Injury. 2025 Jul 13;56(8):112607. doi: 10.1016/j.injury.2025.112607. Online ahead of print.

ABSTRACT

INTRODUCTION: There is a strong demand for research on the long-term outcomes of tibial plateau fractures (TPFs) in large cohorts. Stringent data protection regulations and high ethical standards are essential for safeguarding participants' rights, but they can increase the logistical complexity of conducting multicentre studies. This study aims to evaluate clinical outcome data collected over more than a decade through a collaborative data network in surgically treated TPFs.

PATIENTS AND METHODS: This retrospective cohort study was conducted at two level-I trauma centers and included 364 adult patients with operatively TPFs, classified according to the Schatzker system. Eligible patients were treated between January 2010 and September 2022, were ≥18 years of age at the time of injury, resided in Germany, and had a minimum follow-up of 1.25 years with completed patient-reported outcome measures. Patients with cognitive or physical impairments preventing survey participation were excluded. Data collection occurred between September 2022 and January 2023. Outcome measures included the International Knee Documentation Committee (IKDC) form, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm Score. Multiple linear regression was used to assess associations between outcome scores, follow-up duration, and Schatzker classification.

RESULTS: Longer follow-up times were associated with significantly higher scores for IKDC (p < 0.05), KOOS Pain (p < 0.05), Activities of Daily Living (ADL) (p < 0.05), Sports (p < 0.05), and Quality of Life (QoL) (p < 0.00001). Complex fractures (Schatzker IV-VI) were consistently linked to worse outcomes, particularly in the KOOS Sports (p < 0.001) and Quality of Life (p < 0.00001) subscores. Adjusted R-squared values ranged from 2 % to 10 %, with the highest values observed in KOOS QoL scores.

CONCLUSIONS: Patient-reported outcomes (PROMs) were found to be positively associated with longer follow-up durations, up to 12 years postoperatively emphasizing the need for prolonged aftercare in TPFs. Complex fractures, in particular, might benefit from tailored, long-term follow-up. Given the severity of TPFs, it is crucial to manage patient expectations and address psychosocial factors to optimize the outcome. Collaborative data networks, like the one used here, hold promise for expanding research and improving treatment strategies across multiple centers.

PMID:40683056 | DOI:10.1016/j.injury.2025.112607

Injury. 2025 Jul 12;56(8):112606. doi: 10.1016/j.injury.2025.112606. Online ahead of print.

ABSTRACT

BACKGROUND: Indirect calorimetry (IC) is the gold standard method for measuring resting energy expenditure (REE). Although clinical guidelines recommend nutrition be delivered based on measured REE, easily applied predictive equations are most commonly used in practice, with potential for over-and under-estimation of energy needs. We aimed to 1) determine the feasibility and acceptability of using IC to measure REE and 2) compare measured to estimated REE in self-ventilating patients with a traumatic injury.

METHODS: In a single-centre prospective observational study, REE was measured using IC via a canopy hood in patients admitted to a trauma ward with ≥7day hospital stay. Feasibility was set at >50 % of IC measurements being valid (≥5 min with a respiratory quotient between 0.67 - 1.3, and ≤10 % variation in VO2 and VCO2). Following the measurement, patients and staff completed an acceptability survey. Measured REE (kcal) was compared to estimated REE (kcal) using predictive equations (Schofield, 25kcal/kg and 30kcal/kg), with ±10 % difference considered clinically significant.

RESULTS: Of 30 IC measurements, 25 (83 %) were valid. Measurements were not completed or valid in 5 (17 %) participants due to discomfort (n = 1), pain (n = 1), difficult bedspace (n = 1) and high CO2 variability (n = 2). Of those that completed the survey, 83 % of participants (n = 24) reported that the test was comfortable, and all staff (n = 11) agreed IC was acceptable to incorporate into usual care. Measured REE was within ±10 % of estimated REE with the Schofield equation, 25 kcal/kg and 30 kcal/kg in 44 %, 28 %, and 60 % cases, respectively.

CONCLUSION: Measured REE using IC is feasible and acceptable following traumatic injury. Estimated REE using predictive equations were not commonly within 10 % of measured REE, which may lead to under or over-feeding of patients following traumatic injury. Further research is warranted to evaluate whether IC-guided energy delivery improves patient outcomes.

PMID:40683055 | DOI:10.1016/j.injury.2025.112606

Injury. 2025 Jul 1;56(8):112570. doi: 10.1016/j.injury.2025.112570. Online ahead of print.

ABSTRACT

Artificial intelligence (AI) has emerged as a transformative technology in healthcare, with significant applications in orthopedic trauma. This comprehensive review analyzes 217 studies published between 2015 and 2025 to evaluate the current state, applications, and future directions of AI in orthopedic trauma. The field has experienced exponential growth, with 52.5 % of all studies published in 2024 alone. Deep learning approaches (43.3 %) and traditional machine learning methods (39.2 %) dominated the research landscape. Fracture detection (24.4 %) and classification (12.0 %) were the most common applications, followed by prediction (21.2 %) and segmentation (8.3 %). Hip/femur (19.4 %), spine (18.9 %), and wrist fractures (12.0 %) represented the most frequently studied anatomical sites. AI systems frequently matched or exceeded specialist performance in detection and classification tasks, with sensitivities and specificities above 90 % commonly reported. Predictive models for complications and mortality consistently outperformed traditional scoring systems, with improvements in AUC typically between 0.10-0.15. However, only 14.5 % of studies underwent external validation, and just 3.2 % reported prospective clinical validation. Despite remarkable progress in developing accurate AI systems for orthopedic trauma, significant challenges remain in clinical integration, data standardization, and validation across diverse populations. Future development should focus on multimodal approaches integrating diverse data sources, transparent algorithms providing rationales for predictions, and rigorous clinical validation. Point-of-care applications and integration with emerging technologies offer promising directions for clinical impact. As these challenges are addressed, AI has the potential to significantly enhance orthopedic trauma care by improving diagnostic accuracy, optimizing treatment selection, and identifying high-risk patients for targeted interventions.

PMID:40683054 | DOI:10.1016/j.injury.2025.112570

Injury. 2025 Jul 3:112586. doi: 10.1016/j.injury.2025.112586. Online ahead of print.

NO ABSTRACT

PMID:40681385 | DOI:10.1016/j.injury.2025.112586

Injury. 2025 Jul 8:112590. doi: 10.1016/j.injury.2025.112590. Online ahead of print.

NO ABSTRACT

PMID:40670206 | DOI:10.1016/j.injury.2025.112590

Injury. 2025 Jul 8:112603. doi: 10.1016/j.injury.2025.112603. Online ahead of print.

NO ABSTRACT

PMID:40670205 | DOI:10.1016/j.injury.2025.112603

Injury. 2025 Jul 15;56(8):112588. doi: 10.1016/j.injury.2025.112588. Online ahead of print.

NO ABSTRACT

PMID:40669261 | DOI:10.1016/j.injury.2025.112588

Injury. 2025 Jul 11;56(8):112610. doi: 10.1016/j.injury.2025.112610. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to compare the safety and efficacy of ultrasound-guided and arthrogram-guided techniques in the treatment of radial neck fractures in early childhood using the percutaneous leverage technique.

METHODS: This retrospective case series study included children under 7 years of age with closed radial neck fractures who underwent surgery between November 2015 and July 2021. Patients were divided into two groups based on the guidance techniques employed: the ultrasound guidance group (19 cases) and the arthrogram guidance group (14 cases). The primary outcomes included operative time, radiation exposure, and postoperative functional outcomes assessed using the Métaizeau criteria and the Mayo Elbow Performance Score (MEPS).

RESULTS: No statistically significant differences were observed between the two groups concerning age, gender, injured side, or type of fractures. The ultrasound guidance group had a significantly shorter operative time (23.7 ± 5.9 min) compared to the arthrogram guidance group (33.1 ± 10.0 min) (P < 0.05). The ultrasound guidance group did not require radiation exposure (mean 0), in contrast to the arthrogram guidance group (mean 60.55±46.46 mGy) (P = 0.000). According to the Métaizeau criteria, there were no significant differences in the postoperative anatomical reduction between the two groups. Similarly, no significant differences were observed in the functional outcomes based on MEPS, with excellent results in 94.7 % of the ultrasound guidance group and 85.7 % of the arthrogram guidance group (P = 0.380). Complications were comparable between the groups, with no cases of secondary displacement, pin tract infection, or nerve injury.

CONCLUSION: Ultrasound-guided reduction offers several distinct advantages, including enhanced real-time visualization, the absence of radiation exposure, and reduced operative times. Although outcomes are comparable, ultrasound may be considered a viable alternative to arthrogram for guiding percutaneous leverage reduction in the early childhood population.

LEVEL OF EVIDENCE: Therapeutic Level III.

PMID:40669260 | DOI:10.1016/j.injury.2025.112610

Injury. 2025 Jul 11;56(8):112580. doi: 10.1016/j.injury.2025.112580. Online ahead of print.

ABSTRACT

OBJECTIVES: Hardware removal is a common procedure performed by orthopaedic surgeons, yet there is not a consensus on the disposition of explanted hardware. There seems to be increasing discordance between institutional policy and surgeon or patient preference. The purpose of this study was to gain insight on hardware removal polices across North America and determine surgeons' opinions regarding the return of orthopedic fixation devices to patients and if these opinions are related to surgeon-specific demographic factors.

METHODS: A voluntary Qualtrics Survey was created and distributed to orthopedic surgeons with a self-identified substantial practice in trauma. Survey items included information about the surgeon's practice, hospital hardware removal policy, and personal opinion on institutional explant management. We also sought to evaluate variability in hospital policy among different geographic regions and types of hospitals/institutions.

RESULTS: One hundred forty-two surgeons met inclusion criteria for this survey. 88 % of respondents believe that patients should be entitled to keep their explanted hardware. Years in practice, frequency of hardware removal procedures, and subspecialty were not correlated with surgeon opinion. 66 % of hospitals have a policy allowing patients to keep their explanted hardware. There was no correlation between hospital policy and region or type of institution.

CONCLUSIONS: While 88 % of surgeons believe that patients should be allowed to keep their explanted hardware, only 66 % of hospitals currently allow this practice. Despite the clear consensus among orthopedic surgeons, hospital policy across North America is not standardized and does not correlate with the opinions held by the majority of surgeons.

PMID:40669259 | DOI:10.1016/j.injury.2025.112580

Injury. 2025 Jul 11;56(8):112608. doi: 10.1016/j.injury.2025.112608. Online ahead of print.

ABSTRACT

Eighty-eight patients with chronic wounds with financial difficulties were enrolled in a philanthropic programme implemented in Zhejiang Province (China) from August 1, 2021 to July 31, 2022. The patients were divided into surgical and non-surgical groups based on their demographic and wound characteristics, and the outcomes were then compared between the groups. In total, 54 (61.36 %) patients were males and 34 (38.64 %) females. The mean age of the patients was 55.27 ± 19.80 years, and the (81.82 %) had physical disabilities. The most common type of chronic wound was pressure injury (46.59 %), followed by traumatic wounds (19.32 %). In the surgical group, the average hospital stay was 24.50 days (range: 18.00-44.50 days), and the treatment efficacy rate was 76.92 %. In the non-surgical group, the average treatment duration was 35 days (range: 21.75-78.25 days), and the efficacy rate was 51.61 %. The overall wound healing rate was 60 % on the 1-year follow-up. In conclusion, most chronic wound patients were middle-aged or elderly, and pressure injury was the most common wound type. Although dressing change was the most common treatment, surgical treatment could get a better result in large and deep chronic wounds.

PMID:40669258 | DOI:10.1016/j.injury.2025.112608

Injury. 2025 Jul 8:112593. doi: 10.1016/j.injury.2025.112593. Online ahead of print.

ABSTRACT

INTRODUCTION: Management of patients after blunt splenic injury treated with Splenic Artery Embolisation (SAE) varies. This includes vaccination, post-procedure antibiotic use, and follow-up. This study aimed to assess current practice of management and infection prevention across Australia.

METHODS: A 29-question survey was sent via the Australian and New Zealand Trauma Registry to all 28 contributing trauma hospitals in Australia. Questions were based on data from the 2022 calendar year.

RESULTS: Responses were received from 12 sites (43 %) including 6 of 8 Australian regions (75 %). Of responding sites, 10 (83 %) offer SAE via a 24-hour 7-day rostered service. Of a total 568 splenic injuries, there were 177 SAE treatments with a median of 8 per site (range 0-65). SAE constituted 31 % of all splenic management, conservative management in 65 %, and splenectomy in 4 %. 8 sites (67 %) had a protocol for splenic trauma. Prophylactic SAE was performed for AAST IV-V injuries at 8 sites (67 %), which included 80 % of adult hospitals. Distal SAE was the predominant treatment type (70 %). Patients were routinely admitted for median 4 days after SAE (range 2-5). Routine inpatient antibiotics were administered to SAE patients at 2 sites (17 %) while 1 site (8 %) routinely recommended lifelong antibiotics after SAE. Routine inpatient vaccinations were used by 4 of 11 sites (36 %), while 3 sites (25 %) recommend vaccinations in the future. 11 sites (92 %) follow-up patients post-discharge. Written information on SAE was given to patients at 9 hospitals (75 %) while splenic function testing was performed at 5 sites (42 %), mostly assessment for Howell-Jolly Bodies (80 %). 11 sites (92 %) would change clinical practice in the future if evidence on splenic immune function evolved.

CONCLUSION: Across responding Australian hospitals, the use of vaccinations, antibiotics, and splenic function testing after SAE was low, which reflects existing evidence for preserved splenic function after SAE, plus unpublished experience of key stakeholders. Key societies should consider clinical practice guidelines that merge existing evidence with modern practice.

PMID:40664568 | DOI:10.1016/j.injury.2025.112593

Injury. 2025 Jul 4:112585. doi: 10.1016/j.injury.2025.112585. Online ahead of print.

NO ABSTRACT

PMID:40664567 | DOI:10.1016/j.injury.2025.112585

Injury. 2025 Jul 9:112589. doi: 10.1016/j.injury.2025.112589. Online ahead of print.

ABSTRACT

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used in recent years as an adjunctive strategy to haemostatic procedures to counteract exsanguination in patients with trauma. However, no consensus has been reached regarding the haemostatic procedures deemed appropriate indications for REBOA. This study aimed to define appropriate indications for REBOA through consensus among trauma specialists and to investigate the characteristics and outcomes of patients undergoing REBOA with or without appropriate indications defined in this study.

METHODS: Using the 42 haemostatic procedures defined in the Japan Trauma Databank (JTDB), we conducted a repeated Delphi survey to obtain consensus from trauma specialists on the haemostatic procedures deemed appropriate indications for REBOA. Subsequently, patients registered in the JTDB who underwent REBOA were divided into two groups based on whether they had appropriate or inappropriate indications, as defined through the Delphi survey. Patient baseline characteristics, door-to-haemostasis time, door-to-blood transfusion time, emergency-department and in-hospital mortality, and complications were compared between the groups. The observed mortality and predicted mortality were compared.

RESULTS: After five rounds of questionnaire assessments including 11 trauma specialists, intraabdominal, retroperitoneal, pelvic, and extremity haemorrhage were defined as consensus-based appropriate indications for REBOA. Among the 361,706 patients with trauma registered in the JTDB, 1833 underwent REBOA: 1077 with appropriate and 756 with inappropriate indications. Crude in-hospital mortality (57.6 vs. 72.9 %, p < 0.001) and crude emergency-department mortality (15.4 vs. 38.6 %, p < 0.001) were significantly higher in patients with inappropriate indications than in those with appropriate indications. The observed mortality was higher than the predicted mortality, but it more closely aligned with the predicted mortality in 2013-2019 than in 2004-2012.

CONCLUSION: In over 40 % of cases in which REBOA was employed, it was used outside the appropriate indications defined in this study. Mortality was higher among patients with inappropriate indications than in those with appropriate indications. Further studies are required to elucidate the association between corresponding haemostatic procedures and outcomes for REBOA.

PMID:40664566 | DOI:10.1016/j.injury.2025.112589

Injury. 2025 Jul 9;56(8):112597. doi: 10.1016/j.injury.2025.112597. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to evaluate the outcomes of two-stage bone grafting versus amputation for the treatment of distal phalangeal osteomyelitis.

METHODS: We conducted a retrospective multicenter study of 102 patients with distal phalangeal osteomyelitis, of whom 53 underwent amputation and 49 underwent two-stage bone grafting. Preoperative characteristics were analyzed, including sex, age, BMI, prevalence of diabetes and osteoporosis, infection etiology, and fingers involved. The primary endpoint was infection recurrence. Meanwhile, patient-reported outcomes such as hand function and aesthetic satisfaction were also evaluated. Covariance analysis was performed to adjust for the disparity in soft tissue defect scores between the groups.

RESULTS: The two treatment groups were initially comparable in most preoperative characteristics; except for a significant difference in soft tissue defect scores (P-value = 0.011). No differences in the occurrence of reinfection were observed between the groups (1/49 in the bone graft group vs. 0/52 in the amputation group, P-value = 0.960). The two-stage bone grafting group reported significantly lower rates of neuropathic pain (2/49 vs. 18/52, P-value < 0.001) and higher aesthetic satisfaction scores (adjusted P-value = 0.007), while the amputation group exhibited lower hand functional scores, especially in fine motor skills (adjusted P-value = 0.031 for lifting large objects, adjusted P-value < 0.001 for the rest).

CONCLUSION: Both surgical treatments showed comparable efficacy in preventing infection recurrence. However, the two-stage bone grafting group demonstrated better patient-reported outcomes in terms of hand function and aesthetic satisfaction and a lower rate of neuropathic pain.

PMID:40663875 | DOI:10.1016/j.injury.2025.112597

Injury. 2025 Jul 8:112598. doi: 10.1016/j.injury.2025.112598. Online ahead of print.

NO ABSTRACT

PMID:40651873 | DOI:10.1016/j.injury.2025.112598

Injury. 2025 Jul 3:112583. doi: 10.1016/j.injury.2025.112583. Online ahead of print.

NO ABSTRACT

PMID:40651872 | DOI:10.1016/j.injury.2025.112583

Injury. 2025 Jul 4:112581. doi: 10.1016/j.injury.2025.112581. Online ahead of print.

NO ABSTRACT

PMID:40651871 | DOI:10.1016/j.injury.2025.112581

Injury. 2025 Jul 1:112571. doi: 10.1016/j.injury.2025.112571. Online ahead of print.

NO ABSTRACT

PMID:40651870 | DOI:10.1016/j.injury.2025.112571

Injury. 2025 Jul 4:112587. doi: 10.1016/j.injury.2025.112587. Online ahead of print.

NO ABSTRACT

PMID:40645870 | DOI:10.1016/j.injury.2025.112587

Injury. 2025 Jul 3:112575. doi: 10.1016/j.injury.2025.112575. Online ahead of print.

ABSTRACT

BACKGROUND: For acetabular fractures of both columns, the antegrade posterior column screw (APCS) is often inserted via the anterior intrapelvic approach to stabilize both columns. Insertion of the APCS can be technically demanding due to the complex anatomy of the posterior column. Misdirection or mispositioning of the screw during surgery can result in penetrate the hip joint or damage the neurovascular structures. The purpose of this study was to detect the ideal insertion point and angles of the APCS based on anatomical landmarks that can be directly identified intraoperatively.

METHODS: We retrospectively reviewed the pelvic CT of 50 adults who underwent serial slice CT imaging. Three reference plane was determined using image analysis software; (1) iliac plane (IP), which contains the anterior superior iliac spine (ASIS), the anterior margin of sacroiliac joint (AMS), and the posterior margin of pubic symphysis (PMS), (2) pelvic inlet plane (PIP), which contains the AMS of both sides, and the PMS, (3) sagittal midline plane of the pelvis (SMP). The ideal insertion point and angles of the APCS, and its maximum length were measured. The ideal insertion point was measured on the line connecting ASIS and AMS (AA line) at a distance from AMS (APCS horizontal distance) and vertical distance from AA line (APCS vertical distance). The ideal angles were measured between the screw and the PIP and between the screw and the SMP.

RESULTS: The APCS horizontal distance was 27.4 ± 6.4 mm. The APCS vertical distance was 1.6 ± 6.6 mm. The angle between the ideal APCS and yz-plane on the outlet view (α-angle) was 5.8 ± 5.8° The angle between the ideal APCS and y-axis on the xy-plane (β-angle) was 51.6 ± 5.0° The length of the APCS was 125.8 ± 9.5 mm.

CONCLUSION: The ideal insertion point detected as the distance from the AMS on the AA line and the ideal insertion angles relative to the PIP and the SMP may aid in proper insertion of the APCS during surgery.

PMID:40645869 | DOI:10.1016/j.injury.2025.112575