Injury. 2026 Feb 27;57(4):113126. doi: 10.1016/j.injury.2026.113126. Online ahead of print.

NO ABSTRACT

PMID:41764816 | DOI:10.1016/j.injury.2026.113126

Injury. 2026 Feb 16;57(4):113112. doi: 10.1016/j.injury.2026.113112. Online ahead of print.

ABSTRACT

BACKGROUND: Polytrauma requiring intensive care remains a leading cause of morbidity and mortality, particularly among patients with orthopedic injuries. Despite advances in trauma systems and surgical management, outcomes for this cohort are influenced by complex interactions between injury burden, physiological status, and pre-existing comorbidities. There remains limited evidence focused specifically on predictors of outcome within orthopedic trauma patients admitted to the intensive care unit (ICU).

METHODS: This retrospective cohort study analyzed all adults (≥18 years) admitted with orthopedic trauma to the ICU of a major Irish tertiary trauma centre between January 2011 and December 2020. Orthopedic injuries included fractures, dislocations, or musculoskeletal trauma requiring specialist management. Demographic, clinical, and injury-related data were extracted from institutional databases. Outcomes assessed were 30-day, 90-day, and 1-year mortality, complication burden (graded by the Adapted Clavien-Dindo in Trauma [ACDiT] score), and discharge destination. Multivariate regression was used to identify independent predictors of adverse outcomes.

RESULTS: Of 720 trauma patients admitted to the ICU over 10 years, 458 with orthopedic injuries were included. The mean age was 56.2 years; 63.8 % were male, and two-thirds had at least one comorbidity. The most common mechanisms were low-level falls and road traffic accidents. The median Injury Severity Score was 16, and 23.4 % required mechanical ventilation. One-year survival was 79.7 %. Key predictors of mortality and complications included advanced age, cervical spine injury, lower Glasgow Coma Scale, higher ASA and ISS, mechanical ventilation, malignancy, and polytrauma. Most patients returned home at discharge, though a significant minority required institutional care or died in-hospital.

CONCLUSIONS: Orthopedic polytrauma patients admitted to ICU represent a high-risk group with substantial mortality and complication rates, particularly among the elderly and those with severe physiological compromise. Early identification of prognostic factors such as age, ISS, GCS, ASA, and need for ventilation may inform tailored management strategies and support improved risk stratification in this vulnerable population.

PMID:41764815 | DOI:10.1016/j.injury.2026.113112

Injury. 2026 Feb 21;57(4):113130. doi: 10.1016/j.injury.2026.113130. Online ahead of print.

ABSTRACT

BACKGROUND: Rigid intramedullary (IM) fixation is avoided in skeletally immature patients because of the risk of physeal injury, causing subsequent growth disturbances. However, with the increasing numbers of high-energy injuries and complex fractures in older adolescents, suprapatellar rigid IM nailing (RIMN) has emerged as an alternative. This study evaluated whether RIMN in skeletally immature adolescents results in coronal or sagittal deformities and to evaluate the clinical outcomes.

METHODS: We retrospectively reviewed skeletally immature patients who underwent suprapatellar RIMN for tibial shaft fractures between January 2014 and October 2024. The inclusion criteria were an open proximal tibial physis, a diaphyseal fracture pattern, and > 12-month follow-up. Radiographic parameters, including the mechanical medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA), were measured twice on standardized anteroposterior and lateral radiographs by a single senior pediatric orthopaedic surgeon. Malalignment was defined as a deviation greater than 5° in the coronal plane or 10° in the sagittal plane relative to the contralateral side. Discrepancies in limb length were considered significant when exceeding 2 cm. Statistical comparisons between the immediate postoperative and final radiographs were performed using the paired t-test and equivalence test.

RESULTS: Twenty-four patients (mean age 15.9 ± 1.3 years) were included, and 17 (70.8%) were classified as having proximal tibial ossification stage III and seven (29.2%) as stage II. All fractures achieved union at a mean of 14.3 ± 5.3 weeks. No significant changes were observed in MPTA or PPTA. Two patients with open fractures developed nonunion requiring secondary surgery. Mild anterior knee pain occurred in ten patients (41.7%) without activity limitation, and four (16.7%) experienced compartment syndrome requiring fasciotomy. No patient demonstrated coronal or sagittal deformity, limb-length discrepancy, or growth disturbance.

CONCLUSIONS: Although physeal preservation remains fundamental in pediatric fracture management, suprapatellar RIMN can provide stable fixation and satisfactory outcomes in adolescents nearing skeletal maturity. For selected patients in whom plating or flexible nailing are suboptimal, rigid IM fixation represents a reasonable alternative.

LEVEL OF EVIDENCE: Level IV, retrospective cohort study.

PMID:41764814 | DOI:10.1016/j.injury.2026.113130

Injury. 2026 Feb 19;57(4):113124. doi: 10.1016/j.injury.2026.113124. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic distal femoral fractures after total knee arthroplasty (TKAPF) are challenging in very elderly patients. This study aimed to identify the incidence and risk factors for post-operative complications in patients aged over 80 years surgically treated for these fractures.

METHODS: A multicentre SOFCOT database (2012-2019) was analyzed. Patients aged >80 years with TKAPF were compared to a < 80 control group. Outcomes included complications, reoperation, mortality, and operative delay. Multivariable logistic regression was used to identify independent risk factors for reoperation and mortality.

RESULTS: Among 376 patients aged >80 (mean age 87.5 ± 4.4 years; 87.5% female), 359 patients (95.5%) were surgically treated, the reoperation rate was 10.0%, the complication rate was 19.5%, and mortality at two-year follow-up reached 29.5%. Mortality was independently associated with ASA score (p = 0.0096), but not with age, fracture pattern, or surgical approach. Operative delay (mean 2.9 days) had no impact on mortality or reoperation but was associated with more infections and implant loosening (p < 0.001).

CONCLUSIONS: In patients over 80 years, systemic frailty, reflected by ASA score, was the main determinant of mortality, while delayed surgery (>72 h) increased local complications, supporting an individualized surgical approach, based on general conditions rather than fracture morphology or surgical preference.

PMID:41762854 | DOI:10.1016/j.injury.2026.113124

Injury. 2026 Feb 21;57(4):113122. doi: 10.1016/j.injury.2026.113122. Online ahead of print.

ABSTRACT

INTRODUCTION/OBJECTIVES: Increased BMI has been linked to increased risk of meniscal tears, yet outcomes following meniscus repair in these patients remain unclear. This study aims to compare post-traumatic meniscus repair failure rates and return to sport outcomes in pediatric and adolescent populations based on weight, BMI, BMI percentile, and CDC BMI Category.

METHODS: This retrospective cohort study included patients aged <19 years who underwent meniscus repair at our multi-center institution between 2017 and 2023, including both isolated and concomitant repairs. The primary outcome was meniscus repair failure, defined as clinical, radiographic, and/or intraoperative evidence of meniscal pathology, or the need for additional surgical intervention at the meniscus. Secondary outcomes included Return to Sport (RTS) and Return to Sport at Pre-Injury Level (RTSPIL). An analysis of outcomes by weight, BMI, BMI percentile, and weight category was performed.

RESULTS: 203 patients were included (54.0% female, mean age 15.7 ± 1.7 years, weight 69.8 ± 19.7 kg, and BMI 24.3 ± 5.5 kg/m²), with a mean follow-up of 23.3 ± 13.9 months. Overall repair failure rate was 24.6%. Patients with meniscus failure were significantly heavier (p < .05) with higher BMIs (p < .001) than those without, but they did not differ in BMI percentile (p = .10). There were no significant differences in weight, BMI, or BMI percentile for those who failed to RTS or RTSPIL, compared to those who successfully returned. Increasing BMI categories showed higher rates of failure, failure to RTS, and failure to RTSPIL. Meniscus failure and failure to RTS did not vary based on age, follow-up, or gender.

CONCLUSIONS: This study identifies elevated rates of meniscal repair failure in pediatric and adolescent patients who have increased weight and BMI. Notably, this association was not demonstrated for BMI percentile. None of these measures predicted return to sport, suggesting functional recovery depends on factors beyond body composition. Thus, surgeons must retain a heightened clinical awareness and perform close postoperative monitoring following meniscus repair in patients with elevated weight and BMI.

LEVEL OF EVIDENCE: III, Retrospective Cohort.

PMID:41762853 | DOI:10.1016/j.injury.2026.113122

Injury. 2026 Feb 16:113106. doi: 10.1016/j.injury.2026.113106. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe the outcomes of a protocol using ultrasound-guided pericardiocentesis with pericardial drain placement as definitive treatment for penetrating cardiac injury with tamponade in a resource-limited war zone setting, where emergency thoracotomy is often unavailable.

DESIGN: Single-center prospective case series.

SETTING: Nasser Medical Complex, a major tertiary trauma center in southern Gaza, over a period of 24 months during active conflict.

PARTICIPANTS: 25 patients (21 male, 4 female), aged 4-65 years, not in cardiac arrest, with traumatic pericardial effusions and hematoma caused by penetrating injury presenting within approximately 3 hours.

INTERVENTIONS: Ultrasound-guided pericardiocentesis via a large-bore 16 gauge dialysis catheter, aggressive aspiration of fresh blood, instilling 1 gram of intrapericardial tranexamic acid (TXA) and pericardial drain placement for 48 hours with serial echocardiographic monitoring.

MAIN OUTCOME MEASURES: Survival to hospital discharge, need for subsequent thoracotomy and complications.

RESULTS: This study demonstrated a high survival rate of 96%, with 24 out of 25 patients surviving to hospital discharge (the sole non-survivor died from other injuries). The protocol successfully prevented the need for thoracotomy in 100% of cases, establishing it as a definitive treatment. A recurrence rate of 8% was observed, requiring repeat drainage in two patients, while follow-up was maintained for 83% of survivors.

CONCLUSIONS: In a warzone setting, a protocol of pericardiocentesis with pericardial drain placement and intrapericardial TXA served as definitive management for selected patients with penetrating cardiac tamponade, resulting in high survival and avoiding the need for thoracotomy. This approach challenges current practice and offers a life-saving alternative in resource-constrained environments.

PMID:41760498 | DOI:10.1016/j.injury.2026.113106

Injury. 2026 Feb 13;57(4):113100. doi: 10.1016/j.injury.2026.113100. Online ahead of print.

ABSTRACT

INTRODUCTION: Transporting injured patients to an appropriate level of care remains a complex challenge. In our trauma system, paramedics are mostly limited to basic life support and perform field triage guided by an algorithm that considers the type of injury and the estimated transport time to a Level 1 Trauma Center (L1TC). This study evaluates the effect of this triage protocol by comparing patient mortality between those transported directly to a L1TC and those initially transferred from another facility.

METHODS: This retrospective study queried a Canadian L1TC trauma registry, which included all adult trauma patients who were admitted or died in the emergency department, between 2016 and 2022. Isolated burns, hanging, isolated hip fractures, arrival ≥ 72 h post-injury, death within 2 h of arrival at L1TC, or direct ward admissions were excluded from the study. We used multivariable logistic regression to compare in-hospital mortality between direct transport and interfacility transfer cohorts. Sensitivity and subgroup analyses were performed to further aid in refining triage criteria.

RESULTS: Of 9488 registry patients, 1645 were excluded, leaving 4702 direct transports and 3141 interfacility transfers. Transferred patients were younger (median 59 vs. 67 years, p < 0.001), more severely injured (44.1 % vs 31.1 % ISS>15, p < 0.001) and had longer times to definitive care (9.32 h vs 1.15 h, p < 0.001). Overall, interfacility transfer was associated with a decreased odds of in-hospital mortality [aOR 0.54 (95 % CI 0.42-0.69)]. However, in our sensitivity and subgroup analyses, interfacility transfer was associated with an increased odds of mortality [aOR 4.17 (95 % 1.02-17.1)] if time to definitive care was <1 h.

CONCLUSION: The application of a provincial prehospital triage criteria translates to improved survival for select patients through interfacility transfers. However, our results support direct transport to a L1TC if the time to definitive care can be achieved within an hour. These findings should be used to further refine prehospital triage protocols and interfacility transport policies.

PMID:41759436 | DOI:10.1016/j.injury.2026.113100

Injury. 2026 Feb 22;57(4):113129. doi: 10.1016/j.injury.2026.113129. Online ahead of print.

ABSTRACT

BACKGROUND: Nutritional Vulnerability may increase complications and reintervention after calcaneus fracture care. This study compared 90-day and 2-year outcomes among malnourished adults treated with closed management, percutaneous fixation, or open reduction and internal fixation (ORIF).

METHODS: Adults (≥18 years) with calcaneus fracture and laboratory-defined nutritional vulnerability (albumin ≤3.5 g/dL and/or leukocytes ≤1.5 × 10³/µL within 1 year pre-index) were identified. Three independent 1:1 propensity score-matched comparisons were performed (closed vs ORIF, percutaneous vs ORIF, and closed vs percutaneous). Outcomes were assessed at 90 and 730 days.

RESULTS: Matched cohorts included 981 per group (closed vs ORIF), 403 per group (percutaneous vs ORIF), and 386 per group (closed vs percutaneous). At 90 days, closed treatment had higher acute respiratory failure/mechanical ventilation than ORIF (11.5% vs 7.7%, P=.005); otherwise no differences were detected. Percutaneous fixation had lower wound disruption than ORIF (6.2% vs 10.4%, P=.03) but higher acute respiratory failure/mechanical ventilation (13.4% vs 8.2%, P=.017); no differences were detected between closed and percutaneous. By 2 years, subsequent fixation was higher after closed reduction compared to ORIF (6.9% vs 3.8%, P=.002) and percutaneous vs ORIF (9.5% vs 4.0%, P=.002), and salvage procedures were lower after closed reduction compared to ORIF (2.9% vs 4.6%, P=.035); otherwise no differences were detected.

CONCLUSION: Among malnourished adults with calcaneus fracture, less invasive strategies were associated with lower short-term wound disruption compared with ORIF but higher subsequent fixation by 2 years, highlighting clinically important management tradeoffs. These findings underscore the importance of preoperative host optimization and individualized strategy selection in high-risk patients, weighing early soft-tissue morbidity against the potential need for later conversion to ORIF and downstream reintervention in routine practice.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.

PMID:41747641 | DOI:10.1016/j.injury.2026.113129

Injury. 2026 Feb 16;57(4):113107. doi: 10.1016/j.injury.2026.113107. Online ahead of print.

ABSTRACT

PURPOSE: The primary aim of this study was to present an up-to-date overview of postoperative complications during hospitalization of patients undergoing hip fracture surgery in a Western European country. The secondary aim of this study was to evaluate clinical outcomes (length of hospital stay and mortality) in relation to postoperative complications.

PATIENTS AND METHODS: A prospective proximal femoral fracture database was used to obtain data. In total, 2603 patients older than 18 years undergoing hip fracture surgery between January 2018 and January 2021 were included. Baseline characteristics, clinical outcomes and postoperative complications were retrospectively analyzed. Complications were categorized as minor or major (requiring medical intervention and prolonged hospital stay).

RESULTS: Of 2603 patients, 51% experienced at least one complication. Major complications occurred in 30% of all cases. The most frequent major complications were delirium (16%), pneumonia (9%), and urinary tract infections (UTI) (8%). Minor complications occurred in 19% of all cases. The most frequent minor complication was anemia requiring transfusion (19%). Of all major complications delirium, pneumonia, and acute kidney injury (AKI) were significantly associated with increased 30-day and 1-year mortality (p < 0.001).

CONCLUSION: Proximal femoral fractures are associated with a high overall incidence of complications. Most complications are associated with either a significantly longer hospitalization or higher 30-day and 1-year mortality rates.

LEVEL OF EVIDENCE: Level II prospective multicenter cohort study.

PMID:41747640 | DOI:10.1016/j.injury.2026.113107

Injury. 2026 Feb 18;57(4):113118. doi: 10.1016/j.injury.2026.113118. Online ahead of print.

ABSTRACT

INTRODUCTION: The axillary nerve is a crucial peripheral branch arising from the posterior cord of the brachial plexus. It provides both motor and sensory innervation to the shoulder girdle, enabling essential movements such as abduction and external rotation-functions that are crucial for daily activities and various athletic movements. Despite its significance, detailed documentation of the axillary nerve's branching patterns remains limited. This study aimed to examine the branching configurations of the axillary nerve in a South African cadaveric sample.

MATERIALS AND METHODS: Thirty adult cadavers (15 females and 15 males) were examined. To minimise the risk of damaging the axillary nerve during dissection, key surface anatomy landmarks-including the acromion and coracoid process-were identified and marked, enabling accurate location of the nerve as it traversed the deltoid muscle. Dissection followed established protocols, involving careful incision and reflection of the deltoid and pectoral muscles to expose the axillary nerve and associated neurovascular structures.

RESULTS: The study identified and classified four distinct axillary nerve branching patterns. Type 1, in which the nerve branches before entering the quadrangular space, was observed in 16.67% of cases. Type 2, characterized by branching within the quadrangular space, was noted in 18.33%. Type 3, where branching occurred after exiting the quadrangular space, was observed in 25.00%. Type 4, a combination of the previous three patterns, was the most prevalent, occurring in 40.00% of specimens. No significant differences were observed between the left and right shoulders regarding branching pattern (p = 0.9998). However, a significant difference was found in the overall distribution of branching types across all categories (p = 0.01299).

CONCLUSION: These findings suggest that the axillary nerve does not exhibit a definitive branching pattern, highlighting the anatomical complexity and variability of this structure. This underscores the need for a more nuanced and comprehensive classification system when analyzing the axillary nerve morphology.

PMID:41747639 | DOI:10.1016/j.injury.2026.113118

Injury. 2026 Feb 13;57(4):113101. doi: 10.1016/j.injury.2026.113101. Online ahead of print.

ABSTRACT

BACKGROUND: Pretibial lacerations are a common and costly injury in elderly patients. At present, no standardised evidence-based guidelines exist to aid in their management. This systematic review aims to collate and evaluate all available evidence on the assessment and management of pretibial lacerations, including outcomes such as wound healing time, complications and mortality.

METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, CENTRAL, and clinicaltrials.gov was conducted from inception to November 2024. Studies were eligible if they investigated patients with pretibial lacerations and reported at least one clinical outcome.

RESULTS: Twenty-nine studies published between 1973 and 2023 were included. This included 11 case series, 12 cohort studies and six randomised controlled trials, with a total of 2893 patients. The weighted mean age for patients was 75.4 years. For studies that reported gender data, 85.1% were female. Management strategies varied widely, with 12 studies reporting operative management, four reporting non-operative management and 13 reporting both. Operative management was associated with shorter healing times compared to non-operative management. Infection was the most common complication across both groups (0% to 63%). One month mortality rates were as high as 15%. Risk of bias was high in the majority (55%) of studies.

CONCLUSION: Considerable variability exists in the assessment and management of pretibial lacerations, with a lack of high-quality evidence to inform clinical practice. Further research is required to establish best practice for this common injury within our ageing population.

PMID:41747638 | DOI:10.1016/j.injury.2026.113101

Injury. 2026 Feb 17;57(4):113123. doi: 10.1016/j.injury.2026.113123. Online ahead of print.

ABSTRACT

Mesenchymal stromal cells (MSCs) have been used for inducing skin regeneration in patients with severe cutaneous wounds. However, transportation of these cells from cellular therapy units to hospitals is an important issue for clinical use. Several types of synthetic biomaterial scaffolds have been used for carrying different type of cells. Among them, polyethylene terephthalate (PET) scaffolds have shown that maintains the viability and biological functionality of MSCs. Here, we aimed to evaluate the viability and functionality of MSCs seeded on PET membranes, maintained under different cell culture conditions, as a possible system for cell transportation. In this work, human MSCs were seeded and cultured on PET membranes (MSCs/PET) at 37 °C or room temperature (RT) for 24 h. Adhesion, viability, proliferation, migration and multipotential differentiation were evaluated in all experimental conditions. MSCs survival, viability, proliferation and multipotential differentiation were similar on both PET membranes and plastic culture dishes, after 24 h of culture at 37 °C or RT. Microscopic observation of MSCs seeded on PET membranes or plastic culture dishes showed their characteristic fibroblastoid morphology at both temperature conditions. Our results show that PET membranes constitute an optimal scaffold for MSCs transportation. The MSCs-PET system might be used not only for transporting MSCs to health center but also as cell-based wound dressing system for inducing skin regeneration in patients with cutaneous wounds such as burned patients.

PMID:41747637 | DOI:10.1016/j.injury.2026.113123

Injury. 2026 Feb 17;57(4):113103. doi: 10.1016/j.injury.2026.113103. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFP) are increasing with the aging population and differ from high-energy pelvic trauma. The Rommens classification and the more recent OF classification guide treatment decisions. The OF pelvis score aims to objectify therapy choice by integrating fracture type, mobility, and pain among other variables. However, the rationale behind key thresholds, such as the VAS cut-off of 5 and the emphasis on mobilization remains unclear. This study seeks to define evidence-based thresholds to improve treatment decision-making.

MATERIAL AND METHODS: This retrospective single-center study includes all patients ≥65 years with an FFP treated as inpatients between 2018 and 2023. Demographics, comorbidities, diagnostics, treatment type, pain level (VAS), mobility, and length of stay are demonstrated. A custom Likert-based mobility score is calculated for each patient. Statistical analysis is performed on pain level and mobilization between conservatively and operatively treated patients.

RESULTS: Totally 428 patients were included in the study. The median age was 85 (80-90) years. While 60.0% (n=257) were treated conservatively, 40.0% (n=171) underwent surgical treatment. The median time to decision for surgical treatment was 3 (2-7) days. At the third day of inpatient stay conservatively treated patients had a significantly better mobilization level (p<0.01) and lower pain level (p=0.015) than patient treated surgically. The suggested Likert Score for mobilization showed a cut-off value of <4 for operative treatment. Patients with a VAS >4 at the third day of the inpatient stay were more likely to be treated surgically. There was no significant difference in proportions of analgesics. Classification, mobilization and pain level had significant influence on the choice of treatment, with classification having the most impact.

CONCLUSION: This study presents comprehensive demographic data and inpatient information on pain level, analgesia, and mobility in FFP patients. A novel Likert-based mobility score is introduced to objectively quantify mobilization. For the first time, the typical timing of surgical decision-making is determined and used to compare pain level and mobility levels between treatment groups. Multivariable analysis identifies and weighs key factors influencing treatment decisions.

PMID:41740217 | DOI:10.1016/j.injury.2026.113103

Injury. 2026 Feb 18;57(4):113102. doi: 10.1016/j.injury.2026.113102. Online ahead of print.

ABSTRACT

INTRODUCTION: Venous thromboembolism (VTE) is a major contributor to morbidity and mortality following traumatic injury. The optimal pharmacological VTE prophylaxis (VTEp) regimen is uncertain. There are limited data on VTE events and VTEp practice, particularly in the trauma population requiring admission to an intensive care unit (ICU).

OBJECTIVE: To describe the incidence and timing of VTE events, VTEp regimens, and associated risk factors for VTE in a severe trauma cohort requiring ICU admission.

METHODS: Retrospective cohort study of all trauma patients (n = 969) admitted to the ICU of the Royal Brisbane and Women's Hospital between 1/2/19 and 31/12/23. Data collected included baseline characteristics, VTEp administered, VTE investigations and outcomes including VTE events, length of stay, and mortality. Competing risks survival analysis was used to describe the association between baseline characteristics and risk of VTE development.

RESULTS: The median injury severity score was 22 (IQR 16-29). The incidence of new VTE events, as diagnosed on imaging, within 28 days of injury was 12 %. The median time to first VTE event was 9 days (IQR 4.8-13.1), and 5 of the 121 (4 %) events occurred within 24 h of injury. In the group that were admitted within 24 h of injury, the median time to VTEp commencement was 48 h (IQR 29-71) and 74 % received unfractionated heparin as the first VTEp administered. In those that had not experienced the competing risks of death or hospital discharge, only the presence of a severe lower extremity injury (cause specific HR 1.81, 95 % CI 1.19-2.76, p= 0.005) and increasing weight (cause specific HR 1.02, 95 % CI 1.01-1.03) were associated with an increased adjusted rate of developing a VTE by day 28.

CONCLUSIONS: Although the incidence of VTE in our cohort was lower than reported in international studies, it remains a significant burden of disease. These data can be used to inform the design of clinical trials that seek to address the evidence gaps in the optimal post-trauma VTEp regimen in the severely injured trauma population.

PMID:41740216 | DOI:10.1016/j.injury.2026.113102

Injury. 2026 Feb 17;57(4):113125. doi: 10.1016/j.injury.2026.113125. Online ahead of print.

ABSTRACT

BACKGROUND: Acromioclavicular joint (ACJ) injuries, accounting for approximately 12 % of all shoulder ligament injuries, are common. Conservative treatment is recommended for Rockwood type Ⅰ and Ⅱ dislocations, while the optimal treatment for type Ⅲ remains debated. For Rockwood type Ⅳ, Ⅴ, and VI dislocations, most scholars advocate surgical treatment. However, other studies have found no significant difference in clinical outcomes between conservative and surgical treatments for Rockwood type Ⅴ dislocations.

METHODS: This systematic review and meta-analysis, conducted following PRISMA guidelines, evaluated randomized controlled trials using the PICO framework. Searches were conducted across four databases: PubMed, Cochrane Library, Embase, and Web of Science. Data were extracted and assessed after evaluating the evidence levels in the selected articles. This study was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY).

RESULTS: The study included 367 patients with Rockwood type Ⅲ-Ⅴ ACJ dislocations: 193 underwent surgical treatment and 174 received conservative treatment. Analyses of three outcomes-Constant Score (CS), complications, and delayed additional surgical treatment-revealed no significant differences in functional outcomes or the necessity for additional surgeries. However, the surgical group exhibited a significantly higher complication rate compared to the conservative treatment group. Notably, for Rockwood type Ⅲ dislocations, complication rates did not differ between the treatment modalities.

CONCLUSION: This systematic review and meta-analysis, encompassing patients with an average age ranging from 30 to 54 years, found no evidence of superiority for surgical intervention over conservative management in treating Rockwood type Ⅲ ACJ dislocations concerning functional outcomes, rates of delayed surgical interventions, or complications. Nonetheless, additional evaluations targeting other age demographics or patients with specific athletic requirements remain necessary. Furthermore, evidence concerning Rockwood type Ⅳ dislocations is notably insufficient, and available data on type Ⅴ dislocations remain limited. Given the paucity of comprehensive imaging studies and objective functional assessments, coupled with a limited number of high-quality studies, further randomized controlled trials focusing explicitly on Rockwood types Ⅲ (including subtypes ⅢA and ⅢB), Ⅳ, andⅤ are urgently warranted. Future research should particularly emphasize functional comparisons relative to pre-injury status and contralateral shoulder performance to enhance the objectivity and clinical applicability of the findings.

PMID:41724020 | DOI:10.1016/j.injury.2026.113125

Injury. 2026 Feb 17;57(4):113108. doi: 10.1016/j.injury.2026.113108. Online ahead of print.

ABSTRACT

BACKGROUND: Although various dermal substitutes are available, their use in the acute setting or for extensive surface areas is often constrained by high costs and labor-intensive application procedures. Despite these challenges, they have proven effective in treating different skin and soft tissue defects.

METHODS: In this prospective case series, 26 adults with acute complex deep soft tissue defects resulting from different etiologies were treated with Glyaderm. Glyaderm is a low-cost acellular dermal substitute and can be applied in either a one- or two-stage procedure with a split skin graft for epidermal coverage. Primary outcomes were graft take in percentage of the total covered wound area and time to complete wound closure.

RESULTS: In total, 25 patients with an average age of 55.9 years completed the follow-up period. Etiologies of the acute complex wounds consisted of defects after oncological surgery (28%), debridement of soft tissue infections (28%), trauma (24%), donor site defects after free flap reconstruction (16%), and other (4%). Mean affected Total Body Surface Area was 2.2%, the mean size was 203 cm2. At 5 to 7 days post-application, the mean graft take rate was 89.7%. The average time for wound closure was 30 days. A complication occurred in 16% of cases: three patients developed wound infection resulting in incomplete graft loss, while one patient experienced complete graft loss without an identifiable cause. All cases were regrafted using Glyaderm and subsequently healed without complications.

CONCLUSION: Glyaderm appears to be a valid and effective reconstructive option for acute complex wounds.

PMID:41724019 | DOI:10.1016/j.injury.2026.113108

Injury. 2026 Feb 14;57(4):113099. doi: 10.1016/j.injury.2026.113099. Online ahead of print.

ABSTRACT

BACKGROUND: Avalanches present a significant risk in mountainous environments, frequently causing severe trauma and death. While asphyxia is often the primary cause of mortality (65-100 %), the incidence of traumatic injuries, particularly bone fractures, may be increasing due to evolving recreational practices and climate change. This study aims to characterize the distribution and types of fractures in avalanche fatalities.

METHODS: We conducted a retrospective study at Grenoble Alpes University Hospital from April 2023 to April 2025. It included deceased adult avalanche victims with post-mortem computed tomography (CT) scans showing at least one bone fracture. MPR, MIP, and 3D reconstructions were used for image analysis.

RESULTS: Thirteen individuals were included (61.5 % male; mean age 37 years). The thorax was the most affected region (92 % of cases). Analysis of 265 fractured bones (79 distinct bones) showed primary fracture distribution in the thorax (52 %), spine (21 %) and skull (14 %). A strong correlation existed between external trauma signs and vital skull lesions, but vital spinal and thoracic lesions often lacked clear external indicators.

CONCLUSION: These preliminary findings contribute to a better understanding of avalanche-specific bone injuries, which could optimize initial management strategies. While extremity fractures are important due to their potential contribution to non-traumatic death and ease of on-site detection, thoracic, spinal and pelvic fractures are challenging to detect in the field. Their accurate identification is yet essential for determining appropriate hospital destination. This exploratory work highlights the need for further larger-cohort studies to establish robust correlations between traumatic mechanisms and avalanche characteristics.

PMID:41724018 | DOI:10.1016/j.injury.2026.113099

Injury. 2026 Feb 16;57(4):113104. doi: 10.1016/j.injury.2026.113104. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional fracture fixation has long provided reliable mechanical stability, yet it remains largely passive in the biological process of healing. The persistence of nonunion, delayed union, and implant-related complications reveals the limitations of a fixation-centric paradigm. Emerging advances in materials science, biology, digital technologies, and implant design have progressively challenged this model, opening the door to a broader reframing of fracture management.

PURPOSE: To propose a conceptual and strategic reframing of fracture management-shifting emphasis from mechanical support alone toward a dynamic, multidimensional dialogue where implants actively sense, respond, and adapt to the biological environment.

METHODS: A narrative and conceptual synthesis of contemporary literature integrating evidence from materials science, biomechanics, bioengineering, immunology, and digital health. Core design principles and translational pathways are identified to outline how modern technologies support a biologically centred reframing of fracture care.

FINDINGS: Five foundational principles - designed temporality, biological integration, mechanical modulation, therapeutic multifunctionality, and feedback intelligence - underpin a framework for a dynamic host-implant dialogue. Ten technological pathways demonstrate how this interactive paradigm translates into practice, encompassing material, mechanical, biological, and data-enabled strategies that integrate mechanical, biological, and digital intelligence.

CONCLUSIONS: This evolution reframes fracture care: from fixing bones to orchestrating healing. It marks a genuine philosophical shift - from implants as static hardware to treatment as a dynamic partnership between biology, technology, and clinical judgement.

PMID:41724017 | DOI:10.1016/j.injury.2026.113104

Injury. 2026 Feb 13;57(4):113097. doi: 10.1016/j.injury.2026.113097. Online ahead of print.

ABSTRACT

OBJECTIVE: Quadriceps tendon rupture is a rare disabling injury, predominantly affecting older males. Prompt surgical intervention is essential to restore knee extensor mechanism. Patellar trans-osseous tunnels technique is considered the treatment of choice, however recently suture anchors technique is suggested as a comparative method to restore the integrity of the quadriceps tendon. This study aimed to compare patient-reported outcomes, operative times, and complication rates between trans-osseous tunnel and suture anchor fixation techniques for acute quadriceps tendon rupture.

METHODS: A retrospective, IRB-approved cohort study was conducted at an academic level I trauma center. Eighty-five patients who underwent surgical repair for acute quadriceps tendon rupture using either trans-osseous tunnels (n=46) or suture anchors (n=39) were included, with one-year follow-up. Demographic, clinical, and surgical data were extracted from electronic medical records. Patient-reported outcome measures (PROMs) assessed at one year included the International Knee Documentation Committee (IKDC) score, Lysholm score, and Visual Analog Scale (VAS) for pain. Operative times and complications were also analyzed.

RESULTS: There were no significant differences in age or gender distribution between groups. The anchor group demonstrated a significantly shorter mean operative time. At one-year follow-up, no statistically significant differences were observed in PROMs: IKDC, and VAS. Complication rates were similar between groups, with two fixation failures (anchor group) and two infections (one per group), all managed successfully.

CONCLUSION: Both trans-osseous tunnel and suture anchor techniques yield comparable functional outcomes and complication rates in the surgical management of acute quadriceps tendon rupture. Suture anchors offer reduced operative time significantly.

PMID:41724016 | DOI:10.1016/j.injury.2026.113097

Injury. 2026 Feb 16;57(4):113113. doi: 10.1016/j.injury.2026.113113. Online ahead of print.

ABSTRACT

Acute Respiratory Distress Syndrome (ARDS) remains a major cause of morbidity and mortality in trauma patients, rising from a complex interplay of direct lung injury, systemic inflammation, transfusion and mechanical ventilation-related factors. Optimal management requires a multifaceted approach that balances lung-protective ventilation strategies, hemodynamic stability and supportive interventions. Positive end-expiratory pressure (PEEP) and prone positioning improve alveolar recruitment, ventilation homogeneity and oxygenation, moderating ventilator-induced lung injury (VILI). Extracorporeal membrane oxygenation (ECMO), particularly veno-venous ECMO, provides a rescue strategy in refractory hypoxemia but carries significant bleeding risks in multi-trauma patients due to necessary anticoagulation. Fluid management remains critical: both overload and excessive restriction can exacerbate pulmonary compromise or hemodynamic instability. Transfusion practices, including the timing and volume of blood products, significantly influence ARDS development, with blunt thoracic trauma, emergent surgery and high BMI identified as independent risk factors. Despite the progress that has been made, the heterogeneity of ARDS pathophysiology and patient's specific variables necessitate individualized, multidisciplinary management to optimize outcomes in critically ill, trauma patients.

PMID:41724015 | DOI:10.1016/j.injury.2026.113113