Injury. 2025 Aug 7;56(10):112653. doi: 10.1016/j.injury.2025.112653. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to compare demographics, treatments, and outcomes of interprosthetic (IPFFs) and periprosthetic femur fractures (PPFFs). IPFFs were hypothesized to occur in older patients and have higher rates of reoperation, implant failure, and mortality.

METHODS: This was a retrospective cohort at a Level 1 trauma center analyzing adults with PPFFs/IPFFs from 2012-2024. Patients with < 30 days follow-up were excluded. Patient characteristics, treatments, and complications were compared between IPFFs and PPFFs.

RESULTS: 276 patients with 30 IPFFs and 246 PPFFs were included. IPFFs were older (74y v 69y p=.035), more commonly osteoporotic (33% v 11% p<.001), and more commonly current (17% v 14%) or former smokers (7% v 0% p<.001). IPFFs presented with 29 total hip (THA) and knee (TKA) arthroplasties and one THA and unicompartmental knee arthroplasty. PPFFs presented with 130 fractures around THAs and 116 fractures around TKAs. IPFFs more commonly presented with unstable prostheses (40% v 21% p=.017). Of the seven IPFFs treated with nail-plate hybrid constructs (NPCs), six (86%) were immediately weightbearing as tolerated (WBAT). Of the 23 IPFFs not treated with NPCs, 9 (39%) were immediately WBAT (p=.031). IPFFs had more blood loss (811mL v 513mL p=.016). The mortality rate was 15% in IPFFs and 4% in PPFFs (p=.02). IPFFs had higher rates of implant failure (23% v 7% p=.004) and superficial infection (15% v 4% p=.013). Of the seven IPFFs treated with NPCs, there were no implant failures, while 7/23 (30%) IPFFs treated with other techniques failed (p=.09).

CONCLUSIONS: IPFFs were older, more commonly osteoporotic, more likely to be smokers, and more often had unstable prostheses at presentation than PPFFs. While treatments were similar, the rate of mortality, implant failure and superficial infection was higher in IPFFs. NPCs may allow for earlier weightbearing but their long-term effects regarding outcomes and stability require further investigation in prospective studies.

LEVEL OF EVIDENCE: III.

PMID:40812247 | DOI:10.1016/j.injury.2025.112653

Injury. 2025 Aug 8;56(10):112672. doi: 10.1016/j.injury.2025.112672. Online ahead of print.

ABSTRACT

Mountain accidents have increased over the last decade all around the globe mostly due to a raise of mountain activity practitioners. Outcomes of accidents usually imply evacuation, traumatic injuries or even cardiovascular events. Sex, age, activity, altitude, experience, and equipment adequacy relate to accidents as direct causes or moderators of accident severity. This study focuses on the mountain accidents in Catalonia with descriptive and ordinal regression analysis aiming to characterize a victim vulnerability profile, which remains largely unexplored. The current sample includes 3257 mountain rescue operations from the Catalan Fire Department records between 2011 and 2021. Descriptive analysis showed that the most common profile was being hiker (63 %), climber (11.6 %), mountain biker (10.2 %), man (60.3 %), going in group (84.3 %), occurring in weekends (53.7 %), and suffering traumatic events (61.4 %) or needing technical support (20.4 %). Moreover, the main causes of fatality were falls and cardiovascular issues with the latter showing the higher fatality rate (55.5 %). Ordinal regression analysis explained a modest amount of variance (Nagelkerke R2 = 0.12), suggesting that predictors of higher severity were Group, Altitude, Male, Gathering, Mountain Biking and other practices such as Hunting. Recommendation to rescue teams comprise standardizing and potentiate data collection, conducting awareness campaigns targeted mainly to hikers, mountain bikers and elderly men, and to reinforce awareness campaigns and rescue teams during weekends.

PMID:40812246 | DOI:10.1016/j.injury.2025.112672

Injury. 2025 Aug 8;56(10):112668. doi: 10.1016/j.injury.2025.112668. Online ahead of print.

ABSTRACT

This study explores the effects of some of the key factors, including emergency response measures, roadway and environment, traffic-related attributes, and crash-specific factors, on the Injury Severity Score (ISS) of Road Traffic Crashes' (RTCs) victims, both directly and through pre-hospital time (PHT), using rigorous path analysis. Data for 298,654 crashes, compiled by the Road Traffic Injury Research and Prevention Center (RTIRPC) in Karachi (Pakistan), were used for analyses. Owing to the corner-solution distribution of the response variables (PHT and ISS), two Tobit regression models are estimated after accounting for missing values through synthetic data generation. Marginal effects from these models are used in the path analysis. The findings suggest that ISS increases by 0.01 units with a unit increase in PHT, highlighting the critical need for rapid evacuation of crash victims to medical facilities. The mode of evacuation emerged as a crucial factor, with ambulances resulting in increased PHT and ISS compared to private or public transport, underscoring the improvement needed in the dedicated ambulance-based emergency response. PHT and ISS were found to be higher in nighttime crashes, necessitating better emergency medical services (EMS) response during the night. Intersection crashes were associated with lower PHT and ISS; whereas, crashes on undivided roads and those involving multiple or large vehicles increased PHT and ISS. The path analysis revealed that the overall effects of some of the key variables on ISS were higher than their direct effects - something that could not be explored without the path analysis. These insights can help policymakers develop strategies to improve emergency response and road safety, ultimately reducing the number of RTC-related injuries and fatalities.

PMID:40812245 | DOI:10.1016/j.injury.2025.112668

Injury. 2025 Aug 6;56(10):112673. doi: 10.1016/j.injury.2025.112673. Online ahead of print.

ABSTRACT

BACKGROUND: Resuscitative thoracotomies (RTs) are controversial interventions that heavily consume resources and can pose risks for the surgical team. Increasingly limited resources and risk to healthcare teams have encouraged the continued refinement of RT guidelines. We evaluated RT futility indicators amid institutional RT practice guideline changes.

METHODS: Thoracotomies conducted at our Level 1 Trauma Center from January 2017 to July 2023 were reviewed and classified as either RT or non-resuscitative (non-RT). Injury characteristics, patient demographics, procedure details, and mortality outcomes were collected through chart review.

RESULTS: Of 78 thoracotomies, 56 (71.8 %) were RTs, predominantly on patients with penetrating injuries (55.4 %), specifically gunshot wounds (46.4 %). Most RTs (87.5 %) complied with Eastern Association for the Surgery of Trauma guidelines. The procedure mortality rate was 4.6 % for non-RT and 67.9 % for RT, and hospital mortality was 13.6 % for non-RT and 89.3 % for RT. Thus, 10.7 % of RT patients survived to discharge, including 5 (16.2 %) with penetrating injuries and 1 (4.0 %) with blunt injuries. Ten (17.8 %) RT patients arrived with fixed and dilated pupils, 11 (19.6 %) arrived with no signs of life, and 4 (10.7 %) received pre-hospital CPR, all of whom did not survive to discharge. Changes in institutional practice guidelines decreased the frequency of total thoracotomies, but not RT numbers.

DISCUSSION: RT utilization and mortality rates remained consistent after implementing stricter institutional guideline policies. Improving odds of survival may require further refinement to RT practice guidelines regarding patient selection criteria. We recommend adding witnessed cardiac arrest and prioritizing pupillary response to RT futility guidelines regardless of injury pattern.

PMID:40812244 | DOI:10.1016/j.injury.2025.112673

Injury. 2025 Aug 5:112627. doi: 10.1016/j.injury.2025.112627. Online ahead of print.

ABSTRACT

BACKGROUND: The role for routine follow-up imaging in nonoperative management (NOM) of blunt splenic injury (BSI) remains controversial. Delayed complications, specifically vascular abnormalities such as pseudoaneurysms are associated with failure of NOM (FNOM). This study examined a ten-year experience with NOM of BSI and the influence of repeat imaging. Our centers have no guidelines for follow-up imaging.

METHODS: A retrospective cohort study was conducted including all trauma patients with BSI admitted within a regional trauma system (two Level III and one Level I ACS-verified trauma centers) between 2013 and 2022. Patient demographics, injury features, imaging and outcomes were obtained from trauma registry data and chart review. Patients undergoing splenectomy 6 hours or more after presentation were categorized as FNOM.

RESULTS: A total of 1815 patients presented with BSI during the study period. Urgent splenectomy was performed in 15.6 % (N=283). The rate of FNOM was 3.4 % (N=62). Among the 1532 patients initially managed nonoperatively, 139 (9.1 %) underwent a follow-up CT scan. Most scans were obtained in response to clinical changes, while 13.7 % (N= 19) were obtained for splenic surveillance. Follow-up scans were followed by 8 splenectomies and 9 embolizations. Among the 19 scans performed for surveillance, two revealed a pseudoaneurysm; one of which underwent embolization. Results are limited by a low rate of screening imaging and a lack of long-term outcome information.

CONCLUSION: A low rate of FNOM was achieved despite less than 2 % (19/1532) of patients undergoing screening follow-up imaging. These findings suggest that there is limited opportunity for routine surveillance imaging to improve outcomes in BSI. Reimaging in response to clinical changes is a cost-effective alternative.

PMID:40803925 | DOI:10.1016/j.injury.2025.112627

Injury. 2025 Aug 7;56(10):112664. doi: 10.1016/j.injury.2025.112664. Online ahead of print.

ABSTRACT

OBJECTIVES: We conducted a sex-stratified analysis to assess the prevalence and predictors of violence and non-fatal injury among adolescents attending school in Thailand.

METHODS: The data for this study were obtained from the Thailand Global School-based Student Health Survey (GSHS), a nationally representative survey conducted in 2021 with a sample size of 5661 students aged 13-17 years. Multiple logistic regression analyses were used to examine the protective factors and risk factors that influence non-fatal injury and violence. The regression analysis was reported using adjusted odds ratios (AORs) and 95 % confidence intervals (CIs), with a p-value < 0.05.

RESULTS: The national prevalence of violence and non-fatal injury among school-going adolescents was 11.6 % and 52.6 %, respectively. Boys had a substantially higher prevalence of violence (7.6 %) and non-fatal injury (26.4 %) compared to girls (3.6 % and 24.1 %, respectively). Stratifying by sex, school truancy, and bullying were associated with violence and non-fatal injuries in girls, as well as suicidal ideation, anxiety, hunger, and various health risk behaviors, like tobacco, alcohol, and cigarette use, were found to be associated with violence and non-fatal injuries in boys. In contrast, parental supervision, peer support, and sedentary behavior were found to be protective factors for Thai adolescents.

CONCLUSIONS: Future policies should consider individual risk factors and parent-child-teacher bonding to mitigate the burden of violence and injury among in-school adolescents in Thailand.

PMID:40803265 | DOI:10.1016/j.injury.2025.112664

Injury. 2025 Aug 6;56(10):112674. doi: 10.1016/j.injury.2025.112674. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric extremity fractures represent a frequent cause of emergency department visits, with inequity in care linked to socioeconomic status, race, and insurance type. Despite standardized treatment algorithms, currently available evidence indicates that socially disadvantaged children experience delays in surgical fixation and pain management. This scoping review aims to evaluate the impact of socioeconomic factors on multiple elements of pediatric extremity fracture management.

METHODS: This scoping review followed PRISMA standards. Eligible studies included pediatric patients (<18 years) with extremity fractures, incorporated measures of social or economic status, and evaluated pre-defined management outcomes. Studies conducted before 2010 or outside of the United States were excluded. Abstracts and full texts were screened independently by multiple reviewers using Covidence software.

RESULTS: After duplicate removal, 9,671 articles were screened, with 78 undergoing full-text review; 33 articles met all inclusion criteria. The 33 eligible studies predominantly consisted of retrospective cohort analyses, with sample sizes ranging from fewer than 500 to over 9 million patients. Major outcomes evaluated included type of treatment offered (n=10), pain management (n=10), time to care (n=8), post-discharge care (n=4), imaging (n=3), and pre-hospital care (n=1). Inequities were identified across multiple domains, commonly associated with insurance status, race, family income, and primary language. Children with public insurance consistently experienced higher rates of nonoperative management and longer delays to definitive treatment. Racial/ethnic minority children had lower odds of receiving opioid analgesics despite equivalent pain levels.

DISCUSSION AND CONCLUSION: Socioeconomic disadvantage, measured at both the individual and regional level, is strongly associated with differences in pediatric extremity fracture management, including inequitable access to timely imaging, operative care, and adequate pain control. These findings underscore the critical need for targeted policy interventions, standardized clinical protocols, and improved care coordination to reduce disparities and ensure equitable pediatric fracture care for all children.

PMID:40803264 | DOI:10.1016/j.injury.2025.112674

Injury. 2025 Aug 9;56(10):112656. doi: 10.1016/j.injury.2025.112656. Online ahead of print.

ABSTRACT

BACKGROUND: Portugal's favourable conditions for water-based recreational activities (WRA) often lead to incidents requiring intervention by the National Maritime Authority (AMN). Despite being documented in the SEGMAR database, participant profiles and severity factors, particularly for water-board-related incidents (BRIs), remain underexplored. This study aims to profile individuals involved in BRIs, identify determinants of severe incidents, and examine key clusters within the AMN's jurisdiction from 2020 to 2023.

METHODS: A cross-sectional observational study analysed 14,456 WRA incidents from the SEGMAR database. BRIs included activities involving water-boards (e.g., surfing, bodyboarding, kitesurfing) and collisions with water-boards. Severe BRIs were defined as incidents causing injuries, fatalities, or disappearances. Sociodemographic, temporal, and spatial factors were analysed using descriptive analysis and Quasi-Poisson regression to estimate frequency ratios (FR). Cluster analysis identified at-risk groups, and the severe to non-severe BRIs ratio was mapped by captaincy and municipality. Statistical significance was set at p<0.05.

RESULTS: BRIs made up 11.9% of all incidents, occurring more often among men, individuals aged 15-55, and foreigners, especially outside the bathing season and in unsupervised areas (p<0.001). Severe BRIs were linked to winter (FR 1.92; 95% CI 1.15-3.19), nighttime (FR 2.0; 95% CI 1.6-2.6), dawn (FR 1.6; 95% CI 1.3-2.0), and the bathing season (FR 1.9; 95% CI 1.3-2.7). Clusters revealed at-risk groups: children under 14 at patrolled beaches in summer evenings, men over 55 at unpatrolled areas in autumn, and young females at unpatrolled beaches in winter. Seven captaincies and 20 municipalities had a severe to non-severe BRIs ratio above 1.

CONCLUSION: BRIs predominantly affect men, young adults, and foreigners. Key risk factors include extreme ages, non-summer seasons, unsupervised areas, and low-light conditions. Targeted interventions, such as adjusting lifeguard schedules to cover high-risk times, promoting safety campaigns for children and older adults, and reinforcing safety infrastructure at unpatrolled beaches, might be important to mitigate risks and reduce incident severity.

PMID:40803263 | DOI:10.1016/j.injury.2025.112656

Injury. 2025 Aug 6:112652. doi: 10.1016/j.injury.2025.112652. Online ahead of print.

NO ABSTRACT

PMID:40796423 | DOI:10.1016/j.injury.2025.112652

Injury. 2025 Aug 7;56(10):112671. doi: 10.1016/j.injury.2025.112671. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Medial column disruption in proximal humeral fractures (PHFs) is associated with poor outcomes following reduction and internal fixation. Current assessments of unstable medial columns rely on qualitative descriptors such as disrupted hinges and insufficient osseous contact, often overlooking the quantification of bone defects. This study aims to quantitatively analyze bone defect characteristics in varus PHFs using advanced computer image processing techniques.

METHODS: A retrospective cohort study was conducted on 202 patients diagnosed with varus proximal humeral fractures who received treatment at two tertiary hospitals between January 2017 and December 2022. Three-dimensional (3D) fracture models were reconstructed using Mimics software based on preoperative computed tomography (CT) scans, followed by virtual reduction procedures performed in 3-matic software. Comprehensive demographic and morphological data were collected, including patient age, gender distribution, fracture classification, and quantitative parameters of bone defects the volume of bone defect (VBD), extent of bone defect area (EBDA), main defect region (MDR), and maximal defect height (MDH).

RESULTS: Quantile regression demonstrated that age exhibited strong positive associations with VBD across all quantiles (P < 0.001). EBDA and MDH showed consistently significant positive associations with VBD at every quantile level (all P < 0.001). For Sex, males showed no statistically significant differences compared to females (all P > 0.05). Among fracture classifications, 2-part fracture and 3-part fracture had comparable VBD values to 4-part fracture in most quantiles (all P > 0.05), except for 2-part fracture at Q90 (P = 0.017).

CONCLUSION: This study demonstrates that all varus PHFs with significant displacement are associated with bone defects. Age, EBDA, and MDH are positively correlated with VBD, highlighting the importance of considering these factors in surgical planning.

PMID:40795797 | DOI:10.1016/j.injury.2025.112671

Injury. 2025 Aug 5;56(10):112648. doi: 10.1016/j.injury.2025.112648. Online ahead of print.

ABSTRACT

INTRODUCTION: Fragility ankle and distal tibia fractures in the elderly population present a complex clinical situation, due to the poor bone quality, soft tissue condition and medical comorbidities in this age group. This study aims to assess the outcome of long hindfoot nail fixation using standard tibial nails in managing these injuries. This is the largest and possibly first study to date of this implant used in ankle trauma hindfoot fixation.

METHODS: This was a retrospective observational study across two level 1 major trauma centres in the United Kingdom, from January 2019 to December 2024. Patients included were above the age of 60 years, with acute ankle or distal tibia fractures and underwent long hindfoot nail fixation with standard tibial nails. Postoperative complications, early weightbearing and mortality rates were assessed.

RESULTS: A total of 36 patients were included, of which 44.4 % were malleolar fractures, 38.9 % distal tibia extra-articular fractures, and 16.7 % distal tibia intra-articular fractures. Half of the cases were open fractures. There were no cases of periprosthetic fracture, re-fracture, fixation or implant failure. There were six (16.7 %) postoperative complication cases, of which only one (2.8 %) was deemed a major complication; re-operation for removal of proximal locking bolt due to infection. 88.9 % were able to full weightbear within 30 days after surgery. The mortality rate was 8.3 % at 30 days and 16.7 % at 1 year.

CONCLUSION: The use of standard tibial nails, a universally available and feasible implant, for long hindfoot nail fixation in fragility ankle and distal tibia fractures is a safe and reliable treatment option, with a success rate of 97.2 % without major complications. They permit early weightbearing and provide a stable construct with reduced risk of periprosthetic fractures and fixation failure. The mortality rate was comparable to fragility hip fractures, highlighting the medical complexity of patients with these injuries.

PMID:40795796 | DOI:10.1016/j.injury.2025.112648

Injury. 2025 Aug 6;56(10):112670. doi: 10.1016/j.injury.2025.112670. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify risk factors and develop a scoring system based on static x-rays that can predict late displacement and deformity of non-operatively treated Young-Burgess lateral compression type 1 (LC1) pelvic ring injuries METHODS: A retrospective review of all non-operatively treated low-energy LC1 (AO/OTA 61-B2/B3) pelvic ring injuries in patients aged ≥50 associated with incomplete zone 1 sacral fractures and minimum three-month follow-up between January 2019 through January 2024 from two academic level 1 trauma centers. Exclusion criteria were non-acute presentations, nonunions, pathological fractures and non-ambulatory patients. Anterior-posterior, inlet and outlet radiographic imaging at initial, post-operative and final follow-up were assessed.The primary outcome measure was greater than 1 cm of pelvic ring displacement from initial to final radiographs showing fracture healing. Patient demographic and radiographic factors were described with univariate analyses. Statistically significant variables (P < 0.05) entered a multivariable logarithmic regression to develop a scoring system through stepwise elimination, which was assessed via receiver operator characteristic (ROC) curve analysis.

RESULTS: A total of 197 LC1 injuries in patients managed non-operatively (mean age 75.6 (50-103) years, n= 147 (74.6 %) female) were included for analyses. Variables correlated with pelvic deformity development on univariate analysis included, increasing age (p = 0.038), whether the anterior ring had initial displacement present (p < 0.001), bilateral anterior ring involvement (p = 0.027), unstable superior ramus fracture angle (p < 0.001), superior ramus comminution (p < 0.001), Nakatani zone 1 of ipsilateral fracture (p < 0.001), and Nakatani zone 1 of contralateral fracture (if bilateral) (p = 0.031). After multivariate analysis with stepwise elimination, only superior ramus fracture angle (oblique OR 4.88, 95 % CI 2.09-12.25; longitudinal OR 15.55, 95 % CI 4.81-56.42), anterior ring initial displacement present (OR 5.05, 95 % CI 1.93-14.29) and superior ramus comminution (OR 4.43 95 % CI 1.99-10.15) remained significant as variables correlating with the development of pelvic deformity (all p ≤ 0.001).

CONCLUSIONS: The statistically significant variables that correlated with late displacement and deformity of LC1 fracture patterns were superior ramus fracture angle, comminution, and initial anterior ring displacement. A combination of these factors increased the risk of displacement.

PMID:40795795 | DOI:10.1016/j.injury.2025.112670

Injury. 2025 Aug 7;56(10):112666. doi: 10.1016/j.injury.2025.112666. Online ahead of print.

ABSTRACT

BACKGROUND: Severe thoracic trauma is a leading contributor to mortality in critically injured patients, particularly when complicated by concomitant severe traumatic brain injury (TBI), which may independently impair neurological and respiratory function. Accurate assessment and timely intervention play a crucial role in these patients. However, risk factors for severe thoracic trauma remain unclear, and a prediction rule remains to be established. We developed and internally validated a nomogram that allows clinicians to quantify the risk of severe thoracic trauma.

METHODS: Clinical data from the MIMIC-IV database were retrospectively searched to identify a study cohort comprising patients with severe thoracic trauma. Using LASSO regression analysis, We screened out independent risk factors associated with 28-day mortality and incorporated them into nomogram model. The performance of each model was assessed by calculating receiver operating characteristic (ROC) curves, calibration plots and decision curve analysis (DCA).

RESULTS: The final analysis incorporated 2159 patients, with 192 deaths (8.9 %) occurring within 28-day of ICU admission. we constructed a nomogram that incorporates risk factors including heart rate (HR), traumatic brain injury (TBI), oxygen saturation (SpO2), systolic blood pressure (SBP), ventilation, and Sequential Organ Failure Assessment (SOFA) score on the first day of admission to ICU. The nomogram outperformed SOFA and Model 1 (risk factors including SBP, SpO2, TBI and ventilation) with an area under the receiver operating characteristic curve (ROC) of 0.854 (95 %CI 0.736-0.791, P < 0.001) in the training cohort and 0.859 (95 %CI 0.713-0.794, P < 0.001) in the validation cohort. The analysis of the calibration curve demonstrated that the nomogram exhibited a strong alignment with the observed 28-day mortality rates in severe thoracic trauma patients.

CONCLUSIONS: The study identified independent risk factors associated with the 28-day mortality risk and developed predictive nomogram models for ICU patients suffering from severe thoracic trauma. The nomogram shows promise in guiding strategies aimed at improving prognosis for patients with such injuries.

PMID:40789237 | DOI:10.1016/j.injury.2025.112666

Injury. 2025 Jul 15;56(10):112616. doi: 10.1016/j.injury.2025.112616. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic posttraumatic sequelae, such as chronic ankle joint infection with loss of the articular cartilage, significant ankle deformities with advanced osteoarthritis, or significant bone loss of the distal tibia or talus, cause chronic ankle pain and functional impairment. Arthrodesis is usually required to relieve pain and improve function. These disabling conditions cannot be treated with ordinary arthrodesis methods, particularly if they are associated with severe osteoporosis and/or poor soft-tissue coverage. The present study aimed to report the outcomes and complications of ankle arthrodesis with circular external fixators in patients with end-stage, posttraumatic ankle arthritis, infection, and/or bone loss.

METHODS: Patients treated with tibiotalar and tibiocalcaneal fusion for posttraumatic sequelae using the circular external fixator between January 2001 and January 2022 were retrospectively reviewed. The outcomes were evaluated using the Catagni tibiotarsal fusion score, and the complications were recorded.

RESULTS: The study included 81 consecutive patients; 58 were males, and 23 were females. The mean age of the patients was 41.52 years (range, 18-75). Successful arthrodesis was obtained in 73 patients (90.1 %). Twenty-four patients (29.6 %) developed complications. Most complications were minor except for unacceptable deformity in four patients, refracture of the arthrodesis site in one patient, and failure of arthrodesis in seven patients. At the final evaluation, the mean Catagni Score was 85.4 (range, 52-96). Fifty-eight patients achieved excellent results, 13 patients achieved good results, two patients achieved fair results, and eight patients achieved poor results. Higher Catagni scores were associated with patients without pre-operative infection, with union, without unplanned additional surgical procedures, without complications, and with better final results (all p < 0.001). In the multivariate regression analyses, we observed that the Catagni score tends to decrease as patient age increases (p = 0.010). Catagni scores of the anterior arthrodesis position were higher than the cases of the sinus tarsi position (p < 0.001).

CONCLUSION: Tibiotarsal arthrodesis with the circular external fixator can effectively treat complex ankle joint problems resulting from severe injuries. The Catagni score is a simple and reliable evaluation score after tibiotarsal arthrodesis surgeries.

PMID:40784318 | DOI:10.1016/j.injury.2025.112616

Injury. 2025 Jul 27:112631. doi: 10.1016/j.injury.2025.112631. Online ahead of print.

ABSTRACT

BACKGROUND: The reverse sural artery flap (RSAF) was reported to be a less technically demanding method for the coverage of defects in the distal lower leg, which can be elevated with short operative times. However, several studies pointed out the high frequency of partial necrosis in patients with comorbidities, which was primarily attributed to inadequate venous drainage. To overcome this challenge, we hypothesized that venous supercharging could effectively alleviate congestion of RSAF, potentially minimizing partial necrosis and related complications not only in healthy patients but also in comorbid patients.

METHODS: A single-center retrospective observational study was conducted. We reviewed patients with severe limb trauma who underwent RSAF for soft tissue defects on the distal lower legs, ankles, and feet from 2009 to 2022. All flaps were performed within 2 months of the injuries. Patients were divided into the Supercharge group and the Control group based on the presence of supercharge. The flap necrosis, major and minor complications, and nonunion were compared between the two groups. Additionally, these outcomes were also evaluated among high-risk patients with at least one comorbidity, including diabetes mellitus, peripheral arterial disease, venous insufficiency, advanced age over 50 years, or history of smoking.

RESULTS: A total of 30 patients including 16 males met the criteria, with 9 cases in the Supercharge group and 21 cases in the Control group. The Supercharge group decreased the frequencies of overall necrosis (11 % vs 71 %) as well as wound dehiscence (22 % vs 67 %). The Supercharge group also exhibited a relatively lower frequency of major complications (0 % vs 29 %) and minor complications (0 % vs 33 %) compared to the Control group. Among 21 high-risk patients with 7 supercharged cases and 14 control cases, supercharging decreased overall necrosis (14 % vs 71 %) and relatively suppressed major and minor complications (both of them: 0 % vs 36 %).

CONCLUSION: Venous supercharging of RSAF decreased the overall necrosis, potentially enhancing its clinical utility even in high-risk patients. Supercharged RSAF can be a valuable option as initial flap reconstruction for traumatic distal limb defects.

PMID:40783329 | DOI:10.1016/j.injury.2025.112631

Injury. 2025 Jul 27:112632. doi: 10.1016/j.injury.2025.112632. Online ahead of print.

NO ABSTRACT

PMID:40783328 | DOI:10.1016/j.injury.2025.112632

Injury. 2025 Aug 7:112651. doi: 10.1016/j.injury.2025.112651. Online ahead of print.

ABSTRACT

INTRODUCTION: The delivery of optimal trauma care requires an interdisciplinary team approach. However, the composition of these teams often varies across health services and systems. Moreover, different models of care exist which impact the way trauma teams operate, including consultative models and admitting models. This study aimed to explore contextual factors (e.g., barriers and facilitators) influencing trauma service model optimisation, propose strategies to address the factors, and understand implementation outcomes of the model.

METHODS: Staff and patients within a large public, major trauma referral centre with statewide outreach were interviewed, and data were analysed using a hybrid qualitative inductive and deductive design. The predominantly inductive approach used interpretive description methodology to produce a narrative and themes related to the interviews. The deductive approach used the Consolidated Framework for Implementation Research (CFIR 2.0) to understanding the influence of multi-level factors on implementation, and mapped data to five implementation outcomes. Finally, strategies addressing the factors were mapped to the nine domains of Expert Recommendations for Implementing Change (ERIC) to inform future research and service redesign.

RESULTS: Twelve staff and six patient interviews were conducted. 'Connecting with people' was a concept that underpinned all three themes of caring for the patient as a whole person; coming together to create a cohesive team identity; and securing a place in the bigger health system. The findings suggest that the Trauma Service improved continuity and enabled patient-centred care, but its perceived effectiveness was hindered by hospital attitudes, leadership changes, staff shortages, and dependence on key individuals. Participants highlighted acceptability and sustainability as key implementation outcomes, with patients viewing the Trauma Service positively while staff had mixed opinions. Fourteen implementation strategies were identified, including restructuring the Trauma Service for continuity of care, pre-planning with stakeholders, using cohorted trauma wards and advocating for funding to ensure sustainability.

CONCLUSIONS: The themes highlighted that optimal trauma care delivery is focussed on connecting with people; recognising and caring for the trauma patient as a whole person; and knowing individual and collective strengths. The findings may have implications for designing or redesigning similar trauma services in the future by ensuring external and internal risks to service provision are mitigated.

PMID:40783327 | DOI:10.1016/j.injury.2025.112651

Injury. 2025 Aug 7;56(10):112647. doi: 10.1016/j.injury.2025.112647. Online ahead of print.

ABSTRACT

BACKGROUND: Acute extensor tendon injuries of the hand, commonly managed by plastic surgeons, require timely repair to optimize outcomes. This study evaluates the functional results, complications, and patient-reported outcomes of acute extensor tendon repairs performed in an outpatient setting using the Wide Awake Local Anaesthetic No Tourniquet (WALANT) technique in Northern Ireland.

METHODS: A retrospective service evaluation analyzed 222 patients undergoing extensor tendon repair between 2018 and 2023. Inclusion criteria were adults (>18 years) with open injuries repaired via sutures. Exclusions included partial tears, fractures, and chronic injuries. Primary outcomes included Total Active Motion (TAM) and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores. Secondary outcomes were infection, rupture rates, and grip strength.

RESULTS: Mean age was 41 years, with 72.5 % males and 54.1 % non-dominant hand injuries. Mechanisms included lacerations (64 %), crush injuries (22 %), and avulsions (14 %). TAM was comparable across injury zones (Verdan classification), though distal zones (e.g., Zone 1) showed ∼30° lower TAM. PRWHE scores (mean: 8.2/50) indicated minimal pain/functional disability. Complications included two superficial infections (0.82 %) and one re-rupture (0.41 %). Grip strength matched normative values. Controlled Active Motion (CAM) rehabilitation yielded satisfactory outcomes, with proximal zones (Zones 7-8) associated with poorer PROMs.

CONCLUSION: Outpatient extensor tendon repair under WALANT is safe and effective, with low complication rates and favorable functional outcomes. Timely repair (<3 days), meticulous technique, and CAM rehabilitation contributed to success, supporting cost-effective management outside main operating theatres. Proximal injuries and rehabilitation protocols warrant further optimization. This study addresses a regional literature gap, advocating for prospective research to refine surgical and therapeutic strategies.

THERAPEUTIC LEVEL: IV.

PMID:40782631 | DOI:10.1016/j.injury.2025.112647

Injury. 2025 Jul 29;56(10):112634. doi: 10.1016/j.injury.2025.112634. Online ahead of print.

ABSTRACT

PURPOSE: Malrotation of the radius following a shaft fracture can lead to persistent pain, limited motion, and adjacent joint instability. This study aimed to evaluate radial torsion patterns by specific location.

METHODS: We included 50 patients with uninjured radii on computed tomography (CT). The torsion measuring zone (TMZ), defined along the longitudinal axis from just proximal to the watershed line to the distal end of the radial tuberosity, was divided into 3 mm intervals, generating cross-sectional images for torsion evaluation. Distal and proximal 30 mm segments were defined as distal end zone (DEZ) and proximal end zone (PEZ), respectively. The area with the largest 30 mm angular difference in distal half was designated the distal shaft torsion zone (DSTZ). The area between the proximal end of DSTZ and distal end of PEZ was the mid-shaft zone (MSZ). Angle change rate was evaluated in each zone, with the DSTZ compared to DEZ, MSZ, and PEZ.

RESULTS: The cohort included 27 men and 23 women, mean age of 54.8 ± 19.6 years. TMZ length was 160.5 ± 16.3 mm, with torsion angle of 49.8 ± 13.3° The angle change rate was 4.6 ± 1.9°/cm in the DEZ and 5.1 ± 3.3°/cm in the PEZ. The centre of the DSTZ was 4.8 ± 1.4 cm from distal end, with an angle change rate of 6.5 ± 1.8°/cm. The MSZ length was 6.7 ± 1.7 cm, with angle change rate of 0.3 ± 1.6°/cm. DSTZ showed significantly higher angle change rates compared to DEZ (P < 0.001) and MSZ (P < 0.001).

CONCLUSION: The DSTZ, located about 5 cm from the distal end, exhibited the most significant torsion, while the MSZ showed minimal torsion. Recognising these torsion patterns will guide proper plate positioning and prevent iatrogenic malrotation during plate osteosynthesis for radius shaft fracture.

PMID:40774028 | DOI:10.1016/j.injury.2025.112634

Injury. 2025 Jul 28;56(10):112624. doi: 10.1016/j.injury.2025.112624. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to utilize a large national database to evaluate short- and long-term outcomes of acute management of proximal humerus fractures (PHF) with reverse total shoulder arthroplasty (RSA) compared to open reduction internal fixation (ORIF).

METHODS: The TriNetX platform was utilized to perform a retrospective review of patients who sustained PHFs treated within three weeks of injury. Patients were identified using Current Procedural Terminology codes and the International Classification of Disease diagnosis codes. The cohorts were 1:1 propensity matched. Patients who received RSA were propensity matched to patients who underwent ORIF. Short-term and long-term outcomes were compared across the cohorts across various post operative periods. Kaplan Meier survival analysis was used to analyze implant survival rate and Cox hazard ratio was used to identify risk factors of re-operation.

RESULTS: Following propensity matching, each cohort included 2733 patients with an average age of 71±9.5. Patients treated with ORIF were more likely to have a re-operation or hospital admission than patients who underwent RSA at both 1 and 2 year follow up (5.5 % vs 2.1 %; p < 0.001; 6.9 % vs 2.6 %, p < 0.001 and 13.7 % vs 11.3 %, p = 0.01; 19.6 % vs 16.4 %, p = 0.003). At two year follow up, 173 patients treated with ORIF had a re-operation of which 60 (35 %) were converted to arthroplasty. On Kaplan Meier survival analysis for re-operation, both implants had satisfactory survival rates at both one and two year time point with survival rates over 90 %. However, there was a difference between survival rates at both one and two years between the ORIF and RSA groups (94 % vs 98 %, p < 0.0001; 91 % vs 97 %, p < 0.0001). For ORIF, patients with four part PHF and osteoporosis had a 39 % and 19 % increased risk of re-operation (p < 0.001; p = 0.03).

CONCLUSION: While both ORIF and RSA have been shown to be acceptable techniques for managing PHFs in the elderly, ORIF had a significantly higher re-operation and hospital readmission rate at mid- and long-term follow up. Additionally, a large portion of patients undergoing re-operation following ORIF were converted to shoulder arthroplasty although acute RSA has superior outcomes compared to delayed RSA. Therefore, for operative elderly candidates we advocate for the use of RSA in three- and four-part PHFs.

PMID:40763431 | DOI:10.1016/j.injury.2025.112624