Injury. 2025 Oct 14;56(12):112817. doi: 10.1016/j.injury.2025.112817. Online ahead of print.

ABSTRACT

INTRODUCTION: Spinopelvic injuries represent some of the most challenging patterns in trauma surgery due to the complex anatomy and the high-energy mechanisms typically involved. Stabilization is critical to restore lumbopelvic alignment, enable early mobilization, and reduce long-term disability. Triangular osteosynthesis has emerged as a technique that combines lumbopelvic fixation with sacroiliac stabilization, providing robust mechanical stability. Despite its growing use, concerns remain regarding its complication profile, particularly implant prominence and wound-related morbidity. This review sought to collate and critically appraise the available evidence on triangular osteosynthesis for spinopelvic injuries, with a focus on reported complications and functional outcomes.

METHODS: A systematic search of PubMed, EMBASE, and Web of Science was performed in line with PRISMA recommendations, covering studies published up to June 2024. Eligible studies were restricted to English-language articles with abstracts and excluded reports on non-traumatic conditions, technical notes, expert commentaries, animal models, and purely biomechanical investigations.

RESULTS: Eighteen studies met the inclusion criteria, comprising 431 patients with a minimum follow-up of eight months. The majority were retrospective case series or cohort designs (12 retrospective, 6 prospective; levels III-IV evidence). Patient age ranged between 15 and 78 years. Falls from height represented the leading injury mechanism, followed by road traffic accidents. Reported complications included prominent hardware in 61 cases (14.35 %) and surgical site infection in 29 cases (6.73 %). Nonunion and sacral malunion were rare, each affecting only two patients (0.46 %). Functional outcomes, reported in nine studies using the Majeed score, showed 78 % excellent results (n = 137), 21.1 % good or fair (n = 37), and one poor outcome (0.57 %).

CONCLUSION: Although implant prominence and wound-related complications are relatively frequent, triangular osteosynthesis remains a dependable treatment for complex spinopelvic injuries, demonstrating very low nonunion rates and generally favourable functional recovery.

PMID:41237660 | DOI:10.1016/j.injury.2025.112817

Injury. 2025 Nov 12:112847. doi: 10.1016/j.injury.2025.112847. Online ahead of print.

ABSTRACT

BACKGROUND: The clamshell thoracotomy (CST) is a rare, but lifesaving procedure often performed in austere environments. The closure of a CST is challenging and can be fraught with post-operative complications/failure resulting in debilitating chest wall instability. The recent advent of rib and sternal fixation hardware has provided additional tools possibly offering better ways to close a CST. The objective of this study was to examine the use of plates and screws to close CSTs, hypothesizing it is safe and effective, providing good functional outcomes.

METHODS: This was a multi-institutional, international, retrospective review of patients undergoing CST closure with plates and screws utilized in rib/sternal fixation. Exclusion criteria included patients that died prior to hospital discharge. Exact methods for closure were left to the discretion of the operating surgeon, however plates and screws were the main foundation. Basic demographics were obtained. Outcomes of interest included number of plates used, days to closure, complications post-operatively, length of follow-up, and post-operative functional status (1=worst functional status; 5=best functional status). Descriptive statistics were reported.

RESULTS: Nineteen patients from 7 centers were included. Two patients were excluded as they died inpatient. Of the remaining 17 patients, mean age was 34.6 (±18.8) years and 82.4 % were male. 35.3 % percent were white, 41.2 % were black, and 23.5 % were Hispanic. 82.4 % suffered penetrating trauma. Median number of plates used per patient was 1 (Interquartile range (IQR) 1,3). Median time to closure was 1 day (IQR 1,2). Four patients (23.5 %) experienced post-operative complications. Mean follow-up was 197.4 (±206.4) days with all patients obtaining satisfactory chest x-rays during this time. Median functional status reported by patients at follow-up was 4 (IQR 3,5).

CONCLUSION: Clamshell thoracotomy closure with plates and screws appears to be safe and effective. Most patients reported favorable long-term functional status.

LEVEL OF EVIDENCE: Level V, Therapeutic/care management.

PMID:41233201 | DOI:10.1016/j.injury.2025.112847

Injury. 2025 Oct 27:112849. doi: 10.1016/j.injury.2025.112849. Online ahead of print.

ABSTRACT

AIM: This study evaluates the efficacy and safety of Dynatract®, a novel device designed to facilitate early primary closure and prevent aponeurotic retraction in patients with an open abdomen (OA).

METHOD: A preclinical trial was conducted using a porcine model, comparing two groups: one treated solely with AbThera™ Negative Pressure Wound Therapy (NPWT), and another combining AbThera™ NPWT with Dynatract®. The primary endpoint was to evaluate the distance between fascial edges, with secondary measures including the force required to achieve abdominal closure and overall closure success.

RESULTS: "The Dynatract® group showed a progressive reduction in fascial edge distance over time compared to the control group, with statistically significant differences observed at the caudal and midpoint positions (but not at the cranial position), as well as in the force required to achieve closure after 36 h. Complete fascial closure was achieved in all animals in both groups.

PMID:41233200 | DOI:10.1016/j.injury.2025.112849

Injury. 2025 Oct 31;56(12):112856. doi: 10.1016/j.injury.2025.112856. Online ahead of print.

ABSTRACT

BACKGROUND: Hip fractures are a leading orthopaedic injury worldwide, often causing disability, cognitive decline, and loss of independence. Identifying early predictors is therefore a major healthcare priority yet the impact of weather on hip fracture incidence remains poorly understood. This study is the first to examine hip fracture admissions in England and Wales in relation to weather. We hypothesised that (a) lower ambient temperatures are associated with increased hip fracture admissions, and (b) the strength of this association differs by age and baseline mobility status.

MATERIALS AND METHODS: Weather data from the United Kingdom Meteorological Office and patient data from the National Hip Fracture Database (NHFD) were analysed to investigate associations between weather variables and hip fracture in the period from 2015 to 2023.

RESULTS: A total of 567,623 patients with hip fractures were admitted during the nine year period. Hip fracture admissions dropped by about 10 % on weekends. Mobile individuals aged 60-79 years experienced more hip fractures during cold weather with minimal seasonal variation, while less mobile individuals aged 80-99 years had higher rates of fractures in winter.

CONCLUSIONS: The findings highlight trends that inform future strategies to mitigate hip fracture risks and adapt healthcare planning.

PMID:41232178 | DOI:10.1016/j.injury.2025.112856

Injury. 2025 Nov 8;56(12):112885. doi: 10.1016/j.injury.2025.112885. Online ahead of print.

ABSTRACT

BACKGROUND: Subsequent contralateral hip fractures pose a significant challenge in the management of geriatric patients. This study aimed to evaluate the impact of contralateral hip fractures within the past six months in patients with hip fractures.

METHODS: A registry-based cohort study with prospective follow-up was conducted using data from hip fracture patients (femoral neck and pertrochanteric fractures) in Germany, Switzerland, and Austria. Patients with a contralateral hip fracture in the past six months (risk group) were compared to those without (control group). Matching analysis was performed to adjust for confounding factors, including age, sex, American Society of Anesthesiologists (ASA) grade, pre-fracture mobility, and fracture type. The primary outcome was mobility seven days postoperatively, while secondary outcomes included the EQ-5D-5 L index, length of hospital stay, necessity for intensive care unit, reoperation rate, discharge destination, mortality, and complications.

RESULTS: Before matching, patients in the risk group exhibited significantly worse mobility and functional outcomes than those in the control group. However, after adjusting for confounders, no significant differences in mobility or the EQ-5D-5 L index remained. No significant difference was found in the in-house and mid-term mortality rate. The risk group was prone to having a higher risk of delirium and decubitus ulcers without statistical significance. In contrast, the risk of renal failure was significantly lower.

CONCLUSION: Contralateral hip fractures in the past six months are associated with inferior early mobility and functional outcomes in general. However, this association was not independent.

PMID:41232177 | DOI:10.1016/j.injury.2025.112885

Injury. 2025 Nov 6:112882. doi: 10.1016/j.injury.2025.112882. Online ahead of print.

ABSTRACT

INTRODUCTION: Social determinants of health (SDOH) and their relationship to patient outcomes have become center-points in efforts to improve healthcare. Most studies rely on aggregated datasets and proxy measures, often using geographic location to assess SDOH, but this approach is prone to ecological fallacy. Using patient-level data, this study sought to analyze the correlation between SDOH and specific outcomes in trauma.

PATIENTS AND METHODS: Patient demographics, social work interview data and trauma admission data were combined for the years 2019-2020 at a large urban academic level 1 trauma center. Missing data were estimated using multiple imputation. Post-operative outcomes were studied including mortality, major complication, readmission, length of stay (LOS), and discharge location. Multivariable analysis was performed by creating models that included the SDOH.

RESULTS: 868 patients with social work evaluations were identified. The mean age was 60.8 years, 62.2 % were male and 77.4 % were white. Financial concerns was the most common SDOH in this population (33.4 %). In multivariable analysis, financial concerns and interpreter requirement were associated with major complication and mortality. Psychiatric history was associated with major complications. Alcohol use was associated with major complications and increased LOS. Male sex, black race, and motor vehicle collision were also associated with an increased LOS.

CONCLUSION: At the patient level, certain demographics and SDOH are predictors of negative outcomes. Early identification of social barriers to discharge in trauma patients may help facilitate disposition, reduce LOS, and help identify patients at risk for post-operative complications and mortality. The mechanism by which SDOH affect post-operative outcomes should be further evaluated.

PMID:41224618 | DOI:10.1016/j.injury.2025.112882

Injury. 2025 Nov 4:112878. doi: 10.1016/j.injury.2025.112878. Online ahead of print.

ABSTRACT

BACKGROUND: Blunt trauma is the main trauma mechanism leading to severe trauma, mortality and disability. Improving data on early death would help in improving current trauma management.

METHODS: This retrospective observational multicentric study was conducted using data from a prospective French national registry (TraumaBase) from January 2017 to December 2022. Inclusion criteria were: blunt trauma who died within the first 24 h in Level 1 Trauma Centers.

RESULTS: Seven hundred twenty-two patients were included. The mean age was 51 (SD 23) years with a male predominance (72.7 %). Mechanisms involved were: road traffic accidents (n = 404, 56.0 %), falls (n = 293, 40.6 %), blunt object traumas (n = 23, 3.2 %), and other mechanisms (n = 2, 0.3 %). Median Injury Severity Score (ISS) was 30 (22-45). The anatomical regions affected were: head/neck (n = 590, 81.7 %), thorax (n = 426, 59.0 %), extremities (n = 339, 47.0 %), abdomen (n = 251, 34.8 %), face (n = 184, 25.5 %), and skin (n = 86, 4.7 %). Two-thirds (n = 508, 70.4 %) of patients presented hemorrhagic shock (HS), with the origin being abdominal (35.0 %), pelvic (25.8 %), or thoracic (15.2 %). Hemostasis was achieved through open surgery (n = 77/126, 61.1 %) or interventional radiology (n = 49/126, 38.9 %). The three main causes of mortality at 24 h were: central nervous system (CNS) injury (n = 310, 42.9 %), hemorrhage (n = 169, 23.4 %), multi-organ failure (MOF) (n = 156, 21.6 %). Potentially Preventable Death (PPD) accounted for 353 patients (48.9 %).

CONCLUSIONS: Early mortality causes after severe blunt trauma in France were neurological (42.9 %), hemorrhagic (23.4 %), and MOF (21.6 %). Among patients with traumatic brain injury (TBI), 65.2 % presented concomitant HS. Hemorrhage remained the second presumed cause of death among PDD, with pelvic origin being the most frequent. Victims of severe blunt trauma should be considered as having isolated or concomitant life-threatening traumatic brain injury and non-compressible extra cranial hemorrhage. Every effort must be made to stabilize these patients, at least temporarily, to obtain rapid injury assessment to identify the "first lethal injury" to treat.

PMID:41224617 | DOI:10.1016/j.injury.2025.112878

Injury. 2025 Oct 31:112877. doi: 10.1016/j.injury.2025.112877. Online ahead of print.

NO ABSTRACT

PMID:41224616 | DOI:10.1016/j.injury.2025.112877

Injury. 2025 Nov 3;56(12):112872. doi: 10.1016/j.injury.2025.112872. Online ahead of print.

ABSTRACT

INTRODUCTION: Humeral shaft fractures are common, often affecting younger patients through high-energy mechanisms. With rising use of e-cigarettes, vapes, and nicotine pouches, the impact of non-tobacco nicotine dependence (NTND) on fracture healing remains unclear. This study evaluates postoperative outcomes following fixation of humeral shaft fractures among NTND patients compared with traditional tobacco users and non-nicotine controls.

METHODS: The US collaborative network (TriNetX) was queried to identify adults undergoing humeral shaft ORIF between the dates of January 1, 2004, and June 1, 2023. Three cohorts were stratified by nicotine status: NTND, tobacco, and nicotine-naive controls. Patients were 1:1 propensity matched by demographics and comorbidities. Significance was set at p < 0.05.

RESULTS: A total of 16,404 patients met inclusion: 1250 with NTND, 2515 with tobacco use, and 12,639 controls. After matching, NTND and control groups each included 1250 patients; NTND and tobacco groups had 1243 each. At 90 days, NTND patients demonstrated higher rates of postoperative complications, including pneumonia (OR 2.19, 95 % CI 1.44-3.31), acute blood loss anemia (OR 1.34, 95 % CI 1.01-1.78), surgical site infection (SSI) (OR 1.785, 95 % CI 1.04-3.07), and ED visits (OR 1.56, 95 % CI 1.22-1.98) compared to non-nicotine controls. Relative to tobacco users, NTND patients experienced increased pneumonia (OR 1.72, 95 % CI 1.17-2.52) at 90 days. At 2 years, NTND patients experienced higher rates of nonunion or malunion (OR 1.63, 95 % CI 1.07-2.49), hardware failure (OR 1.28, 95 % CI 1.01-1.64), and opioid dependence (OR 2.37, 95 % CI 1.289-4.36) compared to non-nicotine controls. There were no significant differences between NTND patients and traditional tobacco users at 2 years.

CONCLUSION: NTND is associated with increased perioperative complications and long-term morbidity following humeral shaft fixation. These findings demonstrate that NTND is not a risk-free alternative to traditional tobacco use and may pose even greater perioperative and long-term risks. NTND should be recognized as a distinct risk factor, underscoring the importance of surgeon awareness in patient counseling and the need for future studies evaluating product-specific effects.

PMID:41223580 | DOI:10.1016/j.injury.2025.112872

Injury. 2025 Nov 5;56(12):112857. doi: 10.1016/j.injury.2025.112857. Online ahead of print.

ABSTRACT

BACKGROUND: Rib fractures are common conditions often associated with significant complications, including respiratory failure, pneumonia, prolonged hospitalisation, and chronic pain. Adequate pain management is crucial to improve outcomes and reduce morbidity in these patients. Despite the wide adoption of multimodal analgesia, the optimal combination of analgesic strategies remains uncertain.

OBJECTIVE: To review and synthesize current evidence on analgesic strategies for acute pain management in patients with rib fractures.

METHODS: We conducted a narrative review by searching scientific literature on PubMed and Scopus to identify randomised controlled trials (RCTs) on analgesia for rib fractures from blunt trauma. Included studies assessed pharmacologic, non-pharmacologic and regional anaesthesia interventions. Studies describing surgical treatment of multiple rib fractures or addressing analgesia for non-traumatic causes of rib fractures (e.g. neoplasms) or study design other than RCTs were excluded. Forty-seven RCTs met the inclusion criteria.

RESULTS: Opioids remain the most studied class of analgesics in the context of rib fracture. While effective for acute pain relief, they pose significant risks, especially in the elderly population. Non-opioid agents - especially non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol -are effective components of opioid-sparing strategies. Thoracic epidural and paravertebral blocks offer superior analgesia and respiratory benefits but are associated with a steep learning curve, are time-consuming, and carry a significant risk of procedural complications. Emerging regional anaesthesia techniques, such as the erector spinae plane (ESP) and serratus anterior plane (SAP) blocks, demonstrated promising results due to their ease of administration and favourable safety profiles. Non-pharmacologic approaches, including cryotherapy, transcutaneous electrical nerve stimulation (TENS), and kinesiotaping, represent additional pain relief options, although evidence remains limited.

CONCLUSIONS: Multimodal analgesia - combining pharmacologic, non-pharmacologic and regional anaesthesia approaches -is considered the most effective strategy to guarantee pain relief in patients with multiple rib fractures. However, substantial heterogeneity remains in the regimens employed. Further research is needed to standardize multimodal analgesic protocols and to assess their impact on long-term, patient-centred outcomes.

PMID:41223579 | DOI:10.1016/j.injury.2025.112857

Injury. 2025 Oct 31:112862. doi: 10.1016/j.injury.2025.112862. Online ahead of print.

NO ABSTRACT

PMID:41213847 | DOI:10.1016/j.injury.2025.112862

Injury. 2025 Nov 1:112880. doi: 10.1016/j.injury.2025.112880. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma patients experience significant stress states, leading to physiological and pathological changes. Severe trauma may result in multiple organ dysfunction syndrome (MODS). This study aims to evaluate the association between the stress hyperglycemia ratio (SHR) and MODS in trauma patients.

METHODS: Clinical data from 784 trauma patients were extracted from the MIMIC-IV (3.1) database. Based on clinical diagnoses, trauma patients were divided into a diabetic trauma group and a non-diabetic trauma group. Each group was further stratified into three subgroups according to SHR tertiles. The outcome was the development of MODS within 7 days of ICU admission. We investigated the association between SHR tertiles and MODS by logistic regression, with additional exploration using restricted cubic splines (RCS) to validate the findings.

RESULTS: Data from 784 trauma patients were analyzed. Among non-diabetic patients, a higher SHR was consistently and significantly associated with an increased risk of MODS. When analyzed by tertiles and compared to the first tertile (T1), the third tertile (T3) showed a crude OR of 2.48 (95 % CI: 1.57-3.98, P < 0.001). This association remained significant after adjustment for covariates (adjusted OR = 2.10, 95 % CI: 1.20-3.72, P = 0.010). This non-linear association was further validated by restricted cubic spline (RCS) analysis, which revealed a risk pattern with little change in the first tertile, a mildly increasing risk in the second tertile, and a continued increase that eventually plateaued at a high level in the third tertile. In contrast, no significant association was observed between high SHR and MODS in the diabetic trauma group.

CONCLUSION: In the non-diabetic trauma group, elevated SHR showed a significant association with MODS occurrence, whereas no significant association was observed between high SHR and MODS in the diabetic trauma group.

PMID:41207853 | DOI:10.1016/j.injury.2025.112880

Injury. 2025 Nov 8;56(12):112854. doi: 10.1016/j.injury.2025.112854. Online ahead of print.

NO ABSTRACT

PMID:41207001 | DOI:10.1016/j.injury.2025.112854

Injury. 2025 Oct 26;56(12):112848. doi: 10.1016/j.injury.2025.112848. Online ahead of print.

ABSTRACT

INTRODUCTION: To analyze the anatomy of the sternum and manubrium with a focus on the proximity of vital posterior structures to provide surgeons with guidelines for screw length and to increase awareness of locations for the safest hardware placement.

MATERIALS AND METHODS: A retrospective chart review was conducted at a level one trauma center in the southeastern United States. Patients with a chest CT in 2022 without evidence of abnormalities or prior cardiac or thoracic surgery, chest trauma, or sternotomy were included in the study. The primary study measures were dimensions of the manubrium and sternum and distances to nearby structures including the right atrial appendage, the main pulmonary artery, ascending aorta, right brachiocephalic artery, superior vena cava, and left and right brachiocephalic veins.

RESULTS: 20 male (mean body mass index 29.0, mean age 50.5) and 20 female (mean body mass index 28.9, mean age 64.7) subjects were included. The smallest depth measurements of the manubrium and sternum were 10.3/9.3 mm (male/female) and 10.1/9.2 mm (m/f), respectively. The closest structures behind the manubrium were the left and right brachiocephalic veins with mean distances of 9.8/6.3 mm (m/f) and 15.5/13.5 mm (m/f), respectively. This was followed by the right brachiocephalic artery with mean distances of 20.9/16.4 mm (m/f). The closest structure behind the sternum was the right ventricle with mean distances of 8.5/8.4 mm (m/f), then the right atrial appendage with mean distances of 24.6/21.4 mm (m/f). Inter-rater reliability exceeded 0.80, indicating good reliability.

DISCUSSION AND CONCLUSION: Proximity of vital structures behind the sternum and manubrium creates challenges for bicortical screw fixation of the sternum and manubrium. Females had shorter distances indicating greater potential for injury. Understanding locations of vital structures can assist in preoperative planning and decrease complications.

PMID:41207000 | DOI:10.1016/j.injury.2025.112848

Injury. 2025 Oct 31:112876. doi: 10.1016/j.injury.2025.112876. Online ahead of print.

ABSTRACT

BACKGROUND: Vascular injury is a major risk factor for acute and delayed haemorrhage in blunt solid organ trauma. However, the natural history, including spontaneous resolution, remains poorly described. This study evaluated the incidence, detection timing, treatment, spontaneous resolution, and outcomes of vascular injury in high-grade blunt solid organ trauma.

METHODS: A retrospective cohort study of patients with Grade III or higher splenic, hepatic, or renal injuries (2018-2023) at Western Australia's single adult major trauma centre was conducted. We recorded rates of surgery, angioembolisation, delayed haemorrhage, and the development and regression of vascular injury.

RESULTS: 460 patients with 487 high grade solid organ injuries were admitted during the study period. Vascular injury was noted in 62.2 % of splenic injuries (n = 145/233); 24.1 % of hepatic injuries (n = 32/133) and 21.5 % of renal injuries (n = 26/121). Successful angioembolisation occurred in 61.4 % of splenic vascular injury (n = 89), 10/32 liver vascular injury and 8/26 renal vascular injury. 19 splenectomies were performed (8.2 %). Untreated vascular injury was reported in 41 splenic injuries (28.3 % of vascular injury); 13 hepatic and 15 renal injuries. Three cases of delayed haemorrhage occurred, two splenic and one hepatic; there were no clear uniting factors.

CONCLUSION: Vascular injury is common in high-grade blunt solid organ trauma, particularly splenic injury. Interval inpatient imaging detects clinically relevant new vascular injury, and a substantial proportion resolve without intervention. Given the low delayed haemorrhage rate, universal post-discharge follow-up imaging seems excessive.

PMID:41206267 | DOI:10.1016/j.injury.2025.112876

Injury. 2025 Nov 3:112863. doi: 10.1016/j.injury.2025.112863. Online ahead of print.

NO ABSTRACT

PMID:41206266 | DOI:10.1016/j.injury.2025.112863

Injury. 2025 Oct 31;56(12):112866. doi: 10.1016/j.injury.2025.112866. Online ahead of print.

ABSTRACT

AIMS: The aim of this study was to assess the safety and the union rate when cancellous bone graft was harvested directly from non-union site using the Reamer-Irrigator-Aspirator (RIA) in femoral and tibial non-unions with intramedullary nail (IMN) fixation. Our hypothesis was that harvesting from the same site would yield similar results to the conventional RIA technique in terms of union and complication rates, with a single reaming thus restricting the morbidity to a single site.

MATERIALS AND METHODS: Data was retrospectively analyzed from a single tertiary care center. We included 116 reconstruction surgeries in 116 patients, performed between January 1st 2015 and January 31st 2023. Seventy-one were mechanical non-unions (61.2 %) while forty-five were attributable to a septic origin (38.8 %). Patients went through either a one or two-step procedure depending on their infectious status. The mean age at inclusion was 40.6 years (SD = 17.1) with 81.0 % of patients being males (n = 94). The mean follow-up was 41.2 months (SD = 27.9).

RESULTS: Out of the 116 non-unions, 105 (90.5 %) had radiological union at last follow-up. Mean union duration was 7.8 months (SD = 4.0), with 56.9 % of patients resuming physical activities and 70 % returning to their previous occupation. Mean Lower Extremity Functional Scale was 56.2 points (SD = 20.9). Succes rate for mechanical non-unions was 93.0 % versus 88.7 % for septic non-unions (p = 0.33). Debridement, antibiotics and implant retention (DAIR) was necessary for 14 patients and sufficient to cure 9 out of 14. No septic shock, no tibial/femoral fracture and no embolism were noted.

CONCLUSION: When done according to our protocol, harvesting cancellous bone graft directly from non-union site using the RIA system is a safe technique, with high union rate and great functional recovery.

PMID:41205244 | DOI:10.1016/j.injury.2025.112866

Injury. 2025 Oct 30;56(12):112853. doi: 10.1016/j.injury.2025.112853. Online ahead of print.

NO ABSTRACT

PMID:41205243 | DOI:10.1016/j.injury.2025.112853

Injury. 2025 Nov 7;56(12):112870. doi: 10.1016/j.injury.2025.112870. Online ahead of print.

ABSTRACT

PURPOSE: Volar plate fixation under C-arm fluoroscopy is common in treating distal radius fractures in adults. Limiting live fluoroscopy is recommended as a theoretically simple and effective way of reducing radiation exposure by lowering the dose area product; however, real-world data are absent. This study aims to show which factor influences radiation exposure time and whether it is safe to abandon cine sequences in volar locking plate fixation procedures.

METHODS: This was a retrospective case-control study of distal radius fractures fixed with volar locking plates from 2018 to 2022. During the first period, six orthopaedic surgeons performed the surgery with their preferred fluoroscopy methods. During the second period, the single-shot technique was instructed, where surgeons avoided dynamic video imaging under fluoroscopy. Data collected include fluoroscopy time, operative time, fracture classification according to Association of Osteosynthesis (AO) criteria, post-operative radiographic changes of the radius, and patient demographic information.

RESULTS: During the first period, 59 cases were included in the study. Radiation exposure time did not correlate with time elapsed from fracture to surgery, AO fracture classification or post-operative radiographic changes. Operative time and patients' body mass index showed a weak positive correlation with radiation exposure time. Significantly differing radiation exposure times were observed among surgeons. The surgeon with the shortest exposure time employed the single-shot technique. On the other hand, the surgeon with the longest exposure time continuously pressed the pedal. During the second period, 63 cases were included in the study and irradiation time decreased from a median of 159 seconds to 19.5 seconds. Three cases required implant removal due to complications in each period.

CONCLUSIONS: Behaviours and attitudes toward fluoroscopy vary among surgeons. The single-shot technique reduced the radiation exposure time during volar locking plate implantation without an associated increase in plate removal to manage a complication.

PMID:41205242 | DOI:10.1016/j.injury.2025.112870

Injury. 2025 Oct 31:112869. doi: 10.1016/j.injury.2025.112869. Online ahead of print.

NO ABSTRACT

PMID:41203538 | DOI:10.1016/j.injury.2025.112869