Injury. 2025 May 26;56(8):112457. doi: 10.1016/j.injury.2025.112457. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to systematically compare the clinical efficacy and safety of different surgical approaches in the treatment of posterolateral tibial plateau fractures. Specifically, it evaluated operative time, intraoperative blood loss, fracture healing time, postoperative knee function, and complication rates, to provide evidence-based guidance for clinical surgical approach selection.

METHODS: A comprehensive literature search was conducted in seven major databases-CNKI, PubMed, Web of Science, Cochrane Library, Scopus, VIP, and EMBASE-from their inception to May 2025. Controlled studies comparing different surgical approaches for posterolateral tibial plateau fractures were included. Primary outcomes were operative time, intraoperative blood loss, fracture healing time, postoperative Hospital for Special Surgery (HSS) knee scores, and incidence of postoperative complications. A network meta-analysis was performed using Stata 16.0. A network diagram and league table were generated to present both direct and indirect comparisons among surgical approaches. Surface Under the Cumulative Ranking curve (SUCRA) values were used to rank the interventions. Study quality was assessed using the MINORS scale. Inconsistency testing and publication bias analysis were also conducted to ensure robustness of the results.

RESULTS: A total of 26 studies involving 1864 patients and seven surgical approaches were included. The network meta-analysis showed that the Modified Extended Anterolateral Approach (MEALA) ranked highest across all primary outcomes: operative time (SUCRA: 97.8 %), intraoperative blood loss (94.9 %), fracture healing time (95.0 %), postoperative HSS score (98.2 %), and complication rate (78.5 %). Additionally, the Transfibular Head Approach (TFHA) demonstrated advantages in minimizing intraoperative blood loss and controlling complications. No significant inconsistency or publication bias was detected based on node-splitting analysis and funnel plot assessment, indicating robust results.

CONCLUSION: The Modified Extended Anterolateral Approach demonstrates superior overall performance in the treatment of posterolateral tibial plateau fractures, particularly in reducing operative time, minimizing intraoperative trauma, and enhancing postoperative functional recovery. The Transfibular Head Approach also shows potential benefits in complication management. Surgical approach selection should be individualized based on fracture morphology and surgeon experience. Further high-quality randomized controlled trials are warranted to validate these findings.

PMID:40449183 | DOI:10.1016/j.injury.2025.112457

Injury. 2025 May 24;56(8):112454. doi: 10.1016/j.injury.2025.112454. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal radius fractures (DRFs) are common, with an increasing incidence, particularly among the elderly. Rupture of the extensor pollicis longus (EPL) tendon, essential for thumb extension, is a notable complication, especially in non-displaced DRFs. Several mechanisms, such as local adhesion, ischemic atrophy, and tendon laceration, are associated with EPL tendon rupture. This multicenter retrospective study aims to identify risk factors for EPL tendon rupture in non-displaced DRFs.

MATERIALS AND METHODS: The study reviewed 20 cases of EPL tendon rupture and 52 control cases from 2005 to 2022, excluding those who underwent surgery or had incomplete computed tomography (CT) data. We investigated age, sex, location of fracture line, and the morphology of Lister's tubercle as variables. Logistic regression and decision tree analyses were employed to determine the risk factors for EPL tendon rupture based on these variables.

RESULTS: Fracture lines distal to Lister's tubercle and specific shapes of Lister's tubercle, characterized by shallow peak height and a higher radial peak than the ulnar peak, increased the risk of EPL tendon rupture. Decision tree analysis confirmed them as major risk factors. There was a significant difference in the predicted probability rate of tendon rupture between the case with these factors and those without them (P < 0.001). Conversely, the location and size of Lister's tubercle did not affect the incidence of EPL tendon rupture.

CONCLUSION: The location of fracture line and the shape of Lister's tubercle are key factors influencing EPL tendon rupture in non-displaced DRFs. Understanding these factors can help orthopedic surgeons predict and prevent EPL tendon ruptures, improving patient outcomes following these fractures.

PMID:40449182 | DOI:10.1016/j.injury.2025.112454

Injury. 2025 May 29;56(8):112442. doi: 10.1016/j.injury.2025.112442. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal femur fractures are commonly managed with retrograde femoral nailing or locked lateral plating (LLP). As implant design has evolved, more distal and complex patterns are being treated with intramedullary implants. The aim of the present study was to compare early outcomes in distal femur fractures managed with the novel DePuy Synthes RFN-Advanced (RFNA) Retrograde Femoral Nailing System to a similar cohort treated with locked lateral plating.

PATIENTS AND METHODS: This is a retrospective cohort study of operative distal femur fractures that presented to our Level I trauma center over a 7-year period. We included patients with AO/OTA types 33A2-3, 33C1-2 fractures treated with either the RFNA or a lateral locked plate over two distinct time points. Injury radiographs were reviewed independently by three orthopedic traumatologists to include only cases deemed "nailable." Primary outcomes included coronal and sagittal alignment. Secondary outcomes included nonunion, surgical site infection (SSI), and unplanned reoperation.

RESULTS: We identified 107 patients treated with either the RFNA (n = 45) or LLP (n = 62) over the 7-year study period. No significant differences were identified in the rates of sagittal (2.2 % versus 9.7 %, P = 0.12) or coronal malalignment (2.2 % versus 0 %, P = 0.421). The nonunion rate was 8.9 % in the RFNA cohort versus 19.4 % in the LLP cohort, but this difference was not statistically significant (P = 0.174). We also found no difference in infection or implant failure between groups. Screw backout occurred in 8 RFNA patients (17.8 %), with 7 patients undergoing screw removal (15.6 %) either in clinic (n = 5) or the operating room (n = 2).

DISCUSSION AND CONCLUSIONS: This matched cohort study demonstrated promising results comparing the RFNA to lateral plating of distal femur fractures. The nonunion rate of 9 % in the RFNA cohort adds to recent literature that supports improved union rates with intramedullary nailing of these fractures. Interlocking screw backout was the most common complication with RFNA treatment at a rate of 16 %, with the majority removed in clinic.

LEVEL OF EVIDENCE: Level III.

PMID:40446568 | DOI:10.1016/j.injury.2025.112442

Injury. 2025 May 21;56(8):112450. doi: 10.1016/j.injury.2025.112450. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the safety and efficacy of Pelnac artificial skin one-stage surgical direct repair of significant toenail flap donor area defects.

METHODS: From March 2020 to May 2023, a total of 56 patients with traumatic finger injuries underwent reconstruction using a great toenail flap combined with iliac bone grafting, along with one-stage artificial skin repair of the great toenail flap. These patients were followed prospectively, and their clinical outcomes were systematically evaluated.

RESULTS: The average follow-up was 13.4 months (3 to 30 months). The visual analog scale for pain was 0.23±0.6, and the Vancouver scar scale (VAS) was 2.82±1.06. Among 56 patients, only one case developed postoperative infections. The aesthetic satisfaction of the donor area of the patient's foot was 87.10±5.48 points (out of 100 points). Regarding the sensory recovery, the response "normal or near normal" was obtained in 44 patients (78.6 %). The maximum active mobility of the first metatarsophalangeal joint and the distal interphalangeal joint in the donor area was 66.51±7.38°and 43.21±4.62°, respectively.

CONCLUSIONS: Given its low donor-site morbidity and favorable cosmetic and functional outcomes, one-stage reconstruction of donor site defects using artificial dermis represents an effective and clinically viable treatment option.

PMID:40446567 | DOI:10.1016/j.injury.2025.112450

Injury. 2025 May 22;56(8):112453. doi: 10.1016/j.injury.2025.112453. Online ahead of print.

NO ABSTRACT

PMID:40446566 | DOI:10.1016/j.injury.2025.112453

Injury. 2025 May 21;56(8):112451. doi: 10.1016/j.injury.2025.112451. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the pros and cons of percutaneous kyphoplasty (PKP) and bone-filling mesh containers (BFC) by means of a meta-analysis in the treatment of osteoporotic vertebral compression fractures (OVCFs).

MATERIALS AND METHODS: A comprehensive search of Cochrane Library, PubMed, Embase, CNKI, Wanfang Database, and Chinese biomedical literature database was conducted to identify eligible clinical control studies comparing BFC versus PKP for OVCFs published until December 2022. Meta-analysis was performed utilizing Revman 5.3 to assess the effectiveness and safety of the two procedures.

RESULTS: Thirteen clinical controlled trials with a total of 1025 patients were enrolled, including 487 in the BFC group and 538 in the PKP group. BFC significantly reduced operation time and bone cement leakage rates compared with PKP. No significant differences were found between the two groups in terms of VAS score, ODI score, and Cobb angle at short- and long-term follow-up.

CONCLUSIONS: Both BFC and PKP are effective surgical approaches for the treatment of OVCFs, with BFC having a shorter operative time and a lower incidence of cement leakage.

PMID:40446565 | DOI:10.1016/j.injury.2025.112451

Injury. 2025 May 17;56(8):112445. doi: 10.1016/j.injury.2025.112445. Online ahead of print.

ABSTRACT

Traditionally unstable ankle fractures are surgically managed using open reduction and internal fixation (ORIF) with plate and screws. However, the operative management has gained an innovative technique. In the last decade, intramedullary (IM) nailing was introduced in local guidelines as a treatment for a selective group of elderly patients with compromised soft-tissues, as this technique is minimally invasive and less prone to wound complications including infections. Based on the authors' experience with IM nailing of the fibula using an intramedullary locking fibula nail, common technical challenges are highlighted and tips and tricks are provided to achieve optimal anatomic reduction by optimizing the entry point of the nail. Furthermore, we introduce a flow-diagram for optimal anatomic reduction using a dorsolateral entry point for the nail.

PMID:40446564 | DOI:10.1016/j.injury.2025.112445

Injury. 2025 May 22:112446. doi: 10.1016/j.injury.2025.112446. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, there is a lack of literature reporting on the risk factors associated with various types of subdural effusion (SDE). The purpose of this study is to investigate the incidence, risk factors, and prognosis of different types of SDE that occur secondary to unilateral decompressive craniectomy (DC) in patients with traumatic brain injury (TBI).

METHODS: A total of 417 patients who met the inclusion criteria were analyzed. The incidence, treatment, and prognosis of various types of SDE were examined. Risk factors associated with different types of SDE were identified through univariate analysis followed by multivariable logistic regression analysis.

RESULTS: The overall incidence of SDE was 50.6 %. There was no statistically significant difference in GOS scores among the various types of SDE (P = 0.511). Age (per 10-year increase) (OR, 1.471; 95 % CI, 1.201-1.802; P < 0.001), alcoholism (OR, 2.027; 95 % CI, 1.021-4.022; P = 0.043), combined with contralateral subdural hematoma (OR, 4.874; 95 % CI, 2.676-8.878; P < 0.001), and contralateral pneumocephalus after surgery (OR, 4.051; 95 % CI, 1.837-8.934; P = 0.001) were identified as independent risk factors for the occurrence of contralateral SDE. The type of injury (acute subdural hematoma, ASDH) (OR, 1.918; 95 % CI, 1.367-2.690; P <0.001), was an independent risk factor for the occurrence of ipsilateral SDE. Combined with contralateral subdural hematoma (OR, 2.669; 95 % CI, 1.161-6.139; P = 0.021) and contralateral pneumocephalus after surgery (OR, 2.271; 95 % CI, 1.177-4.381; P = 0.014) were independent risk factors for the occurrence of interhemispheric SDE.

CONCLUSIONS: Various types of SDE do not significantly affect the prognosis of patients with traumatic brain injury (TBI). Independent risk factors for the occurrence of contralateral SDE include age, alcoholism, and the presence of contralateral subdural hematoma and contralateral pneumocephalus following surgery. The type of injury being ASDH is the only risk factor for ipsilateral SDE. Combined with contralateral subdural hematoma and contralateral pneumocephalus after surgery were independent risk factors for the occurrence of interhemispheric SDE.

PMID:40436708 | DOI:10.1016/j.injury.2025.112446

Injury. 2025 May 17:112447. doi: 10.1016/j.injury.2025.112447. Online ahead of print.

ABSTRACT

INTRODUCTION: Open cardiopulmonary resuscitation (OCPR) is a critical treatment for severe torso trauma. While OCPR has shown survival benefits for patients with penetrating traumatic cardiac arrest, its efficacy in blunt trauma patients remains unclear.

MATERIALS AND METHODS: This retrospective cohort study analyzed pulseless blunt chest trauma patients from the National Trauma Data Bank (NTDB) in the United States during 2014-2015. The study excluded patients under 18 years of age, those without initial signs of life, and those with burns, penetrating trauma, unknown mechanisms, incomplete records, severe head injuries, or transportation times over 60 min. The primary outcome was Emergency Department (ED) survival, and the secondary outcome was overall survival.

RESULTS: Out of 1358 pulseless blunt chest trauma patients, 420 met the inclusion criteria, and 15.5 % (65/420) received OCPR. ED survival was significantly greater in the OCPR group (81.5 % [53/65] vs. 46.8 % [166/355], p < 0.001), whereas overall survival was not significantly different between the groups (9.2 % [6/65] vs. 12.4 % [44/355], p = 0.626). A subset analysis of patients with cardiac injuries showed better ED survival (81.3 % [13/16] vs. 40.5 % [17/42], p = 0.012) and a trend of better overall survival (25.0 % [4/16] vs. 3.4 % [2/42], p = 0.086) for those who underwent OCPR.

CONCLUSION: OCPR does not improve overall survival in all pulseless blunt chest trauma patients, but it offers significant benefits for those with cardiac injuries. Further research is needed to refine management strategies for these patients.

PMID:40425418 | DOI:10.1016/j.injury.2025.112447

Injury. 2025 May 14:112437. doi: 10.1016/j.injury.2025.112437. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma-related preventable death is considered death as a consequence of moderate to severe injury under (sub)optimal trauma care conditions and is used as a criterion to evaluate the management and quality of trauma care worldwide. A validated definition of trauma-related preventable death is still lacking due to differences in classification. To reach consensus on a definition and assess the necessity of an additional trauma prediction algorithm, a Delphi procedure was performed.

METHODS: A digital three-round Delphi procedure was performed. Trauma surgeons, neurosurgeons, forensic medicine physicians, anesthesiologists, and emergency care physicians working at a Level 1 or affiliated trauma center in the Netherlands were invited to participate. An electronic questionnaire was administered to assess the most suitable category of trauma-related preventable death (clinical definition, trauma prediction algorithm, clinical definition and trauma prediction algorithm or other) and the additional benefit of a trauma prediction algorithm.

RESULTS: Fifty-four panelists completed the study: 23 trauma surgeons, 13 emergency care physicians, 10 anesthesiologists, 4 neurosurgeons and 4 forensic medicine physicians. In the first round, a clinical definition and a clinical definition and trauma prediction algorithm (Trauma Score and Injury Severity Score and a combination of algorithms) were favored. The results were fed back to the panelists. In the final round, there was a tendency towards group consensus in favor of a clinical definition and trauma prediction algorithm (63 %). Consensus was reached on the most suitable algorithm: the Trauma Score and Injury Severity Score combined with the Probability of survival.

CONCLUSION: The identification of trauma-related preventable death is essential in the evaluation of trauma care. This study elucidates the difficulty of multidisciplinary consensus. However, a propensity towards consensus on a clinical definition, and consensus on the additional benefit of the PS, based on the TRISS, seems to be present.

PMID:40413123 | DOI:10.1016/j.injury.2025.112437

Injury. 2025 May 14;56(8):112427. doi: 10.1016/j.injury.2025.112427. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma video review (TVR), whereby resuscitations in the trauma bay are audio-visually recorded, has not been investigated within the orthopaedic context. The purpose of this study was to evaluate the utility of TVR as a practical method to evaluate the delivery of orthopaedic care and resident competency in the trauma bay.

MATERIALS AND METHODS: This was a retrospective study of 15 trauma resuscitations performed at an academic, level I trauma center between May - June 2024. TVR was used to evaluate the quality of orthopaedic care delivered in the trauma bay and to assess resident competency using Accreditation Council for Graduate Medical Education (ACGME) milestones and American Board of Orthopaedic Surgery (ABOS) Knowledge, Skills and Behavior criteria.

RESULTS: TVR allowed for quantification of multiple orthopaedic time-based metrics. TVR identified themes to prompt institutional quality improvement initiatives in the future. Importantly, TVR provided a unique opportunity to evaluate the resident interacting as part of an impromptu multidisciplinary team in a high stress environment. TVR effectively provided a method to assess competency using ACGME and ABOS criteria.

CONCLUSIONS: TVR is a practical tool to evaluate and improve the quality of orthopaedic care provided in the trauma bay. It offers a unique opportunity to assess resident competency by ACGME and ABOS criteria.

PMID:40412348 | DOI:10.1016/j.injury.2025.112427

Injury. 2025 May 15;56(8):112441. doi: 10.1016/j.injury.2025.112441. Online ahead of print.

ABSTRACT

OBJECTIVES: To address the conflicting evidence in the literature regarding time to surgery and its impact on outcomes for distal femoral fractures.

METHODS: This is a retrospective review of the American College of Surgeon's (ACS) National Surgical Quality Improvement Project (NSQIP®) database, that collects data from 680 hospitals across the United States. The database was queried from 2010-2021. Case selection was done by use of ICD-9 & ICD-10 codes for native distal femoral fractures and periprosthetic distal femur fractures, along with CPT codes for surgical fixation of distal femur, total knee arthroplasty and revision knee arthroplasty. Pre-operative, operative and post-operative factors were compared for patients undergoing surgery on hospital day 0 or 1 (HD ≤ 1) to patients undergoing surgery after hospital day 1(HD > 1). Primary outcome measure was 30-day mortality. Chi-square and logistic regression were used for univariable and multivariable analyses, respectively.

RESULTS: A total of 6857 cases were identified (mean age of 71.5 years). 84.5 % underwent surgery on HD ≤ 1, and 15.5 % on HD > 1. Rate of mortality was 1.37 % and 3.26 %, respectively. Patients who underwent surgical fixation of distal femoral fracture on HD ≤ 1 had a 40 % decrease in odds of mortality compared to fixation on HD > 1 (OR 0.587; p = 0.031). A multi variable analysis revealed that presence of dyspnea (OR 4.338, p = 0.005), preoperative blood transfusion (HR 2.32, p = 0.001) and bleeding disorder (OR 1.727, p = 0.03) were associated with increased mortality at 30-days on multivariable analysis, while younger age (OR 0.216; p = 0.001) had a protective effect.

CONCLUSIONS: Delayed surgical fixation is associated with increased odds of 30-day mortality for patients with distal femoral fractures. Further studies will help determine if the increased mortality is caused by the delay itself or by other confounding variables not identified in this study that may be associated with the reason for the delay.

LEVEL OF EVIDENCE: Level III.

PMID:40412347 | DOI:10.1016/j.injury.2025.112441

Injury. 2025 May 16;56(8):112439. doi: 10.1016/j.injury.2025.112439. Online ahead of print.

ABSTRACT

BACKGROUND: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in patients with acute spinal cord injury (SCI). This study aimed to evaluate VTE incidence in patients with acute SCI and explore injury and management characteristics that may identify high-risk patients.

METHODS: Retrospective review of consecutive patients with acute SCI ≥18 years admitted to the National Spinal Injuries Unit (NSIU) between January 2016 and December 2020 was conducted. Data were extracted from the NSIU database, internal picture archiving and communication system and hospital records. Primary outcome was VTE incidence. Latent Class Analysis (LCA) was used to identify subgroups of patients based on injury level, neurological impairment and operative management. Subgroups were linked to VTE outcomes using BCH-Adjusted Proportional Assignment correction and multiple logistic regression.

RESULTS: 1369 patients were included in the analysis. Mean age was 54 years (SD-20) with a male predominance (831/1369; 61 %). VTE incidence was 2.34 %(CI: 1.60 - 3.28)(32/1369). LCA identified three distinct subgroups: undifferentiated injury, multilevel injury, and thoracic-spine predominant injury. Significant differences in VTE rates were observed across the subgroups, with thoracic spine injury associated with the highest VTE risk. After adjustment, individuals with thoracic-spine injuries and severe neurological impairment had an almost 4-fold increase in the odds of developing VTE compared to those with other injury/management profiles.

CONCLUSION: This study highlights the importance of tailored VTE prevention strategies for patients with acute SCI based on injury and management characteristics. An individualized approached to VTE risk stratification and prevention is required in this group.

PMID:40398331 | DOI:10.1016/j.injury.2025.112439

Injury. 2025 Apr 12;56(7):112288. doi: 10.1016/j.injury.2025.112288. Online ahead of print.

ABSTRACT

Spinal cord injury (SCI) is one of the most devastating neurological disorders associated with severe locomotor disability and a high rate of morbidity. Over the last 20-30 years, animal SCI models have proven to be extremely useful in better understanding the underlying molecular mechanism(s) involved in human traumatic SCI and in assessing the efficacy of available therapeutic agents. Thus, the current review article aims to provide readers with an overview of the methods used to induce traumatic SCI and highlight the recent advances in assessment of the functional recovery in rodent models. SCI models are classified into contusion, compression, transection, and Hypoxia-ischemia based on the mechanism of injury caused. Transection injury models are useful for studying the anatomic regeneration and neural circuitries in locomotion, whereas, compression/contusion injury models are used for studying complex biomechanism and neuropathology of human SCI. The ultimate goal of pre-clinical experimental work on traumatic SCI model is to develop effective repair/regenerative strategies for the clinical purpose. Here, we have summarized recent functional recovery assessment tool including quantification of myelin loss and motor neuron counts, axonal regeneration through behavioural and molecular studies.

PMID:40398195 | DOI:10.1016/j.injury.2025.112288

Injury. 2025 May 12;56(7):112428. doi: 10.1016/j.injury.2025.112428. Online ahead of print.

ABSTRACT

INTRODUCTION: Fractures of the distal humerus are common in older patients with osteoporotic bone, often presenting as complex, multi-fragmentary injuries involving the articular surface. This complexity complicates the decision between open reduction and internal fixation (ORIF) and total elbow arthroplasty (TEA), as both procedures carry specific risks. Hemiarthroplasty (HA) may be a viable alternative, yet few studies have compared its outcomes with those of ORIF. In this retrospective matched-pair study, we aimed to compare primary HA versus ORIF for complex distal humerus fractures. Our hypothesis was that HA could achieve functional outcomes equivalent to ORIF when joint reconstruction is not feasible.

MATERIALS AND METHODS: We matched 10 pairs of patients who underwent HA or ORIF between 2018 and 2022. Matching criteria included age, gender, and fracture classification (Orthopaedic Trauma Association (OTA) or Dubberley classification for coronal shear fractures). Functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score and the Mayo Elbow Performance Score (MEPS). The mean follow-up was 29 months for the HA group and 33 months for the ORIF group.

RESULTS: Both treatment groups exhibited satisfactory functional outcomes. In the HA group, the median MEPS was 89.5 and a qDASH score of 21.6. Mean range of motion in extension/flexion was 105.9°. The ORIF group had a median MEPS of 81.5, a qDASH of 17 and a mean range of motion of 116.5°. No significant differences in functional outcomes were observed between the two groups CONCLUSIONS: HA can yield functional results comparable to ORIF in managing complex distal humerus fractures. When ORIF is not feasible, HA is an effective alternative, particularly for physically active patients over 60 years, as it avoids the limitations associated with linked total elbow arthroplasty, such as weight restrictions and the risk of ulnar component loosening.

LEVEL OF EVIDENCE: Level III.

PMID:40393340 | DOI:10.1016/j.injury.2025.112428

Injury. 2025 May 9:112418. doi: 10.1016/j.injury.2025.112418. Online ahead of print.

ABSTRACT

BACKGROUND: For firearm-related injuries (FRI), understanding spatial injury patterns may inform intervention strategies. This study evaluates geographic FRI patterns, emphasizing (1) proximity of home address to injury location and (2) locational social determinants of health (SDOH).

METHODS: We performed a retrospective analysis of FRI patients at a Level 1 trauma center between 01/2016-10/2022. Patient home and injury ZCTAs (ZCTA tabulation areas) were collected. SDOH indicators were calculated by ZIP codes using the Distressed Communities Index (DCI, ranges from 0-100 [most distressed]) and Social Deprivation Index (SDI, ranges from 1-100 [highest deprivation]). SDOH index variations and distances between ZCTAs were calculated.

RESULTS: Of 37,537 trauma activations, 6326 were due to FRI. ZCTAs were available in 3864 (63.12 %) patients. The cohort was 86.5 % male and 85.2 % Black. Median (IQR) age was 30 (23-39) years. Home and injury locations were the same in 37.8 % of patients, within 5 miles of each other in 57.1 %, and within 20 miles in 87.2 %. DCI and SDI were significantly higher in injury vs home addresses (average DCI: home 59.5, injury 65.7; average SDI: home 71.8, injury 79.6; p < 0.001). Twenty ZCTAs (among 182) made up 68.4 % of injury locations. On linear regression, SDI and DCI were significantly associated with FRI number within ZCTAs.

CONCLUSIONS: FRI often happens close to home, and when ZCTAs differ, injury location SDOH tend to be worse. "Hotspots" with higher-than-average distress/deprivation present opportunity to maximize the impact of violence reduction; efforts should target these regions to mitigate factors perpetuating violence.

PMID:40383685 | DOI:10.1016/j.injury.2025.112418

Injury. 2025 May 8:112419. doi: 10.1016/j.injury.2025.112419. Online ahead of print.

ABSTRACT

INTRODUCTION: Hemorrhagic shock is a life-threatening condition that requires rapid identification for timely intervention. Although shock is easily discernible in the hypotensive patient, compensated shock in the "normotensive" patient is not. This study aimed to evaluate the utility of shock index (SI) in trauma patients with compensated shock.

METHODS: Patients with SBP > 90 mmHg on arrival were identified from our trauma center registry. SI was calculated by arrival heart rate divided by arrival SBP. Patients were stratified by SI using the following thresholds: ≤ 0.7, > 0.7 to 0.9, > 0.9 to 1.1, > 1.1 to 1.3, and > 1.3. Cross tabulations were used to estimate the odds of transfusion within 1 hour of arrival for each SI category with ≤ 0.7 as the referent.

RESULTS: 5958 trauma patients were included. Blood products were transfused within 1 hour of arrival in 211 (3.5 %) patients. A main effect was observed for shock index with increased risk for required transfusion for patients with admission shock index >0.7 (P < 0.001). In comparison to shock index of ≤ 0.7, odds ratios were 2.5(1.7 - 3.8), 8.2(5.4 - 12.2), 24.9(15.1 - 41.1), 59.0(32.0 - 108.6) for each categorical increase in SI.

DISCUSSION: Among trauma patients presenting without hypotension, elevated SI was associated with an increase in odds of receiving transfusion within one hour. SI may be useful in determining the presence of compensated shock in non-hypotensive patients.

PMID:40379507 | DOI:10.1016/j.injury.2025.112419

Injury. 2025 May 10;56(7):112366. doi: 10.1016/j.injury.2025.112366. Online ahead of print.

ABSTRACT

National Mine Action Strategies (NMAS) and National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) have emerged as two frameworks with potential to improve the health and safety of millions living in vulnerable communities through coordinated and systematic planning. NMAS describe strategies for eliminating explosive ordnance (EO) and providing services and support to EO victims. NSOAPs outline a strategy to enhance surgical systems through surgical, anesthesia, and obstetric capacity building, taking broad approaches spanning from individual health providers and facilities to country-level Ministry of Health governance and financing. Though NMAS and NSOAPs originate in different sectors, they both adopt a systemic approach to complex problems with population-wide effects in low-resource settings. While seemingly disparate plans, NMAS and NSOAPs share overlapping objectives and methods to achieve them, each centered around promoting population health at national levels through complex infrastructure, human capacity, and resources development. NMAS and NSOAPs both encounter similar objectives, challenges, and implementation considerations which could benefit from improved communication and coordination between these communities. Analyzing the strengths and criticisms of current NMAS and NSOAPs in light of one another can help to mutually strengthen and support these critically important strategic plans.

PMID:40378730 | DOI:10.1016/j.injury.2025.112366

Injury. 2025 May 6:112414. doi: 10.1016/j.injury.2025.112414. Online ahead of print.

ABSTRACT

PURPOSE: The Rural Trauma Team Development Course (RTTDC) was introduced in 1998 in response to a growing number of deaths in rural areas due to trauma. Current literature provides evidence of the effectiveness of the RTTDC in reducing delays in the trauma transfer process in the United States. London Health Sciences Centre (LHSC) implemented the RTTDC in August of 2017. The objective of this study was to evaluate its impact in the Canadian setting.

METHODS: A retrospective cohort study of referred trauma patients before and after delivery of the RTTDC was conducted. The primary outcome was the proportion of patients transferred within 3 h of arrival at referring hospital. Statistical analyses compared pre and post RTTDC groups. Following multiple imputation, multivariable logistic regression analysis was used to control for confounding between groups. A planned subgroup analysis included only patients who met trauma team activation criteria and/or had an ISS ≥16. Course attendee satisfaction was measured using the American College of Surgeons RTTDC 4th Edition Course Evaluation and the Southwest Regional Trauma Network RTTDC Evaluation.

RESULTS: In total 180 patients were included in the study. Patients had a mean age of 52.0 (20.4) years, were most often male (73.3 %), sustained a blunt injury (92.8 %) with a mean ISS of 15.8 (10.5). The proportion of patients who were transferred within 3 h of arrival at primary hospital was 48.9 % pre-RTTDC and 56.7 % post-RTTDC (p = 0.370). Hosting an RTTDC did not have a significant impact on the proportion of patients transferred within 3 h of primary hospital arrival (OR = 1.18 (0.63, 2.20)). Median time (hours) spent at a primary hospital was similar (3.1 (1.4, 4.2) vs 2.7 (1.7, 3.8), p = 0.702), as was median decision to transfer time (hours) (1.5 (0.6, 2.5) vs 1.6 (0.6, 2.5), p = 0.837). Results of the subgroup analyses were similar (N = 98). Attendee satisfaction with the RTTDC was exceedingly positive.

CONCLUSION: In this study, participation in a one-day RTTDC did not result in a 20 % improvement in the proportion of patients being transferred from a referring hospital within 3 h. More accessible and sustainable educational outreach strategies are required to make further improvements.

PMID:40374421 | DOI:10.1016/j.injury.2025.112414

Injury. 2025 May 14;56(7):112409. doi: 10.1016/j.injury.2025.112409. Online ahead of print.

ABSTRACT

BACKGROUND: Following multiple trauma, individuals experience significant disability and poor functioning across several health domains. Rehabilitation is a component of trauma care management, however, there is limited evidence on patient outcomes after multiple trauma and the effectiveness of rehabilitation. This study was based on a Value-Based HealthCare (VBHC) framework and aimed to evaluate the impact of multiple trauma on patients' function and quality of life, and the relationship between these outcomes and the cost of inpatient rehabilitation. It also aimed to obtain the patient perspective regarding health areas to address for future trauma research.

METHODS: This prospective, cohort study recruited 62 adult participants from a specialist inpatient rehabilitation unit following multiple trauma orthopaedic injuries. Patients health-related quality of life was measured using the 12-Item Short Form Health Survey (Version 2) (SF-12v2). The SF-12v2 was completed during inpatient rehabilitation (to capture patient recalled pre-injury quality of life) and via a telephone interview at two weeks after rehabilitation discharge. Patients also self-reported their satisfaction with the SF-12v2 and identified important health areas to address after multiple trauma. Routine inpatient rehabilitation data was collected including: the Functional Independence Measure (FIM) (assesses patients' functional independence on rehabilitation admission and discharge) and demographics.

RESULTS: The sample's mean age was 51.6 years (standard deviation: 17.8) and the majority were male (69.4 %). Between rehabilitation admission to discharge, patients' demonstrated a statistically significant increase in function (FIM scores). However, quality of life (SF-12v2 scores) significantly decreased between pre-injury to after hospital discharge. At both timepoints, an increased proportion of patients had quality of life scores that were below the population norms. Increased rehabilitation costs (i.e., longer inpatient stays) were positively and significantly associated with increased functional independence, albeit, not quality of life scores. Patients identified important health areas that related to individual outcomes (e.g., mental health, limitations, goals) and familial impacts.

CONCLUSIONS: This study reported that an individually tailored rehabilitation program was cost effective and led to significant improvements in patient function. Patients experienced significant impacts to quality of life after multiple trauma, which suggests the need for a long-term and integrated care plan including psychological medical input.

PMID:40373364 | DOI:10.1016/j.injury.2025.112409