Injury. 2025 Jun 3:112514. doi: 10.1016/j.injury.2025.112514. Online ahead of print.

ABSTRACT

INTRODUCTION: Major Trauma Hospitals are receiving increasing numbers of older patients after serious injury. Outcomes in these patients vary with the nature of the injury and other factors such as frailty. We aimed to determine the prevalence of frailty and adverse events in older patients managed by acute trauma services during the index hospital admission, and the frequency of adverse outcomes at three, six and twelve months after discharge in an Australian setting.

METHODOLOGY: This study assessed the prevalence of frailty in a prospective multicentre cohort study of seriously injured patients aged ≥ 70 years admitted to three Major Trauma Services in Australia. Patients were followed for twelve months after injury to assess for adverse outcomes associated with the presence of frailty or other factors. During the index admission patients were assessed for frailty, co-morbidities, Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Patients were monitored for adverse events and whether a Geriatrician review occurred. Outcomes assessed at three, six and twelve months included increased dependency, falls, confusion, readmission to hospital, transfer to a Residential Aged Care Facility and death.

RESULTS: 217 patients were recruited between 2018 and 2023 across the three hospitals. At index admission, 32 (14.7%) patients were frail and another 28 (12.9%) were near frail. Geriatrician review was more likely for frail patients and there were similar rates of inpatient complications for both frail and non-frail patients. Frailty at index admission was associated with increased dependency, falls, readmission and confusion at three, six and twelve months and with an increased risk of death at three and six months.

CONCLUSIONS: Frailty was associated with delayed adverse outcomes up to 12 months following admission for serious trauma in older people at three major Australian trauma services. Assessment of frailty on admission may be useful in stratifying outcome risk for older patients. Further research into frailty interventions and pathways is recommended.

PMID:40506331 | DOI:10.1016/j.injury.2025.112514

Injury. 2025 Jun 7;56(8):112520. doi: 10.1016/j.injury.2025.112520. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical outcomes of a novel hybrid bone transport technique using an antibacterial-coated nail for the treatment of infected segmental tibial bone defects.

METHODS: This retrospective study included 19 patients with infected segmental tibial bone defects treated using hybrid bone transport with an antibacterial-coated nail, the ZNN™ Bactiguard® nail. Patients were divided into two groups: nailing after bone transport (NABT, n = 11) and bone transport over nail (BTON, n = 8). These groups were compared with a control group of 10 infected patients treated with conventional external fixation bone transport (EFBT). The primary endpoint was infection eradication, while secondary endpoints included external fixation time (EFT), external fixation index (EFI), complications, and bone regeneration quality.

RESULTS: The mean external fixation time (EFT) for the entire cohort was 280.2 ± 142.7 days. The BTON group had the shortest EFT (150 ± 45 days), significantly lower than both NABT (279 ± 99 days) and EFBT (927 ± 1710 days, p = 0.001). The external fixation index (EFI) was also significantly lower for BTON compared to EFBT (25 ± 10.7 vs. 77.5 ± 38.7 days/cm, p = 0.009). A single case of a recurrent infection was reported in the BTON group (5.3 %), which was managed with nail removal and the continuation of external fixation bone transport without further complications. The infection was fully resolved in all cases (29/29) at the end of the follow-up period. Complication rates were similar across groups. The primary docking site union rate was 89.7 %, with no significant differences between groups.

CONCLUSIONS: The BTON technique using an antibacterial-coated nail reduces EFT by threefold compared to traditional external fixation bone transports methods, without increasing complications. A notable reduction was also observed in the NABT group, although it did not reach statistical significance. This approach offers a promising alternative to conventional methods for the treatment of infected tibial bone defects.

PMID:40505442 | DOI:10.1016/j.injury.2025.112520

Injury. 2025 Jun 4;56(8):112519. doi: 10.1016/j.injury.2025.112519. Online ahead of print.

ABSTRACT

INTRODUCTION: A Fracture-related infection (FRI) is a rare but serious complication of surgical fracture treatment in children and adolescents. Exact data on the incidence of FRI in children and adolescents are not available in the literature. In adults, criteria for the diagnosis and treatment of FRI were published in 2018 by an expert group and divided into suggestive and confirmatory categories. However, there is no recommended approach for diagnosing and treating FRI in children or adolescents.

PURPOSE OF THE STUDY: This study aimed to determine the incidence of FRI in children and adolescents who underwent operative fracture treatment at a Level I trauma center between 2019 and 2023, to evaluate age distribution, anatomical sites and bacterial spectrum of FRI in children and adolescents, to evaluate risk anatomical locations and initial fracture treatment methods in relation to the development of FRI and to assess the applicability of FRI diagnostic criteria in the pediatric patients.

MATERIALS AND METHODS: It is a retrospective monocentric study conducted by reviewing hospital database. The study included all patients under 18 years of age with present growth plates who underwent surgical fracture treatment between 2019 and 2023.

RESULTS: The incidence of FRI in children was 0,95 % among 1156 osteosynthesis procedures performed between 2019 and 2023. The average age of pediatric patients with FRI was 11,18 years. The most common anatomical site of FRI in out cohort was the forearm (36,36 %). High-risk locations in terms of developing FRI relative to the number of osteosyntheses performed included the proximal femur (20 %) and the diaphysis of the humerus (7.69 %). The most common pathogen causing FRI in children was S. aureus (63,6 %). On average, 2.1 additional surgical procedures were required to eradicate the infection.

CONCLUSION: FRI in children is a rare but serious complication, which most commonly occurs in the upper extremity, specifically in the forearm area. However, some anatomical sites with a lower incidence of fractures demonstrate a significantly higher relative risk for the development of FRI. The recommended guidelines developed in 2018, including diagnostic criteria for FRI, can be successfully applied to the pediatric population.

PMID:40505441 | DOI:10.1016/j.injury.2025.112519

Injury. 2025 Jun 3;56(8):112512. doi: 10.1016/j.injury.2025.112512. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if 4-8-week radiographs are useful for predicting nonunions in patients with femoral shaft fractures treated with an intramedullary nail (IMN).

METHODS: A retrospective case-control study; 1:2 ratio was conducted at a level I trauma center. Adult patients with a femoral shaft fracture (OTA/AO 32) treated with IMN between 2016 and 2022 were identified via Current Procedural Terminology code. The included cases underwent nonunion surgery a minimum of 3 months after the index procedure. The controls were randomly selected from the cohort and had a minimum of 6 months postoperative follow-up and evidence of radiographic union. The modified Radiographic Union Score of the Tibia (mRUST) applied to femur fractures was determined on radiographs obtained 4-8 weeks after the index surgery.

RESULTS: One hundred forty-eight patients (mean age, 35 [SD, 15] years) were included. A significant difference was found between cases and controls relating to the distribution of mRUST scores at 4-8 weeks postoperatively (median, 6 versus 9; p < 0.0001). Logistic regression analysis demonstrated that the mRUST score at 4-8 weeks is a strong predictor of union with an area under the curve of 0.85 (95 % CI: 0.78-0.92). If the mRUST score at 4-8 weeks postoperatively is 9 or above, the probability of eventual union is 99 % (95 % CI: 94-100 %).

CONCLUSION: The results suggest that healing on 4-8-week radiographs after IMN fixation for femoral shaft fractures may help identify patients at elevated risk of nonunion. Patients with mRUST scores 9 or above on the 4-8-week postoperative radiographs have a low likelihood of nonunion and less frequent radiographic follow-up may be needed.

PMID:40505440 | DOI:10.1016/j.injury.2025.112512

Injury. 2025 May 28;56(8):112464. doi: 10.1016/j.injury.2025.112464. Online ahead of print.

ABSTRACT

AIMS: The aim of this study was to compare clinical outcomes of the Femoral Neck System (FNS) (Depuy Synthes) and the Dynamic Hip Screw (DHS) (Depuy Synthes) in the head preserving treatment of femoral neck fractures.

METHODS: A multicenter retrospective study was performed in three level II trauma centers in The Netherlands. All patients younger than 90 years treated with the DHS or the FNS for a femoral neck fracture between 2012 and 2022 were included. The follow-up of the included patients was two years. The primary outcome was treatment failure, defined as avascular necrosis, non-union or implant cut-out. Secondary outcomes were postoperative infections, total hip prosthesis conversion rates and mortality.

RESULTS: A total of 505 patients were included in this study: 239 patients with the DHS and 266 patients with the FNS. Patients treated with the FNS had a higher prevalence of Garden I type fractures and a lower prevalence of Pauwels' type III fractures. Treatment failure occurred in 77 patients, with 39 in the DHS and 38 in the FNS group. After correction for Garden and Pauwels' classification, no significant difference was noted regarding treatment failure within 2 years follow-up between both groups. No differences in conversion rates to total hip arthroplasty (coxarthrosis as surgical indication) was observed. However, patients treated with the DHS underwent implant removal more often. No differences in mortality rate between the groups was observed during two years of follow-up.

CONCLUSION: This multicenter study showed that no difference in treatment failure was found between the two groups, making the FNS a viable alternative for head preserving treatment of femoral neck fractures.

PMID:40494184 | DOI:10.1016/j.injury.2025.112464

Injury. 2025 May 31;56(8):112470. doi: 10.1016/j.injury.2025.112470. Online ahead of print.

ABSTRACT

BACKGROUND: Plastic surgeons must document initial facial injuries before surgery for medicolegal purposes. Distinguishing between accidental and assaultive injuries poses a challenging issue. Therefore, this study explored the features that differentiate assaultive facial soft tissue injuries from accidental injuries.

METHODS: This prospective cross-sectional study included 179 patients with facial soft tissue injuries. We recorded sex, age, occupation, marital status, residence, and history of drug abuse. Additionally, the traumatic events were analyzed, and injuries were assessed. All patients received standard medical care.

RESULTS: Males constituted 82.7 % of patients. 62.57 % of patients had accidental facial injuries, while the rest of the patients attributed their injuries to assaults. A significantly higher percentage of assaultive injuries were located on the left side of the face, with p < 0.001 (OR = 5.966, 95 % CI=3.013- 11.813). Whereas a significantly higher percentage of accidental injuries were located on the midface, with p < 0.001. A multivariate binary logistic regression analysis that identified strong predictors of assaultive facial injuries, including a history of drug abuse (OR = 44.998, 95 % CI: 3.049-661.107), injury with sharp instruments (OR = 638.601, 95 % CI: 20.296-20,093), and a cutting/piercing mechanism of injury (OR = 89,298.81, 95 % CI: 196.963-404,861). Regarding the characteristics of soft tissue facial injuries, the probability of assaultive trauma increases with the presence of injuries on the left side of the face (OR = 27.309, 95 % CI: 1.653-451.157), involvement of the mandibular zone (OR = 40.780, 95 % CI: 1.147-1449.419), neurovascular or duct injury (OR = 121.806, 95 % CI: 1.110-13,369.2), and the presence of multiple associated injuries (OR = 1.005, 95 % CI: 1.001-1.254).

CONCLUSIONS: Accidental facial injuries are more common than assaultive injuries, and males are particularly vulnerable to both traumas. This study helps differentiate between assault-related and accidental facial injuries. A history of drug abuse, injuries caused by sharp instruments, and mechanisms involving cutting or piercing are strong indicators of assaults. Clinical signs that strongly suggest assault-related injuries include injuries on the left side of the face, involvement of the mandibular area, damage to neurovascular structures or ducts, and the presence of multiple associated injuries.

PMID:40483942 | DOI:10.1016/j.injury.2025.112470

Injury. 2025 Jun 3;56(8):112511. doi: 10.1016/j.injury.2025.112511. Online ahead of print.

ABSTRACT

PURPOSE: With no clear consensus on absorbable verses non-absorbable suture-usage for glabrous skin closures, the purpose of this study was to investigate whether incisions closed with Monocryl sutures displayed higher wound complication rates than nylon sutures following carpal tunnel and trigger finger release surgery.

METHODS: A total of 155 carpal tunnel or trigger finger release surgeries in 138 patients performed in an outpatient academic medical center were analyzed. Patients with pre-operative trauma or infection, or who received concurrent surgeries were excluded. Incisions were closed using either 4-0 poliglecaprone 25 (Monocryl) or 4-0 nylon (Ethilon). Suture choice was determined via a pseudo-randomized method: Monocryl sutures were utilized in surgeries performed on even dates (e.g. 4/10/2024) and nylon sutures on odd dates (e.g. 4/11/2024). The medical records were reviewed for demographics and wound-related complications occurring within 90 days post-surgery. Criteria including additional medical encounters, co-morbidities, and assisting resident level-of-training between Monocryl and nylon cohorts were also evaluated for differences in complication rates.

RESULTS: There were 86 carpal tunnel release (55.5 %) and 69 trigger finger release (44.5 %) surgeries. The average age at surgery was 62.4 ± 11.6 years, with Monocryl used in 73 (47.1 %) and nylon in 82 (52.9 %) procedures. The rates of infection requiring antibiotics were similar between Monocryl (4.1 %, n = 3) and nylon cohorts (2.4 %, n = 2). However, higher rates of dehiscence were observed with Monocryl (11.0 %, n = 8) compared to nylon (2.4 %, n = 2). Multivariable logistic regression showed that inflammatory arthritis, immunosuppressant drug use, and junior resident assistance were independent predictors of wound complications.

CONCLUSION: In conclusion, we found usage of Monocryl sutures following carpal tunnel and trigger finger release associated with higher a dehiscence rate within 90 days post-operation. Additionally, factors including resident training level, immunosuppression, and inflammatory arthritis were associated with increased complications.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

PMID:40483941 | DOI:10.1016/j.injury.2025.112511

Injury. 2025 May 31;56(8):112462. doi: 10.1016/j.injury.2025.112462. Online ahead of print.

ABSTRACT

OBJECTIVES: Non-surgical management (NSM) of posterior pelvic fragility fractures (PFF) can lead to prolonged disability, morbidity, and death. Surgical management (SM) also has risks but has been reported to rapidly restore mobility. This study sought to compare improvement in mobility between NSM and SM in a prospective cohort of patients with PFF.

METHODS: Design: Prospective, randomized controlled trial of SM vs NSM SETTING: Academic and community trauma centers PATIENT SELECTION CRITERIA: PFF patients without significant cognitive impairment who are bedbound OUTCOME MEASURES AND COMPARISONS: The primary endpoint was time to regain two points on a modified functional mobility scale (MFMS). Secondary endpoints included PROMIS physical function and pain interference, Oswestry Disability Index (ODI), and numeric rating scale (NRS) pain score. A 12-month CT scan was performed in the SM group only.

RESULTS: Enrollment was challenging despite modifying the study to include an observational cohort. 28 subjects were enrolled (age 78±9.8); 16 underwent SM and 12 received NSM. The primary endpoint occurred at a median of 10 days in the SM group and 16 days in the NSM group (p = .1). 100 % of SM and 83 % of NSM subjects achieved the primary endpoint by 6 weeks. Five subjects who received SM could be considered NSM failures; including these failed subjects in the NSM group widened the difference in primary endpoint success rates (100 % in SM vs. 48 % in NSM, p < 0001). Some trends in secondary outcome measures favored SM, but they did not reach statistical significance. There were no device- or procedure-related serious adverse events.

CONCLUSION: Despite enrollment challenges, consistent trends were observed to suggest that SM may be superior to NSM in patients with painful PFF. Key challenges in enrollment in geriatric fracture trials comparing NSM to SM were identified. It is conceivable that studies such as this may represent the most robust investigations possible in comparing SM to NSM in PFF.

LEVEL OF EVIDENCE: II.

PMID:40483940 | DOI:10.1016/j.injury.2025.112462

Injury. 2025 May 30;56(8):112469. doi: 10.1016/j.injury.2025.112469. Online ahead of print.

ABSTRACT

INTRODUCTION: There were concerns about depleting trauma care capabilities due to the significant strain on healthcare services and resources during the COVID-19 pandemic. We aimed to describe the epidemiology of trauma care in New York State (NYS) during this period to elucidate how a healthcare crisis, such as a pandemic, can alter trauma care delivery.

MATERIALS AND METHODS: We conducted a retrospective review of trauma and non-trauma hospital discharges in New York State from 2016 to 2022 using the Statewide Planning and Research Cooperative System (SPARCS) database. The years 2016-2019 served as the baseline, March 2020 to December 2021 as the COVID period, and 2022 as the post-COVID recovery period. Changes in case volumes were analyzed by trauma center levels and non-trauma centers, presenting demographic characteristics, injury mechanisms, health services areas, illness severity, and in-hospital fatalities.

RESULTS: Level 1 trauma centers accounted for the highest percentage of trauma admissions, making up 44 % of the total, and also had the majority of non-trauma cases. During this period, pediatric trauma admissions decreased in these centers. However, trauma admissions for individuals categorized as Black or African American, Multi-racial, and Other increased. There was a notable rise in motorcycle-related injuries, other land transport injuries, and assaults involving firearms during the COVID period, which increased by up to 53 %, 49 %, and 48 %, respectively. Severity of illness scores revealed a significant increase in extreme cases. Additionally, trauma-related fatalities rose in trauma centers during the COVID period, whereas they decreased in most non-trauma centers during the same time frame.

DISCUSSION: During the COVID-19 pandemic, trauma centers in NYS continued to treat critically injured patients despite increased healthcare strain. There was a disproportionate impact across age groups and racial backgrounds, with a rise in violent injuries observed in both trauma and non-trauma centers. Higher fatality rates in trauma centers may be due to the admission of more severely injured patients. We recommend that regional and local trauma stakeholders tailor trauma care services preparedness to the vulnerability of their served communities to anticipate the accommodation of resources in the face of future healthcare crises.

PMID:40483939 | DOI:10.1016/j.injury.2025.112469

Injury. 2025 May 26;56(8):112458. doi: 10.1016/j.injury.2025.112458. Online ahead of print.

ABSTRACT

The purpose of the study was to examine and compare the tensile characteristics of 1.8 mm smooth Kirschner wires (K-wires) fixed with four different clamping mechanisms:Ilizarov and Taylor Spatial Frame (TSF) are two widely used types of external fixation devices, in both of which fine K-wires are used as transosseous elements. The K-wires are pretensioned and fixed to the rings using specialised fixation bolts. In this study, two types of fixation bolts, namely slotted and cannulated bolts, are used to clamp wires to Ilizarov as well as TSF rings, resulting in a total of four groups of tests. Each of the four groups of tests were carried out three times. A fixation torque of 15 Nm was applied to all bolts. The wires were then subjected to tensile loads up to failure. The results for load-deflection characteristics, ultimate load and elastic stiffness, and maximum deflection are presented. The results show the TSF rings had a better grip on the wires than the Ilizarov rings.

PMID:40482343 | DOI:10.1016/j.injury.2025.112458

Injury. 2025 May 27;56(8):112448. doi: 10.1016/j.injury.2025.112448. Online ahead of print.

ABSTRACT

BACKGROUND: Clavicle fractures account for 2-10 % of skeletal injuries, often resulting from lateral shoulder falls (87 % of cases), and are common in pediatric and young adult populations. Despite their clinical importance, the role of anatomical factors like thoracic inlet dimensions in fracture risk is poorly understood.

METHODS: This STROBE-compliant case-control study evaluated the association between thoracic inlet measurements-anterior-posterior (AP) diameter, transverse diameter, and area-and clavicle fracture risk, with secondary analyses by age, sex, and BMI.

RESULTS: We studied 27 patients with clavicle fractures and 53 matched controls (aged 18-65 years) who underwent chest CT evaluation for suspected clavicle fracture following upper chest trauma but were confirmed to have no fracture; their CTs were then used for thoracic inlet measurements. Statistical analyses compared AP diameter, transverse diameter, and transverse/AP ratio between groups. The fracture group showed a significantly larger AP diameter (5. 80 ± 0.90 cm vs. 5. 34 ± 0.77 cm, p = 0.0181) and a significantly lower transverse/AP ratio (1. 88 ± 0.31 vs. 2. 08 ± 0.39, p = 0.025) than controls, suggesting a relatively broader, narrower inlet shape is associated with fractures. Transverse diameter (10. 68 ± 1.15 cm vs. 10. 85 ± 0.93 cm, p = 0.424) and inlet area (59. 15 ± 10.60 cm² vs. 57. 84 ± 9.34 cm², p = 0.5742) were similar between groups. Subgroup analyses indicated stronger differences in males (e.g., transverse/AP ratio: 1. 77 ± 0.33 vs. 2. 09 ± 0.40, p = 0.005) and those with BMI <23 kg/m ² (e.g., transverse/AP ratio: 1. 69 ± 0.39 vs. 2. 14 ± 0.42, p = 0.007).

CONCLUSIONS: We conclude that increased AP diameter and reduced transverse/AP ratio of the thoracic inlet may elevate clavicle fracture risk, highlighting anatomical influences on susceptibility. Further biomechanical and preventive studies are needed.

PMID:40479941 | DOI:10.1016/j.injury.2025.112448

Injury. 2025 May 22;56(8):112452. doi: 10.1016/j.injury.2025.112452. Online ahead of print.

ABSTRACT

BACKGROUND: Fracture healing is a complex biological process involving multiple cellular and molecular mechanisms. Despite advances in understanding, the molecular regulation of bone regeneration remains incompletely understood. MicroRNAs (miRNAs) are emerging as critical post-transcriptional regulators of gene expression, with growing evidence suggesting their roles in osteogenesis and fracture repair. This study investigates the role of miRNA-130b in fracture healing and its molecular mechanisms, particularly focusing on its interaction with phosphatase and tensin homolog (PTEN) and the Wnt/β-catenin signaling pathway.

METHODS: Bone marrow mesenchymal stem cells (BMSCs) were isolated from rats and transfected with miRNA-130b mimic, inhibitor, or siPTEN. Osteogenic differentiation was assessed via alkaline phosphatase (ALP) activity, alizarin red S staining, and scratch wound healing assays. Pathway activation was evaluated using qRT-PCR and Western blotting. A rat tibial fracture model was established, and miRNA-130b mimic was administered intraperitoneally. Fracture healing was assessed via radiography, histology, and biomechanical testing at 2, 4, and 6 weeks post-surgery.

RESULTS: MiRNA-130b overexpression enhanced BMSC proliferation, migration, and osteogenic differentiation by directly targeting PTEN and activating the Wnt/β-catenin signaling pathway. Conversely, miRNA-130b inhibition reduced osteogenic activity. MiRNA-130b mimic accelerated fracture healing, as evidenced by improved callus formation, enhanced bone mineralization, and superior biomechanical properties compared to control groups.

CONCLUSION: miRNA-130b promotes osteogenesis and fracture healing by targeting PTEN and activating the Wnt/β-catenin signaling pathway. These findings highlight miRNA-130b as a promising therapeutic target for improving fracture repair outcomes.

PMID:40479940 | DOI:10.1016/j.injury.2025.112452

Injury. 2025 May 30;56(8):112468. doi: 10.1016/j.injury.2025.112468. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify platelet hypofunction and its associations in severely injured trauma patients presenting with haemorrhage.

DESIGN: Planned sub-study of data collected from the FEISTY trial; an Australian multicentre, randomised controlled pilot trial investigating early fibrinogen replacement in severely injured trauma patients.

SETTING: Four major trauma centres in Queensland, Australia.

PARTICIPANTS: Adult trauma patients (age ≥18 years) presenting with clinically significant haemorrhage or potential for significant transfusion requirements.

MAIN OUTCOME MEASURES: Platelet function parameters arachidonic acid (ASPI), adenosine diphosphate (ADP), and thrombin receptor-activating peptide (TRAP) assessed via Multiplate® analysis, rotational thromboelastometry (ROTEM®) parameters EXTEM, FIBTEM, and PLTEM (EXTEM - FIBTEM), transfusion requirements, and clinical outcomes.

RESULTS: Significant platelet hypofunction was detected in this cohort of severely injured trauma patients at time of presentation, with 70 % of patients having hypofunction in at least one Multiplate® channel. The median ASPI area under the curve and 95 % confidence interval were below the lower reference range, indicating this population had reduced platelet function. In patients with deranged platelet function, significantly lower platelet count (p ≤ 0.001), EXTEM amplitude at five minutes (A5) and maximum clot firmness (MCF) (p = 0.001, p ≤ 0.001), and PLTEM A5 and MCF (p = 0.005, p = 0.003) were identified compared to patients with normal platelet function. A significant improvement in platelet function parameters was not observed following platelet transfusion.

CONCLUSION: Platelet hypofunction is common in severely injured trauma patients. This was true both before and after platelet transfusion, suggesting trauma precipitates alteration of the vascular circulating milieu in a way that impairs platelet function. Characterisation of this change might lead to targeted interventions to improve haemostasis.

PMID:40479939 | DOI:10.1016/j.injury.2025.112468

Injury. 2025 May 23;56(8):112372. doi: 10.1016/j.injury.2025.112372. Online ahead of print.

ABSTRACT

OBJECTIVES: Tibial non-unions have always been extremely difficult to manage for surgeons. This problem becomes all the more compounded in presence of infection and/or bone loss [1-6] The purpose of this study is to evaluate the management of bone loss of 4 to10cm in patients presenting with tibia non unions through monitored acute shortening and subsequent lengthening using Ilizarov ring fixator METHOD: The present study was carried out in the Department of Orthopaedics, R.D. Gardi Medical College, Ujjain. Madhya Pradesh. The study was carried out between August 2019 to August 2024. A total of 15 adult patients with tibia shaft non union with bone gap of 4 - 10 cm were included in the study. All the patients were operated by the same surgeon with the help of ilizarov ring fixator method RESULT: All patients in the present study had fracture union after primary surgery. Bone gap closure and compression at the fracture ends was achieved by one week postoperatively. There was no recurrence of deep infection nor the procedure was associated with any neurovascular complications.

CONCLUSION: With the use of our Monitored Acute Shortening and Lengthening method we were able to manage tibia non unions with Bone gaps ranging from 4 - 10 cm through Ilizarov ring fixator by utilization of natural bone healing potential. We were able to achieve union in all our cases without the requirement of any secondary union enhancing surgery.

PMID:40472528 | DOI:10.1016/j.injury.2025.112372

Injury. 2025 May 27;56(8):112460. doi: 10.1016/j.injury.2025.112460. Online ahead of print.

ABSTRACT

INTRODUCTION: Post-traumatic arthritis and avascular necrosis are common sequelae following acetabular fractures, often leading to conversion to total hip arthroplasty (THA). Traditionally, conversions to THA have been performed through posterior or direct lateral approaches, which navigate through scar tissue and previously placed implants. The direct anterior approach (DAA) is increasingly adopted for these conversions, as it accesses a 'virgin' surgical plane, potentially reducing the risks of infection and neurovascular injury. This study aims to compare clinical outcomes and complication rates between the DAA and traditional approaches in conversion THA after acetabular fracture fixation.

MATERIALS AND METHODS: A retrospective review was conducted of acetabular fractures treated at a Level-I trauma center between 2008 and 2021. Patients were grouped by surgical approach (direct anterior (DA), posterior (P), or direct lateral (DL)). The study included patients with a minimum of one-year follow-up. Outcomes measured included Harris Hip Score (HHS), complications necessitating reoperation, infections, blood loss, surgical time, transfusions heterotopic ossification (HO) removal, acetabular implants encountered during reaming, and THA implants used.

RESULTS: Seventy-one patients were included: 30 in the DA group, 28 in the P group, and 13 in the DL group. The mean follow-up time was 51 months. No significant differences in demographics were found. The DA group had significantly higher HHS (90.1) compared to the P (70.5) and DL groups (84.8, p < 0.001). Blood loss was significantly lower in the DA (440 mL) and direct lateral (304 mL) groups compared to the posterior group (547 mL, p = 0.04). The DA group had no infections, the posterior group had 4 infections, and the DL group had one infection (p = 0.10). At final follow-up, the DA and DL groups had significantly higher HHS: 90.1 (DA) and 84.8 (DL) compared to 70.5 (P) (p < 0.001).

CONCLUSION: Conversion THA after acetabular fracture remains a high-risk procedure with significant complication rates. The DAA offers a safe and effective approach, with lower complication rates and superior functional outcomes compared to traditional approaches. This approach may reduce infection rates and neurovascular complications in straightforward cases. For complex cases involving extensive bone loss or acetabular defects, a more extensile approach may be necessary.

PMID:40472527 | DOI:10.1016/j.injury.2025.112460

Injury. 2025 May 28;56(8):112463. doi: 10.1016/j.injury.2025.112463. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study is to report on the frequency and correlates of serious unintentional physical injury (SPI), road traffic injury, and near drowning experience as well as the mediation of exposure to interpersonal violence in the relationship between substance use and SPI among adolescents in Philippines in 2019.

METHOD: The 2019 Philippines Global School-based Student Health Survey (GSHS), a nationally representative survey of teenagers aged 11 to 18 (mean age 13.8 years, Standard Deviation-SD=1.5) that used a multistage sampling technique, provided the study's data. In order to determine the variables associated with past 12-month SPI, road traffic injury and near drowning experience, the study used bivariate and multivariable logistic regression analysis as well as causal mediation of interpersonal violence exposure in the relationship between substance use and SPI.

RESULTS: Regression results showed that male sex, food insecurity, psychological distress, suicide attempt, current drug use, bullying victimization, current alcohol use, and school truancy were positively associated with SPI and road traffic injury. Furthermore, soft drink intake, and fast-food consumption were positively associated, and being 15 to 18 years-old and higher parental support were negatively associated with SPI and with near drowning experience, and not aways wearing a seatbelt was associated with road traffic injury. In addition, being religious or spiritual, psychological distress, suicide attempt, current drug use, bullying victimization, and current alcohol use were associated with near drowning experience. Causal mediation analyses found a significant indirect effect of substance use (explaining 5.9 %) on serious injury count via types of bullied, a significant indirect effect of substance use (explaining 42.8 %) on serious injury count via physically attacked counts, and a significant indirect effect of substance use (explaining 54.5 %) on serious injury count via in physical fights counts.

CONCLUSION: Almost half of participants had a SPI and more than one in three had experienced near drowning. Various sociodemographic, protective, and psychosocial associated factors were identified, which can assist in targeting injury prevention among adolescents in the Philippines.

PMID:40472526 | DOI:10.1016/j.injury.2025.112463

Injury. 2025 May 27;56(8):112459. doi: 10.1016/j.injury.2025.112459. Online ahead of print.

ABSTRACT

INTRODUCTION: The gull sign, representing superomedial dome impaction in acetabular fractures, was first described approximately 20 years ago by Anglen and co-workers. They concluded that this sign equates with poor outcomes after open reduction and internal fixation (ORIF), terming it a "harbinger for failure". Since then, the presence of the gull sign has frequently influenced surgical decision-making in geriatric acetabular fractures. The aim of this radiological descriptive study was to revisit the accuracy of the gull sign seen on pelvic radiographs in predicting dome impaction on computed tomography (CT).

PATIENTS AND METHODS: In a retrospective study, conventional pelvic radiographs and CT scans of n = 201 patients (mean age±SD: 68±17y, 75 % male) with acetabular fractures treated surgically between 2009 and 2020 were analyzed. The presence of the gull sign was assessed on anteroposterior pelvic radiographs. CT scans were assessed for true impaction ("brick sign") with focus on the acetabular surface and compared to the findings according to Anglen`s description.

RESULTS: The gull sign was noted on pelvic radiographs in 49 of 201 cases (24 %). In 28 out of these 49 cases (57 %) a dome impaction was noted on CT. In the remaining 21 cases (43 %), CT revealed no actual impaction but rather an elevated dome following displaced fracture fragments. Conversely, among the 152 patients (76 %) without a gull sign, CT identified previously undetected dome impactions in 41 cases. Overall, the gull sign had a sensitivity of 41 %, a specificity of 84 %, and a positive predictive value of 57 % for detecting dome impactions.

CONCLUSION: The gull sign is an unreliable predictor for dome impaction in acetabular fractures for the following reasons: in the presence of the gull sign nearly half of the cases an elevated fragment only (not an impacted fragment) was noted on CT; despite an absence of the gull sign in nearly one-third of these cases dome impactions ("brick sign") were present on CT. Consequently, routine preoperative CT imaging is essential to accurately differentiate true dome impactions ("brick sign") from dome elevation, thereby guiding appropriate surgical decision-making between "disimpaction versus reduction" and in general between the "fix or replace" debate.

PMID:40466585 | DOI:10.1016/j.injury.2025.112459

Injury. 2025 Jun 3;56(8):112461. doi: 10.1016/j.injury.2025.112461. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic acetabular fractures (PPAF) are a rare and serious complication in hip arthroplasty. The increase in the number of hip arthroplasty patients and the long service life of implants are leading to a rise in periprosthetic fractures.

PURPOSE: We hypothesized (1) that modified Stoppa approach in Combination with direct anterior approach of PPAF leads to good patient outcomes in both patients with and without acetabular cup instability; (2) the complication rate of our combined surgical procedures is lower than reported in the literature; (3) that combined surgical procedures for PPAF have a low 1-year mortality.

METHODS: A retrospective analysis was performed from January 2013 to February 2024. Patients were treated with osteosynthesis using the modified Stoppa approach and revision of the cup using the direct anterior approach (DAA). Mobility before and after surgical treatment, modified Harris Hip Score (mHHS), complications, revision rates, and 1-year mortality were recorded using a questionnaire.

RESULTS: A total of 24 PPAF were identified, of which 18 patients were included in this study. Of 18 PPAF that were treated interdisciplinary by the trauma and orthopedic department, 13 cases showed cup instability. Fifty percent of the patients achieved a satisfactory result after mHHS, however, with a mean mHHS of 57±30, showing a wide range between good and poor outcomes. 13 (61.1 %) patients reported the same mobility postoperatively as prior to fracture. The complication and revision rates were 16.6 % and 5.6 %, respectively, which is below the rates reported in the literature. The 1-year mortality rate was 33.3 %.

CONCLUSION: Combined surgery showed low perioperative complication and revision rates. However, a 1/3 mortality rate at 1 year is quite high, which is likely a reflection of these patients' fragility and co-morbidities. Furthermore, there is no advantage for the functional outcome according to the mHHS.

PMID:40466584 | DOI:10.1016/j.injury.2025.112461

Injury. 2025 May 23:112438. doi: 10.1016/j.injury.2025.112438. Online ahead of print.

NO ABSTRACT

PMID:40451656 | DOI:10.1016/j.injury.2025.112438

Injury. 2025 May 24;56(8):112455. doi: 10.1016/j.injury.2025.112455. Online ahead of print.

ABSTRACT

OBJECTIVE: Surgical treatment of scaphoid nonunion after failed screw fixation is a unique challenge for hand surgeons. This retrospective study evaluated the clinical results of revisional reconstruction by a hand trauma plate system with bone grafting for this situation.

METHODS: From 2019 to 2022, 12 patients with scaphoid nonunion after failed closed or open reduction and internal fixation surgery were treated with revisional surgery using a 1.7-mm nonlocking hand trauma plate system. Pure cancellous bone was harvested from the iliac crest or olecranon of the patient to fill the bony defect between the proximal and distal segments of the fracture. Visual analog scale scores and functional outcomes were assessed after at least 2 years of follow-up.

RESULTS: We used computed tomography (CT) to assess the union, and all fractures healed. The mean interval between primary and definitive surgery was 14.4 (range, 6-36) months. The mean follow-up period was 43.4 (range, 27-72) months. The mean union time was 11 (range, 8-16) weeks. The clinical outcomes included active wrist range of motion (67.2 % ± 16.4 % vs. 82.9 % ± 12.0 %, P = 0.002), visual analog scale score (5.0 ± 1.3 vs. 2.3 ± 1.2, P < 0.001), grip strength (69.4 % ± 11.3 % vs. 88.5 % ± 16.6 %, P < 0.001), and modified Mayo wrist score (51.7 ± 16.1 vs. 71.7 ± 8.9, P < 0.001). Three patients complained of clicking at the volar part of the wrist joint, which was resolved by plate removal.

CONCLUSION: A hand trauma plate system can be used to stabilize the scaphoid fracture nonunion in the treatment of failed screw fixation for scaphoid waist fractures. Hardware removal may be considered if impingement symptoms persist after fracture healing.

PMID:40450785 | DOI:10.1016/j.injury.2025.112455