Injury. 2025 Nov;56 Suppl 1:112604. doi: 10.1016/j.injury.2025.112604.

ABSTRACT

INTRODUCTION: In South Africa, the prevalence of violent crime, especially involving firearms, poses a significant public health challenge, particularly when it affects children. Previous studies showed a decrease in paediatric civilian gunshot injuries following the introduction of the 2004 Firearms Control Act This study aims to describe the epidemiology, injury patterns, management, and outcomes of paediatric gunshot wounds (GSWs) at a tertiary paediatric referral centre in Cape Town over 10 years (2011-2020).

METHODS: A retrospective cross-sectional analysis was performed on children aged 0-12 years presenting to the Red Cross War Memorial Children's Hospital (RXH) in Cape Town with gunshot injuries from 1 January 2011 to 31 December 2020. The data were drawn from the ChildSafe database and hospital. Detailed demographic, clinical, management, and outcome data were extracted from hospital records and ancillary databases. Descriptive statistics, linear regression, and Chi-square tests were used for analysis.

RESULTS: A total of 236 paediatric firearm injury cases were identified, representing 0.3 % of all trauma cases during the study period. The annual incidence of GSWs increased significantly (+2.69 cases/year, p < 0.01). Crossfire accounted for 56.4 % of injuries, with a significant upward trend over the decade (p = 0.04). Most injuries occurred in males (56.8 %) and children aged 5-9 years (44 %). Extremity injuries were most common (50.3 %), but head and chest injuries were significantly associated with ICU admission (p < 0.001), mortality (p < 0.001), and resultant morbidity (p < 0.01). Eleven deaths were recorded (4.7 %), predominantly from isolated head injuries. Surgery was performed in 114 cases during first admission; 35 patients experienced complications, and 29 sustained resultant long-term morbidities including paralysis, traumatic brain injury sequelae, and vision loss. Crossfire was significantly associated with increased weekend incidence (p < 0.001) but paradoxically associated with lower mortality (p < 0.01).

CONCLUSION: Paediatric firearm injuries in Cape Town have increased over the past decade, with crossfire in gang-affected communities being a contributing factor. Despite legislative controls, these injuries remain a growing public health crisis with high rates of complications, disability, and mortality-particularly in cases involving the head and chest. A multi-sectoral approach encompassing violence prevention, community intervention, trauma care optimization, and improved surveillance is recommended.

PMID:41173553 | DOI:10.1016/j.injury.2025.112604

Injury. 2025 Nov;56 Suppl 1:112534. doi: 10.1016/j.injury.2025.112534.

ABSTRACT

After years of preparatory work, the implementation of bone-anchored prosthesis (BAP) for individuals with lower limb amputation started in 2009 in The Netherlands. Since then, several developments took place in indications, surgical techniques, implants, rehabilitation programs, and aftercare. In this article, we describe our journey and the lessons learned with BAP in the last 16 years. Although numerous positive developments have taken place, there remains both room and necessity for further improvement.

PMID:41173552 | DOI:10.1016/j.injury.2025.112534

Injury. 2025 Nov;56 Suppl 1:112535. doi: 10.1016/j.injury.2025.112535.

ABSTRACT

The management of complex limb injuries has evolved from a survival-focused approach to one emphasizing functional preservation, patient autonomy and reintegration. Historically, high amputation rates were due to limited vascular repair techniques and prolonged ischemia, particularly during World War II. Pioneering vascular interventions during the Korean and Vietnam Wars, coupled with advances in evacuation and early stabilization, significantly improved limb salvage outcomes. The advent of microsurgery and the orthoplastic approach further revolutionized treatment, facilitating early soft tissue coverage and biologically robust reconstructions. Despite these advancements, modern conflicts - especially those involving improvised explosive devices - present challenges of scale, resource constraints and delayed evacuations, necessitating flexible, phase-based care strategies. Contemporary decision-making increasingly involves patient-centered shared consent processes and must balance surgical feasibility with psychosocial and rehabilitative factors. Studies such as METALS and LEAP highlight that elective amputation may yield comparable, if not superior, outcomes in some cases, especially when supported by advanced prosthetic technologies. This review advocates for a strategic orthoplastic framework where early biological reconstruction, rather than anatomical perfection, guides decision-making. Rehabilitation is reframed as a parallel and integral process rather than a post-surgical adjunct, beginning from the acute phase and continuing iteratively throughout recovery. Utilizing ICF-based tools and patient-reported outcome measures allows individualized goal-setting and dynamic evaluation. Moreover, holistic rehabilitation - especially in military settings - demands interdisciplinary collaboration, early planning, and recognition of personal and environmental factors. Rehabilitation-specific counselling is crucial for both upper and lower extremity injuries, particularly given the psychological, functional, and social consequences of amputation or salvage. Ultimately, successful outcomes hinge not solely on surgical excellence but on the integration of rehabilitation planning, shared decision-making, and patient empowerment throughout the continuum of care.

PMID:41173551 | DOI:10.1016/j.injury.2025.112535

Injury. 2025 Nov;56 Suppl 1:112533. doi: 10.1016/j.injury.2025.112533.

ABSTRACT

INTRODUCTION: The incidence of civilian gunshot injuries is on the rise worldwide. Unfortunately, there is a lack of high-level evidence guiding management. The treatment of orthopaedic injuries from gunshots is complex and requires consideration of multiple aspects, including energy transfer to the tissue, severity of the wound, possible contamination, presence of fractures and associated injuries. Our study aimed to describe the variations in the treatment of GSW fractures across orthopaedic units across South Africa, a country with a high burden of GSW injuries.

METHODS: The gunshot-related injuries in trauma (GRIT) study was a snapshot study by a multicentre research network in South Africa. During the study period, a survey was distributed to the participating units. The aim was to determine variations in practice in certain key aspects of the management of GSW fractures across South Africa.

RESULTS: Twenty-three units representing all nine provinces in South Africa responded to the survey. All responding units managed gunshot injuries. The results showed great variation in the management in the bullet tract. While all units administered prophylactic antibiotics, there was no consensus on the duration. In a simulated case of a lower limb long bone fracture caused by a low-velocity gunshot, most units (n-18) indicated that they would manage the fracture with an intramedullary nail.

CONCLUSION: In South Africa, a country with a high burden of GSW injuries, there is substantial variability in the management of GSW fractures, especially of the long bones of the lower limb. Across participating units, there were variations in the treatment of the GSW tract, duration of prophylactic antibiotics and choice of fixation.

PMID:41173550 | DOI:10.1016/j.injury.2025.112533

Injury. 2025 Oct 24;56(12):112839. doi: 10.1016/j.injury.2025.112839. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior pelvic ring injuries frequently involve obturator ring disruption. With advancements in surgical techniques and rising patient expectations, there is growing interest in repairing these injuries within anterior pelvic ring treatment strategies. While current approaches (e.g., transabdominal, ilioinguinal) are used, they present limitations. This study describes a Modified Lateral-Perineal Approach (MLPA) for treating obturator ring fractures.

METHODS: We retrospectively reviewed 22 pelvic fracture patients with obturator ring injuries that had been treated via the MLPA. All patients underwent open reduction and internal fixation (ORIF) between June 2019-June 2024. According to the Tile classification, there were 16 type B fractures and 6 case of type C fractures. All patients had a reduction and fixation to the fracture of the superior pubic ramus and inferior ramus of pubis-ischium ramus. Incision length, operative time, blood loss, time to sitting/weight-bearing, union time, adductor strength (MRC 0-5), satisfaction and complications were recorded. The quality of fracture reduction was evaluated according to Matta radiographic criteria. The pelvic function was evaluated according to Majeed Pelvic Score at the last follow-up.

RESULTS: Twenty-two patients (10 male, 12 female; mean age 49.7 ± 13.7 years) were included. Mean follow-up was 15 ± 3 months. Mean surgical parameters: incision length 8.5 ± 1.1 cm, operative time 106.4 ± 23.4 min, blood loss 89.1 ± 41.2 mL. All achieved "excellent" Matta scores. Functional recovery: sitting at 6.6 ± 3.4 days, partial weight-bearing at 15.7 ± 7.2 days, full weight-bearing at 8.9 ± 2.5 weeks. Radiographic union occurred at 9.5 ± 2.4 months. One-year Majeed score averaged 88.5 ± 4.5. Adductor strength was MRC grade IV in 3 patients and V in 19. All patients expressed satisfaction. There were no complications of nonunion, internal fixation failure, vascular injury, nerve palsy, or hernia. All of the patients were esthetically satisfied with the scar.

CONCLUSION: The MLPA provides a safe and effective simultaneous exposure of the obturator ring's key structures: the superior pubic ramus, inferior ramus of pubis-ischium ramus. The advantage of this approache to repair the obturator ring include safety, simplicity, early weight-bearing, aesthetics, and satisfactory clinical efficacy with a low incidence of complications.

PMID:41172618 | DOI:10.1016/j.injury.2025.112839

Injury. 2025 Oct 17:112816. doi: 10.1016/j.injury.2025.112816. Online ahead of print.

ABSTRACT

BACKGROUND: Blunt splenic trauma in children is increasingly managed non-operatively (NOM), given the spleen's critical role in immune function and the high success rate of NOM. While the immunodeficiency following splenectomy is well-established, the long-term immune outcomes after NOM for high-grade splenic injuries remain underexplored in pediatric patients.

METHODS: A matched-pair case-control study was conducted, including children under 18 treated with NOM for AAST grade III-V blunt splenic injuries between 2013 and 2023, and age-, sex-, and year-matched controls with acute appendicitis. Data on demographics, medical history, infection-related outcomes, and healthcare utilization were collected from medical records, national health databases, and caregiver questionnaires.

RESULTS: Sixty children with high-grade splenic injuries were matched with 60 controls. Over a mean follow-up of 5.4 years, infection rates, including pneumonia and otitis media, were comparable between groups. No cases of overwhelming post-splenectomy sepsis or positive blood cultures were reported. Antibiotic use was similar (31% in the NOM group vs. 24% in controls, p=0.52).

CONCLUSIONS: Non-operative management of high-grade blunt splenic injuries in children is associated with infection rates comparable to healthy controls, suggesting that splenic immune function may not be significantly compromised. These findings suggest there is no need for vaccination and prophylactic antibiotic treatment in this population. Further research incorporating laboratory assessments is warranted to validate and refine long-term management strategies.

PMID:41162235 | DOI:10.1016/j.injury.2025.112816

Injury. 2025 Oct 20;56(12):112837. doi: 10.1016/j.injury.2025.112837. Online ahead of print.

ABSTRACT

AIM: The presence of bacteria in bones may lead to osteolysis, potentially compromising fracture healing. While radiographic assessment is essential for identifying osteolysis, the relationship between causative pathogens and visible radiolucency in fracture-related infections (FRI) remains poorly understood. This study aimed to evaluate the association between causative organisms, host factors, and radiographic osteolysis in unhealed FRIs.

METHODS: This retrospective study included 79 patients with unhealed FRIs, with available microbiological data and serial radiographs from the time of initial fracture fixation to index surgery for infection. Osteolysis was scored using a modified Mirel's-based severity scale, classifying cortical, medullary, and combined bone loss relative to adjacent normal bone. Pathogens were categorized as: (1) Gram-negative bacteria (GN), (2) Staphylococcus aureus, (3) other Gram-positive bacteria (GP), (4) polymicrobial (PM) (Gram-positive and Gram-negative bacteria), and (5) culture negative (CN).

RESULTS: Patients had a median of two radiographs (IQR 1.5-4) over a median of 81 days (IQR 28-216), after fracture fixation. Host factors were not associated with osteolysis severity. The 79 cases were distributed as: 17 GN, 19 S. aureus, 17 GP, 17 CN, and 9 PM infections. All pathogens induced degrees of osteolysis but the progression of bone loss over time was different between groups. Gram-negative infections showed the fastest and most aggressive bone loss, with a 4.3-fold increase in osteolysis severity compared to CN cases (p = 0.001). S. aureus and polymicrobial infections showed 1.8- and 2.9-fold increases, respectively.

CONCLUSION: Gram-negative pathogens pose significant clinical challenges and there is an urgent need to broaden the focus on GN infections in FRIs. This study provides new clinical insights into the role of pathogen-specific osteolytic patterns in FRIs. Gram-negative bacteria exhibit the most rapid and destructive bone loss, emphasizing the need for early recognition and timely intervention. Radiographic osteolysis appearing early should raise suspicion for GN infections. These findings also highlight the need for basic science models to expand beyond S. aureus and better address the underexplored osteolytic potential of GN organisms.

PMID:41151183 | DOI:10.1016/j.injury.2025.112837

Injury. 2025 Oct 19;56(12):112838. doi: 10.1016/j.injury.2025.112838. Online ahead of print.

ABSTRACT

PURPOSE: To assess whether weight-bearing impaction of the femoral head may be a valid predictor of joint failure in patients with geriatric acetabular fractures treated with open reduction and internal fixation (ORIF).

METHODS: We retrospectively analyzed data from consecutive elderly patients (including 60 men and 52 women) with acetabular fractures treated with ORIF between January 2015 and January 2022 at the largest orthopedic hospital in western China. The patients had an average age of 69.9 years. Preoperative and postoperative computed tomography scans were evaluated for the presence of medial displacement of the femoral head and femoral head impaction. Impaction of the femoral head was identified on coronal-plane CT images and then classified based on its anatomic characteristics as large, medium, or small. To determine whether total hip arthroplasty (THA) was eventually required over a 24-month follow-up period, binary logistic regression analyses were performed to assess whether impaction of the femoral head was an independent predictor of joint failure in patients with geriatric acetabular fractures treated by ORIF.

RESULTS: Impaction of the femoral head was found in 33.9 % (38 out of 112) of all geriatric acetabular fractures. Preoperative and postoperative radiological data, along with the characteristics of acetabular fractures, were compared between patients with impaction (group 1) and those without (group 2). There were no significant inter-group differences in the quality of reduction, acetabular dome impaction, and acetabular fracture type (P > 0.05). Medialization displacement of the femoral head was more frequent in group 1, being present in 76.3 % of weight-bearing impactions (29/38) compared with 23.7 % of those without medialization (9/38). This difference between the two groups was statistically significant. Large or medium impaction was present in 50.0 % (19 out of 38) of the patients with impaction and 84.2 % (16 out of 19) of the patients with joint failure, while small impaction was present in 50.0 % (19 out of 38) of the patients with impaction and 21.1 % (4 out of 19) of the patients with joint failure. Logistic regression analysis revealed that femoral head impaction was significantly and independently associated with a higher risk for joint failure (odds ratio 24.77, P < 0.001).

CONCLUSIONS: Femoral head impaction frequently occurs in geriatric acetabular fractures, and is a valid predictor of joint failure in patients with geriatric acetabular fractures treated with ORIF. The preferred treatment option for such patients is acute THA, especially if impaction is large or medium.

PMID:41151182 | DOI:10.1016/j.injury.2025.112838

Injury. 2025 Oct 19;56(12):112842. doi: 10.1016/j.injury.2025.112842. Online ahead of print.

ABSTRACT

BACKGROUND: Posterior pelvic ring restoration and stabilization are widely recognized as the primary goal in managing pelvic ring injuries. However, anterior pelvic ring (APR) stabilization is also essential in certain cases. Traditional methods, including open plating or intramedullary screw fixation alone, may be insufficient for addressing several challenging situations. The intramedullary screw and plate combination (SPC) technique for APR stabilization offers a feasible solution for these complex cases while achieving favorable clinical outcomes. Therefore, the present study aimed to introduce the SPC technique for APR stabilization and evaluate its clinical and radiological outcomes.

METHODS: This retrospective study analyzed the data of patients who underwent APR stabilization with the SPC technique at two urban university hospitals. The indications for the SPC technique included straddle fractures involving Nakatani zone III, symphysis pubis diastasis with ramus fractures, segmental ramus fractures, and cases requiring construct length augmentation. The radiologic and functional outcomes, including bone union, pelvic displacement index (PDI), symphysis pubis width (SPW), Matta and Tornetta grading, and Majeed scores, were assessed.

RESULTS: Altogether, 17 patients were included in the present study. Bone union was achieved in 94.12 % of the patients, with a mean union time of 3.88 ± 1.34 months. The PDI significantly improved from 1.10 ± 0.08 preoperatively to 1.05 ± 0.07 postoperatively (p = 0.015) and remained stable at the last follow-up. SPW showed a significant reduction postoperatively (p = 0.041) and remained stable at the last follow-up. According to the Matta and Tornetta grading system, 82.35 % of the patients demonstrated good or excellent outcomes, and the mean Majeed score was 93.19 ± 8.91. No implant-related complication was observed.

CONCLUSION: The SPC technique is a feasible and effective approach for stabilizing challenging APR injuries, offering favorable clinical and radiologic outcomes while minimizing the risks associated with traditional plating.

PMID:41151181 | DOI:10.1016/j.injury.2025.112842

Injury. 2025 Oct 15:112821. doi: 10.1016/j.injury.2025.112821. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to assess the impact of the on-scene time interval on survival in traumatic out-of-hospital cardiac arrest (TOHCA) patients and to determine the threshold for the optimal on-scene time interval.

METHODS: We analyzed TOHCA patients aged >15 years in South Korea from January 2019 to December 2021. The on-scene time interval was defined as the duration spent at the scene, from emergency medical service (EMS) arrival at the scene to departure for the hospital. The primary outcome was survival to discharge. Mixed-effects logistic regression analysis was performed to assess the impact of the on-scene time interval on the outcome, adjusting for demographic variables and Utstein factors. We also performed a restricted cubic spline analysis to determine the optimal on-scene time interval associated with survival to discharge.

RESULTS: A total of 6106 TOHCA cases were included, with a survival to discharge rate of 3.7 %. Each 1 min increase in the on-scene time interval was associated with a 2 % decrease in the odds of survival to discharge (adjusted odds ratio [aOR]: 0.98, 95 % confidence interval [CI]: 0.96-0.99). The restricted cubic spline analysis showed a decrease in the odds of survival to discharge after 10 min of on-scene time interval. Additionally, TOHCA patients with on-scene time ≥20 min had a 51 % lower probability of survival to discharge compared to those with <10 min (aOR: 0.49, 95 % CI: 0.27-0.89).

CONCLUSION: A prolonged on-scene time interval has a negative impact on survival to discharge in TOHCA patients. Specifically, the probability of survival to discharge declined after 10 min on scene and was substantially lower when the interval exceeds 20 min.

PMID:41145320 | DOI:10.1016/j.injury.2025.112821

Injury. 2025 Oct 15;56(12):112810. doi: 10.1016/j.injury.2025.112810. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to retrospectively evaluate musculoskeletal injuries, clinical follow-ups and treatments of trauma patients admitted to our hospital after the 2023 Lattakia earthquakes and to analyze pelvic ring and acetabulum injuries.

PATIENTS AND METHODS: A total of 468 patients were admitted to our hospital. Of them, 235 who did not meet the inclusion criteria were excluded and a total of 233 trauma patients (113 males, 120 females; mean age: 32.2 ± 20.3 years; range, 6 to 94 years) affected by the earthquake were recruited. Age, sex, presence of orthopedic consultation, diagnosis of open/closed fracture, diagnosis of dislocation, presence of soft tissue injury, additional systemic injuries, neurovascular examination status, presence of compartment syndrome, conservative/surgical interventions.

RESULTS: The mean age of the patients was 32.2 ± 20.3 years. 120 were female, and 113 were male. In 13 patients, musculoskeletal injuries with additional system injuries were observed and evaluated as multiple injuries. In 15 patients, fractures were observed in more than one region and were evaluated as multi-trauma. 53 % had soft tissue injuries, 33.4 % had closed fractures, 6.4 % had other system injuries, 3.8 % had crush injuries, 2.1 % had nerve injuries, 0.8 % had compartment syndrome, 2.5 % had vascular injury, 2.1 % had dislocation, and 5.5 % had an open fracture.

CONCLUSIONS: The most common injuries due to high-energy trauma are isolated soft tissue injuries and fractures. The definition of the demographic characteristics and clinical outcomes of earthquake patients is critical to the development of preparedness, response, and recovery policies for future disasters.

PMID:41145024 | DOI:10.1016/j.injury.2025.112810

Injury. 2025 Oct 15;56(12):112813. doi: 10.1016/j.injury.2025.112813. Online ahead of print.

ABSTRACT

OBJECTIVE: Autograft application is the gold standard in the treatment of peripheral nerve damage, but alternative graft materials are needed. This study examines the effects of bacterial cellulose (BC) graft and vascular endothelial growth factor (VEGF) impregnated in bacterial cellulose graft on peripheral nerve repair.

METHODS: Bacterial cellulose derived from Gluconacetobacter xylinus cell culture was impregnated with 0.2 µm/ml VEGF and formed into conduits. Unilateral 8 mm sciatic nerve defect was created in Wistar rats (n = 18). Rats were divided into three groups as autograft (n = 6), BC/Cs (n = 6) and VEGF-BC/Cs (n = 6). Gait analysis and electromyography (EMG) measurements were performed at the end of the 8th week. Sciatic nerve tissues were taken for histological analysis. Myelinated axon numbers and vascular structures were examined in sections stained with toluidine blue under a light microscope.

RESULTS: According to the sciatic function index obtained from gait analysis and the EMG measurements, at the end of the 8th week, both graft groups obtained similar results to the autograft group. Analyses of myelinated axon counts, axon diameters, and myelin sheath thickness revealed similar results between the autograft and VEGF-BC/Cs groups. Examining the quantity of vessels and their diameters, the VEGF-BC/Cs group showed a significantly higher number of vessels than the other groups (p < 0.0001).

CONCLUSION: In the treatment of peripheral nerve injury, the application of VEGF-BC/Cs gave functional and histologically similar healing results to autograft. The positive effect of VEGF application on nerve regeneration was also observed by increasing the formation of new vessels.

PMID:41138332 | DOI:10.1016/j.injury.2025.112813

Injury. 2025 Oct 20:112840. doi: 10.1016/j.injury.2025.112840. Online ahead of print.

ABSTRACT

BACKGROUND: Physiotherapists have a vital role in the assessment and management of patients with blunt mechanism chest wall injuries (CWI). Physiotherapy interventions focus on the prevention of both early and late complications and the promotion of functional rehabilitation. The aim of this study was to examine the experiences of physiotherapists, healthcare professional (HCP) stakeholders and patients/carers to develop deeper understanding of the role and capabilities required by physiotherapists when caring for patients with blunt mechanism CWI.

METHOD: Qualitative focus groups were run with physiotherapy, HCP stakeholders and patients/carers following a pre-designed topic guide. Focus groups explored participants' experience of physiotherapy care in relation to blunt mechanism chest wall injuries. Data analysis followed Braun and Clarke's Reflexive Thematic Analysis process, and the Dreyfus model of adult skill acquisition was applied as a theoretical model to support the analysis process.

RESULTS: Seven focus groups were run with 41 participants (26 physiotherapist participants, 8 HCP stakeholder participants, and 7 patient/carer participants), between November 2024 and January 2025. Four main themes were identified from the data, including (i) Recognising clinical patterns and complexity, (ii) Applying clinical decision making to patient care, (iii) The role of experiential learning in shaping expertise, and (iv) Modelling effective interprofessional working strategies. Using these data, a framework of practice domains was formed. The results of this study will form the foundation of a new competency assessment tool that can be used by physiotherapists caring for patients with blunt mechanism chest wall injuries.

CONCLUSIONS: These findings have provided deeper insights into the role of the physiotherapist in the management of patients with blunt mechanism chest wall injuries. The study also demonstrates the importance of clinical experience in safe clinical decision making, and the need for capabilities that are relevant for both novice and expert physiotherapy practice.

PMID:41136264 | DOI:10.1016/j.injury.2025.112840

Injury. 2025 Oct 20;56(12):112836. doi: 10.1016/j.injury.2025.112836. Online ahead of print.

ABSTRACT

BACKGROUND & OBJECTIVES: Personal values have undergone rapid transformations, resulting in a generational clash between traditionalist values and contemporary values. We hypothesized that understanding the personal values of younger physicians will help reduce conflicts and define new medical education strategies focused on their interests and lifestyle. The primary aim of this study was to examine the associations among those in training and junior orthopaedic surgeons' self-reported values using the Rokeach Value Survey. As a secondary aim, we sought to compare these findings with those of a cohort of orthopaedic surgeons from four generations.

METHODS: A cross-sectional survey study using the Rokeach Values Survey (RVS) was performed. The RVS was distributed electronically via email and through the social network Instagram to 270 orthopaedic surgeons and orthopaedic residents and fellows from Baby Boomers, Generation X, Generation Y, and Generation Z. The distribution was based on the number of previously identified members of each generation from the orthopaedic departments of five institutions taking part in this study. The exclusion criteria were no response from both value sets, no response from either value set, or graduate medical students. Descriptive analysis and multiple comparison tests were used to analyze the order of importance for the values between the generations.

RESULTS: Of the 270 potential participants invited, 236 (87.4 %) respondents, 207 (87.7 %) men and 29 (12.3 %) women, were included. There were 52 (22 %) generation Z respondents (response rate, 65 %), 74 (31.4 %) generation Y respondents (response rate, 92.5 %), 60 (25.4 %) generation X respondents (response rate, 100 %), and 50 (21.2 %) Baby Boomers respondents (response rate, 100 %). The mean age of Generation Z participants was 24.9 years, ranging from 23.2 to 26.0 years, the mean age of Generation Y participants was 36.6 years, ranging from 27.2 to 43.6 years, the mean age of Generation X participants was 50.8 years, ranging from 44.6 to 58.2 years, and the mean age of Baby Boomer participants was 65.5 years, ranging from 59.9 to 72.9 years. Overall, younger generations (Y and Z) presented significant differences in self-reported values compared with Baby Boomers and Generation X.

CONCLUSIONS: In our study, we found that the younger generations presented greater ambition, cheerfulness, courage, independence, and desire for a comfortable and exciting life; and lower imagination, politeness, honesty, forgiveness, and interest in wisdom and true friendship. Our findings may provide more insight for managing age-related conflicts, encouraging balance and respect, and developing skills and strategies to promote effective learning and teaching.

PMID:41135431 | DOI:10.1016/j.injury.2025.112836

Injury. 2025 Oct 15;56(12):112819. doi: 10.1016/j.injury.2025.112819. Online ahead of print.

ABSTRACT

Fertility preservation in males with spinal cord injuries (SCI), pelvic trauma, traumatic brain injury (TBI), and other trauma-related conditions that impact male fertility and sexual function represents a crucial yet underexplored aspect of trauma medicine. These injuries can severely impair sperm quality, hormonal balance, and reproductive potential due to direct physiological damage and secondary effects, such as erectile and ejaculatory dysfunction. This review outlines the mechanisms by which these injuries impact fertility, examines the timeline of potential sperm quality deterioration, and evaluates both acute and chronic management strategies, including sperm retrieval techniques. In this context, the importance of early fertility counseling and timely cryopreservation is emphasized as a means to mitigate long-term impacts on quality of life, while a multidisciplinary approach-encompassing surgical, hormonal, and psychological interventions-is essential to optimize reproductive outcome. We highlight two key opportunities for intervention that trauma teams should consider: an early-stage andrologist consultation to assess fertility preservation options, and a later-stage consultation to address the frequent risk of sexual dysfunction. These simple steps-early sperm cryopreservation and follow-up for erectile and ejaculatory function-can meaningfully improve reproductive and psychosocial outcomes. By synthesizing current evidence, this article underscores the need for targeted research and standardized protocols to support fertility preservation in male trauma patients-an aspect of care that deserves greater attention given the potential of simple, timely actions to improve quality of life.

PMID:41135430 | DOI:10.1016/j.injury.2025.112819

Injury. 2025 Oct 13;56(12):112801. doi: 10.1016/j.injury.2025.112801. Online ahead of print.

ABSTRACT

AIM: Comminuted radial head fractures pose technical challenges regarding visualisation and access for anatomical reduction and fixation. The traditional lateral 'window' approaches (Kocher, Kaplan and EDC split) can, at times, offer limited views and a more extensive exposure can be beneficial in comminuted patterns (Mason II/III). We present a lateral epicondyle osteotomy as an alternative for unobstructed views of the radial head to utilise for open reduction and internal fixation (ORIF).

METHODS: The patient is positioned supine with the operative arm on an arm board. A standard lateral skin incision centred over the radial head and lateral epicondyle is utilised. Both the Kaplan and Kochers interval are opened through deep dissection and the annular ligament is released. The lateral epicondyle is exposed using sharp dissection and a drill hole is made (for subsequent lag screw) either angled anteriorly to the coronoid fossa or posteriorly to the olecranon fossa. A chevron osteotomy is completed around the drill hole and the bone block along with attached common extensor origin and LUCL reflected distally to expose the radial head. The fracture stabilisation can then be performed and the osteotomy reduced and compressed through the pre drilled orientation. 2 cases are used to describe the use of a lateral epicondyle osteotomy for varied fracture patterns.

RESULTS AND CONCLUSIONS: In our experience the radial head is exposed with an unobscured exposure. All performed osteotomies have healed with good post operative DASH scores (average 31.65). No removal of metalwork has been required and patient satisfaction has been rated as high. Previously no literature has described the lateral epicondyle osteotomy in detail for accessing the radial head. Using our experience, through a lateral epicondyle osteotomy one can achieve a clear visualisation of the radial head and its articular surface without the need to strip fragments of its periosteum and blood supply, avoiding the need for removal and 'back table' reconstruction. It also prevents the need to detatch the LUCL complex and offers a more robust reconstruction with a reliable healing potential through an osteotomy.

PMID:41135429 | DOI:10.1016/j.injury.2025.112801

Injury. 2025 Oct 20:112835. doi: 10.1016/j.injury.2025.112835. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic brachial plexus injuries (TBPIs) are severe, life-altering injuries associated with significant functional impairment. While previous studies have highlighted mechanisms of injury, there is limited research on the geographical and socioeconomic factors influencing TBPI incidence. This study examines TBPI patterns across England and Wales, identifying demographic risk factors and geographic "hotspots".

METHODS: A retrospective cohort study was conducted using data from the Trauma Audit and Research Network (TARN) and the STATS-19 road traffic accident database from January 2010 to March 2022. Patients with confirmed TBPIs meeting TARN inclusion criteria were analysed. Cases were categorised into vehicular collisions (VCs) and non-vehicular injuries (NVIs). Key variables included age, sex, injury mechanism, Index of Multiple Deprivation (IMD) scores, and urban-rural classification. Geographic distribution was assessed to identify high-incidence regions.

RESULTS: A total of 1003 TBPI cases were identified: 601 (60 %) vehicular and 402 (40 %) non-vehicular related injuries. VC TBPIs were more frequent in young males (median age: 35 years), whereas NVIs occurred more in older females (median age: 63 years), mainly due to falls <2 m. Higher IMD scores were associated with penetrating injuries. Urban "hotspots" for penetrating injuries included cities in Greater London, Greater Manchester, and West Yorkshire.

DISCUSSION: This study describes geographic and socioeconomic patterns of TBPIs across England and Wales. Although less frequent than other trauma entities, TBPIs carry a high per-patient burden due to upper-limb paralysis and neuropathic pain, with substantial indirect costs. The identification of demographic profiles and regional clustering provides an epidemiological baseline to inform clinicians and major trauma services.

PMID:41130884 | DOI:10.1016/j.injury.2025.112835

Injury. 2025 Oct 11;56(12):112806. doi: 10.1016/j.injury.2025.112806. Online ahead of print.

ABSTRACT

INTRODUCTION: The mortality rate for tibial shaft fractures in the elderly is comparable to that of hip fractures, yet there is considerable variation in their management. Operative treatment allows for earlier weight-bearing and reduces potential complications of prolonged immobilization; however, it carries risks for this comorbid cohort. The main objective of this study was to assess the difference in 1-year mortality between operative and non-operative management.

METHODS: A multicentre study was conducted across six trusts in England, including eight acute hospitals: three major trauma centres and five district general hospitals (DGHs). Data were collected retrospectively, covering a 5-year period from January 2017 to December 2021. The study included all patients aged 65 and over with diaphyseal tibial fractures (AO42). Patients with non-acute (>3 weeks), periprosthetic, pathological, or multiple lower limb fractures were excluded.

RESULTS: A total of 171 patients were identified, comprising 38 % males and 62 % females. Of these, 59.6 % were managed operatively, while 40.4 % were managed non-operatively. The median length of stay was similar between groups (8 days non-operative vs. 8.5 days operative, p = 0.87). Non-union (21.7 % vs. 6.3 %, p < 0.001) and malunion rates (27.7 % vs. 4.6 %, p = 0.001) were significantly higher in the non-operative group. One-year mortality was also higher in the non-operative group (38.3 % vs. 12.1 %, p < 0.001). Univariate and multivariate analyses showed an odds ratio of 4.5 and 4.7 for one-year mortality with non-operative treatment, with p-values of <0.001 and 0.005, respectively.

CONCLUSION: This study demonstrated that non-operatively treated tibial shaft fractures in the elderly are associated with significantly higher rates of non-union, malunion, and 1-year mortality. Therefore, we recommend an expedited multi-disciplinary approach to managing these patients, including surgical treatment and unrestricted weight bearing where possible, to optimize outcomes.

LEVEL OF EVIDENCE: Level III.

PMID:41130139 | DOI:10.1016/j.injury.2025.112806

Injury. 2025 Oct 22;56(12):112804. doi: 10.1016/j.injury.2025.112804. Online ahead of print.

NO ABSTRACT

PMID:41130138 | DOI:10.1016/j.injury.2025.112804

Injury. 2025 Oct 17;56(12):112834. doi: 10.1016/j.injury.2025.112834. Online ahead of print.

ABSTRACT

BACKGROUND: Femoral neck fractures are significant injuries, often seen in the elderly and less commonly in patients younger than 65 years old. If internal fixation is preferable and feasible, many options for cannulated screw orientation exist. One of the standard approaches remains three screws in a parallel trajectory and inverted triangle formation. It is hypothesized that the diverging constructs are non-superior biomechanically to the parallel configuration when treating moderate Pauwels angle, transcervical femoral neck fractures.

METHODS: This study used 32 identical femur models (16 parallel trajectory, 16 diverging) representing healthy bone. A fracture with Pauwel's angle of 40 degrees was created for all femurs, and a 3D printed guide was utilized for screw placement for both parallel and divergent screw trajectories. Torsional stiffness, axial stiffness, and axial load to failure were tested for both screw trajectories. The models were examined immediately after testing for anatomical points of failure. Statistical analysis included two-tailed t-tests and Fisher exact testing.

RESULTS: Thirty femurs were included for final analysis. One model from each group exceeded the testing machine's limits and was excluded. Parallel screws demonstrated significantly greater axial stiffness compared to the diverging screws (431 N/mm ± 45 N/mm vs 367 N/mm ± 104 N/mm, respectively, p = 0.032). No significant difference was found between torsional stiffness and axial load to failure between the parallel and diverging screws (6.36 Nmm/deg ± 2.46 Nmm/deg vs 6.69 Nmm/deg ± 2.14 Nmm/deg, respectively, p = 0.691) (4461 N ± 402 N vs 4095 N ± 601 N, respectively, p = 0.063). No one failure mode occurred more often when comparing the two groups (p > 0.05).

CONCLUSION: Parallel trajectory of cannulated screws in moderate Pauwels angle femoral neck fractures is biomechanically superior to diverging trajectory of cannulated screws. With widely available guides for consistent placement and reproducibility of parallel screws, this clinically feasible and efficient screw trajectory can most likely be relied upon for robust femoral neck fracture fixation.

LEVEL OF EVIDENCE: Controlled laboratory study.

PMID:41130137 | DOI:10.1016/j.injury.2025.112834