Injury. 2025 Mar 26;56(6):112280. doi: 10.1016/j.injury.2025.112280. Online ahead of print.

ABSTRACT

BACKGROUND: Snowboarding, skateboarding, and water surfing have emerged as popular pediatric sports. While prior work has examined differences among some types of board sports in certain populations, no prior study has directly compared pediatric injury patterns in board sports with similar techniques but on different terrains. The aim of this study was to compare the frequency and severity of orthopedic and craniofacial trauma sustained by pediatric skateboarders, snowboarders, and surfers. These injury types were selected as they encompass the majority of board sport-related trauma, providing a broad overview of injury patterns across different terrains.

HYPOTHESIS: We hypothesized that pediatric skateboarders and snowboarders sustained more fractures and strains/sprains to the upper extremity, while pediatric surfers sustained more injuries to the head and neck.

METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for orthopedic and craniofacial trauma related to unpowered skateboarding, snowboarding, and surfing between 2014 and 2023. Annualized trends in injury type, injury location, and injury prevalence were examined over the study period and across sport type. Univariate analyses were utilized to compare injury characteristics and patient demographics across board sport cohorts.

RESULTS: NEISS case criteria identified an estimated 546,231 board sport injuries over the study period. Early-adolescent males were the most commonly injured cohort (76.0 %; CI: 73.8-78.2 %). Fractures to the upper extremity were the most common orthopedic injury among skateboarders (31.6 %; CI: 24.8-38.4 %) and snowboarders (45.7 %; CI: 38.9-52.5 %), while lacerations to the head and neck were the most common injury among surfers (24.5 %; CI: 22.0-26.95 %). Pediatric snowboarders sustained more upper extremity fractures and concussions, but sustained less trauma to the lower extremity.

CONCLUSIONS: Findings from this study indicate that pediatric board sport athletes sustain injuries that are analogous but unique. Upper extremity fractures are common in skateboarding and snowboarding. While surfing has a higher incidence of laceration injuries, snowboarding has a higher incidence of concussions but lower incidence of lower extremity injuries. It is important for healthcare personnel to be aware of these injury patterns, especially in settings where immediate healthcare is limited.

PMID:40187108 | DOI:10.1016/j.injury.2025.112280

Injury. 2025 Mar 17;56(6):112081. doi: 10.1016/j.injury.2024.112081. Online ahead of print.

ABSTRACT

BACKGROUND: diabetic Wound is one of the most common complications throughout the world. .This experiment was conducted in order to study the effects of vitamin k cream on repair of full thickness wound in diabetic rat.

METHODS: 75 adult Male Wistar rats were randomly divided into five groups of equal numbers; each group consists of 15 animals. After diabetes induction, full thickness wound in the shape of 2.25 CM2 square was created on the back of the rats. Group one was not treated and served as control. The woud areas in the second, third and fourth groups were covered twice a day with phenytoin (PHT) cream,0.05 and 1 % vitamin k creams, respectively. Group five treated with eucerin(vichel group) The size of wound area were measured in the 1, 4, 7, 10, 14, 18 and 21 days after wound induction. and histopathological observation and tissue parameters (hydroxyprolin(HP), collagen, glutation(GSH), malondialdeid (MDA), superoxiddesmutase(SOD), glutation peroxidase(GPX), catalase(CAT),tumor necrosis factor alpha (TNF-α), interlukin 1 bata(IL-1β)) were analysed as onther indicators of wound healing on days of 7, 14 and 21.

RESULTS: the findings indicated that PHT and 1 % vitamin k creams significantly elevated HP and collagen in contrast with control group. furthermore, in all time points, the average wound size in PHT and 1 % vitamin k groups was significantly greater than other groups (P < 0.05). Also, PHT and vitamin K 1 % creams improved oxidative and inflammatory stress parameters at all times courses. Theses findings were confirmed by histological examination.

CONCLUSION: The findings showed that 1 % vitamin k creams have potential effects on wound healing. Vitamin K exerts this effect through its antioxidant and anti-inflammatory properties, as well as stimulating collagen synthesis.

PMID:40187107 | DOI:10.1016/j.injury.2024.112081

Injury. 2025 Mar 30;56(6):112305. doi: 10.1016/j.injury.2025.112305. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic spine injury (TSI) is a prevalent condition that often requires surgical intervention. Two serious infectious complications after surgery are surgical site infections (SSI) and lower respiratory tract infections (LRTI). Yet, studies on SSI and LRTI on trauma patients, particularly with a specific focus on microbiology are lacking. The primary aim of this study is to investigate the prevalence rate of early SSI, occurring within one month of surgery or three months when instrumented, and LRTI in level-1 trauma center patients requiring surgery after TSI.

METHODS: This monocenter retrospective observational study was conducted at an academic level-1 trauma center, including patients with TSI requiring surgery. Data on patients' baseline characteristics, trauma related information, initial and intra-operative management, infectious complications data and hospitalization outcomes were collected. The two primary outcomes were the prevalence of early SSI and LRTI. Secondary outcomes included the identification of factors associated with developing these infections, analysis of identified organisms, and assessment of clinical outcomes.

RESULTS: A total of 2606 patients were screened between May 2018 and October 2022, 194 were included. Most of them were polytrauma patients defined by Injury Severity Score ≥ 16 (71 %). Early SSI occurred in 20 patients (10 %) and LRTI occurred in 58 patients (30 %). The number of vertebral levels instrumented (odds ratio [OR] 1.24, 95 % confidence interval [95 % CI] 1.01-1.52) was associated with SSI. The causative organisms were predominantly Gram-positive cocci (19/36 identified organisms). Factors associated with LRTI were an injury severity score ≥ 25 (OR 7.41; 95 % CI, 3.28-17.99), spinal injury at levels C3-C7 (OR 2.24; 95 % CI 1.01-5.14) and antibiotics during initial management (OR 7.09; 95 % CI, 2.71-20.49). The causative organisms were predominantly Gram-negative bacilli (58/80 identified organisms). Patients with LRTI experienced longer hospital stays, extended durations of mechanical ventilation, and higher mortality rates at 30 days and one year than those without.

CONCLUSION: Early SSI and LRTI are underestimated complications in severe trauma patients with TSI requiring surgery. Identifying risk factors and causative organisms is an important step for advancing research on targeted prevention and treatment of SSI and LRTI after trauma.

PMID:40187106 | DOI:10.1016/j.injury.2025.112305

Injury. 2025 Mar 25;56(6):112289. doi: 10.1016/j.injury.2025.112289. Online ahead of print.

ABSTRACT

BACKGROUND: Martial arts participation appears to be increasing in the US, and along with benefits to health and wellbeing, the sport carries musculoskeletal and neurological injury risks which differ among disciplines. Evidence is limited regarding the burden of concussion injuries in many martial arts disciplines, particularly among female athletes and outside of competitions. The purposes were: 1) to characterize injury patterns over 2013-2022 for concussion injuries treated in emergency departments (ED) related to martial arts; and 2) to compare the number of concussions by mechanism, circumstance, sex and martial art discipline.

METHODS: This was a retrospective, epidemiological study of National Electronic Injury Surveillance System (NEISS) data from patients who sought ED care for martial arts-related concussions (N = 581; 29.1 % female). Annual concussion case numbers compared over time and by sex using linear regression. Concussion case numbers were compared by major discipline (Karate, Jiu-Jitsu, Taekwondo, Mixed martial arts [MMA], kickboxing, Judo, and other forms) and sex. Mechanisms (fall, kicked, tackled/thrown, punched-hit-struck, weapon, unspecified) and circumstances (practice, competition) were compared by discipline and sex.

RESULTS: Regressions indicated that year or sex were significant contributors to annual concussion case numbers (both p>.05). The number of concussions was highest for Karate for males (p < .05). A greater proportion of cases occurred in males than females in MMA, Taekwondo, Jiu-Jitsu, and other forms (p = .031). Falls and being punched-hit-struck were the most commonly-documented mechanisms of concussion (23 % and 20 %, respectively). For females, more concussions were incurred during competition for Judo and Taekwondo than in other disciplines (p = .002). For males, more concussions occurred in class/practice with Judo and Karate than in other disciplines (p = .018). 96.4 % of cases were treated and released, and 3.1 % were hospitalized.

CONCLUSION: Since 2020, the concussion burden in martial arts has grown, particularly among males, which may be related to overall greater participation in the sport, especially karate and other forms. Prospective injury surveillance, better uptake of safety gear and implementation of skills risk into routine sport participation that minimize head injury, and careful documentation of injury circumstance could help advance martial arts safety.

PMID:40187105 | DOI:10.1016/j.injury.2025.112289

Injury. 2025 Mar 26;56(6):112283. doi: 10.1016/j.injury.2025.112283. Online ahead of print.

ABSTRACT

The meniscus, a critical load-bearing structure between the femur and the tibia, plays a key role in the functioning of the knee joint by distributing mechanical stress and minimizing friction. A brief overview of the anatomical characteristics and biomechanical functions of the meniscus is provided in this review, followed by a discussion of recent developments in tissue engineering scaffolds for meniscus repair over the past five years. The classification of scaffolds is based on the materials with an analysis of their respective advantages and limitations. The challenges associated with meniscal tissue engineering are summarized and potential research directions are proposed to guide the development of more effective regenerative strategies.

PMID:40184758 | DOI:10.1016/j.injury.2025.112283

Injury. 2025 Mar 22:112284. doi: 10.1016/j.injury.2025.112284. Online ahead of print.

NO ABSTRACT

PMID:40169293 | DOI:10.1016/j.injury.2025.112284

Injury. 2025 Mar 23;56(6):112293. doi: 10.1016/j.injury.2025.112293. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic brain injuries (TBI) are a considerable health burden on adolescents and young adults. This study aims to assess the influence of health compromising behavior, poor perceived health, poor school success, and low family socioeconomic background during adolescence on subsequent TBI in a large cohort of Finnish adolescents with an average 25-year follow-up.

MATERIALS AND METHODS: Baseline Finnish Adolescent Health and Lifestyle survey data gathered biennially (1981-1997) was linked with the diagnosis of subsequent TBI from the Finnish Care Register for Health Care. A structural equation modeling (SEM) was used to analyze the associations between health behavior, poor perceived health, poor school success, and low family socioeconomic background during adolescence on subsequent TBI.

RESULTS: Total of 41 336 persons were included in the analyses. During the follow-up, 1 459 (3.5 %) TBIs occurred. Men were more likely to suffer a TBI. The mean follow-up time was 25.3 years (SD 4.0) and the mean age at the time of TBI was 32.1 years (SD 7.7). Health compromising behavior and not living with both parents in adolescence were associated with the increased risk of TBI. Also, poor perceived health and stress symptoms increased the risk of TBI. Low family socioeconomic status (SES) was only indirectly associated with TBI trough health compromising behavior.

CONCLUSION: The main finding was that health compromising behavior was associated with TBI, and low family SES was associated with TBI through health compromising behavior in later life. Poor perceived health, stress symptoms, and not living with both parents in adolescence increased the risk of TBI, too. Our findings suggest that adolescents who are at risk of drifting into health compromising behavior and report stress symptoms have an increased risk of TBI in later life.

PMID:40168891 | DOI:10.1016/j.injury.2025.112293

Injury. 2025 Mar 24;56(6):112296. doi: 10.1016/j.injury.2025.112296. Online ahead of print.

ABSTRACT

BACKGROUND: Falls are a leading cause of disability-adjusted life years (DALYs) and mobility difficulties. Previous estimates have relied on restricted regional scope and lack a thorough global study. This study, for the first time, examines the evolving trends in the global burden of falls from 1990 to 2021, focusing on geographic variation in disease burden and risk factors, predicting the development of burden of falls. Our aim was to provide information for allocating medical resources, taking health policies into action, and making patient management systems operate better.

METHOD: Data on incident cases, deaths, and DALYs were collected for countries, regions, ages, and sexes worldwide from the Global Burden Disease (GBD) 2021 database. Using R (version 4.3.2), we calculated estimated annual percent changes (EAPCs) for assessing trends in age-standardized rates, visualized risk factors, and predicted the global burden of falls. Joinpoint regression (version 4.9.1.0) was used to identify significant temporal trends and change points.

RESULTS: In 2021, 548.8 million people were affected by falls. There were 215 million incidence, 43.8 million DALYs, and 800,000 deaths caused by falls. The incidence rate of falls increases with age, and sex inequalities exist. Compared with 1990, the age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate (ASDALYsR) declined despite an increase in absolute numbers. The ASDR and ASDALYsR of falls are expected to decline in the future, whereas the ASIR is expected to rise. The fall burden varied significantly according to region and its sociodemographic index (SDI). Both ASIR (R = 0.510, p < 0.001) and ASDALYsR (R = 0.2762, p < 0.001) were positively correlated with SDI. In contrast, ASDR (R=-0.536, p < 0.001) showed a consistently negative association with SDI. Low bone mineral density, occupational injuries, alcohol use, and smoking emerged as the top factors associated with fall-related DALYs and deaths.

CONCLUSIONS: The overall burden of falls declined between 1990 and 2021, but the future incidence is expected to increase. The global burden of falls remains unchanged and shows significant regional and sex-based differences. Effective prevention and strategies against risk factors are imperative for reducing the future burden.

PMID:40168890 | DOI:10.1016/j.injury.2025.112296

Injury. 2025 Mar 26;56(6):112287. doi: 10.1016/j.injury.2025.112287. Online ahead of print.

ABSTRACT

BACKGROUND: The ear is one of the most technically difficult areas to reconstruct following traumatic injury. Utilizing the largest national multicenter patient sample to date, this study seeks to provide a critical overview of the epidemiology of traumatic ear injuries.

METHODS: The NEISS database was searched from 2003-2022 to identify patients with related traumatic ear injuries. Three age groups were examined: geriatric (65+), adult (18-64), and pediatric (2-17). Variables including race, sex, incident location, commercial products involved, and emergency department disposition were evaluated between the groups utilizing two-proportion z-tests with Bonferroni correction.

RESULTS: 25,285 patients who sustained ear injuries were identified from the NEISS database. The top five types of ear injuries were laceration, contusion, puncture, hematoma, and burn. Geriatric patients experienced a significantly higher frequency of ear lacerations (82.5 % vs 68.6 %, p < 0.001) relative to non-geriatric adults, while children had a significantly greater frequency of hematomas (3.7 % vs 2.8 %, p = 0.001), and contusions (18.0 % vs 16.0 %, p = 0.006). The top five products involved for ear injuries were tables, first aid equipment, bed/bedframe, jewelry, and chairs. Geriatric adults had a significantly higher frequency of ear injuries from bed frames relative to non-geriatric adults (20.0 % vs 3.2 %, p < 0.001) and were over five times more likely to be admitted to the hospital..

CONCLUSIONS: This study offers novel insights into the epidemiology of traumatic ear injuries in the U.S especially across different age demographics. The greater prevalence of ear injuries from tables, first aid equipment, and with sporting activities among children highlights needs for childproofing homes and providing greater patient education and regulation on ear safety. The increased fragility of tissue and greater prevalence of fall injuries among geriatric patients demonstrates need for ongoing physical therapy and fall risk measures to be implemented. Collectively, the results help inform public health strategies to prevent such injuries as well as provide invaluable clinical context for reconstructive surgeons.

PMID:40168889 | DOI:10.1016/j.injury.2025.112287

Injury. 2025 Mar 22:112278. doi: 10.1016/j.injury.2025.112278. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma is the leading cause of death and disability in children globally. Studies indicate that severe traumatic brain injury (TBI) negatively affects quality of life (QoL) in children, but little is known about QoL after injury in children without TBI. This study aimed to investigate QoL in this group six months post-discharge.

METHODS: Trauma patients aged 13-17 years admitted to a major Scandinavian trauma center were eligible if they met the following criteria: received by a trauma team, ISS > 9, required ICU monitoring, and hospital stay > 4 days. Patients with moderate to severe head injuries (AIS > 2) were excluded. Eighteen consenting adolescents were interviewed six to nine months after discharge.

RESULTS: The main finding was that most participants were "coping well after experienced injuries." A minority reported challenges in daily life, including fatigue and difficulty in keeping up. Few used regular painkillers, and most were unconcerned about long-term consequences. However, many felt that more structured follow-up post-discharge would have been helpful.

CONCLUSION: Among 18 moderate to severely injured adolescents, we found that the majority were coping well. Strong social relationships and involvement in school and social activities was important in all interviews. While several experienced fatigue and challenges in keeping up, the negative impact on daily life was manageable at the time of the interviews.

PMID:40164532 | DOI:10.1016/j.injury.2025.112278

Injury. 2025 Mar 25;56(6):112302. doi: 10.1016/j.injury.2025.112302. Online ahead of print.

ABSTRACT

OBJECTIVES: Management of civilian gunshot wound (GSW) fractures is controversial, with limited data on infection risk and controversy regarding treatment. While lower-energy GSWs are considered lower risk than other open fractures, complication rates remain high. This study aimed to identify risk factors for infection in operatively treated ballistic fractures.

METHODS: After institutional review board approval, we identified 2136 GSW-related fractures from 01/01/2012 to 12/31/2021 at our level one trauma center. After excluding articular, hand, foot, injuries through viscera and pre-existing infections, 110 patients with 125 long bone fractures were retrospectively reviewed. The primary outcome was infection requiring reoperation. Statistical analysis included Mann-Whitney U, T-tests, Pearson's Chi-square, ROC analysis, and Youden's index.

RESULTS: Sixteen patients (14.5 %) developed infections requiring reoperation. The cohort had a mean age of 30 years, 90 % male, BMI 27.7 ± 7.2 kg/m², Charlson comorbidity index <1, and 37 % smokers. Increased infection risk was associated with admission glucose (p < 0.001) and length of stay (p < 0.001). Admission glucose >156 mg/dL increased odds of infection sixfold (OR 6.1, 95 % CI 2.0-19.0), while a hospital stay >10 days increased odds of infection twentyfold (OR 21.1, 95 % CI 5.3-82.7). Transfusion (p = 0.004), abdominal (p = 0.007), and chest trauma (p = 0.010) also correlated with infection risk. No significant associations were found with nicotine use, Charlson comorbidity index, or BMI.

CONCLUSIONS: Operatively treated long bone injuries had a 14.5 % infection rate. Elevated admission glucose and prolonged hospital stay significantly increased infection risk, particularly in polytrauma patients. Identifying high-risk patients, promoting early mobilization, and ensuring glycemic control may help reduce infections. Further research is needed to develop targeted prevention strategies.

LEVEL OF EVIDENCE: 3 (Retrospective Comparative Study).

PMID:40163958 | DOI:10.1016/j.injury.2025.112302

Injury. 2025 Mar 25;56(6):112282. doi: 10.1016/j.injury.2025.112282. Online ahead of print.

ABSTRACT

OBJECTIVE: Fragility fractures in the elderly population is increasing due to the global aging population. Rehabilitation following hip fracture surgery plays a crucial role in restoring functional independence and quality of life. There are currently limited bedside rehabilitation tool for geriatric hip fracture patients. A novel tool (Time-Up and Flex [TUF]) was designed with the aim to allow patients perform bedside rehab exercises, provide objective feedback and enhance recovery.

DESIGN: A single centre, double-blinded, prospective validation study. A 3D printed TUF tool measures time taken to actively flex the operated hip to 30° on post-operative days [POD] 1, 7 and 14. The time is compared against subjective (Numerical Patient Reported Pain Scale [NPRS]) and objective outcomes (Tinetti Scale [TS], Functional Ambulation Category [FAC]). Assessors of the TUF score are blinded to the assessors of patient report outcome measures.

RESULTS: Mean time for TUF were 12.7 s (seconds), 9.5 s and 6.7 s, NPRS were 7.3, 4.8, 3.2, TS were 9.8, 14.1, 18.6, FAC were 1.2, 2.0, 3.1 on POD1, 7 and 14 respectively. Coefficient of correlation for TUF time against NPRS was 0.729 (p < 0.05), TUF time against TS was -0.721 (p < 0.05), TUF time against FAC -0.688 (p < 0.05). A decrease in TUF time correlated to a statistically significant decrease in NPRS, increase in TS and FAC. The calculated Cohen's D and Cronbach Alpha for TUF tool supported its ability to produce consistent and valid results.

CONCLUSION: TUF tool is valid and correlates with patient's subjective and objective outcomes. It has a good predictor value for the patient's pain, mobility and future falls risk. TUF tool has potential to be incorporated into geriatric hip fracture rehabilitation pathway in the future.

PMID:40163957 | DOI:10.1016/j.injury.2025.112282

Injury. 2025 Mar 24;56(6):112300. doi: 10.1016/j.injury.2025.112300. Online ahead of print.

ABSTRACT

- A 49yo woman was involved in a car crash. She suffered an isolated, open, left both bones forearm mid-diaphyseal fracture. She had a sling applied at the scene but had a 16-hour transport time from an isolated rural location. She was found to have no other injuries upon her careful work-up at the Level 1 emergency department. The injury had not compromised the distal neurovascular status of the limb. The ER staff admitted the patient to the orthopedic team. The patient had an evaluation by a senior resident and their assessment was that this was a grade 3A open fracture of the dorsum of the mid forearm (Figure 1 and Figure 2). By the time surgery could be initiated at the Trauma center, fully 36 hours had passed. Most of the delay at the Trauma center was due to other very significant injuries in the Trauma room that day. PAST MEDICAL HISTORY AND SOCIAL HISTORY: - She is a married woman and lives with her husband and a university aged teenager. She has been a nonsmoker. She has no medical problems that she sees a physician about. She works as a secretary but presently is unemployed. She has only had obstetrical surgery, has no allergies and takes no medications. She is a regular wine drinker.

PMID:40158403 | DOI:10.1016/j.injury.2025.112300

Injury. 2025 Mar 24:112286. doi: 10.1016/j.injury.2025.112286. Online ahead of print.

NO ABSTRACT

PMID:40157870 | DOI:10.1016/j.injury.2025.112286

Injury. 2025 Mar 20:112277. doi: 10.1016/j.injury.2025.112277. Online ahead of print.

NO ABSTRACT

PMID:40157869 | DOI:10.1016/j.injury.2025.112277

Injury. 2025 Mar 22;56(4):112291. doi: 10.1016/j.injury.2025.112291. Online ahead of print.

ABSTRACT

Novel and innovative orthopedic devices are needed to address clinical challenges in orthopedic practice. Obtaining regulatory authorization for such devices, however, can prove challenging. An inherent dilemma exists between innovation to address unmet needs and imitation to demonstrate substantial equivalence to a predicate device, which is required for the less burdensome 510(k) pathway. This article provides both an overview of highly innovative orthopedic devices over the last 10 years as well as considerations for FDA regulatory pathways and programs available to manufacturers of such devices. A review of 20 innovative orthopedic devices receiving Breakthrough Device Designation and/or a De Novo classification found that devices had diverse features and applications, but did possess shared technological trends including bioresorption, flexible components, and new substance/material use. A review of all new orthopedic devices authorized through the three major regulatory pathways in the last 10 years was also conducted. Spinal devices represented the largest share of recent orthopedic devices (38 % of 510(k) clearances and 25 % of De Novo classifications). Across all three pathways, decision time was on average around 30 % shorter for orthopedic devices with a Breakthrough Device Designation versus those without, though differences were not significant. New orthopedic devices authorized in the last 10 years were found to be highly reliant on the 510(k) pathway, with a 99 % utilization rate. However, the FDA Breakthrough Devices Program and De Novo pathway offer opportunities specific to innovative technologies, such as expedited review and potential market competition protection, as demonstrated through specific case studies in this review. As these FDA initiatives continue to evolve and manufacturers continue to take advantage of these opportunities, orthopedic device development, which has primarily prioritized incremental innovation, may too evolve to produce more breakthrough innovations.

PMID:40157338 | DOI:10.1016/j.injury.2025.112291

Injury. 2025 Mar 20;56(6):112274. doi: 10.1016/j.injury.2025.112274. Online ahead of print.

ABSTRACT

The long-term effects of injuries have significant implications for forensic practice. There is a dearth of research highlighting long-term psychological problems resulting from various injuries in under-researched populations like Mozambique. This study employed multiple logistic regression analyses on the 2022-2023 Mozambique Demographic and Health Survey (DHS) data to determine injury types predictive of emotional trauma, limb function loss, and chronic pain as continuing health problems. The data from the Accidents and Injury module was used for all participants. The injuries analyzed included broken bones, wounds, internal injuries, and burns. Additionally, we investigated the predictive capacity of unintentional and violent injuries on emotional trauma as a continuing health problem. The total number of injured people (whether due to traffic or non-traffic accidents) was 419. The proportion of unintentional injuries was much higher than violent injuries (86.4% vs 7.7%). Our results indicated that burn injuries were strongly associated with emotional trauma (Odds Ratio (OR) = 4.15, 95% CI: [1.24-13.84], P = 0.021), broken-bone injuries predicted both limb function loss (OR = 2.67, 95% CI: [1.17- 6.09], P = 0.02) and emotional trauma (OR = 3.73, 95% CI: [1.51-9.22], P = 0.005), internal injuries predicted chronic pain (OR = 2.52, 95% CI: [1.18-5.38], P = 0.018), and violent injuries predicted emotional trauma (OR = 4.41, 95% CI: [1.16-16.67], P = 0.03). These findings enhance comprehension of how injury types predict long-term psychological complications in Mozambique and provide valuable insights regarding the enduring consequences of various injuries in similar populations.

PMID:40157228 | DOI:10.1016/j.injury.2025.112274

Injury. 2025 Mar 3;56(4):112241. doi: 10.1016/j.injury.2025.112241. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the outcome of pararectus, ilioinguinal, and intrapelvic approaches in patients with acetabular fracture and to rank the best, second best, and third best surgical approach.

METHODS: A literature search was conducted in PubMed, Epistemonikos, and Embase up to 30 November 2024. A network meta-analyses was conducted to assess the outcomes of pararectus, ilioinguinal, and intrapelvic surgical approaches. Random-effects models with mean differences (MDs) and odds ratios (ORs) were calculated for continuous and binary variables, respectively, all with 95 % confidence intervals (CIs).

RESULTS: A total of 30 primary studies (2,348 patients) were included. There was no statistically significant difference between the pararectus and intrapelvic approach in overall complications (OR 0.86, 95 % CI 0.47 to 1.58). The pararectus approach had 0.51 lower odds for overall complications compared with the ilioinguinal approach (OR 0.51, 95 % CI 0.28 to 0.94). The intrapelvic approach had 0.59 lower odds for overall complications compared with the ilioinguinal approach (OR 0.59, 95 % CI 0.37 to 0.94). There was no statistically significant difference between the pararectus and intrapelvic approach in reduction quality (OR 1.32, 95 % CI 0.89 to 1.95). The pararectus approach had 2.02 higher odds for reduction quality compared with the ilioinguinal approach (OR 2.02, 95 % CI 1.30 to 3.15). The intrapelvic approach had 1.53 higher odds for reduction quality compared with the ilioinguinal approach (OR 1.53, 95 % CI 1.12 to 2.10). There was no statistically significant difference between the pararectus and intrapelvic approach in intraoperative blood loss (MD -31.38, 95 % CI -105.62 to 42.85). The pararectus approach had a 207.35 mL lower intraoperative blood loss compared with the ilioinguinal approach (MD -207.35, 95 % CI -288.52 to -126.18). The intrapelvic approach had a 175.97 mL lower intraoperative blood loss compared with the ilioinguinal approach (MD -175.97, 95 % CI -233.51 to -118.42).

CONCLUSION: This is the first study to rank the three anterior surgical approaches for acetabular fractures. The findings establish that while the pararectus and intrapelvic approaches are comparable, the ilioinguinal approach ranks third. The superior outcomes of the pararectus and intrapelvic approaches in complications, operative efficiency, and reduction quality highlight their importance in surgical practice.

PMID:40154238 | DOI:10.1016/j.injury.2025.112241

Injury. 2025 Mar 14;56(4):112268. doi: 10.1016/j.injury.2025.112268. Online ahead of print.

ABSTRACT

BACKGROUND: Time to union in civilian firearm injuries is variable and not well described in the literature. This study measures the time to union for femoral and tibial shaft fractures treated with an intramedullary nail (IMN). Time to union is compared across open, closed, or ballistic trauma (BT) fractures. The goal of the study is to answer the questions: (1) Do tibial shaft fractures heal in specific temporal patterns based on mechanism of injury and (2) Do these temporal healing patterns apply to both the tibia and femur?

PATIENTS AND METHODS: Included patients had tibial or femoral shaft fractures (OTA/AO 32 and 42) treated at an urban level 1 trauma center between 2015 and 2020 with IMN. Patients were eligible if radiographic imaging was available for any four of five follow-up timepoints, absence of preexisting hardware, and BT was from low velocity handgun injuries. Radiographic union scale (RUS) was compared amongst six groups (Open, Closed or BT for Femur and Tibia fractures), at 60-90 days, 91-180 days, 181- 270 days, and 271-365 days and greater than 365 days. Statistical comparison was performed using a two-way ANOVA and Tukey's multiple comparisons.

RESULTS: Included in the study were 114 patients, with 20 patients in each group except the OPEN femur fracture group with 14.

TIBIA: At the 91-180 day time point, CLOSED tibia RUS was significantly higher than for BT and OPEN tibia RUS. At 181-270 days, CLOSED tibia RUS was significantly higher than OPEN tibia. At 271-365 days and >365, CLOSED and BT RUS were significantly higher than OPEN RUS.Femur: At the 91-180 day time point, OPEN femur RUS was significantly lower than CLOSED and BT femur RUS. At later timepoints, all three groups achieved union with mean RUS>10.

DISCUSSION: This study demonstrates that healing of tibial shaft fractures from BT is not significantly different from closed fractures after 180 days post-operatively. Additionally, femoral shaft fractures from a BT healed similarly to closed and open fractures after 180 days post-operatively.

LEVEL OF EVIDENCE: Prognostic Level III.

PMID:40154237 | DOI:10.1016/j.injury.2025.112268

Injury. 2025 Mar 24:112285. doi: 10.1016/j.injury.2025.112285. Online ahead of print.

NO ABSTRACT

PMID:40148146 | DOI:10.1016/j.injury.2025.112285