Injury. 2026 Jan 11;57(3):113046. doi: 10.1016/j.injury.2026.113046. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients with deep second- and third-degree burns are at high risk of bloodstream infections (BSIs) due to skin barrier disruption and immune suppression, with poor prognosis. Early risk identification is crucial for improving outcomes. This study aimed to construct and validate a machine learning model using multidimensional clinical indicators to accurately predict BSI risk in such patients.

METHODS: A retrospective cohort study enrolled 301 patients with deep second- and third-degree burns (75 with BSIs) from Yongchuan Hospital Affiliated to Chongqing Medical University between January 2020 and January 2025. Multidimensional data on burn characteristics, laboratory indicators, and therapeutic measures were collected within 72 h of admission. After data preprocessing and feature screening, four models were built: logistic regression (LR), support vector machine (SVM), naive Bayes (NB), and back propagation artificial neural network (BP-ANN). Model performance was evaluated via stratified sampling and 5-fold cross-validation.

RESULTS: Eight key predictors were identified: total body surface area, lymphocytes (LYM, most important), platelet crit, total bilirubin, creatinine, C-reactive protein, procalcitonin, and 24-hour rehydration. The BP-ANN model performed best in the test set, with accuracy, recall, precision, F1 value, and AUC all reaching 0.857, good calibration (Hosmer-Lemeshow test, P = 0.142), and significant net benefit in the 0-0.3 risk threshold interval (decision curve analysis). The LR model had an AUC of 0.891 and high generalization stability (0.999) but less balanced indicators. SVM was overfitted (limited practical value), and NB had insufficient generalization (test set AUC=0.775).

CONCLUSION: The BP-ANN model based on multidimensional clinical indicators accurately predicts BSI risk in patients with deep second- and third-degree burns, with good differentiation, calibration, and clinical utility, providing a reliable tool for early intervention.

PMID:41604758 | DOI:10.1016/j.injury.2026.113046

Injury. 2026 Jan 22:113058. doi: 10.1016/j.injury.2026.113058. Online ahead of print.

ABSTRACT

INTRODUCTION: Prehospital erythrocyte transfusion, well-established in the management of hemorrhagic shock in developed countries, was incorporated into trauma care in Brazil in 2022, representing a significant advance in the treatment of severe trauma. This study aimed to describe the clinical profile of patients with severe trauma who received prehospital erythrocyte transfusion by the SAMU aeromedical team in a health macro-region in Southern Brazil.

METHODS: This retrospective cross-sectional study (2022-2024) included patients with severe trauma treated by a regional SAMU aeromedical team who received prehospital erythrocyte transfusion at the trauma scene. Clinical, laboratory, and hemodynamic variables were collected, including prehospital and hospital shock index values. The primary outcome was 24-hour mortality. Associations with early mortality were explored using Fisher's exact test with exact odds ratios. Changes in shock index between prehospital and hospital moments were evaluated with the Wilcoxon signed-rank test, while differences between survivors and non-survivors were assessed with the Mann-Whitney test.

RESULTS: Results: Thirty-eight patients were included, and 10 (26%) died within 24 hours. Prehospital erythrocyte transfusion was associated with a significant reduction in shock index, decreasing from a median of 1.85 (IQR 1.53-2.40) at the scene to 1.15 (IQR 0.90-1.68) on hospital arrival (p < 0.001), with no difference in the magnitude of reduction between survivors and non-survivors (p = 0.38). Non-survivors presented a more unfavorable metabolic profile on admission, with lower base excess and hematocrit and higher lactate levels. Older age (≥60 years) and a positive FAST showed higher odds of early mortality (OR 5.2 and 5.8, respectively), although both associations had wide confidence intervals and two-sided Fisher p-values of 0.06. All seven patients who experienced cardiac arrest at the scene died within 24 hours. No transfusion-related adverse events were recorded; however, key physiological parameters such as ionized calcium and core temperature were not systematically monitored.

CONCLUSION: Prehospital erythrocyte transfusion was feasible within this aeromedical service and was associated with early improvement in shock index. Although no transfusion-related adverse events were recorded, incomplete physiological monitoring limits definitive conclusions regarding safety. These findings support the potential role of prehospital transfusion as a supportive measure in severe trauma, particularly in aeromedical settings.

PMID:41582035 | DOI:10.1016/j.injury.2026.113058

Injury. 2026 Jan 22:113057. doi: 10.1016/j.injury.2026.113057. Online ahead of print.

NO ABSTRACT

PMID:41582034 | DOI:10.1016/j.injury.2026.113057

Injury. 2026 Jan 22;57(3):113062. doi: 10.1016/j.injury.2026.113062. Online ahead of print.

ABSTRACT

BACKGROUND: The indications for temporizing knee-spanning external fixation (KSEF) in the setting of knee dislocation (KD) are poorly defined, leading to significant uncertainty and inconsistency in clinical practice. This study aimed to analyze and describe the documented indications for temporizing KSEF in a series of patients with KDs.

METHODS: A retrospective, multi-center review was conducted at two level I trauma centers from January 2001 to May 2024, identifying patients with documented KD treated with KSEF. Data were extracted from operative records, imaging, and clinical notes, and reviewed for demographics, injury characteristics, and documented indications for KSEF. A set of KSEF indications derived from the literature was developed a priori to individually assess the appropriateness of each KSEF application. Knees were classified as 'did not meet criteria' for KSEF only when both of the following conditions were true: (1) no predefined indication was met; and (2) there was no radiographic, clinical, or documented evidence of persistent post-reduction instability.

RESULTS: A total of 33 patients with 36 documented KDs treated with KSEF were identified from a cohort of 289 multiple ligament injured knees (12.5 %). Of the 36 KDs, 28 (77.8 %) met the selected criteria for KSEF. The most common primary indications for KSEF were vascular injury, tibial plateau fracture-dislocation, inability to maintain tibiofemoral reduction via non-invasive means, and morbid obesity. The remaining eight KDs (22.2 %) did not meet criteria for KSEF either as isolated injuries or in the setting of "polytrauma." The rationale for KSEF application was cited as "polytrauma" in 6/8 (75.0 %) of these cases.

CONCLUSION: Eight of the 36 (22.2 %) KSEF applications did not meet the predefined criteria for KSEF in the setting of KD, nor showed evidence of an inability to maintain tibiofemoral reduction via non-invasive means. Polytrauma is frequently cited in the literature as a primary indication for temporizing KSEF in the setting of KD without a clear definition. Further investigation into the role of temporizing KSEF is needed, particularly in the polytraumatized patient, to determine its specific role in the management of KDs.

PMID:41581256 | DOI:10.1016/j.injury.2026.113062

Injury. 2026 Jan 22;57(3):113060. doi: 10.1016/j.injury.2026.113060. Online ahead of print.

ABSTRACT

Tourniquet use is the most effective tool for controlling life-threatening extremity hemorrhage before other treatments and for creating bloodless operating fields in surgical procedures. However, tourniquet-induced ischemia-reperfusion (tourniquet/IR) also causes skeletal muscle injury and is associated with secondary remote organ injuries. Our previous studies have demonstrated that there is involvement of inflammatory cytokines in tourniquet-induced skeletal muscle IR injuries. In this study, we investigated the inflammatory responses and tissue injuries in remote organs after tourniquet/IR. The unilateral hindlimbs of mice were subjected to 3 h of tourniquet application by placing a rubber band at the hip joint. Then the rubber bands were released to initiate reperfusion, and tissues were harvested after 1, 3, 7, 14, and 28 days of reperfusion. The data from real-time RT-PCR and western blot showed that the levels of IL-1β and TNFα (two pro-inflammatory cytokines) mRNAs and proteins increased in the lungs and livers, whereas these cytokines did not rise in hearts and kidneys during 28 days of tourniquet/IR, compared to the sham tissues. Histological images also confirmed the infiltration of inflammatory cells in lungs and livers, but not in hearts and kidneys during 28 days of tourniquet/IR. Tourniquet/IR induced tissue structural injuries in the lungs but not the livers, hearts, and kidneys. Additionally, 21.8 % (12/55) of mice died at 1 day and 3 days of tourniquet/IR. These results suggest that inflammatory responses and severity of tissue injuries are different among remote organs and tourniquet/IR-related lung injuries could be a major cause of death during tourniquet/IR, which can help to develop therapeutic strategies for reducing mortality and improving outcomes after the use of tourniquet.

PMID:41581255 | DOI:10.1016/j.injury.2026.113060

Injury. 2026 Jan 10;57(3):113031. doi: 10.1016/j.injury.2026.113031. Online ahead of print.

ABSTRACT

OBJECTIVES: Distal femur fractures (DFF) are serious injuries that frequently affect older, medically complex patients. Malnutrition worsens outcomes in elective orthopaedic surgery, but its impact in urgent DFF fixation, where preoperative optimization time is limited, remains unclear. This study evaluated whether preoperative malnutrition predicts 90-day morbidity after DFF fixation and whether implant choice modifies risk among malnourished patients.

METHODS: Adults undergoing operative DFF fixation from 2005 to 2025 were identified in the TriNetX US Collaborative Network. Malnutrition was defined as serum albumin ≤3.5 g/dL or leukocyte count ≤1.5 × 10³/µL within one year before surgery. After 1:1 propensity matching for demographics and comorbidities, outcomes were compared between 13,924 malnourished and 13,924 non-malnourished patients. A secondary matched analysis compared plate versus intramedullary nail fixation in malnourished patients (n = 662). Ninety-day postoperative complications, readmission, and opioid-related outcomes were assessed.

RESULTS: Malnourished patients had significantly higher rates of nearly all 90-day complications, including sepsis (risk ratio [RR] 3.55), surgical site infection (RR 3.05), wound disruption (RR 3.38), pulmonary embolism (RR 2.09), pneumonia (RR 2.45), renal failure (RR 2.53), anemia (RR 1.97), and transfusion (RR 2.52) (all p < 0.001). Ninety-day readmission and opioid-related outcomes were also substantially increased. Among malnourished patients, overall complication rates were similar between plate and nail fixation, with the exception of lower pneumonia rates in the plate cohort (p = 0.045).

CONCLUSIONS: Preoperative malnutrition is a strong, independent predictor of postoperative morbidity after DFF fixation, and complication risk remains high regardless of implant choice. Routine nutritional screening with simple laboratory markers and targeted perioperative optimization should be integrated into trauma workflows to improve outcomes in this vulnerable population.

PMID:41579563 | DOI:10.1016/j.injury.2026.113031

Injury. 2026 Jan 17;57(3):113052. doi: 10.1016/j.injury.2026.113052. Online ahead of print.

ABSTRACT

INTRODUCTION: Chronic bone infection is a challenging condition to treat, often requiring multiple surgeries and prolonged antibiotic therapy, which although effective, can increase patient morbidity and are resource intensive. This study was designed to evaluate midterm results of a single-stage management approach for chronic bone infection, incorporating debridement, local antibiotic delivery via calcium sulphate antibiotic loaded carrier (CALC), and soft-tissue coverage to effectively manage infection and improve patient outcomes while minimizing morbidity associated with multi-stage procedures.

MATERIALS AND METHODS: In this retrospective observational cohort study, patients who underwent single-stage surgery with a minimum of two-year follow-up were included. Data on demographics and clinical outcomes were collected. Key objectives included assessing disease recurrence, treatment impact, and postoperative complications.

RESULTS: Ninety-three patients, of which 60 were male, were included, with a mean age of 51 years. The median follow-up period was 57.5 months. The mean postoperative stay was 13 days. Thirty-nine patients were smokers, 11 were diabetics, and 10 had peripheral vascular disease. The leading cause of chronic bone infection was fracture related infection following trauma (n = 68), predominantly affecting the tibia (n = 33). Significant microbiological growth occurred in 77 patients with Staphylococcus aureus being the predominant pathogen (n = 42). Cierny-Mader classification revealed 31 patients with localized lesions in Class B hosts and 25 in Class A hosts. Only 24 patients required surgical stabilization at index procedure. Most patients (n = 70) underwent excision with primary closure, while 22 needed a soft tissue flap. Postoperative complications included wound leakage in 21 cases, with 13 recurrent infections, 10 of which needed further surgery. An infection control rate was initially achieved at 86%, and 89.2% at a 5.5-year follow-up.

DISCUSSION AND CONCLUSION: Our study constitutes a large patient cohort with one of the longest available follow-up periods. Single-stage management of chronic bone infection with intralesional debridement using antibiotic impregnated CaSO4 pellets is safe and an effective method with low recurrence rates. Our results suggest that pre-operative sampling is not essential for successful outcomes. A multidisciplinary approach following the essential basic principles of the management of CBI is essential.

PMID:41579562 | DOI:10.1016/j.injury.2026.113052

Injury. 2026 Jan 10:113038. doi: 10.1016/j.injury.2026.113038. Online ahead of print.

ABSTRACT

BACKGROUND: Thoracic epidural anesthesia and paravertebral blocks (PVBs) are the gold standard techniques for pain relief of chest trauma, but they are technically challenging and have failure rates. The Erector Spinae Plane block (ESPB) is a PVB surrogate that provides effective hemi-thoracic analgesia. The costotransverse foramen block (CTFB) is a novel block that deposits local anaesthetic adjacent to the costotransverse foramen. We hypothesized that CFTB might offer superior analgesia compared to ESPB.

METHODS: This double-blinded, prospective, randomized controlled trial was conducted in the emergency department (ED) of a tertiary care institution. Fifty-eight patients with chest trauma were randomized into two groups, Group-1 (USG-ESPB; n = 29) or Group-2 (USG-CTFB; n = 29). The primary outcome was to compare pain scores in the Numeric Rating Scale (NRS) at 20 min. The secondary outcomes were onset and duration of analgesia, pain score at fixed time intervals, block failure rates, need for rescue analgesia, assessment of pain score at one and three months, and adverse events.

RESULTS: Demographic and vital parameters were similar between the two groups. Baseline pain scores recorded at rest [9.6(0.8) vs 9.5(0.9)] and on movement [9.8(0.6) vs 9.8(0.6)] did not differ. At 20 min following intervention, mean pain scores at rest were very similar in both groups [5.2 (1.7) vs. 5.3 (1.5)] (mean difference: 0.1; 95% CI: -0.55 to 0.50; P = 0.94). Pain scores during movement were also very similar in both groups [6.4 (1.7) vs. 6.3 (1.4)] (mean difference: 0.1; 95% CI: -0.43 to 0.62; P = 0.76). The NRS score was persistently lower in the CTFB group at all other designated time points, though the difference was not statistically significant. The onset, duration, requirement of rescue analgesia, and block failure were similar. There were no complications in any group. During assessments at one and three months, both techniques yielded equivalent pain control.

CONCLUSION: CTFB provides analgesia equivalent to ESPB in terms of acute and long-term pain relief, onset, duration, and opioid consumption for chest trauma patients. CTFB, however, is technically more challenging, and ESPB is a safer and more user-friendly option.

PMID:41577530 | DOI:10.1016/j.injury.2026.113038

Injury. 2026 Jan 14:113025. doi: 10.1016/j.injury.2026.113025. Online ahead of print.

ABSTRACT

INTRODUCTION: Fractures and soft tissue damage are the main causes for traumatic peripheral nerve injuries. Discontinuity of peripheral nerve after injury results in loss of motor function or sensation or both combined. This is often associated with debilitating consequences for the affected person. Current data on the epidemiology of peripheral nerve injuries in Germany are scarce.

MATERIAL AND METHODS: In a non-interventional retrospective population-based cohort study (registry-based), publicly available, anonymized patient data (2019-2023) were analyzed with respect to traumatic peripheral nerve injuries (PNI). Incidences regarding PNI in total and stratified to gender, age and anatomic regions were calculated and stratified to the official German reference population/100,000.

RESULTS: The incidence for a peripheral nerve injury in Germany as a concomitant trauma diagnosis is 11.27 (95CI 10.39; 12.2)/100,000. Males are more than twice as likely as females to have a PNI, with a ratio of 2.17:1. The most common site for PNI is the forearm, wrist, and hand. 55.83% (95CI 55.01; 56.65) are between the ages of 18-49. 22.88% of all registered peripheral nerve injuries are caused by a bone fracture.

CONCLUSION: In conclusion, a national mean incidence for traumatic peripheral nerve injuries was evaluated with 11.27 (95CI 10.39; 12.2) /100,000 stratified to the German standard population.

PMID:41577529 | DOI:10.1016/j.injury.2026.113025

Injury. 2026 Jan 10:113047. doi: 10.1016/j.injury.2026.113047. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma is a major global health burden leading to significant morbidity, disability, and mortality. Predictive models in trauma care traditionally focus on mortality, but early predictions of hospital length of stay (LOS) and intensive care unit (ICU) needs could greatly enhance hospital planning and resource allocation. Machine learning (ML) offers new possibilities for developing prediction tools for these outcomes but remain underexplored in large, unselected trauma populations.

AIM: To develop and validate machine learning-based models for early prediction of hospital length of stay and ICU admission among severely injured trauma patients using a large patient cohort from a national trauma registry.

METHODS: Patient data from 9056 adult severely injured trauma patients (NISS >15) registered in the Swedish trauma registry SweTrau between 2015 and 2019 were analyzed. Only variables available at hospital arrival were used as predictors. Outcomes were LOS (1-2, 3-9, or ≥10 days) and ICU admission (yes/no). Patients from 2015 to 2018 (n = 6706) were used for training Generalized Linear Model (GLM), Random Forest (RF), and Extreme Gradient Boosting (XGB) models, and patients from 2019 (n = 2350) were used for temporal internal-external validation. Model performance was assessed with ROC curves, calibration curves and DCA.

RESULTS: The XGB models consistently outperformed GLM and RF models for all outcomes. For estimation of ICU admission, the XGB model achieved an AUC of 0.85 (95% CI: 0.84-0.87). For estimations of LOS, the XGB model achieved "one-vs- all" AUCs of 0.69, 0.64, and 0.71 for the three LOS categories, respectively. A clinical prediction tool based on the best-performing models was created and is available online (https://hipfx.shinyapps.io/traumaadvisorapp/).

CONCLUSION: Machine learning models trained on national trauma registry data demonstrated strong performance in predicting ICU admission and moderate accuracy in categorizing hospital length of stay. The XGB model showed the highest overall predictive power and may serve as a useful tool to support early triage, guide clinical decision-making, and optimize resource allocation in trauma care settings.

PMID:41571542 | DOI:10.1016/j.injury.2026.113047

Injury. 2026 Jan 9;57(3):113021. doi: 10.1016/j.injury.2026.113021. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to compare the efficacy of the posterolateral and posteromedial approaches in the surgical treatment of trimalleolar ankle fractures involving the posterior malleolus.

METHODS: A total of 120 patients with trimalleolar ankle fractures (Haraguchi type II posterior malleolar fractures confirmed by computed tomography scans involving >30% of the tibial articular surface) admitted to our hospital were separated into two subgroups according to different intervention methods. The posterolateral approach subgroup had 60 patients (finally, 58 patients were included), and the posteromedial approach subgroup had 60 patients (finally, 57 patients were included). Open reduction and internal fixation (ORIF) were conducted in all patients, addressing the fibula through the same posterolateral incision or through a separate lateral incision in the posteromedial group. The general operation, fracture healing and complication rate of the two subgroups were compared.

RESULTS: The operation time, intraoperative bleeding, incision length and postoperative hospitalisation time of the posterolateral approach subgroup were significantly shorter than those of the posteromedial approach subgroup. The fracture healing time in the posterolateral approach subgroup was significantly shorter than that in the posteromedial approach subgroup, and the complication rate was significantly less than that in the posteromedial approach subgroup. At a mean follow-up of 14.3 months (range: 12-18 months), there was no notable distinction in the excellent and good rates for the posterolateral approach subgroup (94.83%) and the posteromedial approach subgroup (87.72%).

CONCLUSION: The posterolateral approach for the treatment of trimalleolar ankle fractures shortens the operation time, promotes fracture healing through improved visualisation and reduction quality, lessens the incidence of complications and, compared with posteromedial ORIF, does not affect the functional recovery of the ankle joint.

PMID:41570410 | DOI:10.1016/j.injury.2026.113021

Injury. 2026 Jan 14;57(3):113042. doi: 10.1016/j.injury.2026.113042. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFP) are increasingly common, particularly in the ageing population. Traditionally, those low-energy pelvic ring fractures have been managed conservatively, but this approach can lead to immobility and therefore complications. Surgical intervention is indicated based on various factors including type of fracture, mobility, and pain. Minimal-invasive percutaneous sacroiliac and/or transsacral screw stabilisation offers an effective treatment, enabling immediate mobilisation. There are multiple technical methods for the implantation. This study aimed to assess the precision of CT-guided percutaneous screw stabilisation and functional outcomes in elderly patients with FFP.

METHODS: A retrospective analysis was conducted on 114 elderly patients who underwent CT-controlled percutaneous sacroiliac screw implantation for FFP between 2010 and 2021. Data on demographics, pre-operative characteristics, surgical procedure, and postoperative outcomes were collected from routine data and analysed.

RESULTS: Stabilisation using CT-guidance demonstrated favourable outcomes with low rates of screw malposition. 96% of the sacroiliac screws in S1 were placed completely intraosseous. Sacroiliac placement showed higher rates of completely intraosseous placement than transsacral placement. Placement in S1 showed higher accuracy rates than placement in S2. Operations with more radiation had a higher percentage of perfectly positioned screws and the simple fracture type had more perfectly positioned screws than the more complex type FFP4. Eighteen screws showed signs of loosening after one year, necessitating re-operation in 2 cases. Patients with 3 screws had less risk of loosening. Screws inserted from the left showed lower rates of loosening than screws from the right. Postoperative mobility assessment showed that 70% were still living at home after one year and 63% were painfree. The one-year mortality was 18%.

CONCLUSION: CT-guided implantation of 231 sacrum screws had a very high precision with no malpositioned screws. The precision of implantation is not affected by the BMI or age of the patient, but the rate of perfect position was lower in complex fractures than in simple fractures. Precision of sacroiliac screw implantation is higher than that of transsacral screws but the rate of loosening is not higher. Surgery provided freedom from pain for most patients and only few patients lost their self-dependence.

PMID:41570409 | DOI:10.1016/j.injury.2026.113042

Injury. 2026 Jan 9:113030. doi: 10.1016/j.injury.2026.113030. Online ahead of print.

ABSTRACT

BACKGROUND: Surgical stabilization of rib fractures (SSRF) has been associated with improved pain scores, fewer ventilator days, lower rates of ventilator-associated pneumonia and tracheostomy, shorter hospitalization, and reduced mortality. RibScore is a 6-point scoring system using chest wall injury radiographic data to predict adverse pulmonary outcomes (APOs). This study examines the incidence of APOs using RibScore criteria, hypothesizing the incidence of APOs decreases after SSRF.

METHODS: A single-institution retrospective review was performed for adult SSRF patients at a Level I trauma center between 1/2017 and 4/2023. Basic demographics were obtained. CT imaging was reviewed, and each patient was given a score based on RibScore criteria. Our primary outcome was incidence of adverse pulmonary outcomes (pneumonia, respiratory failure, need for tracheostomy) stratified by RibScore. The Mantel-Haenszel test for trend was used to create a linear trend between RibScore and APOs for patients who underwent SSRF. Rates of APOs after SSRF were compared to the original APOs for each RibScore.

RESULTS: A total of 452 patients were included in the study. There was an increase in rate of tracheostomy with increasing RibScore, which was statistically significant on linear-by-linear association (p = 0.003). Similar results were demonstrated for rate of pneumonia (p < 0.001) as well as rate of respiratory failure (p < 0.001). When comparing our SSRF patients to the original RibScore adverse pulmonary outcomes, there was a significant decrease in incidence of tracheostomy (p = 0.003), pneumonia (p < 0.001), and respiratory failure (p < 0.001).

CONCLUSION: In this cohort, SSRF was associated with lower adverse pulmonary outcome rates across RibScore strata within our center. RibScore supports risk stratification and shared decision making. Historical comparisons are descriptive and cannot establish causality.

LEVEL OF EVIDENCE: Level IV, therapeutic/care management.

PMID:41565515 | DOI:10.1016/j.injury.2026.113030

Injury. 2026 Jan 9;57(3):113017. doi: 10.1016/j.injury.2026.113017. Online ahead of print.

ABSTRACT

BACKGROUND: Although road traffic injuries (RTIs) pose a significant public health burden in the Gulf Cooperation Council countries (GCC), the true extent of motorcycle crash injuries (MCCIs) remains unclear because of limited published data from this region. Emerging evidence suggests that MCCIs are on the rise because of the growing use of motorcycles for transport and delivery services, even though road safety overall has improved. We sought to review regional evidence on MCCIs' patterns, key risk factors, and temporal trends to inform policy interventions and research priorities for effective prevention.

METHODS: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Articles on GCC MCCIs published from July 2008 to October 2025, examining injury patterns, mortality, and safety practices, were included in the review. Search was conducted across PubMed, Scopus, Google Scholar, and grey literature sources. The GCC consists of six countries: Saudi Arabia (KSA), Qatar, Kuwait, the United Arab Emirates (UAE), Bahrain, and Oman.

RESULTS: Of 1344 studies identified, 9 met the inclusion criteria and were analyzed. The GCC has seen an increase in the number of motorcycles registered, resulting in higher MCC rates over time. During the COVID-19 pandemic, these rates surged again as the delivery sector grew. MCCI victims were mainly young males (mean age of 29 years). Extremity injuries were the most frequent (two-thirds), followed by head injuries (20-41%), often associated with poor helmet use compliance (range 13-17%). Delivery riders represented a high-risk subgroup, reflecting occupational exposure, fatigue, and time pressure. Despite advances in trauma care, geographic gaps persist. Helmet use non-compliance, alcohol use, and inadequate documentation remain significant risk factors. Extremity injuries were the most common in the GCC.

CONCLUSION: MCCIs in the GCC are on the rise with high rates of extremity and head trauma. Poor helmet use compliance is a significant factor. Therefore, we suggest strengthening helmet use laws and safety standards, increasing community efforts, and establishing motorcycle lanes with lower speed limits. Protection for riders at work should be enhanced. Road infrastructure and robust data systems also need improvement.

PMID:41564655 | DOI:10.1016/j.injury.2026.113017

Injury. 2026 Jan 11;57(3):113051. doi: 10.1016/j.injury.2026.113051. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Unstable pelvic ring fractures are severe injuries with substantial mortality and a high burden of associated injuries. Advances in trauma care have improved outcomes. However, recent data from high-volume centers remain scarce. We aimed to evaluate mortality, associated injuries, and predictors of mortality in surgically treated unstable pelvic ring fractures.

METHODS: We retrospectively analyzed 451 consecutive patients with surgically treated Tile B or C pelvic ring fractures admitted to a Level 1 trauma center between 2008 and 2021. Patient demographics, injury characteristics, and associated injuries were recorded. Kaplan-Meier methods were used to estimate survival, and Cox regression for identifying independent predictors of mortality.

RESULTS: Overall mortality at 3-month was 4.2% (95% CI 2.3-6.0) and at 1-year at 6.0% (95% CI 3.8-8.2). Tile C fractures had a higher early mortality than Tile B (3-month: 6.5% vs. 2.1%; 1-year: 7.4% vs. 4.7%). Associated injuries were common: 78% of patients had at least one and 66% had two or more injured regions. Patients with injuries in ≥2 regions had markedly higher intensive care unit (ICU) admission, transfusion requirements, and early mortality. In multivariable Cox regression, age (HR 1.06 per year), Glascow Coma Scale (GCS) ≤8 (HR 4.9), and Tile C (HR 3.6) were independently associated with 90-day mortality.

CONCLUSION: Mortality after surgically treated unstable pelvic ring fractures at 3- month and 1 year was 4.2% and 6.0%, respectively. Age, low GCS, and Tile C fracture pattern were independent predictors of early death. Associated injuries and overall trauma burden were strongly associated with ICU admission, transfusion, and early mortality.

PMID:41558223 | DOI:10.1016/j.injury.2026.113051

Injury. 2026 Jan 10;57(3):113035. doi: 10.1016/j.injury.2026.113035. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic acromio-clavicular dislocation is a challenging injury to treat. Many surgical procedures are available for its management which may be anatomical or non-anatomical. The aim of this study was to assess the clinical and radiological outcome in the patients with chronic acromio-clavicular dislocation treated by hybrid biological semitendinosus autograft and synthetic non-absorbable sutures.

METHODS: From July 2021 to January 2025, 21 patients with chronic acromio-clavicular dislocation were treated by hybrid biological semitendinosus autograft and synthetic non-absorbable sutures. Grade III to VI chronic acromio-clavicular injuries were included. Post-operatively, the patients were clinically assessed using Constant shoulder and Acromio-clavicular joint instability scores. Acromio-clavicular arthritis, coraco-clavicular ossification, distal clavicle osteolysis, coraco-clavicular and acromio-clavicular distances were radiologically evaluated.

RESULTS: The mean age at time of surgery was 28.52 ± 8.0 (range: 19-45) years. The acromio-clavicular dislocation was type III in 7 patients (33.4 %), type IV in 12 patients ( %57.1) and type V in 2 patients (9.5 %). The mean follow-up period was 24.29 ± 3.51 (range: 18-30) months. The mean post-operative Acromio-clavicular joint instability and Constant shoulder scores were 93.14 ± 8.16 (range: 78-100) and 90.14 ± 8.16 (range: 80-100) points respectively. None of the patients showed recurrent dislocation, arthritis and distal clavicle osteolysis.

CONCLUSION: Bi-modal stabilization using hybrid biological semitendinosus autograft and synthetic non-absorbable sutures is an effective and reliable surgical option to treat chronic acromio-clavicular dislocation. Most of the reported complications associated with this procedure didn't affect the functional outcome.

PMID:41558222 | DOI:10.1016/j.injury.2026.113035

Injury. 2026 Jan 10:113050. doi: 10.1016/j.injury.2026.113050. Online ahead of print.

ABSTRACT

BACKGROUND: Vascular compromise is a serious complication in free-flap surgery for traumatic reconstruction or fracture-related infections, often leading to partial or total flap loss if not detected promptly. We evaluated transcutaneous partial pressure of carbon dioxide (TcPCO₂) real-time monitoring as an objective, non-invasive method for ultra-early detection of vascular compromise in free flap reconstruction.

METHODS: This sequential cohort study consisted of a retrospective development phase and a prospective validation phase. An abnormality was defined as a rise of >10 mmHg from the baseline TcPCO₂ value, with re-exploration performed if the elevation persisted after recalibration. High-resolution (1-s interval) TcPCO₂ data were analyzed to assess diagnostic accuracy and concordance with arterial partial pressure of carbon dioxide (PaCO₂).

RESULTS: In pilot studies, TcPCO₂ increased within 20-100 s of induced ischemia and correlated strongly with PaCO₂ (r = 0.708, p < 0.001). Among 81 clinical free flap cases (50 retrospective, 31 prospective), TcPCO₂ monitoring detected all seven episodes of vascular compromise with 100% sensitivity and specificity, and no false positives. All the compromised flaps were successfully salvaged. Compared with conventional clinical assessment, TcPCO₂ monitoring provided earlier recognition of perfusion disturbances.

CONCLUSION: TcPCO₂ monitoring is a non-invasive, objective, and reproducible tool for ultra-early detection of vascular compromise in free flap surgery. Its implementation enables timely re-exploration, reduces reliance on subjective bedside assessments, and may significantly improve flap salvage outcomes.

PMID:41549011 | DOI:10.1016/j.injury.2026.113050

Injury. 2026 Jan 10:113026. doi: 10.1016/j.injury.2026.113026. Online ahead of print.

ABSTRACT

BACKGROUND: The 2023-2025 war on Gaza has severely impacted healthcare infrastructure, necessitating the establishment of makeshift facilities to manage war-related injuries. This study evaluates the outcomes and resource accessibility for emergency laparotomy or thoracotomy injuries in a makeshift trauma surgery unit in Gaza during the war.

METHODS: A prospective cohort study was conducted from July 16 to August 31, 2024, including consecutive patients with war-related injuries who underwent emergency laparotomy or thoracotomy, with 30-day follow-up. Obstetrics and gynecology facilities were repurposed as a trauma surgery unit. Outcomes included mortality, complications, unplanned reoperations, and resource accessibility.

FINDINGS: Among 79 patients, 84% (66/79) sustained injuries due to blast mechanism, of which 53% (35/66) were prehospital reported as caused by airstrikes. 94% (74/79) underwent emergency laparotomy, 9% (7/79) underwent emergency thoracotomy, and 3% (2/79) underwent both surgeries. In-hospital mortality was 32% (25/79). Postoperative complications occurred in 69% (51/74), with surgical site infections being the most common (58%, 43/79). Additionally, 15% (11/74) required an unplanned return to the operating theater. Only 5% (4/79) had access to preoperative CT imaging. 62% (49/74) of patients were treated postoperatively in corridors or outdoors. 56% (24/43) of patients were lost to follow-up by day 30.

CONCLUSION: This study describes severe truncal trauma managed in a makeshift civilian facility with limited medical resources, where non-surgical hospital spaces were repurposed for trauma care. High rates of mortality and postoperative complications were observed, and basic surgical resources were unavailable for the majority of patients. A trauma database was able to be maintained despite the constraints of a humanitarian crisis.

PMID:41549010 | DOI:10.1016/j.injury.2026.113026

Injury. 2026 Jan 10;57(3):113027. doi: 10.1016/j.injury.2026.113027. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma results in approximately 1.19 million deaths and 20-50 million disabilities globally each year. With increasing industrialization, road traffic injuries have become a leading cause of Disability Adjusted Life Years and traumatic amputations. These sudden amputations often lead to significant psychological distress. This study aims to assess the effectiveness of psychosocial interventions in enhancing the Quality of Life of post-traumatic amputees.

MATERIAL AND METHODS: This randomized controlled trial enrolled 74 post-traumatic extremity amputees aged over 18 years, who were cognitively coherent, had adequate social support, and no prior psychological illness. Following baseline psychosocial assessment, participants were randomly assigned to two groups: Group A (n = 39) received conventional care, while Group B (n = 35) received both psychosocial intervention and conventional care for seven weeks. Psychosocial outcomes were reassessed in both groups at the eighth week post-intervention.

RESULTS: Quality of life showed significant improvement in both the groups. However, there was no significant difference between the groups. Level of depression, anxiety and stress significantly decreased in both the groups at 8 weeks, but the difference was not significant between the groups. However, body image showed a significant improvement in Group B as compared to Group A (p = 0.023).

CONCLUSION: Our study did not show any observable positive effects of psychosocial intervention over conventional care on quality of life, depression, stress, or anxiety except on body image. We hypothesize that positive results might be seen in quality of life of amputees if a larger study with longer duration of psychosocial intervention is conducted.

PMID:41548408 | DOI:10.1016/j.injury.2026.113027

Injury. 2026 Jan 9;57(3):113019. doi: 10.1016/j.injury.2026.113019. Online ahead of print.

ABSTRACT

BACKGROUND: Percutaneous sacroiliac (SI) screw fixation is a widely used technique for stabilizing sacral fractures but is considered technically demanding due to complex pelvic anatomy and proximity to neurovascular structures. Conventional fluoroscopy-guided methods are associated with a relatively high risk of screw misplacement and considerable radiation exposure to patients and staff. Robotic-assisted navigation systems have been introduced to enhance screw accuracy and reduce radiation exposure. The aim of this study was to assess the efficiency, safety, and accuracy of sacroiliac screw fixation using a robot-assisted method compared with a conventional freehand technique.

METHODS: Medical records of patients treated with sacroiliac screw fixation for sacral fractures at a single Level 1 trauma center between December 2014 and August 2025 were retrospectively analyzed. Patients were divided into robotic-assisted and freehand fluoroscopy-guided groups for comparative analysis. Primary outcomes were intraoperative radiation exposure and operative time; secondary outcomes included screw position accuracy and complications. Statistical analysis was performed with significance set at p < 0.05.

RESULTS: Twenty-five patients (mean age: 57.7 ± 22.4 years) were included; 15 in the robotic-assisted and 10 in the conventional fluoroscopy-guided groups. A total of 47 SI-screws were inserted: 29 in the robotic group and 18 in the conventional group. Operative times were comparable between groups (47.1 ± 16.3 min and. 45.1 ± 30.0 min, respectively; p = 0.85). Compared to conventional fluoroscopy, robotic assistance was associated with reduced fluoroscopy time (55.1 ± 23.1 vs. 181.1 ± 104.4 s, p=0.053) and higher screw placement accuracy (94 % vs. 62 %, p = 0.06), although these did not reach statistical significance. No major intraoperative complications occurred.

CONCLUSION: Robotic-assisted navigation in sacroiliac screw insertion can potentially lower radiation exposure and improve screw placement accuracy compared to conventional techniques, without prolonging surgical time. These findings support robotic guidance as a safe and potentially more precise alternative for sacral fracture fixation. Further prospective studies should be performed to evaluate the possible benefits of robotic assisted sacroiliac screw fixation.

PMID:41548407 | DOI:10.1016/j.injury.2026.113019