < 0.0001; 91 % vs 97 %, p < 0.0001). For ORIF, patients with four part PHF and osteoporosis had a 39 % and 19 % increased risk of re-operation (p < 0.001; p = 0.03).

CONCLUSION: While both ORIF and RSA have been shown to be acceptable techniques for managing PHFs in the elderly, ORIF had a significantly higher re-operation and hospital readmission rate at mid- and long-term follow up. Additionally, a large portion of patients undergoing re-operation following ORIF were converted to shoulder arthroplasty although acute RSA has superior outcomes compared to delayed RSA. Therefore, for operative elderly candidates we advocate for the use of RSA in three- and four-part PHFs.

PMID:40763431 | DOI:10.1016/j.injury.2025.112624

Injury. 2025 Jul 27;56(10):112626. doi: 10.1016/j.injury.2025.112626. Online ahead of print.

ABSTRACT

Burn injuries result in profound and enduring consequences that extend well beyond the initial physical trauma. Although survival rates have significantly improved in recent decades, particularly in high-income countries, many survivors continue to experience complex psychological and social challenges that persist long after discharge from hospital care. This review outlines the current understanding of the psychological and social impacts of burn injuries and highlights key strategies to support survivors and their families through each stage of recovery. Common psychological concerns include post-traumatic stress, anxiety, depression, and disruptions to self-perception. These issues frequently emerge early in the recovery process and may endure for several years, influencing daily functioning, interpersonal relationships, and the ability to return to work. Caregivers are also affected, often experiencing emotional fatigue and psychological strain, particularly when access to support services is limited. Reintegration into everyday life is frequently marked by social stigma and exclusion, with children and adolescents being especially vulnerable due to ongoing identity development. Holistic recovery requires more than physical rehabilitation; it requires a coordinated, multidisciplinary approach that incorporates psychological support, social reintegration, and long-term follow-up. Interventions such as cognitive-behavioural therapy, peer and family support programs, and digital health platforms have shown promise in addressing these needs. While some individuals report personal growth following burn trauma, outcomes are influenced by various factors, including mental health history, community context and available support. Psychosocial care must be responsive to cultural and developmental differences and accessible across diverse settings. Innovations such as virtual reality and telehealth are increasingly valuable in bridging service gaps, particularly for individuals in rural or underserved areas.

PMID:40753695 | DOI:10.1016/j.injury.2025.112626

Injury. 2025 Jul 29;56(10):112635. doi: 10.1016/j.injury.2025.112635. Online ahead of print.

ABSTRACT

INTRODUCTION: The far cortical locking (FCL) system reduces axial stiffness in locked plating constructs while maintaining construct strength, thereby promoting secondary bone healing following fracture fixation. However, studies evaluating its efficacy compared with standard locked plating (LP) systems for upper extremity fractures remain limited. This study compared humeral shaft fractures treated with minimally invasive plate osteosynthesis (MIPO) using either the FCL or LP system.

MATERIALS AND METHODS: We analyzed 40 patients with diaphyseal humeral fractures treated with MIPO using either FCL or LP and conducted a matched-pair comparative analysis. Prospective data were collected from 20 consecutive patients who underwent MIPO with FCL. A matched case-control cohort was constructed by pairing MIPO cases using LP with the most closely matched FCL cases. The primary outcome was a comparison of radiographic and clinical fracture healing, as well as complications, between the two groups using statistical analysis. Statistical significance was set at p < 0.05.

RESULTS: Union was achieved in 18 of 20 cases (90 %) in the FCL group at a mean of 13.6 weeks. All 20 cases in the LP group achieved union after a mean of 20.1 weeks. Time to union was significantly shorter in the FCL group (p < 0.05), though the union rate did not differ significantly (p = 0.49). Near cortex healing occurred at a mean of 11.2 weeks in the FCL group and 18.8 weeks in the LP group (p < 0.01). Two FCL cases required revision surgery due to screw breakage or pull-out at the proximal fracture segment. Mean coronal and sagittal angulations were 2.9° and 4.8° in the FCL group, and 2.4° and 3.3° in the LP group, with no significant differences (p = 0.60 and 0.24). No significant differences in functional outcomes were observed between the groups.

CONCLUSIONS: The FCL group showed significantly faster union compared to the LP group, but no significant differences in union rate, alignment, or functional outcomes. Although not statistically significant, a 10 % complication rate was observed in the FCL group. Caution is warranted, as FCL screws may fail at the proximal fracture segment, either by breakage due to mechanical overload or by pull-out.

PMID:40753694 | DOI:10.1016/j.injury.2025.112635

Injury. 2025 Jul 24;56(10):112621. doi: 10.1016/j.injury.2025.112621. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate and compare the medium- to long-term outcomes of the Femoral Neck System (FNS), FNS combined with the Anti-Rotation Screw (ARS), and Multiple Cancellous Screws (MCS) in the treatment of femoral neck fractures in young and middle-aged patients.

METHODS: A retrospective, multi-group comparative cohort study was conducted on 731 young and middle-aged patients with femoral neck fractures treated at Level I Trauma Center between September 2019 and January 2024. Patients were divided into three groups based on the surgical method: FNS group (327 cases), FNS+ARS group (120 cases), and MCS group (284 cases). Postoperative follow-up assessments included fracture healing time, functional scores (Harris Hip Score [HHS], Oxford Hip Score [OHS], Hip Outcome Score [HOS]), and complication rates (femoral neck shortening, femoral head necrosis, nonunion, and implant-related complications).

RESULTS: Key findings demonstrated the FNS+ARS group achieved significantly faster fracture healing (10.21 ± 1.33 weeks) versus FNS (12.52 ± 1.91) and MCS (13.57 ± 2.13 weeks; P = 0.036). Functional outcomes consistently favored FNS+ARS across all timepoints:3 months: HHS (61.54 ± 2.98 vs 58.15 ± 2.34 vs 54.43 ± 2.79, P < 0.001), OHS (37.19 ± 2.35 vs 43.20 ± 2.91 vs 42.89 ± 3.00, P < 0.001), HOS (33.59 ± 2.39 vs 32.21 ± 2.32 vs 30.39 ± 2.72, P < 0.001);6 months: HHS (87.35 ± 5.58 vs 81.95 ± 5.99 vs 76.54 ± 5.45, P < 0.001), OHS (22.66 ± 2.78 vs 25.96 ± 3.64 vs 27.66 ± 4.81, P < 0.001), HOS (76.02 ± 5.47 vs 75.42 ± 7.63 vs 73.38 ± 6.75, P < 0.001);Final follow-up: HHS (91.95 ± 9.06 vs 90.38 ± 11.21 vs 87.67 ± 11.71, P < 0.001), OHS (21.04 ± 8.71 vs 20.41 ± 7.88 vs 23.40 ± 10.18, P < 0.001), HOS (87.51 ± 12.93 vs 85.84 ± 16.22 vs 85.98 ± 15.00, P < 0.001);Complication rates were significantly lower with FNS+ARS, particularly for femoral neck shortening (2.50 % vs 8.87 % vs 5.28 %; P = 0.031) and avascular necrosis (6.67 % vs 10.92 %; P = 0.040).

CONCLUSION: FNS combined with ARS outperformed FNS and MCS in promoting fracture healing, reducing postoperative complication rates, and accelerating functional recovery.

PMID:40752181 | DOI:10.1016/j.injury.2025.112621

Injury. 2025 Jul 28:112625. doi: 10.1016/j.injury.2025.112625. Online ahead of print.

ABSTRACT

INTRODUCTION: Uncontrolled rib fracture pain can lead to hypoventilation, impaired airway clearance, and progression to respiratory failure and death. Pain control is a mainstay of treatment, but pain assessments are most commonly obtained while a patient is at rest. A novel approach is to assess movement-evoked pain in order to better capture pain that limits physical function. We hypothesized that movement-evoked pain scores (MPS) for patients with rib fractures would be higher than resting pain scores (RPS) and would better correlate with opioid administration.

METHODS: A retrospective observational study was performed at a single Level 1 trauma center. Adult trauma patients (≥18 years old) admitted between January and March of 2022 with at least one rib fracture were included. Patients with other significant injuries (non-chest AIS >2) or those unable to self-report pain scores were excluded. Pain was scored on a 0-10 scale, with 10 indicating the most severe pain. RPS and MPS obtained at the same time during the first ten hospital days were averaged, and the means were compared using paired t-tests. Additionally, mean daily morphine milligram equivalents (MME) were analyzed.

RESULTS: The cohort consisted of 80 patients (median age 69 [IQR 48-79]; 65 % male; 88 % white). The majority were involved in blunt trauma (95 %) with a median length of admission of 4 days (IQR 2-8). The median number of rib fractures was 4 (IQR 2-6), and the median injury severity score was 10 (IQR 9-14). A total of 1692 paired pain scores from 416 patient hospital days were analyzed with higher mean daily MPS across all hospital days (p < 0.001). MPS and RPS differed for 79 % of patient hospital days, with a mean difference of 2.3 (SD 1.4, p < 0.001). Higher mean daily MPS were correlated with higher mean daily opioid use (R2=0.54), and days with differing scores had higher mean MME [42.5 (SD 49.6) vs 23.6 (56.1)].

CONCLUSIONS: Resting and movement-evoked pain scores for patients with rib fractures varied significantly, and movement-evoked pain scores were consistently higher. Opioid use was positively correlated with movement-evoked pain scores. Utilization of movement-evoked pain scores may improve patient pain control and outcomes.

PMID:40750533 | DOI:10.1016/j.injury.2025.112625

Injury. 2025 Jul 27:112628. doi: 10.1016/j.injury.2025.112628. Online ahead of print.

NO ABSTRACT

PMID:40750532 | DOI:10.1016/j.injury.2025.112628

Injury. 2025 Jul 16:112617. doi: 10.1016/j.injury.2025.112617. Online ahead of print.

ABSTRACT

OBJECTIVE: Electrical burn injuries associated with copper wire theft represent a unique and dangerous subset of injuries observed in clinical practice. Economic hardship and the high value of copper wires drive some individuals to engage in the risky act of scavenging wires, often cutting them directly from live electrical poles. This study aims to investigate the prevalence and clinical outcomes of electrical burn injuries resulting from copper wire theft.

METHODS: This retrospective analysis reviewed medical records of patients presenting with electrical burns caused by contact with live electrical wires in urban settings. Cases were included if patient histories, eyewitness accounts, or police reports confirmed illegal wire cutting as the cause of injury. Data collected included demographic information, total body surface area (TBSA) burned, associated injuries such as fractures and amputations, creatine kinase (CK) levels, and mortality outcomes.

RESULTS: Thirty-six patients were included, with an average age of 27.72 (14.58) years, the majority of whom were male (97 %). The mean TBSA burned was 16.19 %. Fractures were reported in 22 patients (61 %), and 10 patients (28 %) underwent amputations of digits or limbs. Eight individuals (22 %) did not survive their injuries. Statistical analysis revealed a significant relationship between mortality and factors such as TBSA (P = 0.0001), amputation (P = 0.0001), CK levels, and ICU length of stay (P = 0.0001). Additionally, elevated CK levels were strongly correlated with longer ICU stays (P = 0.0001).

CONCLUSION: Electrical burn injuries linked to copper wire theft are severe and frequently lead to debilitating outcomes such as amputations, fractures, and high mortality rates. These injuries highlight the intersection of economic desperation and public health risk. Preventive efforts should prioritize educational campaigns, socio-economic interventions, and stringent measures to deter copper wire theft.

PMID:40744782 | DOI:10.1016/j.injury.2025.112617

Injury. 2025 Jul 27:112630. doi: 10.1016/j.injury.2025.112630. Online ahead of print.

ABSTRACT

BACKGROUND: Ideal blood transfusion practices have evolved over the last decade, with updated recommendations for the plasma:red blood cell (RBC) ratio. A ≥ 1:1 ratio of plasma:RBC has been associated with improved survival. The objective of the current study was to evaluate interhospital variation in plasma:RBC ratio and the associated inpatient mortality.

METHODS: All adult patients (≥18 years) with severe injuries undergoing transfusion within 4 hours of admission were identified in the 2020-2021 Trauma Quality Improvement Program database. Transfusion was considered balanced when whole blood or a ≥ 1:1 ratio of plasma:RBC units was administered. Multilevel mixed-effects models were utilized to generate empirical Bayesian estimates of random intercepts for risk-adjusted plasma:RBC ratio at each center, with centers in the highest quartile labeled High-Ratio Centers (HRC). Multivariable logistic regression was constructed to identify factors independently associated with mortality.

RESULTS: Of 35,215 patients receiving care across 424 facilities, 38.0% were admitted to HRC. An estimated 17% of plasma:RBC variation was attributable to hospital effects (intraclass correlation coefficient = 0.17). Following risk-adjustment, HRC (Adjusted Odds Ratio [AOR] 0.81, 95% Confidence Interval [CI] 0.76-0.86) and balanced transfusion (AOR 0.92, 95%CI 0.86-0.98) were associated with reduced odds of mortality. The association of HRC with lower odds of mortality persisted when examining only unbalanced transfusions (n = 28,280, AOR 0.84, 0.78-0.90 95%CI).

DISCUSSION: Care at centers with high plasma:RBC ratios was linked to reduced mortality, even among unbalanced transfusion. Our findings demonstrate the utility of this value as a hospital quality metric.

PMID:40744781 | DOI:10.1016/j.injury.2025.112630

Injury. 2025 Jul 26:112629. doi: 10.1016/j.injury.2025.112629. Online ahead of print.

NO ABSTRACT

PMID:40744780 | DOI:10.1016/j.injury.2025.112629