Injury. 2025 Aug 7;56(10):112657. doi: 10.1016/j.injury.2025.112657. Online ahead of print.

ABSTRACT

BACKGROUND: Nonunion is a significant complication following nonoperative treatment of displaced midshaft clavicle fractures, potentially leading to impaired shoulder function, pain, and decreased quality of life. This study aims to identify predictors of nonunion in adults treated nonoperatively to optimize treatment decisions and improve outcomes.

METHODS: A retrospective cohort study was conducted using data from 374 patients treated nonoperatively between 2012 and 2024. Patient and fracture characteristics, including age, sex, smoking, diabetes mellitus, and fracture comminution, were assessed. Univariable and multivariable logistic regression analyses identified predictors of nonunion. Model performance was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Diagnostic statistics and number needed to screen (NNS) were calculated.

RESULTS: Of 374 patients, 72 (19.3 %) developed nonunion. Multivariable analyses revealed that increasing age (odds ratio [OR]: 1.03, 95 % confidence interval [CI]: 1.01-1.04, p = 0.002) and smoking (OR: 2.49, 95 % CI: 1.31-4.71, p = 0.005) were independently associated with increased risk of nonunion. Fracture comminution was associated with reduced risk (OR: 0.34, 95 % CI: 0.20-0.58), p < 0.001). The model's AUC was 0.70. At a probability threshold of 0.4, the NNS was 6.

CONCLUSIONS: This study highlights the potential of predictive models to identify patients at risk for nonunion. Age and smoking increase the risk of nonunion, while comminution showed a protective effect. These findings support personalized care to optimize treatment decisions and improve patient outcomes. Further refinement and inclusion of additional risk factors are essential to improve the model's accuracy and clinical applicability.

PMID:40850009 | DOI:10.1016/j.injury.2025.112657

Injury. 2025 Aug 5;56(10):112646. doi: 10.1016/j.injury.2025.112646. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Complex open tibial fractures with soft tissue defects in children represent a major clinical challenge due to high risks of infection, osteomyelitis, and long-term functional impairment. This study aimed to evaluate the effectiveness of a combined orthopedic and reconstructive approach using external fixation and free anterolateral thigh (ALT) flaps in pediatric patients.

METHODS: In this prospective, controlled clinical trial, 78 children (mean age 12.4 ± 3.1 years) with open tibial fractures and extensive soft tissue loss from road traffic accidents were enrolled. Patients were randomized into two groups: the experimental group (n = 40) received Ilizarov external fixation with microsurgical ALT flap reconstruction; the control group (n = 38) underwent conventional internal fixation with standard wound management. Renal function markers (creatinine, urea, GFR) were monitored to assess the impact of trauma, systemic inflammation, and nephrotoxic antibiotic exposure. Healing was evaluated using the Zygo-Scale at 7, 30, 60, 90 days, and 12 months. Incidence of osteomyelitis, joint ankylosis, flap complications, and revision surgeries was recorded.

RESULTS: The experimental group demonstrated significantly faster and more complete soft tissue healing (p ≤ 0.05), with lower rates of osteomyelitis at 6 and 12 months (2.5 % and 0 % vs. 10.5 % and 5.25 %, respectively; p < 0.05). Joint ankylosis scores were also significantly reduced (p = 0.02 and p = 0.01). Flap survival rate was 95 %, with no cases of total necrosis. Donor site morbidity was minimal. While renal function improved in both groups, a modest but significant difference in creatinine levels at 12 months favored the experimental group (p = 0.03). The combined approach was associated with shorter healing times and fewer complications.

CONCLUSION: The integration of Ilizarov fixation with ALT flap reconstruction is a safe and effective strategy for managing severe pediatric lower limb injuries, enhancing healing, reducing infections, and improving functional outcomes. Monitoring renal markers provides insight into systemic stress and antibiotic safety in trauma care.

PMID:40850008 | DOI:10.1016/j.injury.2025.112646

Injury. 2025 Aug 7;56(10):112663. doi: 10.1016/j.injury.2025.112663. Online ahead of print.

ABSTRACT

AIMS: This study aimed to explore safety and feasibility of at-home softcast removal in children with displaced injuries undergoing manipulation; understand caregiver experience; and determine its impact on service at our tertiary centre.

METHODS: Paediatric patients (<16 years) with any fracture requiring application of a circumferential softcast, later removed at home without planned routine follow-up, were retrospectively analysed from two time-points: July-September 2022; February-April 2023. Demographic data including age, fracture location, angulation, whether manipulation was undertaken, and unplanned re-attendances were recorded. Caregivers completed a telephone Likert questionnaire (1=extremely positive, 5=extremely negative) reviewing cast removal time and qualitative descriptors of experience. Cost analysis was performed based on use of consumables, staff and clinical areas.

RESULTS: 77 caregivers completed the questionnaire at mean 93.4 days post-injury. Mean patient age was 7.6 years at time of injury. 41 (53.2 %) were distal radius, 20 (26.0 %) forearm and 16 (20.8 %) were elbow, hand or tibia fractures. Mean sagittal angulation was 24.7 degrees and 40 (52.0 %) injuries underwent manipulation under sedation. 13 (16.9 %) patients re-attended with cast problems. Caregivers estimated a mean 13.3 min to remove the cast. 83.1 % found it 'extremely' or 'somewhat' easy. 75.3 % were 'extremely' or 'somewhat' satisfied. 71.4 % were 'extremely' or 'somewhat' likely to recommend it. Qualitative descriptors ranged from "traumatic" to "easy". Since introduction of this practice, subsequent clinic attendances for children diagnosed with a fracture in the Emergency Department has reduced by >50 %, equating to savings of approximately £22,600 per annum.

CONCLUSION: Our experience confirms at-home softcast removal without further orthopaedic follow-up is safe and feasible, even in displaced injuries undergoing manipulation. The majority of families reported positive experiences. However, this was not universal and adequate patient education was integral to this.

PMID:40850007 | DOI:10.1016/j.injury.2025.112663

Injury. 2025 Aug 7;56(10):112660. doi: 10.1016/j.injury.2025.112660. Online ahead of print.

ABSTRACT

INTRODUCTION: The incidence of postoperative neurocognitive disorder (PND) in elderly patients with hip fractures poses a significant clinical challenge, with current management strategies offering limited efficacy in prevention or resolution. This prospective study evaluated the effectiveness of pre-and postoperative electroacupuncture (EA) intervention in mitigating PND in this patient cohort.

METHODS: A double-masked, randomized controlled trial was conducted involving 60 elderly patients (≥65 years) with fragility hip fractures scheduled for surgical repair. Participants were randomly assigned to either the EA intervention group (Group A) or a non-stimulated control group (Group C). Mini-Mental State Examination (MMSE) scores were recorded at baseline and 1, 3, and 7 days postoperatively, while ELISA was used to assess IL-1β, IL-6, and S-100β levels. Time-varying MAP, SpO2, and HR were measured. Adverse cardiovascular events, extubation duration, recovery room stay, VAS scores, analgesia pump use, postoperative adverse responses, and hospitalization length were recorded.

RESULTS: Among 60 randomized patients (mean age 74.02 years; 54.7 % male), 53 were analyzed for primary outcomes. Postoperative day 1 PND incidence was significantly lower in Group A (25.0 %) than Group C (56.0 %; P < 0.05), persisting on day 3 (Group A: 14.3 %, Group C: 48.0 %; P < 0.05). By day 7, PND incidence was similar in both groups. Time-group interactions were significant for IL-1β, IL-6, and blood pressure (P < 0.05). Group A exhibited a lower VAS score at 24 h postoperatively (2.65 ± 0.94 vs. 3.96 ± 0.96; P < 0.05). Adverse events were reported in 26 Group A and 32 Group C cases. Postoperative nausea and vomiting (PONV) significantly differed (Group A: 3.7 %, Group C: 30.8 %).

CONCLUSIONS: The findings suggest that pre- and postoperative EA stimulation may significantly reduce the risk of PND, modulate inflammatory responses, and lower blood pressure. Furthermore, EA intervention was associated with reduced postoperative pain and a marked decrease in the incidence of PONV in elderly patients with hip fractures. These results highlight the potential therapeutic benefits of EA in managing PND in this vulnerable patient population and warrant further investigation. SUBJECT WORDS: electroacupuncture, transcutaneous electrical acupoint stimulation, hip surgery, perioperative neurocognitive disorders, pain, postoperative nausea and vomiting.

PMID:40848689 | DOI:10.1016/j.injury.2025.112660

Injury. 2025 Aug 15;56(10):112684. doi: 10.1016/j.injury.2025.112684. Online ahead of print.

ABSTRACT

BACKGROUND: Humeral shaft fractures are common in young adults following high-energy trauma. While open fractures often result in infections, infections in closed fractures are rare, making such cases particularly challenging to manage when they occur.

CASE PRESENTATION: We report a unique case of a 25-year-old pregnant female who sustained a closed humeral shaft fracture after a high-energy injury. Although there was no initial open wound, a purulent infection was discovered at the fracture site during surgery a few days after the injury. Cultures identified Haemophilus influenzae as the causative organism. This report details the management of the fracture and associated infection, highlighting the diagnostic challenges and therapeutic steps taken to address this acute osteomyelitis-like infection in a closed fracture.

DISCUSSION: This case represents the first documented instance of an acute Haemophilus influenzae infection in a closed adult humeral fracture, a pathogen traditionally associated with pediatric respiratory infections. Contributing factors may have included the patient's complex medical and social background, including pregnancy, polysubstance abuse, homelessness, and the use of immunomodulatory medications. This case highlights the importance of heightened vigilance, the need for modifications in surgical decision-making, and possibly revised empirical antibiotic protocols in the management of closed fractures in immunocompromised patients.

CONCLUSION: Acute infections in closed humeral fractures, though rare, pose significant diagnostic and therapeutic challenges, particularly in immunocompromised individuals. This case prompts a reconsideration of management strategies in similar contexts, advocating for a broad differential diagnosis and tailored antimicrobial strategies to address atypical pathogens in complex clinical scenarios.

PMID:40848688 | DOI:10.1016/j.injury.2025.112684

Injury. 2025 Aug 10;56(10):112680. doi: 10.1016/j.injury.2025.112680. Online ahead of print.

ABSTRACT

Hip fractures in the older persons are associated with high morbidity and mortality rates, with a growing incidence due to an aging population. Early readmission increases dependence and healthcare costs, and identifying the factors associated with readmission could improve care. This study aims to identify factors associated with 30-day readmission following hip fracture in patients aged 75 and older, as well as to explore the relationship between various clinical variables. A multicentric, retrospective observational study was conducted using data from the National Hip Fracture Registry (NHFR) involving 57,544 patients admitted from January 1, 2017, to December 31, 2022. Patients were excluded if they had died during acute hospitalization or were lost to follow-up. Key demographic, clinical, and surgical variables were collected and analysed. Statistical analyses were performed using RStudio, employing both univariate and multivariate regression models to identify predictors of 30-day readmission. The study revealed a 30-day readmission rate of 5.18 %. Factors significantly protective against readmission included female gender (OR 0.84 p < 0.001), intertrochanteric (OR 0.81 p < 0.008) and subtrochanteric (OR 0.74 p < 0.007) fracture type, neuraxial anaesthesia (OR 0.82 p < 0.015), and increased length of stay (OR 0.98 p < 0.001). Conversely, ASA IV (OR 1.93 p < 0.05), ASA V (OR 5.59 p < 0.05) and discharge to residential care were associated with increased readmission risk. Notably, patients discharged home showed a reduced risk of readmission compared to those transferred to other care facilities such as residential care (OR 1.26 p < 0.001), acute hospitalization (OR 35.46 p < 0.001) and long-term care hospital(OR 2.36 p < 0.001). The readmission rate observed was lower than the reported by comparable registries. Identifying patients at high risk of early readmission following hip fracture is critical for enhancing patient care, and specific variables can serve as effective predictors, enabling targeted interventions to reduce readmission rates.

PMID:40848687 | DOI:10.1016/j.injury.2025.112680

Injury. 2025 Aug 12;56(10):112667. doi: 10.1016/j.injury.2025.112667. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare prevalence and severity of sacral dysmorphism in Indigenous and non-Indigenous Australian populations.

METHODS: We performed a single centre retrospective matched cohort study in consecutive Indigenous and non-Indigenous Australian patients who received a CT scan of the pelvis between January and March 2024 at our institution. Patients were excluded if they were under the age of 18 at the time of the scan or had a history of pelvic fractures or fixation. CT scans were assessed for both qualitative and quantitative features of sacral dysmorphism. The primary outcome of interest was the prevalence and severity of sacral dysmorphism in Indigenous and non-Indigenous Australian populations.

RESULTS: 120 patients were included in the study - 60 Indigenous and 60 non-Indigenous Australians. All patients exhibited at least one characteristic of sacral dysmorphism. There was no difference in the prevalence of qualitative sacral dysmorphism between the two groups. Compared to their non-Indigenous counterpart, Indigenous patients demonstrated a lower S1 transsacral corridor coronal diameter (20.50 vs. 21.85 mm, p = 0.005), S1 oblique corridor axial diameter (17.90 vs. 19.60 mm, p = 0.028), S1 pelvic width (144.85 vs. 158.70 mm, p < 0.001), S2 transsacral corridor coronal diameter (13.70 vs. 14.95 mm, p = 0.013), S2 transsacral corridor axial diameter (10.60 vs. 11.55 mm, p = 0.013), and S2 pelvic width (126.60 vs 136.00 mm, p < 0.001). Additionally, in Indigenous patients, S1 and S2 transsacral and oblique S1 iliosacral fixation lengths were shorter. Where an S1 trans-sacral osseous corridor was not present, the S2 corridor was significantly larger in coronal, axial measurements across both groups (p < 0.001).

CONCLUSIONS: Indigenous Australian patients exhibited more severe forms of sacral dysmorphism when compared to their non-Indigenous counterparts. Additionally the overall prevalence of sacral dysmorphism across this Australian population was amongst the highest reported in the literature. This may present significant technical challenges and warrants consideration when performing percutaneous iliosacral screw fixation.

PMID:40848686 | DOI:10.1016/j.injury.2025.112667

Injury. 2025 Aug 7;56(10):112650. doi: 10.1016/j.injury.2025.112650. Online ahead of print.

ABSTRACT

OBJECTIVES: In acknowledgement of the ongoing transition of surgical education from a time-based approach to competency-based curricula, this study aimed to identify key parameters for assessing the performance of surgical trainees in open reduction and internal fixation (ORIF) of a simple ulnar shaft fracture (AO/OTA classification 2U2A3.B).

METHODS: A 4-round Delphi process regarding seven different orthopedic osteosynthesis surgeries was conducted with an international panel of orthopedic surgeons involved in surgical education. This manuscript focuses on compression plating of isolated ulna fractures. Round 1 focused on item generation, round 2 on importance rating, round 3 on defining optimal intervals and borderline error values for a specific fracture model (not reported in this manuscript), and round 4 on assigning weights to each parameter. Data collection was carried out online.

RESULTS: Ninety-eight surgeons agreed to participate in the study. Round 1 generated 30 assessment parameters. In round 2 and 3, these were reduced to 26 parameters. In round 4, parameters received an overall mean weight of 8.27 out of 10 (SD 0.66) with a range of individual parameter mean weights from 6.7 to 9.4. The assessment parameters that achieved the highest weights were anatomical fracture reduction and assessment of forearm range of motion after fixation. In the final list of parameters, five were related to fracture reduction, three to hardware choice, five to plate placement, nine to screw placement, and four to concluding the procedure.

CONCLUSIONS: Utilizing a Delphi process, expert consensus was reached generating a comprehensive list of 26 assessment parameters that can be used to assess surgeon performance in open reduction and internal fixation of an isolated adult ulnar shaft fracture. This will allow educators to provide standardized feedback (formative assessment) to trainees and use a mastery-learning training approach (summative assessment).

PMID:40845526 | DOI:10.1016/j.injury.2025.112650

Injury. 2025 Aug 8;56(10):112658. doi: 10.1016/j.injury.2025.112658. Online ahead of print.

ABSTRACT

INTRODUCTION: Open pelvic fractures, though rare, are associated with high morbidity and mortality due to severe soft tissue damage, hemorrhage, and associated injuries. This retrospective study aimed to assess injury patterns, management strategies, complications, and outcomes of open pelvic fractures at a Level 1 trauma center MATERIALS AND METHODS: A retrospective analysis of 30 patients with open pelvic fractures treated between 2014 and 2021 was conducted. Data included demographics, injury mechanism, fracture pattern (Jones-Powell classification), soft tissue injury (Faringer classification), hemodynamic status, transfusion requirements, associated injuries, surgical interventions, and functional outcomes (Merle de Au Binge score) RESULTS: The mean age was 35.7 years, with a male predominance (28 males, 2 females). Road traffic accidents were the most common injury mechanism. Most patients (n = 28) sustained multiple injuries. Fracture patterns were: Class 1 (n = 2), Class 2 (n = 7), and Class 3 (n = 21). Faringer classification revealed 22 Zone 1, 4 Zone 2, and 4 Zone 3 injuries. The mean transfusion requirement was 5.63 units within 24 h. Emergency external fixation was performed in 15 patients. Definitive fixation (internal or external) was performed at a mean of 11.27 days post-injury. Complications included urinary incontinence (n = 5), rectal incontinence (n = 2), and infections. The mortality rate was 20 % (n = 6). Functional outcomes showed 3 excellent, 8 good, 8 fair, and 5 poor results CONCLUSION: Open pelvic fractures are complex injuries requiring multidisciplinary management. Early haemorrhage control, aggressive soft tissue management, and appropriate fracture stabilization are crucial for improving outcomes. Delayed internal fixation after thorough debridement and soft tissue healing may reduce infection risk. High transfusion requirements and unstable fractures were associated with increased mortality.

LEVEL OF EVIDENCE: III.

PMID:40840317 | DOI:10.1016/j.injury.2025.112658

Injury. 2025 Aug 6;56(10):112662. doi: 10.1016/j.injury.2025.112662. Online ahead of print.

ABSTRACT

INTRODUCTION: The primary objective was to analyze the trends in hemiarthroplasty (HA) and total hip arthroplasty (THA) for adult patients with fractures (FNFs), with a focus on geriatric population, over the past two decades. The secondary objectives were to compare outcomes between HA and THA and evaluate its association with patient- and surgeon- specific factors.

METHODS AND MATERIALS: Design: Retrospective cohort.

SETTING: Two Level 1 Trauma Centers. Patient Selection Criteria: Adult patients with FNFs between 2001 and 2023.

RESULTS: A total of 3180 cases of FNF treated with arthroplasty were included in the study, comprising 2497 patients who received HA and 683 patients who received THA. There was an overall increase in both THA and HA performed for geriatric FNFs with THA increasing at a faster rate (223 % vs. 172 %, respectively). Patients receiving THA were younger (70.8 vs. 81.4 years, p < 0.001) and more likely to be female (70.9 % vs. 65.1 %, p = 0.006). Patients receiving HA had lower BMI (24.6 vs. 25.4kg/m2, p = 0.002), higher Charlson Comorbidity Index (7.5 vs. 4.6, p < 0.001), and higher rates of dementia (29.9 % vs. 7.8 %, p < 0.001).Factors associated with selection of THA over HA included arthroplasty fellowship training (21.5 % vs. 10.4 %, p < 0.001) and greater surgical experience, as measured by years in practice (15.1 vs. 12.5 years, p < 0.001).. Patients receiving THA had shorter hospitalizations (6.3 vs. 7.9 days, p < 0.001) and were more likely to be discharged home (24.3 % vs. 5.5 %, p < 0.001). Despite similar reoperation rates (4.5 % vs. 5.1 %, p = 0.58), THA resulted in a higher complication rate (9.2 % vs. 6.1 %, p = 0.006). HA had higher 90-day (11.1 % vs. 1.6 %, p < 0.001) and 1 year (21.1 % vs. 3.8 %, p < 0.001) mortality rates.

CONCLUSIONS: There has been a rising trend in THA for the treatment of FNFs over the past two decades, and factors affecting treatment decision are both patient and surgeon driven.

PMID:40840316 | DOI:10.1016/j.injury.2025.112662

Injury. 2025 Aug 13;56(10):112681. doi: 10.1016/j.injury.2025.112681. Online ahead of print.

NO ABSTRACT

PMID:40840315 | DOI:10.1016/j.injury.2025.112681

Injury. 2025 Aug 7;56(10):112654. doi: 10.1016/j.injury.2025.112654. Online ahead of print.

ABSTRACT

BACKGROUND: Determine whether native acetabular anteversion angle increased the risk of ipsilateral limb injuries in patients with traumatic hip dislocations.

METHODS: Retrospective clinical series completed at a large, tertiary health care system between February 2016-November 2021. Patients with a native traumatic hip dislocation requiring a closed reduction in the operating room or open reduction internal fixation (ORIF) of an associated fracture were included, identified using current provider terminology (CPT) codes 27,250 and 27,252. Standard acetabular version angles were measured on CT images.

RESULTS: 121 cases were included in the analysis. The average age of our population was 37.5 years and 72 % were male. The median acetabular version was 14.7° (2-27°). Of the 121 cases of dislocations, 28 experienced a knee injury (23 %, p = 0.89) and 40 had a femoral head injury (33 %, p = 0.88). The most common knee injuries were patellar fractures (29 %, n = 8), tibial plateau fractures (29 %, n = 8), meniscal injuries (25 %, n = 7) and ligamentous knee injuries 21 %, n = 6). Median version angle was not associated with an increase in predisposition to femoral head injury or knee injury for patients with a native hip dislocation (p = 0.13).

CONCLUSION: These findings demonstrate that native acetabular anteversion does not predispose, nor protect, patients from experiencing an ipsilateral limb injury in the setting of a traumatic hip dislocation. Future studies should investigate other factors that may influence the occurrence of ipsilateral limb injuries in these settings.

LEVEL OF EVIDENCE: Level IV - Therapeutic (Retrospective Clinical Series).

PMID:40834614 | DOI:10.1016/j.injury.2025.112654

Injury. 2025 Aug 6;56(10):112675. doi: 10.1016/j.injury.2025.112675. Online ahead of print.

ABSTRACT

OBJECTIVE: External chest wall fixators may provide a new approach as part of multimodal treatment. This study aimed to investigate the effect of external chest wall fixator on patients' pain level, complication development and hospital stay in patients with rib fractures.

MATERIAL AND METHOD: Patients who were admitted due to trauma and had serial rib fractures between December 2020 and December 2021 were evaluated. There were 14 patients in case group and 20 in control group. External chest wall fixator was applied to the case group in addition to standard treatment. Pain levels, development of complications and duration of hospitalization were recorded.

RESULTS: Pain levels in first and third months were lower in case group than control group. Mean pain levels in the first month were 1.79 (SD 0.80) in case group and 2.85 (SD 1.53) in control group, in the third-month were 0.43 (SD 0.64) in case group and 1.34 (SD 1.59) in control group, and the difference was significant (p = 0.022 and 0.032, respectively). Complications were more common in patients with more rib fractures (p = 0.002). While complications developed in 2 patients in the case group and 8 patients in the control group, the difference was not statistically significant (p = 0.216). Duration of hospital stay was shorter in the case group and the difference was significant (2.7 (SD 0.9) days versus 2.0 (SD 0.7) days, p = 0.049).

CONCLUSION: It has been shown in our study that external fixator can be an effective method in reducing patients' pain and hospital stay. This method can be included as part of multimodal treatment in patients with rib fractures.

PMID:40829526 | DOI:10.1016/j.injury.2025.112675

Injury. 2025 Aug 10:112678. doi: 10.1016/j.injury.2025.112678. Online ahead of print.

ABSTRACT

BACKGROUND: High-quality, granular, accessible, and timely data are essential for evaluating regional trauma ecosystems and implementing programs to improve trauma care. State trauma registries play a crucial role in collecting, disseminating, and sharing data for clinicians, researchers, implementation scientists, and policymakers. This study aimed to assess the status and progress of statewide trauma registries in the United States over the past 20 years.

METHODS: A structured electronic survey was administered to eligible and consenting state trauma registry managers or emergency medical services personnel between July 2024 and November 2024. The survey gathered information on registry infrastructure, data collection and reporting processes, and data quality assurance measures. Findings were compared with those from a similar survey conducted in 2004.

RESULTS: All 50 states and the District of Columbia participated in the survey. Forty-seven states (92 %) reported an active trauma registry, an increase of 15 since 2004. Four states have never had a statewide registry, though two are planning to develop one. Among states with registries, only 18 (38 %) mandate data submission from all hospitals. While many registries have transitioned to web-based systems and updated software over the last two decades, 34 registries (72 %) still rely on manual data abstraction, and 28 (60 %) lack integration with electronic health records. Additionally, only 20 (43 %) state registries contribute data to national collection efforts.

CONCLUSIONS: Although progress has been made in establishing and modernizing state trauma registries since 2004, significant gaps remain, particularly in the absence of comprehensive mandatory reporting, the reliance on manual data entry, and the lack of integration with electronic health records and national databases. Addressing these challenges is essential for reducing the burden on registry teams and providing accurate, actionable, and timely data for improving trauma care.

PMID:40825754 | DOI:10.1016/j.injury.2025.112678

Injury. 2025 Aug 7:112661. doi: 10.1016/j.injury.2025.112661. Online ahead of print.

NO ABSTRACT

PMID:40820076 | DOI:10.1016/j.injury.2025.112661

Injury. 2025 Aug 7;56(10):112676. doi: 10.1016/j.injury.2025.112676. Online ahead of print.

ABSTRACT

INTRODUCTION: Equestrian activities are popular in Australia for both work and recreation. However, these activities are associated with high rates of injury [including major trauma] when compared to other physical activities and sports. Research assessing equestrian-related major trauma is limited. This study analyses the characteristics of equestrian-related major trauma in New South Wales, Australia, to guide injury prevention initiatives.

METHODS: A retrospective analysis was conducted using data from the New South Wales Trauma Registry on equestrian-related major trauma cases over an 11-year period from 2012 to 2022. Major trauma was defined as patients with an Injury Severity Score (ISS) greater than 12, as well as those admitted to the Intensive Care Unit or those who died in hospital, regardless of ISS. Incidence rates per 100,000 NSW population were analysed using Poisson regression.

RESULTS: A total of 624 equestrian-related major trauma cases were identified over the study period. The median age was 49 years (IQR 29-60), and the median ISS was 17 (IQR: 13-50). Females comprised 56.74 % of cases, with a significantly higher incidence rate than males (IRR 1.24, 95 % CI: 1.19-1.45, p = 0.007). Older individuals were at greater risk, with the highest incidence in the group aged between 40 to 59 (IRR 2.64, 95 % CI: 2.04-3.42). Most injuries occurred on farms (55.93 %), during leisure riding (28.21%) and were a result of a fall or being thrown from a horse (60.90 %). The most frequently injured anatomical regions included the thorax (25.40 %), spine (20.29 %), and head (18.73 %). Severe-to-critical injuries were proportionally highest in the thorax (65.08 %), head (46.97 %), and lower extremities (43.97 %). The incidence rate of major trauma increased steadily during the study period (IRR 1.027, 95 % CI: 1.002-1.053, p = 0.036).

CONCLUSION: The data presented in this paper provides an overview of the characteristics of equestrian-related major trauma. Salient points are that major equestrian-related trauma predominantly affects females and older individuals, with the thorax, spine, and head the most frequently injured anatomical regions. Farms are identified as the primary location of injuries across all age groups. These findings can guide future injury prevention initiatives.

PMID:40818164 | DOI:10.1016/j.injury.2025.112676

Injury. 2025 Jul 19;56(10):112620. doi: 10.1016/j.injury.2025.112620. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: The best treatment of comminuted, proximal humeral fractures in the elderly population is an unresolved clinical problem. This study aimed to compare the outcome of hemiarthroplasty (HA) and nonoperative treatment in the elderly population patients with a comminuted proximal humeral fracture.

METHOD: From October 6, 2009 to April 26, 2017, 57 elderly patients with a comminuted proximal humeral fracture were enrolled in the multicenter randomized controlled trial (RCT). Patients were randomized to HA or nonoperative treatment. Outcome measures were the Constant-Murley score (primary outcome), Disabilities of the Arm, Shoulder, and Hand, pain (Visual Analog Score), quality of life (Short Form-36 and EuroQoL-5D-3 L), complications, revision operation, health care consumption, and costs. Patients were followed for two years.

RESULT: Of the 57 patients included, 30 underwent treatment with HA and 27 were treated nonoperatively. Patients had a median age of 77 years, and 89 % was female. According to the Hertel classification, most fractures were type 7 (47 %) or type 12 (42 %). The median Constant-Murley score increased from 23 (95 % CI 17-29) at six weeks to 48 (95 % CI 41-53) at 24 months in the HA group, and from 24 (95 % CI 17-31) to 59 (95 % CI 52-65) in the nonoperative group. Throughout follow-up, scores were similar in both groups. The DASH score consistently decreased over time in both groups. At 24 months, median DASH scores were 24.0 (95 % CI 17.4-30.8) and 23.4 (95 % CI 16.5-30.4) in the HA and nonoperative group, respectively. Pain levels, SF-36, and EQ-5D were similar in both groups throughout follow-up. Eleven patients, of which seven in the HA group, developed one or more complications, of which six patients required surgical interventions. Total costs were higher for HA, although not statistically significant.

CONCLUSION: Based on results of this RCT, primary hemiarthroplasty cannot be considered superior to nonoperative treatment for comminuted proximal humeral fractures in the elderly population. A trend favoring nonoperative treatment is observed in outcomes and in costs.

PMID:40818163 | DOI:10.1016/j.injury.2025.112620

Injury. 2025 Aug 8;56(10):112669. doi: 10.1016/j.injury.2025.112669. Online ahead of print.

ABSTRACT

INTRODUCTION: The success rate of antegrade insertion of a full-length ramus osseous fixation pathway (OFP) screw remains unreported. The objective of this study was to assess the safety, feasibility, and effectiveness of a novel antegrade technique for inserting full-length ramus screws, as well as to determine the parameters of the ramus OFP based on screw placement.

PATIENTS AND METHODS: From January 2022 to September 2024, patients with fractures of the superior pubic ramus or the anterior acetabular column treated with a novel technique of an antegrade insertion of a superior ramus OFP screw were recruited into this study. Peri- and postoperative complications were documented. Parameters of the OFP were measured based on the position of the inserted full-length screws on postoperative CT scans.

RESULTS: Thirty-eight fully threaded, large-diameter (7 mm) antegrade full-length screws were successfully inserted in 32 patients with no intraoperative screw insertion failures occurring. The procedure was performed without any noted wound infections or associated neurological, urological, and visceral complications. Postoperative CT images confirmed that all 38 ramus screws were correctly positioned within the bony corridors, with no evidence of screw breaching the hip joint. The OFP measures 118.9 ± 5.6 mm in length, with an angle projection of 38.7 ± 3.8 degrees to the horizontal plane and 15.8 ± 4.9 degrees to the coronal plane. All patients were followed for an average duration of 16.1 months (range, 6.2-31 months). Bone union was achieved in all cases with a union time of 3 months (range, 2.5 to 5 months), and no complications such as loss of reduction, screw loosening, breakage, or bone delayed union were noted.

CONCLUSIONS: Our novel antegrade technique for inserting a full-length large ramus screw has been validated for its safety, feasibility, and effectiveness. The parameters obtained through the insertion of a full-length screw in this study accurately represent those of our new ramus OFP and serve as a guide for the placement of full-length screws.

PMID:40816064 | DOI:10.1016/j.injury.2025.112669

Injury. 2025 Aug 10;56(10):112679. doi: 10.1016/j.injury.2025.112679. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the rate of unplanned reoperation to address fracture-related complications between extraarticular floating knee fracture patterns and those involving the articular surface of the knee, and to assess the impact of concomitant patella fracture on outcomes.

METHODS: Design: Retrospective study of patients with a floating knee injury treated at a single level 1 trauma center from 2012-2022.

SETTING: Single, urban, level 1 trauma center. Patient selection criteria: Patients ≥18 years old with a floating knee injury treated at a single urban level 1 trauma center from 2012-2022, with at least 3 months of followup. Outcome measures and comparisons: The primary outcome measure was the rate of unplanned reoperation to treat infection, obtain union, or surgically address knee stiffness.

RESULTS: Reoperation to address fracture-related complications was high in both extra and intraarticular floating knee patterns, with a trend toward more surgery to address knee stiffness in those with articular involvement (p = 0.078). Concomitant patella fracture and open fracture were present in 12 and 46 of the 64 patients, respectively; the presence of open fracture was significantly associated with reoperation to address either nonunion or infection (p < 0.001). An associated patella fracture was significantly associated with requiring surgery to address knee stiffness (p = 0.009).

CONCLUSIONS: Floating knee injuries with at least one articular fracture, especially when the patella is involved, had higher rates of surgery for knee stiffness. Intraarticular floating knee injuries are challenging, often requiring reoperation for infection, nonunion, or stiffness. Surgeons should be proactive with early motion protocols, supervised therapy, and tools like continuous passive motion to reduce knee stiffness risk.

LEVEL OF EVIDENCE: III.

PMID:40816063 | DOI:10.1016/j.injury.2025.112679

Injury. 2025 Aug 5;56(10):112649. doi: 10.1016/j.injury.2025.112649. Online ahead of print.

ABSTRACT

INTRODUCTION: Occult hip fractures are femoral neck fractures diagnosed by MRI or CT scan following negative plain radiographs. Incomplete intertrochanteric occult hip fractures (IIOHFs) do not involve the medial cortex. These fractures can be isolated but can also occur in the presence of greater trochanter (GT) fractures. Many authors recommend further imaging to exclude IIOHFs in cases where a GT fracture is present on plain radiograph, in order to evaluate the intertrochanteric region fracture extension. There is no consensus on the optimal treatment for IIOHFs, with approaches ranging from surgical fixation to full weight bearing. At our institution a protocol of immediate full weight bearing for patients diagnosed with IIOHFs was implemented. This study retrospectively evaluates the outcomes of this treatment protocol.

METHODS: The medical records of patients who underwent MRI for suspected occult hip fractures were retrospectively analyzed. Inclusion criteria included: (1) patients with no findings on plain radiographs who were diagnosed by MRI with intertrochanteric fractures not involving the medial cortex, and (2) patients with isolated GT fractures diagnosed by plain radiographs and fracture extension greater than one-third of the intertrochanteric width seen on MRI. Data regarding initial hospitalization, diagnostic timing and findings, and follow-up outcomes were collected.

RESULTS: Of 196 MRI scans performed during the study period, 45 patients met the inclusion criteria. None of these patients experienced secondary displacement of the fracture despite immediate full weight bearing. The average age was 81.1 years, and 21(10.7%) patients were male. The mean time from admission to MRI was 30 h, and the average length of hospitalization was 6.3 days. The 45 intertrochanteric fractures that were included in this study include nine isolated incomplete intertrochanteric fractures and 36 GT fractures with extension greater than one third of the intertrochanteric width. None of the GT fractures had involvement of the medial cortex.

CONCLUSION: Our findings suggest that immediate full weight bearing is a safe treatment approach for IIOHFs. Operative fixation or immobilization may be unnecessary for these fractures. Our findings also challenge the clinical necessity of routine MRI scans in patients with GT fractures to assess for fracture progression.

PMID:40816062 | DOI:10.1016/j.injury.2025.112649