Injury. 2025 Feb 20:112223. doi: 10.1016/j.injury.2025.112223. Online ahead of print.

ABSTRACT

OBJECTIVE: A case of traumatic strabismus was painted in two portraits of Franz Josias, Duke of Saxe-Coburg-Saalfeld (1697-1764). Both canvases are held by the Art Collection of Veste Coburg (Accession numbers: M.076 & M.363).

METHODS: Resorting to the "Guidelines for Iconodiagnosis", a careful comparison of the portraits of the Duke pre-dating an accident with those showing evidence of an ocular trauma afterwards, was performed. An analysis of the historical and biographical written sources was carried out as well.

RESULTS: At the age of 32 years, while playing battledore and shuttlecock (in French "jeu de volant", a forerunner of badminton), Duke Franz Josias sustained a traumatic left eye injury. This did not heal with time and was depicted in contemporary paintings of the Duke.

CONCLUSION: Combining both biographical and artistic sources, a diagnosis of post-traumatic strabismus due to injury of the left inferior rectus muscle was proposed with an Iconodiagnosis level of evidence II.

PMID:40021390 | DOI:10.1016/j.injury.2025.112223

Injury. 2025 Feb 20;56(4):112224. doi: 10.1016/j.injury.2025.112224. Online ahead of print.

ABSTRACT

INTRODUCTION: The soft tissue of the heel is weak, and calcaneal bone defects occur easily post-infection, resulting in the inability of paediatric patients to walk normally. Calcaneal reconstruction is challenging. We aimed to evaluate the methodology and clinical effects of the Ilizarov technique in the treatment of calcaneal infectious bone defects.

METHODS: We retrospectively analyzed the cases of 12 children with infectious calcaneal bone defects treated by the Ilizarov technique in our center from January 2018 to August 2022.Stump lengthening of the calcaneus was performed in nine cases. Due to severe calcaneus infection the calcaneus was removed, and talus lengthening was performed in three children. Two children were treated with drug-loaded spacer bone cement to control peripheral soft tissue infection before bone elongation could be performed, while the other ten cases underwent bone lengthening at one stage after radical debridement. Pain, foot function, self-care ability and hind foot function were evaluated using a Visual Analogue Scale (VAS), the Maryland Foot Score, Activity of Daily Living scale, and the American Orthopaedic Foot and Ankle Society retro ankle foot score.

RESULTS: In this cohort of 12 children, the time for bone lengthening ranged from 32 to 64 days (mean 41.75 ± 10.09 days), and the distance of bone lengthening was between 2.6 cm and 5.4 cm (mean 3.57 ± 0.86 cm). The inflammation indicators CRP, ESR, and IL-6 were significantly reduced after radical debridement (15.72 ± 3.09 vs 6.04 ± 1.28, 25.20 ± 2.72 vs 15.11 ± 1.56, 16.39 ± 3.75 vs 2.99 ± 1.08, respectively; p < 0.01). Bone reconstruction effectively reduced pain in the affected limb and significantly improved foot function, self-care ability, and hind foot function in these children. In four cases, external fixators were removed and an Achilles tendon lengthening operation was performed to further reconstruct calcaneal bone function. After surgical treatment, all the children in this cohort were able to return to normal life.

CONCLUSION: The Ilizarov technique for treating large infectious calcaneal bone defects and bone lengthening can effectively reconstruct the function of the calcaneal bone without significantly affecting the ankle joint.

PMID:40020515 | DOI:10.1016/j.injury.2025.112224

Injury. 2025 Feb 21:112222. doi: 10.1016/j.injury.2025.112222. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite disproportionately bearing the global injury burden, low- and middle-income countries often lack emergency medical services(EMS). Equipping lay first responders(LFRs) with emergency medical dispatch(EMD) is a critical next step for formal EMS development. However, few context-appropriate mobile dispatch solutions are available for LFRs, and implementation feasibility and impact on response intervals are not well understood MATERIALS AND METHODS: A simulation-based feasibility trial assessed a novel EMD tool, previously used for shipping in resource-limited settings without formal addresses. Two cohorts of 10 non-EMD enabled LFRs trained in 2019 in Sierra Leone were recruited. 100 total simulations were launched in randomized order over 6 months(Cohort 1 distributed along 10 kms of highway(n = 50), Cohort 2 distributed across 24 square-kilometers of an urban setting(n = 50)). On-scene first aid skill performance was assessed under direct observation with a standardized patient actor using checklists. Participants were blinded to randomized dispatch timing/scenario to assess response intervals, replicating real-world conditions, and compared with two-sample t-tests. At six-month follow-up, participants were surveyed on tool ease-of-use and appropriateness, confidence, and ranked dispatch variable relative importance.

RESULTS: Median total response interval (initial notification to LFR arrival on scene) for Cohort 1 for linearly-plotted highway simulations was 6 mins 33 ss(IQR: 2m27 s; 10m48 s), while Cohort 2 for dispersed urban simulations was 6m41s(IQR:3m59 s;14m47 s) (p = 0.720). Median distance between simulated emergency and LFR at the time of notification acceptance=1.675 km(IQR:1.13 km;2.47 km) and 1.73 km(IQR:0.82 km;2.28 km). Mean completion percentage of all discrete first aid steps across all 10 simulation scenario types for Cohort 1 = 89.8 %(IQR: 80 %;100 %) and Cohort 2 = 94.9 %(IQR: 88.89 %;100 %) (p = 0.017). Mean confidence was 9.4/10(median=10) and 9.5/10(median=10)(p = 0.889). 75 % of LFRs (15/20) used the compass feature for navigation while 25 % used turn-by-turn directions (5/20). 70 % LFRs (14/20) reported no unexpected data costs. Emergency location was considered the most important dispatch variable factor, followed by nature/severity of injury.

DISCUSSION: A novel mobile navigation tool for EMD accurately dispatches LFRs to simulated emergency incidents across linear/dispersed settings without significant difference in response interval. Equipping LFRs with EMD tools may facilitate efficient dispatch in resource-limited settings to trauma while expanding emergency care access, meriting further study.

PMID:40016018 | DOI:10.1016/j.injury.2025.112222

Injury. 2025 Jan 31;56(3):112179. doi: 10.1016/j.injury.2025.112179. Online ahead of print.

ABSTRACT

INTRODUCTION: The older population, especially centenarians, is growing. Hip fractures significantly affect this demographic; however, studies on centenarians are limited. This study aimed to compare hip fracture mortality and associated risk factors between centenarians, nonagenarians, and octogenarians with focus on centenarians.

METHODS: Data from the Korean Health Insurance Review and Assessment database were retrospectively analyzed. Individuals aged ≥ 80 years with an ICD-10 diagnosis code (S72) and procedure codes indicative of hip fracture surgery between 2012 and 2022 were included. The primary outcome was mortality at 1, 3, 6 months, and 1 year postoperatively. The secondary outcomes included the prevalence of comorbidities and postoperative complications.

RESULTS: 131,746 patients were included (106,244 [80.6 %] octogenarians, 24,842 [18.9 %] nonagenarians, and 660 [0.5 %] centenarians). Centenarians had lower Charlson Comorbidity Index than that of nonagenarians and octogenarians (4.4, 4.9, and 5.7, respectively; P < 0.000). However, perioperative medical complications such as acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), pneumonia, sepsis, and urinary tract infection increased linearly with age, significantly affecting centenarians. Mortality rates were highest in centenarians, especially within the first 3 postoperative months. The risk factors for 3-month mortality included the male sex (odds ratio [OR] 1.79, 95 % confidence interval [CI] 1.01-3.12, P = 0.046), and heart failure (OR 1.72, 95 % CI 1.07-2.79, P = 0.026) preoperatively, and AKI (OR 3.92, 95 % CI 1.97-7.82, P < 0.000), ARDS (OR 2.92, 95 % CI 1.04-8.23, P = 0.04), pneumonia (OR 1.91, 95 % CI 1.11-3.29, P = 0.02), and sepsis (OR 10.01, 95 % CI 3.52-28.45, P < 0.000) postoperatively.

CONCLUSION: Despite having fewer comorbidities, centenarians had the highest postoperative mortality, primarily due to organ dysfunction such as pneumonia, AKI, ARDS, and sepsis, rather than vascular events. Tailored medical management strategies focusing on these complications are crucial for improving centenarians outcomes.

PMID:39985925 | DOI:10.1016/j.injury.2025.112179

Injury. 2025 Feb 15;56(3):112215. doi: 10.1016/j.injury.2025.112215. Online ahead of print.

ABSTRACT

BACKGROUND: Cefazolin is the primary antibiotic for surgical prophylaxis in orthopedic procedures. The cessation of cefazolin supply in approximately 60 % of Japanese hospitals from 2019 to 2020 provided an opportunity to evaluate the effectiveness of alternative beta-lactams for preventing surgical site infection (SSI). Given the global potential for antibiotics shortages, confirming the effectiveness of alternative beta-lactams is critical.

PURPOSE: This study aims to evaluate the differences in risk of reoperation for SSI between cefazolin and alternative beta-lactams in patients undergoing lower extremity fracture surgeries.

METHODS: We emulated a target trial to compare the effectiveness of cefazolin with alternative beta-lactams-specifically broad-spectrum penicillins and cephalosporins-in preventing SSI using a Japanese hospital administrative database provided by JMDC Inc. We included patients undergoing initial open reduction and internal fixation for closed lower extremity fractures between March 1, 2019, and February 29, 2020. The outcome was reoperation for SSI within 30 days after surgery. Risks were estimated using pooled logistic regression with adjustment for confounders via inverse probability weighting. Sensitivity analyses extended the follow-up period to 90 and 365 days.

RESULTS: Of the 16,602 patients analyzed, 35 patients (0.30 %) in the cefazolin group (11,538 patients) and 16 patients (0.32 %) in the alternative beta-lactam group (5,064 patients) underwent reoperation for SSI within 30 days. The estimated 30-day risk was 0.31 % in the cefazolin group and 0.37 % in the alternative beta-lactam group, resulting in a risk difference of -0.06 % (95 % confidence interval [CI], -0.33 to 0.14) and a risk ratio of 0.82 (95 % CI, 0.50 to 1.52). In sensitivity analyses, the estimated 90-day risk was 0.67 % in the cefazolin group and 0.57 % in the alternative beta-lactam group, with a risk difference of 0.10 % (95 % CI, -0.15 to 0.32) and a risk ratio of 1.19 (95 % CI, 0.80 to 1.62). The 365-day risk was 1.02 % and 0.90 %, respectively, with a risk difference of 0.12 % (95 % CI, -0.29 to 0.39) and a risk ratio of 1.13 (95 % CI, 0.78 to 1.51).

CONCLUSIONS: In surgeries for lower extremity fractures, substituting cefazolin with alternative beta-lactams did not result in substantial differences in the risk of reoperation for SSI.

PMID:39983535 | DOI:10.1016/j.injury.2025.112215

Injury. 2025 Feb 15;56(3):112217. doi: 10.1016/j.injury.2025.112217. Online ahead of print.

ABSTRACT

INTRODUCTION: Fragility fractures of the proximal femur are common injuries with significant morbidity and mortality. The use of direct oral anticoagulant (DOAC) medications is increasing among the elderly and is associated with perioperative bleeding-related complications. The primary aim of this study was to examine how DOAC use affects surgical timing and postoperative hematologic complications in patients treated operatively for fragility fractures of the proximal femur. The effect of an institutional tranexamic acid (TXA) protocol implemented during the study period was investigated as a secondary aim.

MATERIALS AND METHODS: This was a retrospective analysis performed at a Level I trauma center. Between March 1, 2018 and April 1, 2022, 746 patients age 50 years and older who underwent surgical treatment for a fragility fracture of the femoral neck, intertrochanteric, or subtrochanteric region of the proximal femur (AO/OTA 31A, 31B, 32) and who were either on no chemical anticoagulation, warfarin, or a DOAC at the time of injury were included. The primary outcomes were time to operating room (TTOR), postoperative transfusion, 30-day venous thromboembolism (VTE), and 30-day hospital readmission. Multivariable logistic regression modeling was used to analyze the effect of anticoagulant, TXA use, and TTOR on these outcomes.

RESULTS: TTOR was increased for patients on warfarin (38.3 ± 26.1 h) or a DOAC (46.4 ± 23.4 h) compared to patients not on anticoagulation (28.0 ± 19.0 h) (p < 0.001). There was no significant difference in transfusion rates among patients not on anticoagulants (31.8 %), warfarin (43.4 %), or a DOAC (29.6 %). Multivariable regression showed a decrease in transfusion rate (OR 0.35, 95 % CI 0.23-0.53) and 30-day readmission (OR 0.31, 95 % CI 0.15-0.61) for intravenous (IV) TXA.

CONCLUSIONS: DOAC use was associated with an increase in TTOR without increased rates of transfusion, VTE, or hospital readmission in patients with fragility fractures of the proximal femur. Intravenous TXA was associated with reduced postoperative transfusion and 30-day readmission.

PMID:39983534 | DOI:10.1016/j.injury.2025.112217

Injury. 2025 Feb 15;56(3):112219. doi: 10.1016/j.injury.2025.112219. Online ahead of print.

ABSTRACT

BACKGROUND: Osteoporosis screening guidelines recommend bone mineral density (BMD) testing following fragility fractures. Nevertheless, previous studies have demonstrated low rates of osteoporosis screening. Diagnosis and treatment of osteoporosis is essential for prevention of future fractures, however not much is known about the factors associated with receiving BMD testing in this patient population. The purpose of this study was to evaluate the prevalence, timing, and predictors of BMD testing following distal radius fractures (DRF) in menopausal women.

METHODS: We queried a national insurance database to identify menopausal women aged 45-64 years with a DRF between years 2013 and 2020. The rate of BMD testing within 1 year of injury was calculated. Multivariable logistic regression analysis was used to evaluate the effect of patient- and injury-related variables on the likelihood of undergoing BMD testing following DRF.

RESULTS: Among 31,728 patients meeting inclusion criteria (mean ± SD age: 57.5 ± 4.3), 3,886 (12.2 %) received a BMD test within 1 year following DRF. The rate of BMD tests decreased with the highest rate of 14.5 % in 2015 and the lowest rate of 10.5 % in 2020. Mean time from DRF to BMD testing was 143 ± 102 days. Patients aged 60-64 had the highest adjusted odds of receiving BMD testing (OR 2.85 [95 % CI: 2.26 to 3.64]). Factors associated with increased likelihood of BMD testing included surgical intervention (OR 1.38 [1.28-1.48]), rheumatoid arthritis (OR 1.22 [1.06-1.40]), osteoarthritis (OR 1.28 [1.19-1.37]), breast cancer (OR 1.35 [1.16-1.56]), and vitamin D deficiency (OR 1.29 [1.17-1.43]). Factors associated with decreased likelihood of testing included tobacco use (OR 0.90 [0.84-0.97]), patients with Medicaid (OR 0.73 [0.61-0.86]) or Medicare (OR 0.76 [0.65-0.88]) insurance, and living in Southern (OR 0.67 [0.62-0.73]) or Western (OR 0.69 [0.62-0.77]) regions of the United States. Obesity, diabetes, renal disease, and early menopause were not associated with BMD testing.

CONCLUSIONS: Despite guidelines recommending BMD testing after low-energy fractures, rates of BMD testing were low and decreased among menopausal women with DRF. Mean time to BMD testing was 4.7 months, indicating substantial delays in workup. Known risk factors for osteoporosis did not reliably predict likelihood of BMD testing.

LEVEL OF EVIDENCE: Level III, prognostic.

PMID:39983533 | DOI:10.1016/j.injury.2025.112219

Injury. 2025 Feb 9;56(3):112206. doi: 10.1016/j.injury.2025.112206. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFP) present a growing challenge in aging populations. However, standardized classifications and treatment guidelines remain scarce.

OBJECTIVE: This scoping review examines the application of fracture classifications, treatment strategies, and outcome evaluations for FFP, identifying gaps in the literature, and suggesting directions for future research.

METHODS: A systematic search of multiple electronic databases yielded 117 studies discussing FFP names, classifications, treatment approaches, and outcomes. Data extraction focused on study characteristics, classification systems, treatment details, outcomes, and follow-up periods. Residual analysis using the Chi-square test assessed statistical associations and underrepresentation.

RESULTS: The FFP classification was the most common (51.3%), with additional treatment indicators focused on immobility (44.4%) and pain assessment (using the Visual Analog Scale [VAS] or Numeric Rating Scale [NRS], 37.6%), consistent with existing guidelines. In contrast, the sacral insufficient fractures were statistically associated with pain indications but lacked corresponding classification application. Initial management typically involved conservative or observation period. Regarding the management indications and outcomes, surgical interventions were categorized into osteosynthesis and sacroplasty. Outcome evaluations often incorporated mobility and functional status (59.0%), hospitalization length (49.6%), mortality rates (41.0%), and post-treatment living conditions (41.0%). Patient recovery was assessed through VAS scores (59.0%) and Activities of Daily Living Patient-Reported Outcomes (ADL-PROs, 34.2%). However, inconsistencies in standardized outcomes, particularly in sacroplasty studies, hinder comparative analysis.

CONCLUSION: FFP classifications, along with pain and mobility assessments, were frequently applied as management indicators for FFP. Standardizing treatment indications and establishing consistent outcome measures, including the evidenced gap treatments (sacral insufficient fracture and cement augmentation), could significantly improve comparability across studies.

PMID:39983532 | DOI:10.1016/j.injury.2025.112206

Injury. 2025 Feb 16;56(3):112221. doi: 10.1016/j.injury.2025.112221. Online ahead of print.

ABSTRACT

BACKGROUND: Road injuries remain a significant global health issue, contributing to a high burden of mortality and disability, particularly in low- and middle-income countries. Understanding the global trends in incidence, mortality, and Years Lived with Disability (YLDs) due to road injuries is essential for developing effective prevention strategies.

METHODS: We used data from the Global Burden of Disease (GBD) 2021 to analyze road injury trends from 1990 to 2021. Age-standardized incidence rates (ASIR), mortality rates (ASMR), and YLDs were calculated across different socio-demographic index (SDI) regions. Trends were assessed using the Estimated Annual Percentage Change (EAPC), and disparities by age, sex, and cause of injury were evaluated.

RESULTS: From 1990 to 2021, the global ASIR, ASMR, and YLDs due to road injuries showed a declining trend. However, road injury cases and deaths increased in low and middle-SDI regions, while declining in high-SDI regions. In 2021, the highest ASIR was observed in high-SDI regions (851.75 per 100,000 population), while low-SDI regions experienced the highest mortality rates (22.6 per 100,000 population). Males, particularly those aged 15-49 years, bore the greatest burden of road injuries, accounting for over 60% of YLDs globally. Pedestrian and motorcycle-related injuries were predominant in low-SDI regions.

CONCLUSION: While global road safety interventions have reduced the burden of road injuries, substantial disparities remain between SDI regions. Targeted interventions are needed to address the high burden of road injuries in low-SDI regions, focusing on improving infrastructure and healthcare access.

PMID:39978035 | DOI:10.1016/j.injury.2025.112221

Injury. 2025 Jan 27;56(3):112166. doi: 10.1016/j.injury.2025.112166. Online ahead of print.

ABSTRACT

Despite substantial progress in road safety, road traffic fatalities (RTFs) continue to be a persistent issue in Australia. This study aims to forecast RTFs trends up to 2050 by analyzing factors such as geographic location, age, gender, speed limits, and time of occurrence. Utilizing historical data from 1989 to 2024, fatalities were categorized by road user type, demographics, and day of the week. The Facebook Prophet time series model, incorporating categorical variables like region, age, and speed limits, was employed to predict future trends. The analysis reveals significant regional disparities in fatality reduction rates, with some areas lagging others. Gender-specific forecasts indicate a sharper decline in male fatalities compared to females, while projections highlight persistent risks for older drivers. Additionally, highways with higher speed limits are expected to see a substantial decrease in fatalities. These insights emphasize the need for targeted interventions in areas with slower reductions and high-risk demographic groups, aiding policymakers in refining safety measures, enforcing speed limits, and enhancing public awareness campaigns.

PMID:39970494 | DOI:10.1016/j.injury.2025.112166

Injury. 2025 Feb 10:112214. doi: 10.1016/j.injury.2025.112214. Online ahead of print.

ABSTRACT

BACKGROUND: Houselessness is associated with increased mortality and unmet health needs. Current understanding of traumatic injury in houseless patients is limited.

METHODS: This is a retrospective matched cohort study among houseless and housed adults, admitted to an urban, safety net, level I trauma center from 1/1/2018-12/31/2021. Houseless patients were matched with their housed counterparts 1:2 based on age, sex, injury severity score (ISS) and nature of injury. The primary outcome was in-hospital adverse events. Secondary outcomes included hospital length of stay (LOS), outpatient follow-up, emergency department (ED) utilization post-injury, and readmission. Conditional multivariable regression was used to determine associations between the exposure and outcomes.

RESULTS: 1413 patients were included; 471 houseless patients and 942 matched controls. Median [IQR] age was 42 years [31-58] and median [IQR] ISS was 9 [5-13] for all patients. About 30 % of traumatic injuries were violent in nature. Median [IQR] total LOS was longer for houseless patients (4.4 days [2.0-8.3] vs. 3.1 days [1.4-6.5], p < 0.001). Houseless patients were more frequently admitted to the ICU (5 % versus 3 %, p = 0.045). The rate of any in-hospital adverse event was similar (houseless 17 % vs. housed 16 %, p = 0.537). Adjusting for age, sex, language, insurance, ISS, nature of injury, injury mechanism, ICU admission, and operative intervention, houselessness was inversely associated with outpatient follow-up (OR 0.60, 95 % CI 0.46-0.79) and positively associated with ED representation (OR 2.49, 95 % CI 1.64-3.78) and hospital readmission (OR 4.35, 95 % CI 3.19-5.92).

CONCLUSIONS: Housing status was not associated with increased in-hospital morbidity or mortality in trauma patients in a single institution cohort of trauma patients. Unhoused patients had lower odds of completing outpatient injury-specific follow-up and higher odds of utilizing the ED within 30 days of discharge. These findings highlight gaps in post-discharge care coordination and underscore opportunities to improve discharge services for this population.

PMID:39966000 | DOI:10.1016/j.injury.2025.112214

Injury. 2025 Feb 12;56(3):112213. doi: 10.1016/j.injury.2025.112213. Online ahead of print.

ABSTRACT

Foot and ankle soft tissue defects with exposed bone pose significant challenges in wound healing and patient satisfaction OBJECTIVE: The study aims to assess the impact of nursing care quality and patient satisfaction on optimizing outcomes for complex foot and ankles injuries, focusing on the timing of rh-FGF administration after reconstructive surgery METHODS: This study included eighteen patients (15 males and 3 females) with traumatic foot and ankle soft tissue defects and exposed bone wounds, treated between January 2021 and December 2022. Patients were randomly assigned to three groups, underwent reconstructive surgery, and received rh-bFGF at varying times postoperatively. Key outcomes included wound healing time, hospital stay duration, satisfaction with nursing care scale, American Orthopedic Foot and Ankle Society (AOFAS) score, and Visual Analogue Scale for pain. All patients were followed for at least three months RESULTS: The study population had an average age of 41.1 years, with a range from 16 to 74 years. Findings indicated an average hospital stay of 17 days and a corresponding wound healing time of 17 days. At three months post-operation, the average American Orthopedic Foot and Ankle Society (AOFAS) score was 88. A notable 88.9 % of patients expressed satisfaction with the attentiveness of nursing staff and the privacy afforded to them. Furthermore, 84.3 % rated the nurses' competence positively, and 83.3 % appreciated the support provided to family and friends, along with personalized care and nurses' expertise in patient management. The results demonstrated a consistent trend of improvement in all assessed outcomes across the three treatment groups. Patients in Group 1, who received rh-bFGF one day after surgery, demonstrated the most favorable outcomes. This was followed by Group 3, which received rh-bFGF until ischemic changes were noted. In contrast, Group 2, which received rh-bFGF once inflammatory granulation had subsided, exhibited the least improvement CONCLUSION: The results of this study highlight the crucial role of timing in the administration of rh-bFGF for optimizing soft tissue repair in patients with foot and ankle defects. Timely application of rh-bFGF post-surgery is essential for achieving favorable patient outcomes, improving patient satisfaction with nursing care, and facilitating faster recovery.

PMID:39965533 | DOI:10.1016/j.injury.2025.112213

Injury. 2025 Feb 12;56(3):112212. doi: 10.1016/j.injury.2025.112212. Online ahead of print.

ABSTRACT

INTRODUCTION: Achilles tendon rupture (ATR) carries a high risk of venous thrombo-embolism (VTE) whether the injury is managed surgically or non-operatively. This study reports symptomatic VTE rate following ATR. The influence of patient demographics, treatment type and use of chemical thromboprophylaxis is examined.

MATERIALS AND METHODS: Observational cohort study. The data is from a multi-centre, prospective, national audit of patients from 68 participating United Kingdom centres. Data was prospectively collected from hospital records. The study was conducted between June and November 2022, with a 3-month follow up.

RESULTS: Of 11,363 participants in the National Audit, 9.5 % (n = 1084) had experienced an ATR. Management strategies included both non-surgical (74 %) and surgical (26 %). Following ATR, the VTE rate was 3.69 % (n = 40) compared to 0.57 % (n = 59) for other foot and ankle surgeries. Participants who developed symptomatic VTE after ATR were older than those who did not (mean age 54 years (95 %CI 50.5 - 54.7) vs 48 years (95 %CI 47.3 - 49.1)). There was no significant difference in VTE events due to participant sex, ethnicity or number of comorbidities. Differences in treatment regimen, such as weight-bearing status and immobilisation strategy, showed no significant difference in symptomatic VTE events between groups.

CONCLUSION: After ATR, patients are 6.5-times more likely to experience symptomatic VTE than those recovering from surgery for other foot and ankle pathology. There was no significant difference in symptomatic VTE rate after ATR with specific chemical prophylaxis or early mobilisation strategies.

PMID:39961162 | DOI:10.1016/j.injury.2025.112212

Injury. 2025 Feb 7;56(3):112205. doi: 10.1016/j.injury.2025.112205. Online ahead of print.

ABSTRACT

OBJECTIVES: TAD > 25 mm is a risk factor for cut-out in intramedullary nailing. Less attention has been given to the risk factors for central cut-through and the possible outcomes of TAD <10 mm. Furthermore, the risk of cut-through depending on minimum depth on either anterior-posterior (AP) or lateral views has not been explored. The goal of this study is to outline the parameters that increase risk of cut-through in intertrochanteric hip fractures.

METHODS: A retrospective review of 2128 intertrochanteric hip fractures admitted to a single level 1 academic trauma center from 2014 - 2023 was conducted. Variables included patient and operative characteristics, fracture fixation device, fracture type based on OTA/AO 2018 classification, TAD, neck-shaft angle and radiographic and clinical outcomes.

RESULTS: TAD <10 millimeters carried a significantly higher risk for lag screw and blade cut-through. Cut-through risk increased significantly when either AP or lateral apex-to-center distance was <4 millimeters, including when comparing fracture reduction quality for a cohort including sliding hip screws, lag screws and blades. Cut-out complications in this cohort only occurred with a TAD >10 mm and was significantly more likely to occur with TAD >25 mm, similar to prior studies.

CONCLUSION: TAD optimization between 10 and 25 mm reduces risk of both cut-out and cut-through and maintenance of 4 mm of distance between apex-to-center distance may help decrease the risk of cut-through complications.

PMID:39954635 | DOI:10.1016/j.injury.2025.112205

Injury. 2025 Feb 9;56(3):112211. doi: 10.1016/j.injury.2025.112211. Online ahead of print.

ABSTRACT

INTRODUCTION: Muscle weakness is among the most common motor deficits in individuals with spinal cord injury (SCI). Acute intermittent hypoxia (AIH) has been used to improve motor function by facilitating neuroplasticity. The purpose of this systematic review is to explore the impacts of AIH on muscle strength in individuals with SCI, identify who would most likely respond well to the intervention, and determine the optimal therapeutic protocol.

METHODS: Relevant literature was explored in "PubMed, MEDLINE, The Cochrane Library, Scopus, PEDro, and Web of Science" databases until October 2024. Randomized trials that involved SCI patients who underwent AIH, compared with controls, and assessed muscle strength were included in this review. The methodological quality was assessed using the "Physiotherapy Evidence Database (PEDro)" scale. The effect sizes were calculated using Cohen's d.

RESULTS: Of 502 studies, seven studies met the eligibility criteria, and the sample sizes ranged from 12 to 28 participants across the included studies. In total, 146 SCI patients (mean age 46.76 years; 88 % male) were included in this systematic review. The PEDro scores of the studies included varied between 5 and 8, with a median score of 8.

CONCLUSIONS: AIH is a promising therapeutic modality for enhancing muscle strength post-SCI, specifically in patients with motor-incomplete injuries. Based on good quality studies, delivering AIH independently or in combination with other treatments for 15 short (60-90 s) episodes of hypoxic exposure (Oxygen = 9 %) alternating with 15 (60-90 s) normoxic episodes (Oxygen = 21 %), across one or more sessions, could yield meaningful outcomes. Nevertheless, the evidence is limited by treatment protocol variations, small sample sizes, and a lack of standardization in combining AIH with other treatments. Therefore, further studies with larger sample sizes, more diverse populations, and standardized treatment protocols are strongly needed to verify our findings. Future studies should also address the potential bias, examine the long-term effects, and investigate underlying mechanisms to provide more generalized evidence.

PMID:39951963 | DOI:10.1016/j.injury.2025.112211

Injury. 2025 Feb 8;56(3):112209. doi: 10.1016/j.injury.2025.112209. Online ahead of print.

ABSTRACT

INTRODUCTION: High-energy pelvic ring injuries (PRI) are severe, life-threatening trauma conditions which might require complex surgical management. One of the major complications associated with these injuries is the development of surgical site infections (SSI) which significantly impact patient outcomes. This study aimed to evaluate the rate of SSI in patients undergoing surgical fixation of high-energy blunt PRI and identify the key predisposing factors.

METHODS: A retrospective review of patients treated for high-energy blunt PRI was conducted using the prospectively filled institutional Severely Injured Patients' Registry, focusing on the rate of SSI following surgical fixation. The multifactorial nature of infection risk was analyzed, with particular attention to the type of injury, surgical technique, external fixation devices' usage and the germs encountered.

RESULTS: A SSI rate of 10,5 % (12 out of 114 patients) was encountered among the study population. The primary SSI risk factor was PRI complexity; 83.3 % of patients with SSI had an AO/OTA type C fracture and 16.7 % a type B fracture, while 43.1 % of patients without SSI had a type C fracture and 56.9 % a type B fracture (p = 0.008). Additionally, SSI patients had a trend to have higher extremities/pelvis AIS and higher ISS, and to have been more often treated with a transient pelvic fixation device including supra-acetabular external fixator.

CONCLUSION: These findings emphasize the need for a comprehensive infection prevention strategy in high-energy PRI patients, especially in complex cases. A multidisciplinary approach is of outmost importance and should include surgical techniques with meticulous soft tissue handling, proper implant selection and aggressive post-operative wound care. Despite external fixation devices being related to certain cases of SSI, their life-saving potential during the initial management phase should be carefully weighed against this risk.

PMID:39951962 | DOI:10.1016/j.injury.2025.112209

Injury. 2025 Feb 4;56(3):112208. doi: 10.1016/j.injury.2025.112208. Online ahead of print.

ABSTRACT

AIM: The Aim of the study is to retrospectively analyse intraoperative complications in acetabular fractures treated via the Stoppa approach, identify their frequency and nature, and define potential risk factors, in addition to evaluating clinical outcomes.

METHODS: This retrospective cohort study included a total of 136 acetabulum fracture cases (aged 16 to 82 years) that were managed using Stoppa approach. Records related with age, sex, mode of injury, body mass index, history and type of associated injury and time gap between injury and surgery were noted. Intraoperative records for complications, viz., vascular injury, nerve injury, peritoneum, bowel and bladder injury were retrieved. Data was analysed using SPSS 24.0 software. Chi-square and Independent samples 't'-tests were used for comparison.

RESULTS: Mean age of patients was 40.14±14.95 years. Majority (74.3 %) of patients were males and had road traffic accident (83.8 %) as the cause of injury. Mean BMI of patients was 22.4 ± 2.43 kg/m2. ACPHT (41.2 %) and ACF (27.9 %) were the most common diagnoses. A total of 16 (11.8 %) had associated injuries. Mean time gap between injury and surgery was 6.35±4.25 days. Intraoperative complication rate was 8.8 % (3.7 % peritoneum tear, 2.9 % superior iliac vein injury and 2.2 % external iliac vein injury). Intraoperative complications had a significant association with time gap between injury and surgery (p = 0.015).

CONCLUSION: Stoppa technique was a safe approach for management of acetabulum fractures with a low incidence of intraoperative complications. Early intervention could help to reduce rate of complications further.

PMID:39947007 | DOI:10.1016/j.injury.2025.112208

Injury. 2025 Feb 8;56(3):112210. doi: 10.1016/j.injury.2025.112210. Online ahead of print.

ABSTRACT

BACKGROUND: Long bone fracture is one of the most common concomitant injuries in pediatric traumatic brain injury (TBI) patients, requiring surgical intervention in the form of intramedullary nailing (IMN), open reduction and internal fixation (ORIF), or temporary external fixation, otherwise known as damage control orthopedics (DCO), for transient stabilization before definitive repair. There are no definitive guidelines for femur fracture management in polytrauma TBI pediatric patients. This study investigates the outcomes of patients with TBI and femur fractures who underwent DCO versus early total care (ETC), hypothesizing that delayed fracture fixation is associated with worse outcomes.

METHODS: Pediatric patients admitted with TBI who underwent femur fracture repair between 2016 and 2020 were investigated using the National Inpatient Sample database. Clinical outcomes, healthcare utilization data, baseline demographics, and comorbidities were collected. All Patient Refined Diagnosis Related Groups (APR-DRG) severity was defined for each case. The injury severity scale (ISS) was developed using ICD-10-CM codes for injury. High ISS was defined as greater than 75th percentile. DCO patients were compared with ETC patients. Inpatient death, prolonged LOS, and high total charges were the primary outcomes evaluated. Multivariate binary logistic regression analysis was used to evaluate for independent predictors of primary outcomes.

RESULTS: A total of 6,775 pediatric TBI patients under the age of 21 who underwent repair of femur fracture were identified. The average age was 15.5 years (range: 0-21 years) and there were 2,065 (30.5 %) females. DCO to treat femur fractures was employed in 1,010 (14.9 % of patients). Patients undergoing DCO were significantly more likely to have extreme illness severity (OR = 3.049), early trauma complications (OR = 2.273), and respiratory complications (OR = 2.255). DCO was independently associated with prolonged length of stay (LOS) (OR = 1.263), high total charges (OR = 1.786), and inpatient death (OR = 2.796).

CONCLUSION: This study found that DCO is associated with worse outcomes, likely secondary to injury severity and underlying neurologic injury of patients undergoing DCO. These findings suggest it is time to definitively outline the timing and modality of femur fracture repair for the polytrauma pediatric patient with TBI.

LEVEL OF EVIDENCE: III.

PMID:39947006 | DOI:10.1016/j.injury.2025.112210

Injury. 2025 Feb 6;56(3):112197. doi: 10.1016/j.injury.2025.112197. Online ahead of print.

ABSTRACT

OBJECTIVE: Traumatic native hip dislocations require immediate orthopaedic attention and have been associated with significant long-term morbidity. Previous studies have reported radiographic outcomes and clinical complication rates, however; evidence evaluating the effect of these injuries on patient-reported outcomes (PROs) is limited. The purpose of our study was to evaluate PRO scores among patients with native hip dislocations.

METHODS: Adult patients with native hip dislocations between 2005 and 2020 at a single academic Level 1 trauma center were retrospectively reviewed. Radiographs and medical records were reviewed for patient demographics and comorbidities, injury characteristics, details of treatment including time to reduction, and complications. Patients were given the PROMIS Physical Function (PROMIS PF) and Short Form-36 (SF-36) via HIPAA compliant electronic data capture. Outcomes were analyzed using Student t-tests and Mann-Whitney U comparisons of means/medians. Floor and ceiling effects were also characterized for the various outcomes scores.

RESULTS: A total of 168 patients with native hip dislocation were identified, 78 (46.4 %) of whom completed all PROs measures. Among responders, mean age was 36.2 years (SD 14.5), mean BMI was 29.2 (SD 6.7), and mean dislocation duration was 8.9 h (SD 5.1). On univariable regression, older age was associated with worse SF-36 Physical scores (p = 0.007). PROMIS PF showed an estimated 2.18 decrease for every one grade increase in Kellgren-Lawrence score (p = 0.01). There were no ceiling or floor effects seen with PROMIS PF, SF-36 Physical Summary, or SF-36 Mental Summary Scores.

CONCLUSIONS: Patients of older age and higher Kellgren-Lawrence score exhibited worse SF-36 Physical Function and PROMIS PF scores, respectively, highlighting the functional impact that native hip dislocations may have. PROMIS PF, SF-36 Physical and Mental Summary Scores were without floor or ceiling effects, rendering this an important tool in the evaluation of patients with traumatic native hip dislocation.

PMID:39947005 | DOI:10.1016/j.injury.2025.112197

Injury. 2025 Feb 5:112200. doi: 10.1016/j.injury.2025.112200. Online ahead of print.

NO ABSTRACT

PMID:39933980 | DOI:10.1016/j.injury.2025.112200