Injury. 2025 Jun 17;56(8):112528. doi: 10.1016/j.injury.2025.112528. Online ahead of print.

ABSTRACT

This study reported the development of a novel mouse model for full-thickness articular cartilage defects. A total of 120 C57BL/6 mice were assigned to a sham group and three defect groups. The defect groups included D0.1, D0.2, and D0.3 groups, with 0.1, 0.2, and 0.3 mm wide full-thickness defects in the femoral trochlear grooves, respectively. The reproducibility and consistency of full-thickness defects and cartilage repair were evaluated by histological examination. The mRNA and protein expression levels of cAMP response element binding protein (CREB), phosphorylated CREB (p-CREB), parathyroid receptor 1 (PTH1R), Sonic hedgehog (Shh), Smoothened (Smo), and Gli 1 were assessed by immunohistochemistry and qRT-PCR. The results showed that the full-thickness defects displayed good reproducibility and consistency. Injury widths of 0.1 and 0.2 mm presented superior repair abilities than 0.3 mm (p < 0.05). During cartilage repair, the expression levels of PTH1R, CREB, p-CREB, Shh, Smo, and Gli 1 in the three defect groups were significantly higher than in the sham group (p < 0.05). In addition, the PTH/PTHrP and Hh signaling pathways were activated. In conclusion, we successfully established a novel mouse model for full-thickness articular cartilage defects, which enables deeper exploration of the biological mechanisms involved in cartilage repair in mice.

PMID:40570648 | DOI:10.1016/j.injury.2025.112528

Injury. 2025 Jun 6;56(8):112440. doi: 10.1016/j.injury.2025.112440. Online ahead of print.

ABSTRACT

INTRODUCTION: Controversy surrounds the optimal surgical management of proximal humerus fractures (PHFs). The aim of this study was to evaluate and compare the anatomic and clinical outcomes of open reduction internal fixation (ORIF) of PHFs using FA or VA locking plates.

METHODS: This was a retrospective study of 85 patients (19 male, mean age 60.5 ± 14 years) with displaced surgical neck PHFs treated with VA (44 patients) or FA (41 patients) locking plates. Inclusion criteria were a minimum of 1 year postoperative follow up (mean 3.1 years) or earlier revision surgery. Outcome measures included active range of motion, American Shoulder and Elbow Surgeons (ASES) score, Oxford Shoulder Score (OSS), Single Assessment Numeric Evaluation (SANE), EuroQol-5D (EQ-5D), Visual Analog Scale Pain score (VAS pain) and radiographic assessments of reduction quality, screw position, avascular necrosis (AVN) and failure of fixation.

RESULTS: The initial reduction was anatomic in 47 (55 %), acceptable in 29 (34 %), and malreduced in 9 (11 %). 69 (81 %) met inclusion criteria with no differences in reduction quality between the VA and FA plates (p=.16). VA plating was associated with significantly greater plate height compared to FA plating (B = 4.94; p<.001). Additionally, VA plating was associated with better calcar screw placement in terms of both shorter calcar distance (difference in means =1.8 mm, p=.009) and head distance (difference in means=2.4 mm, p=.007). Reoperation was required in 15 (22 %) patients while AVN occurred in 13 (19 %) patients. Neither reoperation nor AVN differed by plate type (p=.75 and p=.99, respectively). Finally, there were no significant differences in PROMs or ROM at final follow up between groups (difference in mean ASES: 1.1, p=.69; OSS: 1.4, p=.76; SANE: 6.5, p=.07; VAS Pain: 0.1, p=.35; EQ-5D: 0.02, p=.68; Active Forward Flexion: 2.3 degrees, p=.77; Active External Rotation: 6.7 degrees; Active Internal Rotation: 0.8, p=.55).

CONCLUSIONS: ORIF of PHFs with VA locking plates yields comparable outcomes to FA plates while facilitating plate positioning and calcar screw placement. Optimizing fracture reduction and fixation when performing ORIF of displaced PHFs is crucial to reducing the incidence of AVN and reoperation.

LEVEL OF EVIDENCE: Level III, Comparative Cohort Series, Treatment Study.

PMID:40570647 | DOI:10.1016/j.injury.2025.112440

Injury. 2025 Jun 18:112527. doi: 10.1016/j.injury.2025.112527. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence-based clinical practice guidelines play a crucial role in supporting clinical decision-making among healthcare providers, policymakers, and administrators by offering structured, research-informed recommendations. Globally, numerous guidelines have been developed for the management of burn injuries, but they vary considerably in terms of quality, structure, and methodological rigor. This study aimed to critically evaluate the quality of existing burn care guidelines from an interprofessional perspective and assess their adaptability for use in low- and middle-income countries (LMICs).

METHODS: This appraisal study, conducted between 2024 and 2025, employed the AGREE II instrument to evaluate guideline quality through the lens of an interprofessional burn care team. The methodology involved a systematic search to identify relevant guidelines, the formation of a multidisciplinary panel of burn care professionals, and a final quality appraisal of the selected guidelines using the AGREE II framework.

RESULTS: Out of the 38 initially identified clinical guidelines, 31 were excluded due to failure to meet the preliminary thresholds for quality and methodological validity. The remaining seven guidelines were subjected to a comprehensive evaluation using the 23-item AGREE II instrument, encompassing six key quality domains. The appraisal revealed considerable variability across these domains, with particularly marked disparities in stakeholder involvement, methodological rigor, and practical applicability.

CONCLUSION: The findings revealed significant heterogeneity in both the structural and content quality of current burn care guidelines. Among the evaluated documents, the guideline developed by the International Society for Burn Injuries (ISBI) achieved the highest AGREE II scores, demonstrating a strong interprofessional focus and relevance to LMICs. The expert panel subsequently endorsed it as the most appropriate candidate for adaptation in resource-constrained settings. These results highlight the urgent need for more robust, interdisciplinary, and context-sensitive burn care guidelines to improve patient outcomes and healthcare delivery globally.

PMID:40562590 | DOI:10.1016/j.injury.2025.112527

Injury. 2025 Jun 18:112525. doi: 10.1016/j.injury.2025.112525. Online ahead of print.

ABSTRACT

BACKGROUND: Rib fractures are common after blunt chest trauma and are associated with significant morbidity, mortality, and prolonged hospital stays due to pulmonary complications. Effective pain management is crucial in preventing these complications. The 'STUdy of the Management of BLunt chest wall trauma' (STUMBL) score can identify patients with rib fractures at risk of complications and assist with Emergency Department (ED) disposition decisions. Its role in guiding Acute Pain Service (APS) and Intensive Care Unit (ICU) referrals was previously unexplored.

DESIGN AND OBJECTIVES: We conducted a retrospective cohort study on adults with radiologically confirmed rib fractures who presented to The Royal Melbourne Hospital between April 2021 and March 2022. We aimed to assess the association between STUMBL scores and advanced analgesia prescription or ICU admission. Participants were categorised into five STUMBL groups (<11, 11-20, 21-25, 26-30, ≥31). The primary outcome of interest was regional analgesia insertion. The secondary outcomes were patient-controlled analgesia (PCA) use, APS and ICU referrals, and medical emergency team (MET) calls within 48 h. Modified Poisson regression was used to analyse associations, with the <11 group used as the reference.

RESULTS: Among 344 participants, the median STUMBL score was 17 (interquartile range [IQR] 10-24). Higher STUMBL scores were strongly associated with regional analgesia insertion in the STUMBL 26-30 group (RR 15.3, 95 % CI 1.8-130.3, p = 0.013) and the STUMBL ≥31 group (RR 29.3, 95 % CI 4.0-212.5, p = 0.001). Significant associations were also observed for PCA prescription (RR 5.0, 95 % CI 2.6-9.7, p < 0.001), APS referral (RR 4.7, 95 % CI 2.7-8.1, p < 0.001), and ICU admission (RR 3.8, 95 % CI 2.0-6.9, p < 0.001) in the STUMBL ≥31 group.

CONCLUSION: The STUMBL score is a valuable tool for identifying patients likely to require advanced analgesia and APS input, with high scores strongly associated with regional analgesia insertion and PCA prescription. Additionally, patients with STUMBL scores ≥26 were more likely to require ICU admission. Incorporating STUMBL thresholds into rib fracture guidelines could facilitate early APS involvement, guide appropriate admission destinations, optimise hospital resource allocation and improve patient outcomes. Further studies should validate these findings in larger, multi centre cohorts and explore patient-reported outcomes.

PMID:40562589 | DOI:10.1016/j.injury.2025.112525

Injury. 2025 Jun 19;56(8):112538. doi: 10.1016/j.injury.2025.112538. Online ahead of print.

ABSTRACT

AIM: Friction burns are a common paediatric injury that can result in significant morbidity and long-term disability. This systematic review aimed to evaluate the management and outcomes of these injuries.

METHODS: A protocol was developed a priori and registered on the PROSPERO database (CRD42022376782). A comprehensive search of MEDLINE, EMBASE, CENTRAL, CINAHL and trial registries was conducted to identify studies evaluating the management and outcomes of paediatric upper limb friction injuries. Primary outcome measures were healing time, functional outcomes, and the need for surgical intervention. Secondary outcomes included complications such as problematic scarring and cost.

RESULTS: Twenty-two studies met the inclusion criteria, encompassing 842 paediatric patients with upper limb friction injuries, predominantly treadmill-related (95 %). Most injuries (58.7 %) were deep partial-thickness to full-thickness. Conservative management with dressings was the primary treatment in 70.4 % of cases, while 29.6 % underwent acute surgery, predominately full-thickness skin grafting followed by split-thickness skin grafting. Mean healing times ranged from 19.4 to 31.5 days. Problematic scarring affected 20.5 % of patients, with 38.3 % of this group undergoing further scar revision surgery. Functional outcomes were generally positive, with minimal long-term disability reported.

CONCLUSION: Paediatric upper limb friction injuries, particularly those caused by treadmills, have typically been managed conservatively, with good functional outcomes. However, deeper injuries and delayed healing increase the risk of problematic scarring and need for scar revision surgery. Further research is needed to standardise treatment protocols and minimise long-term complications.

PMID:40561811 | DOI:10.1016/j.injury.2025.112538

Injury. 2025 Jun 18;56(8):112526. doi: 10.1016/j.injury.2025.112526. Online ahead of print.

ABSTRACT

BACKGROUND: Displaced distal radial fractures are common among all age groups, but increasingly in older patients, and are frequently managed by emergency nurse practitioners. Most can be manipulated and reduced in the emergency department, often by procedural sedation and analgesia, which can be time consuming and often requiring multiple resources. Using haematoma blocks may offer advantages.

AIM: To examine the use and efficacy of haematoma blocks in managing close reduction of distal radial fractures by emergency nursing practitioners compared to procedural sedation.

DESIGN: Matched case-control study.

RESULTS: Compared to those who had procedural sedation and analgesia (n = 100), the haematoma block group (n = 100) had a shorter procedure time (0.4 hrs vs. 0.7 hrs, Z= -1.24, p < .001), time from reduction to discharge (1.5 hrs vs. 4.6 hrs, Z= -2.98, p < .001), overall ED length of stay (2.8 hrs vs. 4.9 hrs, Z= -3.49, p < .001) and minimal pain post reduction (0/10 vs. 4/10, Z= -2.6, p = .001). No adverse events were noted in the haematoma block group compared to 23 % in the procedural sedation and analgesia group.

CONCLUSION: Hematoma block is a safe, effective and efficient alternative to procedural sedation in the reduction of distal radial fractures by emergency nurse practitioners.

PMID:40561810 | DOI:10.1016/j.injury.2025.112526

Injury. 2025 Jun 11;56(8):112367. doi: 10.1016/j.injury.2025.112367. Online ahead of print.

ABSTRACT

INTRODUCTION: Hemorrhage causes 40 % of deaths from trauma. Low- and middle- income countries (LMICs) claim the majority of these deaths, in part due to lack of resources and organization in the prehospital and hospital arenas. Guatemala experiences a high burden of trauma-related injuries but does not have the resources nor the emergency response system to deal with it. In Guatemala, firefighters (bomberos) lead trauma responses, yet do not receive medical training. Recognizing these gaps in LMICs, we developed "CrashSavers", a low cost, openly accessible, self-training mobile phone-based platform to teach hemorrhage control techniques to first responders in Guatemala City. In this manuscript, we present the evaluation and outcomes of the bomberos who were trained with CrashSavers.

METHODS: Our self-administered educational program teaches first responders to train themselves in the decision making and psychomotor skills of tourniquet placement. This free platform, accessible via mobile phone, provides didactic material, virtual reality cases and instructions to construct a bleeding extremity simulator. Sixty-four bomberos were trained from July-August 2022. Eighteen months later they were retested to assess knowledge retention. Interviews were conducted with all bomberos to elicit feedback, which were then analyzed with narrative synthesis. We assessed medical knowledge, confidence, and surgical skills pre and post training.

RESULTS: After training, bomberos were able to apply the tourniquet more efficiently and more confidently. The time taken to stop a bleed on the simulator dropped from 58.5 s to 39.2 s, p < 0.003. Assessment of their skills 18 months after initial training showed that they were able to retain both confidence and psychomotor skill of tourniquet placement. Qualitative analysis showed overall positive experience with the course.

CONCLUSIONS: A low cost, easily accessible, self-taught course of didactics, VR cases and simulation successfully trained bomberos to control a bleeding extremity. This may be a solution for the large gaps in LMIC trauma response, as traditional programs designed for high income countries (HICs) are inaccessible, expensive and time intensive. With CrashSavers, learners became faster and more confident in stopping a bleed, and in a situation where time is blood and blood is life, efficiency is key.

PMID:40561809 | DOI:10.1016/j.injury.2025.112367

Injury. 2025 Jun 17:112532. doi: 10.1016/j.injury.2025.112532. Online ahead of print.

ABSTRACT

BACKGROUND: The frequent use of computed tomography (CT) scan in the evaluation of trauma patients has led to an increase in the diagnosis of hemothorax. This study aimed to assess whether a hemothorax volume of <300 ml, as determined by CT imaging, can be managed without tube thoracostomy and to identify the factors that recommend its use.

METHODS: A retrospective observational study was conducted at XXX Trauma Center, including all patients with traumatic hemothorax from June 2014 to January 2020. Patient demographics, injury mechanism, severity, associated chest injuries, indications for tube thoracostomy, mechanical ventilation, hospital length of stay, complications, and outcomes were reviewed. The study compared patients with hemothorax volumes < 300 ml and ≥300 ml and assessed the outcomes of conservative management without tube thoracostomy (conservative management) vs therapeutic management with tube thoracostomy placement (failed observation).

RESULTS: A total of 254 patients with hemothorax were included. Most patients (79 %) were successfully managed without tube thoracostomy insertion, while 53 patients (21 %) required tube thoracostomy after failure of conservative management. Patients with larger hemothorax volumes were significantly more likely to require tube thoracostomy (p = 0.001) and had significantly longer hospital stays (p = 0.021). Those with failed observation had higher injury severity scores (p = 0.001), more associated lung contusions (p = 0.015), pneumothorax (p = 0.024), and rib fractures (p = 0.001). They also had larger hemothorax volumes (p = 0.001), a greater need for mechanical ventilation (p = 0.001), and prolonged hospitalization (p = 0.001). Predictors of failed observation included high hemothorax volume (≥300 ml), ISS, and greater number of fractured ribs.

CONCLUSION: Conservative management (without tube thoracostomy) was adequate for most patients with <300 ml of hemothorax volumes. Quantitative assessment of hemothorax volume should be considered part of the clinical decision-making algorithm. Further research is needed to refine management strategies and improve outcomes for traumatic hemothorax.

PMID:40555636 | DOI:10.1016/j.injury.2025.112532

Injury. 2025 Jun 17;56(8):112529. doi: 10.1016/j.injury.2025.112529. Online ahead of print.

ABSTRACT

INTRODUCTION: Sternal fractures are uncommon but may result in significant morbidity when associated with respiratory compromise or severe pain. Conventional methods such as plate fixation are often invasive and technically challenging.

METHODS: We retrospectively reviewed eight cases of transverse sternal fractures treated using an intramedullary fixation technique with cannulated cancellous screws (CCS). Preoperative computed tomography with 3D reconstruction was used for surgical planning. Reduction was achieved percutaneously or through a limited incision, followed by guidewire insertion and screw fixation.

RESULTS: The minimally invasive procedure was completed in 18-35 min (mean, 22 min) with little blood loss (mean, 23 mL). Among six patients with ventilatory compromise, four were successfully extubated within three days postoperatively. There were no complications related to screw insertion, and bone union was confirmed in all cases.

CONCLUSION: Intramedullary screw fixation represents a safe, minimally invasive, and mechanically robust alternative for the management of sternal fractures, particularly in patients with flail chest or severe pain.

PMID:40554841 | DOI:10.1016/j.injury.2025.112529

Injury. 2025 Jun 18;56(8):112522. doi: 10.1016/j.injury.2025.112522. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine (1) if early routine radiographic follow-up at 2-3 weeks for patients with operatively treated tibia, fibula or ankle fractures identified complications (i.e., complications only visible on radiographs and not associated with symptoms on history taking or clinical examination) and (2) if these complications were clinically relevant (i.e., led to treatment change).

METHODS: All adult patients who underwent operative treatment for a tibia, fibula or ankle fracture between January 2021 and January 2023 and who received early routine radiographic follow-up between 10 and 30 days postoperatively were included in this retrospective case series. Routine radiographs were defined as radiographs that were scheduled and obtained as part of the institution's standardized follow-up protocol. The primary outcome was the rate of complications detected on early routine radiographs, stratified by the presence of associated symptoms based on history taking or findings on physical examination. The secondary outcome was any documented treatment change for complications.

RESULTS: Six hundred and twenty-eight patients (median age of 47 years, 42 % male) were included. A total of 5 complications in 628 patients (0.8 %) were seen on early routine radiographs, of which 3 complications (0.5 %) were exclusively identified on radiographs (i.e., not associated with symptoms). None of these 3 complications led to a change in treatment strategy. The remaining 2 complications were visible on radiographs but were accompanied by symptoms on history taking or physical examination.

CONCLUSION: The results of the current study suggest that radiographs at 2-3 weeks following operative treatment of tibia, fibula or ankle fractures may not need to be ordered routinely. Obtaining radiographs should be guided by clinical indication or by patient and surgeon preference (e.g., for reasons beyond complications). These findings should be considered in light of increasing healthcare expenditures and the time investment required of patients and healthcare professionals.

PMID:40554111 | DOI:10.1016/j.injury.2025.112522

Injury. 2025 May 22;56(8):112449. doi: 10.1016/j.injury.2025.112449. Online ahead of print.

NO ABSTRACT

PMID:40544747 | DOI:10.1016/j.injury.2025.112449

Injury. 2025 Jun 12:112524. doi: 10.1016/j.injury.2025.112524. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with blunt solid organ injury (BSOI) face heightened thromboembolic risks, prompting scrutiny of early versus late venous thromboembolic (VTE) prophylaxis effects.

METHODS: Analyzing TQIP data (2017-2019) for adults (≥18 years) with severe BSOI under non-operative management and VTE prophylaxis, we classified patients into early (≤48 h) and late (>48 h) prophylaxis groups. We conducted a propensity score matching (PSM) to balance the population based on demographics, organ injury severity, vital signs and need for blood transfusion. Data were compared post-PSM.

RESULTS: Among 23,668 patients, mortality was 3.1 %, with 42.2 % receiving early and 57.8 % late VTE prophylaxis. Early prophylaxis correlated with lower mortality (2.1 % vs. 3.9 %), lower rates of failure of non-operative management (12.4 % vs. 16.6 %), stroke (0.7 % vs. 1.2 %), DVT (2.1 % vs. 4.9 %) and PE (1.4 % vs. 2.3 %) (p < 0.001 for all). Late prophylaxis associated with longer hospitalization and ICU stays (p < 0.001 for both). Post-match data showed that compared to early VTE prophylaxis, patients that received late VTE prophylaxis had higher mortality rates (2.5 % vs. 1.9 %), failure of non-operative management (14.6 % vs. 11.8 %), longer hospital (15.8 (8.7) vs. 12.4 (6.7) days) and ICU (8.9 (4.7) vs. 6.8 (3.4) days) LOS, and higher rates of developing thrombotic complications during hospital stay (p < 0.05, for all).

CONCLUSION: Early VTE prophylaxis not only proves safe for isolated solid organ injury patients but also is associated with lower mortality, mitigating thromboembolic risks and shortening hospital and ICU stays.

LEVEL OF EVIDENCE: Level III retrospective study.

PMID:40544037 | DOI:10.1016/j.injury.2025.112524

Injury. 2025 Jun 11:112523. doi: 10.1016/j.injury.2025.112523. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic brain injury (TBI) is a major contributor to emergency department (ED) visits worldwide, with older adults being particularly susceptible due to fall-related injuries. The widespread use of anticoagulants, including direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), raises concerns about the risk of delayed intracranial haemorrhage (dICH), even in cases where the initial head computed tomography (CT) scan shows no abnormalities. The optimal strategies for managing and monitoring these patients remain a subject of ongoing debate.

MATERIALS AND METHODS: We conducted a monocentric retrospective observational study at Santa Croce e Carle Hospital, Cuneo, Italy, from January 2019 to August 2024. We included patients aged ≥18 years, on chronic anticoagulant therapy, presenting with mild TBI (GCS ≥13) and a negative initial CT scan. All patients underwent a second CT after 24 h of observation, regardless of clinical changes. The primary outcome was the incidence of dICH. Secondary outcomes included neurosurgical interventions and 30-day mortality.

RESULTS: The study included 596 patients (median age 83 years; 46.5 % male). Most patients were on DOACs (74.5 %), and falls were the most common trauma mechanism (90.4 %). dICH was diagnosed in 2 % of patients (n = 12), with subarachnoid haemorrhage and subdural hematoma being the most frequent findings (5 patients each). None of the dICH cases required neurosurgical intervention or resulted in mortality at 30 days. Patients with dICH were more likely to have a GCS <15 upon arrival (16.7 % vs. 3.9 %; p = 0.17) and experienced high-energy trauma mechanism, (16.7 % vs. 1.7 %; p = 0.044); among patients with dICH, 41.7 % were on VKA therapy, compared to 25.2 % of patients without dICH (p = 0,33). Complications during hospitalization, primarily nosocomial infections and delirium, occurred in 66 % of patients hospitalized for dICH.

CONCLUSION: Our findings confirm that dICH after TBI in anticoagulated patients with a negative initial CT is rare and typically benign. Routine prolonged observation and repeat CTs may not be necessary for all patients, particularly those without high-risk factors; individualized management based on clinical risk factors could minimize unnecessary hospitalizations, reduce complications, and optimize healthcare resources.

PMID:40537351 | DOI:10.1016/j.injury.2025.112523

Injury. 2025 Jun 5;56(8):112471. doi: 10.1016/j.injury.2025.112471. Online ahead of print.

ABSTRACT

INTRODUCTION: Tibial shaft fractures are common injuries seen particularly because of high velocity trauma. Considerable debate exists between the suprapatellar and infrapatellar approach for nailing of tibial shaft fractures. The aim of this study was to compare the clinical, radiological and functional outcomes and intra-operative fluoroscopy time, total blood loss and operative time between supra-patellar and infra-patellar insertion techniques in the treatment of extra-articular tibial shaft fractures.

METHODS: Sixty patients aged between 18-45 years who presented to our Level I trauma-centre with AO/OTA type 42 fractures were randomized into Suprapatellar (SP) and Infrapatellar (IP) groups. Operative time, intra-operative blood loss and radiation exposure was recorded. Severity of knee pain by VAS score and knee range of motion were documented at 2 weeks, 6 weeks, 3 months, 6 months, 12 months, 18 months and 24 months follow-up. Functional outcomes were measured using Knee Society Score, Lysholm Knee Score and KOOS-PF score and radiological union assessed with radiograph done at 6 weeks, 3 months, 6 months, 12 months, 18 months and 24 months post-operatively.

RESULTS: Thirty patients each underwent nailing by suprapatellar and infrapatellar approach. A statistically significant difference favouring the suprapatellar group was noted in the operative time (p-value 0.003) and mean intra-operative blood loss (p-value 0.027). There was no difference between the two groups in terms of knee pain or knee range of motion and the mean functional scores.

CONCLUSION: Suprapatellar nailing of tibial shaft fractures may help to reduce operative time and intra-operative blood loss with similar intra-operative radiation exposure, clinical and functional outcomes compared to infrapatellar nailing.

PMID:40532333 | DOI:10.1016/j.injury.2025.112471

Injury. 2025 May 28;56(8):112456. doi: 10.1016/j.injury.2025.112456. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative planning is a helpful tool for orthopaedic trauma cases, but clinical experience dictates that its use remains inconsistent. The primary aim of this cross-sectional survey study was to investigate practices and applications of preoperative planning for orthopaedic trauma cases and to identify factors influencing its use.

METHODS: A cross-sectional 26-item survey was distributed to members of the Orthopaedic Trauma Association and The Netherlands Orthopaedic Trauma Association between April 2024 and August 2024. Four key areas of interest were assessed: (1) general preoperative planning practices; (2) features of the preoperative plan; (3) use of preoperative planning for resident training; and (4) factors influencing the decision to make a preoperative plan. General preoperative planning practices were compared between attendings and residents or fellows.

RESULTS: Two-hundred-eleven orthopaedic surgeons, fellows, or residents completed the survey (84 % male, 74 % attending, 55 % of attendings trauma-fellowship-trained). Overall, 84 % of respondents considered preoperative planning very or extremely important. Formal preoperative planning was performed on average for 50 % of cases. Residents or fellows planned significantly more often than attendings (76 % vs. 30 %, p < 0.001) and used digital templating more often (59 % vs. 38 %, p= 0.006). The most common features of the plan were tactical, including positioning of implants and specific steps of approach and reduction. Residents reported that preoperative plans were discussed preoperatively in 75 % of cases and postoperatively evaluated in 40 %. Case complexity was the most influential factor in deciding to plan.

CONCLUSION: Respondents considered preoperative planning to be very or extremely important for orthopaedic trauma cases but made a formal preoperative plan on average in only half of cases. Residents or fellows made a preoperative plan twice as often. Complexity of the case was the most important factor in deciding to make a preoperative plan. Benefits of preoperative planning such as improving resident teaching and learning, efficiency, and teamwork should be considered more often in the decision to make a preoperative plan.

PMID:40532332 | DOI:10.1016/j.injury.2025.112456

Injury. 2025 Jun 8;56(8):112465. doi: 10.1016/j.injury.2025.112465. Online ahead of print.

ABSTRACT

BACKGROUND/PURPOSE: Forearm lacerations are frequently associated with involvement of tendon, nerve, and vessel injuries. An accurate diagnosis and timely intervention are critical to avoid any functional impairment, but clinical examination alone may not always be reliable, particularly in combined injuries or uncooperative patients. High-resolution ultrasound (USG) is a useful tool for the rapid assessment of these injuries. This study aims to evaluate the effectiveness of pre-operative USG in diagnosing tendon, nerve, and vascular injuries in acute trauma cases, using surgical exploration as the gold standard.

METHODS: This prospective observational study was conducted at the Department of Plastic Surgery of a tertiary care Trauma centre, between April 2022 and July 2024. Thirty-eight patients with forearm lacerations were included. All patients underwent clinical examination followed by USG (3-15 MHz) for injury assessment. The cases were examined by the operating surgeon. USG findings were compared with intraoperative findings to assess the diagnostic accuracy.

RESULTS: USG demonstrated diagnostic accuracy of 99.62 % in tendon injuries, with a high sensitivity (98.61 %) and specificity (100 %). It identified nerve injuries with a accuracy of 96.49 %, and interpreting arterial injuries was more challenging, with an accuracy of 90.7 %. The outcome of evaluation with high resolution USG with clinical examination was better than that of isolated clinical examination for tendon and neurovascular injuries. The mean time for an USG diagnosis in forearm laceration was 9.53 min.

CONCLUSION: High-resolution ultrasound is an effective, non-invasive tool for a quick assessment of forearm lacerations. It offers a high sensitivity and specificity for tendon and nerve injuries, aiding in targeted surgical interventions. While it is less sensitive for vascular injuries, it remains valuable for surgical planning in combined injuries. This study supports its integration into routine trauma care to improve diagnostic accuracy and better outcomes.

LEVEL OF EVIDENCE: Level IIIA, Prospective observational study.

PMID:40532331 | DOI:10.1016/j.injury.2025.112465

Injury. 2025 Jun 7:112472. doi: 10.1016/j.injury.2025.112472. Online ahead of print.

NO ABSTRACT

PMID:40518338 | DOI:10.1016/j.injury.2025.112472

Injury. 2025 Jun 9;56(8):112515. doi: 10.1016/j.injury.2025.112515. Online ahead of print.

ABSTRACT

Introduction In 2020, we published a new minimally invasive anteromedial distal approach for plate fixation of the humerus (MIAMDAH) to address extra-articular distal shaft fractures in a cadaveric study. After operating on our first patients, it was noted that the distal MIPO window was too small to comfortably fix the plate distally. So, a wider MIPO window was developed to make the surgical procedure more comfortable. This study aimed to evaluate clinical outcomes in patients who underwent surgery using either the original approach or its modified version and to determine whether the modification provided technical or clinical advantages over the original.

MATERIAL AND PATIENTS: Forty-five patients underwent surgery using either the original or modified approach. Twenty-one received the original technique, and twenty-four received the modified one. The primary outcome measured was the Mayo Elbow Performance Scale (MEPS) score at 18 months. The secondary outcome measures included the University of California at Los Angeles (UCLA) score and the elbow motion of the damaged arm at 18 months. A statistical bivariate analysis was performed to compare various subgroups based on the original or modified approach.

RESULTS: All patients were followed for 18 months. The average distance from the fracture to the coronoid fossa was 3.72 cm for the original approach and 3.95 cm for the modified approach. Both approaches showed no statistically significant differences between primary and secondary outcomes. The original approach yielded good to excellent results in all patients (21/21) at the last follow-up, with a mean MEPS score of 98.5 and a UCLA score of 34.7. The modified approach resulted in good to excellent functional outcomes in 22 of 24 patients, with a mean MEPS score of 95.8 and a UCLA score of 34.3. The mean arch elbow motion was 125.3° (11° less than the undamaged arm) in the original approach and 123.5° (13° less than the undamaged arm) in the modified approach.

CONCLUSION: MIAMDAH provides a reliable alternative to laborious open approaches or risky MIPO approaches described to date. The modified version offers a broader MIPO window, which enhances surgery comfort and may reduce the complication rate.

PMID:40517641 | DOI:10.1016/j.injury.2025.112515

Injury. 2025 Jun 6;56(8):112506. doi: 10.1016/j.injury.2025.112506. Online ahead of print.

ABSTRACT

PURPOSE: Certain trauma populations require rehabilitation services after inpatient management. However, studies have shown implicit bias against African American patients regarding the access to rehabilitation services. The purpose of this study was to assess the variance in rehabilitation discharges of adult patients who sustained lower extremity bilateral long bone fractures comparing African American and Caucasian patients.

METHODS: The study included African American and Caucasian adult patients who sustained bilateral long bone fractures of the lower extremities. Data was extracted from the National Inpatient Sample (NIS) database of 2019. Demographic information, clinical characteristics, comorbidities, and outcomes for all qualifying patients were compared using propensity score matching analysis.

RESULTS: Propensity matching analysis created 361 pairs of patients. The two groups (Caucasian patients and African American patients) had comparable characteristics including age (median years [IQR], 42 [30 - 57] vs. 42 [29 - 58], P = 0.790), sex ([male] 60.7 % vs, 60.7 %), injury severity score (ISS) score (median [IQR], 14 [4 - 26] vs. 14 [5 - 29], P = 0.344) and insurance status (private, 125 (34.6 %) vs. 125 (34.6 %)). The analyses found no significant differences in rehabilitation disposition (199 (56.9 %) vs. 185 (53.8 %), P = 0.460, hospital length of stay (median days [95 % CI], 9 [8, 10] vs. 10 [9, 11], P = 0.116) and overall in-hospital mortality (11 (3.0 %) vs. 17 (4.7 %), P = 0.327) between the groups.

CONCLUSION: Our study identified no significant bias against African American patients who suffered from bilateral long bone fractures of the lower extremities and required rehabilitation services.

PMID:40517640 | DOI:10.1016/j.injury.2025.112506

Injury. 2025 Jun 6;56(8):112513. doi: 10.1016/j.injury.2025.112513. Online ahead of print.

ABSTRACT

BACKGROUND: Increasing awareness about fall prevention and osteoporosis screening could reduce the incidence of hip fractures in the elderly, and comprehensive care can improve outcomes. There is limited nationwide data on the health outcomes of hip fractures when comparing operative and non-operative approaches. The study objectives were to ascertain the short-term outcomes of older patients hospitalized with hip fractures and to elucidate the variables correlated with in-hospital mortality.

METHODS: This study utilized a retrospective dataset comprising hospitalized individuals aged ≥60 years who were admitted due to hip fractures during the fiscal years spanning from 2019 to 2023. The National Health Security Office conducted the diagnosis, employing the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification (ICD-10-TM) code S72. Surgical procedures pertinent to hip fractures were categorized under ICD-9-79.1, ICD-9-79.3, ICD-9-81.51, ICD-9-81.52, and ICD-9-81.53. Demographic information was analyzed through descriptive statistical methods. Factors associated with in-hospital mortality were assessed through both univariate and multivariate analyses.

RESULTS: Out of 115,333 diagnosed cases, the admission rate was 205.5 per 100,000 population, with 46.9 % undergoing surgery. The overall in-hospital mortality rate was 4.04 per 100,000 individuals. Patients who underwent surgery showed a lower in-hospital mortality rate compared to those who did not, recorded at 1.3 vs 1.9 (p < 0.05) for males and 2.1 vs 2.6 (p < 0.05) for females per 100,000 population. Outcomes at discharge for those receiving operative versus non-operative treatment revealed a mean length of stay (LOS) of 11.5 versus 10.8 days (p < 0.05), mean healthcare costs of $1973 versus $1554 (p < 0.05), and in-hospital mortality rates of 1.8 % versus 2.1 % (p < 0.05). Factors increasing mortality included age (70-80 years: OR 1.51, 95 %CI 1.30-1.74; ≥80 years: OR 2.59, 95 %CI 2.27-2.97), male gender: OR 1.69, 95 %CI 1.55-1.85, extracapsular fracture: OR 1.15, 95 %CI 1.05-1.25, and a LOS ≥10 days: OR 1.63, 95 %CI 1.49-1.78. Surgery associated with lower mortality: OR 0.88, 95 %CI 0.81-0.96.

CONCLUSION: Hip fracture patients who underwent surgery had better mortality outcomes than those who did not. Less than half of patients opted for surgery in the past five years. Therefore, it is essential to encourage surgical treatment for these patients.

PMID:40513174 | DOI:10.1016/j.injury.2025.112513