Injury. 2026 Apr 15;57(6):113290. doi: 10.1016/j.injury.2026.113290. Online ahead of print.

ABSTRACT

BACKGROUND: Induced membrane technique (IMT), a novel approach for reconstructing critical-size bone defect, encounters the challenge of lengthy mineralization time after bone grafting. This study is to explore the effect of Naringin on M2 macrophage polarization-mediated osteogenesis in the induced membrane's bone graft area.

METHODS: The IMT model was established in SD rats. After 8 weeks of treatment with Naringin and interleukin-4 (IL-4), the repair effect of femoral bone defects was evaluated. Meanwhile, RNA sequencing (RNA-seq) was performed on the bone tissue from rats treated with Naringin to detect changes in gene transcription levels. In vitro, Macrophages were divided into four groups: Control group, si-JAK1 + Naringin group, Naringin group and IL-4 group. At corresponding stages, cell proliferation, cell phenotype (M1 or M2), factors related to the JAK/STAT6 pathway, and osteogenic factors secreted by macrophages were assessed. Additionally, a macrophage-osteoblast coculture system was established to analyze the effects of osteogenic factors derived from M2 macrophages on osteoblasts' viability and mineralization.

RESULTS: The result of RNA-seq on the bone tissue in the bone graft area revealed that genes upregulated by Naringin were significantly enriched in biological processes related to immune regulation and the JAK/STAT pathway. The in vivo study indicated that there is an increase in markers of M1 macrophages and a decrease in markers of M2 macrophages in the bone grafting area of IMT. Treatment with Naringin and IL-4 could stimulate the polarization of M0 macrophages towards M2, accelerate the healing of bone defects, and increase expression of osteogenic factors and JAK1/STAT6 pathway factors. The in vitro experiments showed that treatment of primitive macrophages (M0) with Naringin and IL-4 led to an increase in the number of M2 macrophages, enhanced secretion of osteogenic factors, upregulation of the JAK1/STAT6 pathway. Conversely, the number of M1 macrophages decreased. Additionally, si-JAK1 was able to reverse the positive effect of Naringin on M2 macrophage polarization. Furthermore, after co-culturing macrophages and osteoblasts, it was found that osteogenic factors derived from polarization of M2 macrophages could stimulate the activity and mineralization of osteoblasts. Finally, Molecular docking, molecular dynamics simulation (MDS) and CETSA results indicated that Naringin can directly bind to JAK1 protein in macrophages and maintain its thermal stability.

CONCLUSIONS: JAK1-mediated polarization of M0 macrophages towards M2 has a positive regulatory function in osteoblasts' mineralization. Naringin targets JAK1 in macrophages within the IMT's bone graft area, maintaining its stability, promoting the activation and phosphorylation of the JAK1/STAT6 pathway, stimulating M2 polarization of macrophages, and thereby facilitating bone graft growth and accelerating the repair of large bone defects.

PMID:41997096 | DOI:10.1016/j.injury.2026.113290

Injury. 2026 Apr 15;57(6):113268. doi: 10.1016/j.injury.2026.113268. Online ahead of print.

ABSTRACT

INTRODUCTION: Venous thromboembolism (VTE) is a major complication in pelvic ring and acetabular fractures (PAF). Evidence on incidence and optimal prophylaxis strategies remains limited. This study aimed to investigate the incidence of VTE in PAF patients under a standardized prophylaxis regimen.

METHODS: A prospective cohort study was conducted at a German Level I trauma center between January and December 2024. 81 patients with PAF (Pelvic ring fracture (PF) n = 47, Acetabular fracture (AF) n = 28, Combined fracture (CF) n = 6) were included. All patients received enoxaparin 4000 IU twice daily, initiated within 12 h of admission. Primary outcome was radiologically confirmed VTE during index hospitalization. Secondary outcomes included VTE timing, association with fracture type and treatment, and bleeding complications.

RESULTS: The overall incidence of VTE was 7.4% (6/81), including deep vein thrombosis (DVT) 6.2% (5/81), pulmonary embolism (PE) 2.5% (2/81), and one combined event. VTE occurred more often in AF (10.7% (3/28)) and CF (33.3% (2/6)) compared with PF (2.1% (1/47); p = 0.016). Three of five DVTs (60%) were asymptomatic. No associations were found with age, sex, ASA, trauma mechanism, or associated injuries. In the operatively treated group, one patient (1.9%; 1/53) required revision for postoperative hematoma; no further bleeding complications occurred.

CONCLUSION: A prophylactic regimen with enoxaparin 4000 IU twice daily was associated with a low incidence of VTE in PAF patients without an increased risk of bleeding. Routine duplex ultrasound screening enabled early VTE detection, including asymptomatic cases, and may improve outcomes in this high-risk population.

PMID:41997095 | DOI:10.1016/j.injury.2026.113268

Injury. 2026 Apr 9;57(6):113262. doi: 10.1016/j.injury.2026.113262. Online ahead of print.

ABSTRACT

INTRODUCTION: Respiratory complications following cervical spinal cord injury (CSCI) are a major cause of morbidity and mortality. Although several risk factors have been identified, quantitative predictors for respiratory deterioration are limited. The respiratory rate-oxygenation (ROX) index, defined as the ratio of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) to respiratory rate, has been validated for predicting outcomes in respiratory failure. Because the ROX index is a quantitative indicator that sensitively reflects temporal changes in respiratory status, we hypothesized that variations in the ROX index (delta ROX) could serve as a predictor of respiratory exacerbation (RE) in patients with CSCI. This study aimed to evaluate the association between delta ROX and RE in patients with CSCI.

PATIENTS AND METHODS: A single-center, retrospective observational study was conducted at a major trauma center in Japan between 2012 and 2023. Adult patients (aged ≥18 years) admitted to the intensive care unit (ICU) with traumatic CSCI were eligible. The primary outcome was RE requiring intubation within 7 days. The ROX index was calculated at each time point (2, 6, 12, 18, and 24 h after admission). The delta ROX index was defined as the ratio of the ROX index at each time point to the ROX index at ICU admission.

RESULTS: Among 54 eligible patients, 7 (13%) developed RE. The delta ROX index showed significant differences between the RE and control groups at 12 (0.69 vs. 1.27, p = 0.016), 18 (0.81 vs. 1.29, p = 0.005), and 24 h (0.73 vs. 1.33, p = 0.004). Receiver operating characteristic analysis demonstrated the highest predictive value at 24 h (area under the curve 0.94, 95% CI 0.87-1.00).

CONCLUSION: The delta ROX index may serve as a valuable predictor of RE in patients with CSCI. A decreasing trend in the ROX index during the first 24 h of ICU admission was associated with an increased risk of respiratory deterioration, potentially enabling earlier respiratory intervention. These findings suggest that the delta ROX index provides a dynamic, quantitative measure that may help identify patients at increased risk.

PMID:41997094 | DOI:10.1016/j.injury.2026.113262

Injury. 2026 Apr 14:113275. doi: 10.1016/j.injury.2026.113275. Online ahead of print.

NO ABSTRACT

PMID:41991380 | DOI:10.1016/j.injury.2026.113275

Injury. 2026 Apr 10;57(6):113269. doi: 10.1016/j.injury.2026.113269. Online ahead of print.

ABSTRACT

INTRODUCTION: Choosing which patients should undergo computed tomography (CT) and what specific studies they should undergo remains an important decision point in caring for traumatically injured patients. Patients with physical exam findings isolated to the thoracic and/ or lumbar (T/L) spine may undergo CT T/L spine or CT of the chest, abdomen, and/ or pelvis (C/A/P), with clinicians alternately choosing between approaches based on perceived risks and benefits related to radiation, cost, and diagnostic value. No prior study has evaluated the outcomes of patients who underwent CT T/L spine to assess the risks and benefits of this more limited approach.

METHODS: We performed a retrospective cohort study of patients admitted to a large urban level 1 trauma center from January 1, 2021 to December 31, 2024 who underwent CT T/L spine. We collated data using information collected through our trauma registry as well as data gathered through manual chart review. We generated descriptive data related to patient, intervention, and imaging-related characteristics.

RESULTS: During the study period, 127 patients were admitted following a traumatic injury and underwent CT T/L spine. The imaging studies obtained and their chronologies differed among included patients. Of 58 patients who underwent initial CT T/L spine, 13 (22%) had evolving circumstances prompting additional CT C/A/P. Of these, two had new injuries identified on CT C/A/P. Those patients who first underwent CT T/L spine and then underwent CT C/A/P were administered an additional median of 547 milliGray x centimeters in the second set of images. Patients from all imaging chronology groups had discrepancies between documented physical exam and imaging findings.

DISCUSSION: A substantial number of patients who underwent CT T/L spine developed additional circumstances prompting a repeat set of images with CT C/A/P, with a small number of patients having additional clinically relevant injuries identified at that time. Upfront imaging with CT C/A/P might reduce the need for multiple trips to the CT scanner with an associated impact on labor needs, cost, and administered radiation.

PMID:41990427 | DOI:10.1016/j.injury.2026.113269

Injury. 2026 Apr 9;57(6):113277. doi: 10.1016/j.injury.2026.113277. Online ahead of print.

ABSTRACT

Road traffic crashes are sudden and traumatic events that extend beyond physical injuries, exerting profound adverse effects on individuals' cognitive, emotional, and social functioning. The literature demonstrates that survivors of road traffic crashes may develop a wide range of psychological responses, including Posttraumatic Stress Disorder (PTSD), Acute Stress Disorder, depression, anxiety, traumatic grief, dissociative disorders, sleep disturbances, and avoidance behaviors. The severity and course of these reactions vary depending on multiple factors, such as the nature and intensity of the crash, prior trauma history, personality traits, level of social support, and demographic characteristics. This narrative review examines the psychological and behavioral responses observed in traffic crash survivors, highlighting how these responses differ across developmental stages, the risk factors that contribute to their emergence, and the ways in which psychological intervention needs are shaped. Findings indicate that children and adolescents are particularly vulnerable to the psychological consequences of traffic crashes due to their developmental characteristics. Among psychosocial intervention methods, trauma-focused cognitive-behavioral therapy, Eye Movement Desensitization and Reprocessing (EMDR), group therapy, virtual reality-based exposure techniques, and psychoeducation programs have been found to be effective. Early psychological assessment, timely referral to appropriate intervention programs, and strengthening social support networks are crucial for preventing chronicity and promoting well-being. In conclusion, this review underscores that traffic crashes generate not only physical but also significant psychological and societal consequences. The assessment of multidimensional post-traumatic responses, the identification of risk and protective factors, and the implementation of evidence-based interventions address critical gaps in the literature and make substantial contributions to reducing the psychosocial burden associated with traffic accidents.

PMID:41985390 | DOI:10.1016/j.injury.2026.113277

Injury. 2026 Apr 10;57(6):113283. doi: 10.1016/j.injury.2026.113283. Online ahead of print.

ABSTRACT

BACKGROUND: Acute spinal cord injuries (SCIs) remain a devastating consequence of trauma. Treatment may involve administration of neuroprotective agents, surgery, and hemodynamic management. Hemodynamic management entails setting specific mean arterial pressure (MAP) goals to optimize perfusion of the spinal cord. Maintenance of MAP typically requires monitoring in the intensive care unit (ICU) and may necessitate vasopressor medications. This treatment utilizes significant resources. The objective of this study was to determine whether vasopressor requirements during the initial days of ICU admission are predictive of future need for these medications to maintain MAP goals in patients with SCI.

METHODS: A retrospective review of a prospective database was performed to identify all adult patients who presented to a Level 1 academic medical center with SCI between 2016 and 2024. Patients were included if they were between the ages of 18 and 89, had a cervical or thoracic spinal cord injury, and were managed with a MAP goal of at least 85 mmHg for five days. Patients with injury to the conus medullaris or cauda equina were excluded. Data collected included baseline demographics, mechanism of injury, ICU admission details, MAP measurements, and vasopressor use. Fisher's exact test was used to calculate predicted probabilities for subsequent vasopressor administration.

RESULTS: A total of 98 patients (median age 62.5 years, range: 18-89 years) were identified. Most patients (90.1%, n = 82) had an SCI involving the cervical spine. The median ICU length of stay was 6 days (range: 1-92 days). Among patients who did not require vasopressors within the first two days of ICU admission (n = 27), 88.9% (n = 24) did not require them subsequently. Furthermore, all patients (n = 24, 24.5%) who did not require vasopressors within the first three days of ICU admission did not need them thereafter.

CONCLUSION: Patients with SCI who did not require vasopressors to maintain a MAP of at least 85 mmHg during the initial two days of ICU stay were unlikely to subsequently need them. This finding can assist providers in improving resource allocation and bed assignment for patients with SCI in the ICU.

LEVEL OF EVIDENCE: III.

PMID:41985389 | DOI:10.1016/j.injury.2026.113283

Injury. 2026 Apr 10;57(6):113284. doi: 10.1016/j.injury.2026.113284. Online ahead of print.

ABSTRACT

The bifurcation and confluence of the common iliac vessels and their course are critical considerations for safe surgical acetabular fracture repair. Anatomical variations in the expected placement of these vessels have been associated with intraoperative complications, including hemorrhage. The purpose of this study was therefore to define vertebral levels of bifurcation and confluence of the common iliac vessels and trace their passage across the quadrilateral plate, a surgically significant landmark. The findings revealed 57% and 11% of bifurcation and confluence, respectively, were located at vertebral levels higher than the commonly reported level of L4. Variations were also more common than previous reports, with the current study observing cases of absent common iliac veins and aberrant communicating veins. The course trajectories revealed 10.6% of the study sample would have been predisposed to surgical complications involving the common iliac vessels.

PMID:41985388 | DOI:10.1016/j.injury.2026.113284

Injury. 2026 Apr 10;57(6):113272. doi: 10.1016/j.injury.2026.113272. Online ahead of print.

ABSTRACT

BACKGROUND: As per current British Orthopaedic Association Standards for Trauma (BOAST), all patients presenting with pelvic fractures should undergo a contrasted Computer Tomography (CT) scan and post binder removal X-ray (PBXR). According to those guidelines, retrograde cystography is recommended to investigate suspected bladder injury. However, retrograde cystography is an invasive procedure that is not easy to perform in polytrauma patients. We hypothesise that timely PBXR can show contrast accumulation in the bladder which may help detect bladder or urethra injuries.

AIM: This paper evaluates whether patterns of contrast within the bladder or extravasating on the PBXR indicate associated urological injury. It also examines if catheterisation and timing of the PBXR affects diagnostic ability.

METHODS: Patients with pelvic ring and/or acetabulum fractures were retrospectively identified from Electronic Patient Records of two Level 1 Trauma centres (July 2021 to December 2024). PBXRs were analysed to determine the contrast pattern and to look for extravasation. Patterns were correlated with bladder injury findings from urological investigations or intra-operative findings. Catheterisation and CT-PBXR time interval were recorded.

RESULTS: Of the 601 patients with pelvic fracture, 186 underwent a CT scan followed by PBXR. Five (2.69%) patients had confirmed bladder injury. Contrast extravasation was visible on PBXR in 4 (80%) patients with bladder injury (p < 0.001). Of the 181 patients without bladder injury, none of them showed contrast extravasation and 122 (67%) had contrast visible within the bladder. In patients without bladder injury, 47 (25.97%) were catheterised, which was associated with less commonly seeing contrast filling the bladder when compared to those without a catheter (p = 0.005). PBXR performed within 10 h of CT scan was associated with a significantly higher rate of contrast-filled bladder (85.82%) than those performed more than 10 h after CT scan (14.89%) (p < 0.001). There was also significant correlation between those with a catheter and having a bladder injury (p = 0.021).

CONCLUSIONS: Visible contrast extravasation on PBXR correlates strongly with bladder injury associated with pelvic trauma. This is more reliable when patients are not catheterised and PBXR is performed within 10 h of CT scan. Timely PBXR after contrasted CT can identify patients who would benefit from expedited urological referral. Further prospective investigation is warranted.

PMID:41985387 | DOI:10.1016/j.injury.2026.113272

Injury. 2026 Apr 9;57(6):113264. doi: 10.1016/j.injury.2026.113264. Online ahead of print.

ABSTRACT

INTRODUCTION: Heterotopic ossification (HO) is a frequent complication of acetabular fracture fixation; however, the optimal strategy for prophylaxis remains controversial. This study aimed to evaluate the incidence and clinical course of HO after posterior acetabular fixation performed without routine prophylaxis, and to identify independent predictors of its development.

MATERIALS AND METHODS: A cohort of 257 consecutive patients who underwent acetabular fracture fixation via the Kocher-Langenbeck approach between 2001 and 2023 at a Level I trauma center was retrospectively analyzed. No routine postoperative prophylaxis with non-steroidal anti-inflammatory drugs or radiation therapy was administered. The patients were followed up for a minimum of 12 months (mean, 53 months). HO was graded according to the Brooker classification. Potential risk factors for HO development were examined using univariate and multivariate logistic regression analyses.

RESULTS: HO developed in 34 (13.2%) patients, with 23 (9.0%) demonstrating clinically significant HO (Brooker grade III or IV). Radiographic HO was first detected at a mean of 6.7 weeks postoperatively. Among the patients with HO, seven (20.6%) developed painful ankylosis requiring surgical excision at a mean of 11.5 months after diagnosis: one had Brooker grade III HO and six had grade IV HO. Univariate analysis demonstrated significant associations between HO and traumatic brain injury, mechanical ventilation, traumatic hip dislocation, femoral head fracture, and retained intra-articular debris (all p < 0.05). After adjustment for confounding factors, traumatic brain injury (odds ratio [OR], 6.98; 95% confidence interval [CI] 3.03-16.08), mechanical ventilation (OR, 9.49; 95% CI, 3.70-24.32), and retained intra-articular debris (OR, 7.42; 95% CI, 3.01-18.29) remained independent predictors, whereas hip dislocation and femoral head fracture were no longer significant.

DISCUSSION: In this cohort, posterior acetabular fixation without routine prophylaxis was associated with a relatively low incidence of clinically significant HO, comparable to the rates reported in a contemporary series. HO development is primarily associated with markers of systemic injury severity and the presence of retained intra-articular debris. These findings suggest that risk stratification based on injury severity and meticulous intra-articular management may be appropriate for determining the need for HO prophylaxis.

PMID:41985386 | DOI:10.1016/j.injury.2026.113264

Injury. 2026 Apr 6:113251. doi: 10.1016/j.injury.2026.113251. Online ahead of print.

NO ABSTRACT

PMID:41982036 | DOI:10.1016/j.injury.2026.113251

Injury. 2026 Apr 3:113219. doi: 10.1016/j.injury.2026.113219. Online ahead of print.

NO ABSTRACT

PMID:41982035 | DOI:10.1016/j.injury.2026.113219

Injury. 2026 Apr 2:113212. doi: 10.1016/j.injury.2026.113212. Online ahead of print.

NO ABSTRACT

PMID:41968020 | DOI:10.1016/j.injury.2026.113212

Injury. 2026 Apr 10:113256. doi: 10.1016/j.injury.2026.113256. Online ahead of print.

NO ABSTRACT

PMID:41968019 | DOI:10.1016/j.injury.2026.113256

Injury. 2026 Apr 10:113248. doi: 10.1016/j.injury.2026.113248. Online ahead of print.

NO ABSTRACT

PMID:41968018 | DOI:10.1016/j.injury.2026.113248

Injury. 2026 Apr 3;57(6):113231. doi: 10.1016/j.injury.2026.113231. Online ahead of print.

ABSTRACT

BACKGROUND: Skiing and snowboarding are popular winter sports in the United States that attract millions of participants annually. Despite advancements in protective equipment and adoption, contemporary national data on trends, injury patterns, and resource utilization associated with ski and snowboard-related hospitalizations remains limited.

METHODS: Nonelective hospitalizations for ski and snowboard-related injuries were identified using the 2016-2022 National Inpatient Sample. Trends in hospitalization incidence and costs were assessed, alongside patient demographics, hospital characteristics, and injury patterns.

RESULTS: Of 13,105 cases, 79.5% comprised the Ski cohort, while 20.5% comprised the Snowboard cohort. From 2016 to 2022, the incidence of ski-related hospitalizations increased from 1235 to 1905 cases (p = 0.37; p = 0.03 excluding Covid-19 years), while the incidence of snowboard-related hospitalizations increased from 245 to 455 cases (p = 0.13; p = 0.09 excluding Covid-19 years). Annual costs rose from $29.4 million to $52.5 million for ski-related hospitalizations (p = 0.04), and $3.61 million to $9.20 million for snowboard-related hospitalizations (p = 0.07). Compared to snowboarders, skiers were older and were more commonly treated at hospitals in rural regions. Across both cohorts, the census divisions with the highest total inpatient costs were the Mountain division ($176 million) followed by the Pacific division ($63.8 million) and the New England division ($26.2 million). Following risk-adjustment, snowboarders were more likely to sustain a traumatic brain injury (Adjusted Odds Ratio [AOR] 1.36, 95% Confidence Interval [CI] 1.04-1.78) as well as fractures to the humerus (AOR 2.32, 95%Cl 1.48-3.63) and radius/ulna (AOR 2.52, 95%CI 1.56-4.07) in reference to skiers. However, snowboarders were less likely to experience femur (AOR 0.37, 95%CI 0.25-0.54) and tibia/fibula fractures (AOR 0.22, 95%CI 0.16-0.32). Moreover, snowboarders faced shorter length of stay (-0.54 days, 95%CI -0.81-(-0.27)) and reduced hospitalization costs (-$3500, 95%CI -5,500-(-1500)) compared to skiers.

CONCLUSIONS: Ski and snowboard-related hospitalizations and associated costs rose from 2016 to 2022. Understanding contemporary trends and injury patterns can help inform targeted prevention. Potential strategies include promoting helmet use, equipment maintenance, and enhanced care in rural regions, all of which may help reduce injury risk and healthcare costs.

PMID:41967156 | DOI:10.1016/j.injury.2026.113231

Injury. 2026 Apr 9;57(6):113265. doi: 10.1016/j.injury.2026.113265. Online ahead of print.

ABSTRACT

BACKGROUND: Optimal management of acetabular fractures remains controversial. Open reduction and internal fixation (ORIF) may be followed by post-traumatic degeneration and late conversion arthroplasty, whereas acute total hip arthroplasty (THA) may introduce implant-related risks. We compared short- and long-term outcomes after ORIF versus acute THA in a large, multicenter electronic health record cohort.

METHODS: We performed a retrospective cohort study using the TriNetX Network. Adults with isolated, closed, acute acetabular fractures treated with either ORIF or acute primary THA were identified. Patients were propensity score-matched (PSM) 1:1 on demographics and comorbidities. Outcomes were assessed at 90 days and at 1, 2, 5, and 10 years, including mortality, complications, health care utilization, and procedure-specific failures (for ORIF: nonunion, post-traumatic osteoarthritis, and conversion to THA; for THA: periprosthetic fracture, prosthetic joint infection [PJI], instability/dislocation, and mechanical complications).

RESULTS: After PSM, 3700 matched pairs comprised the early follow-up cohorts. At 90 days, ORIF was associated with higher mortality (5.2% vs 3.5%; OR 1.5; p < 0.0001) and higher rates of stroke, respiratory failure, venous thromboembolism, and ICU admission, whereas acute THA had higher emergency department visits (9.1% vs 5.3%; p < 0.0001) and hip pain (23.2% vs 13.2%; p < 0.0001). Over long-term follow-up, acute THA demonstrated higher implant-related complications at 2 years, including periprosthetic/implant fracture (3.0% vs 0.8%), PJI (6.8% vs 3.8%), instability (7.7% vs 3.0%), and mechanical complications (6.3% vs 3.5%) (all p < 0.0001), while overall reoperation rates were similar at 2 years (11.8% vs 11.2%; p = 0.53) and remained comparable through 10 years. In the ORIF cohort, nonunion reached 11.3%; conversion to THA increased from 4.3% at 2 years to 5.8% at 10 years; and post-traumatic osteoarthritis (PTOA) increased from 21.2% at 2 years to 27.2% at 10 years. Pre-index hip disease was markedly more common among acute THA patients (OA 51% vs 10%; AVN 14% vs 1%).

CONCLUSIONS: In this study, ORIF was associated with higher early mortality and systemic complications, whereas acute THA was associated with higher implant-related complications. Despite these differing complication profiles, cumulative reoperation rates were similar through long-term follow-up. Progressive PTOA and conversion to THA remain important sequelae after ORIF.

PMID:41967155 | DOI:10.1016/j.injury.2026.113265

Injury. 2026 Apr 10;57(6):113281. doi: 10.1016/j.injury.2026.113281. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical calculators are used to determine which trauma patients require computed tomography (CT) scans of the spine. However, mild traumatic spinal cord injury (TSCI) may be present despite a negative CT scan. Therefore, the present study sought to internally validate the use of two calculators (whole spine and cervical-only) to identify such patients.

METHODS: The Spinal Cord Injury Model System Program was used to conduct this retrospective cohort study. Patients at least 15 years old with an American Spinal Injury Association (ASIA) grade D injury due to blunt trauma were included. Patients with and without concurrent vertebral injury were considered CT-evident and CT-occult, respectively. A Firth's regression was used to establish β coefficients, which were converted into points to predict CT-occult TSCI. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated at the optimal point threshold.

RESULTS: This study included 589 patients (mean age = 54.1 ± 16.7), of whom 182 (31%) were CT-occult. In the all-injury level calculator, ages 30-70 added three points; ages 70+ added one point; fall injuries added one point; cervical level injury added seven points; clinical suspicion of central cord syndrome (CCS) added one point, whereas the presence of associated injuries deducted three points. At the seven-point cutoff, sensitivity was 97.3%, specificity was 21.9%, PPV was 35.8%, and NPV was 94.7%. The cervical calculator assigned one point for ages 45-60, fall injuries, and CCS, but deducted two points if there were associated injuries. At the zero-point threshold, sensitivity was 96.6%, specificity was 8.5%, PPV was 36.4%, and NPV was 82.4%.

CONCLUSIONS: The calculators demonstrated high sensitivity and may be invaluable adjuncts for assessing suspected CT-negative TSCI. External validation is necessary to determine their generalizability.

PMID:41967154 | DOI:10.1016/j.injury.2026.113281

Injury. 2026 Apr 9;57(6):113282. doi: 10.1016/j.injury.2026.113282. Online ahead of print.

ABSTRACT

PURPOSE: To report a single-center experience evaluating procedural performance and early imaging-based safety of CBCT-guided cement-augmented percutaneous pelvic fixation for fragility fractures.

MATERIALS AND METHODS: This retrospective cohort included 51 consecutive patients with pelvic fragility fractures who underwent CBCT-guided percutaneous screw fixation with cement augmentation between November 2023 and September 2025. Endpoints were technical success, operative time, radiation exposure, and adverse events. Exploratory analyses assessed associations between operative parameters and fracture classification, body mass index, number of entry sites, and number of screws.

RESULTS: A total of 76 screws were placed in 51 patients. Technical success was 100% (successful completion of planned screw placement). Mean operative time was 51.3 ± 14.1 min and increased with the number of screws (ρ = .368; adjusted P = .018) and the number of entry sites (ρ = .390; adjusted P = .015). Median DAP was 64.45 Gy·cm² (Q1-Q3, 50.35-103.85) and increased with operative time (ρ = .448; adjusted P = .004) and BMI (ρ = .480; adjusted P = .003). Two postoperative hardware-related adverse events required reintervention (modified CIRSE grade 3).

CONCLUSION: This retrospective single-center experience confirms reproducibility of CBCT-guided cement-augmented percutaneous pelvic fixation with 100% technical success. However, without patient-centered outcomes, comparative data, and systematic longer-term follow-up, clinical benefit cannot be assessed.

LEVELS OF EVIDENCE: This paper is Level IV / Level 4 of evidence.

PMID:41967153 | DOI:10.1016/j.injury.2026.113282

Injury. 2026 Apr 9;57(6):113276. doi: 10.1016/j.injury.2026.113276. Online ahead of print.

ABSTRACT

INTRODUCTION: Functional bracing is a common non-operative treatment for humeral shaft fractures. The effects of patient-specific soft tissue characteristics on fracture site biomechanics during bracing are poorly understood and may alter healing. This study leveraged finite element analysis (FEA) to characterize the impact of arm diameter and muscle-adipose composition on fracture site strain during bracing. In conjunction with other factors, researchers and clinicians may apply these findings toward optimizing outcomes in patients with humeral shaft fractures.

METHODS: Nine humerus FEA models were constructed with concentric cylindrical tubes representing fractured diaphyseal bone, muscle, adipose, and a plastic brace. Models had varying arm diameters (small, medium, and large, based on institutional data) and muscle-to-adipose tissue ratios (25%/75%, 50%/50%, 75%/25%). To simulate bracing and physiological bending movements, a uniform radial pressure (5.33 kPa) was applied to the brace, and a lateral force (40 N) was applied to the distal humerus with the proximal end fixed. Fracture site strain values were computed for each arm configuration. FEA findings were validated with biomechanical testing of a cadaveric arm that was braced and subjected to the same bending forces.

RESULTS: For a specific arm size, an increase in adiposity, as indicated by a lower muscle-to-adipose ratio, resulted in increased Perren strain values at the simulated fracture site. Furthermore, at a given ratio of muscle-to-adipose, an increase in arm size corresponded to a decreased level of strain experienced at the fracture site. Cadaveric biomechanical testing yielded comparable strain values to FEA models of similar arm composition.

DISCUSSION: These findings suggest that smaller diameter arms and increased adipose levels may increase fracture instability during functional brace treatment of humeral shaft fractures. Further, these findings may inform patient selection for functional bracing versus surgery for humeral shaft fractures or guide modifications to functional brace design.

PMID:41967152 | DOI:10.1016/j.injury.2026.113276