Injury. 2025 Jul 27;56(10):112626. doi: 10.1016/j.injury.2025.112626. Online ahead of print.

ABSTRACT

Burn injuries result in profound and enduring consequences that extend well beyond the initial physical trauma. Although survival rates have significantly improved in recent decades, particularly in high-income countries, many survivors continue to experience complex psychological and social challenges that persist long after discharge from hospital care. This review outlines the current understanding of the psychological and social impacts of burn injuries and highlights key strategies to support survivors and their families through each stage of recovery. Common psychological concerns include post-traumatic stress, anxiety, depression, and disruptions to self-perception. These issues frequently emerge early in the recovery process and may endure for several years, influencing daily functioning, interpersonal relationships, and the ability to return to work. Caregivers are also affected, often experiencing emotional fatigue and psychological strain, particularly when access to support services is limited. Reintegration into everyday life is frequently marked by social stigma and exclusion, with children and adolescents being especially vulnerable due to ongoing identity development. Holistic recovery requires more than physical rehabilitation; it requires a coordinated, multidisciplinary approach that incorporates psychological support, social reintegration, and long-term follow-up. Interventions such as cognitive-behavioural therapy, peer and family support programs, and digital health platforms have shown promise in addressing these needs. While some individuals report personal growth following burn trauma, outcomes are influenced by various factors, including mental health history, community context and available support. Psychosocial care must be responsive to cultural and developmental differences and accessible across diverse settings. Innovations such as virtual reality and telehealth are increasingly valuable in bridging service gaps, particularly for individuals in rural or underserved areas.

PMID:40753695 | DOI:10.1016/j.injury.2025.112626

Injury. 2025 Jul 29;56(10):112635. doi: 10.1016/j.injury.2025.112635. Online ahead of print.

ABSTRACT

INTRODUCTION: The far cortical locking (FCL) system reduces axial stiffness in locked plating constructs while maintaining construct strength, thereby promoting secondary bone healing following fracture fixation. However, studies evaluating its efficacy compared with standard locked plating (LP) systems for upper extremity fractures remain limited. This study compared humeral shaft fractures treated with minimally invasive plate osteosynthesis (MIPO) using either the FCL or LP system.

MATERIALS AND METHODS: We analyzed 40 patients with diaphyseal humeral fractures treated with MIPO using either FCL or LP and conducted a matched-pair comparative analysis. Prospective data were collected from 20 consecutive patients who underwent MIPO with FCL. A matched case-control cohort was constructed by pairing MIPO cases using LP with the most closely matched FCL cases. The primary outcome was a comparison of radiographic and clinical fracture healing, as well as complications, between the two groups using statistical analysis. Statistical significance was set at p < 0.05.

RESULTS: Union was achieved in 18 of 20 cases (90 %) in the FCL group at a mean of 13.6 weeks. All 20 cases in the LP group achieved union after a mean of 20.1 weeks. Time to union was significantly shorter in the FCL group (p < 0.05), though the union rate did not differ significantly (p = 0.49). Near cortex healing occurred at a mean of 11.2 weeks in the FCL group and 18.8 weeks in the LP group (p < 0.01). Two FCL cases required revision surgery due to screw breakage or pull-out at the proximal fracture segment. Mean coronal and sagittal angulations were 2.9° and 4.8° in the FCL group, and 2.4° and 3.3° in the LP group, with no significant differences (p = 0.60 and 0.24). No significant differences in functional outcomes were observed between the groups.

CONCLUSIONS: The FCL group showed significantly faster union compared to the LP group, but no significant differences in union rate, alignment, or functional outcomes. Although not statistically significant, a 10 % complication rate was observed in the FCL group. Caution is warranted, as FCL screws may fail at the proximal fracture segment, either by breakage due to mechanical overload or by pull-out.

PMID:40753694 | DOI:10.1016/j.injury.2025.112635

Injury. 2025 Jul 24;56(10):112621. doi: 10.1016/j.injury.2025.112621. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate and compare the medium- to long-term outcomes of the Femoral Neck System (FNS), FNS combined with the Anti-Rotation Screw (ARS), and Multiple Cancellous Screws (MCS) in the treatment of femoral neck fractures in young and middle-aged patients.

METHODS: A retrospective, multi-group comparative cohort study was conducted on 731 young and middle-aged patients with femoral neck fractures treated at Level I Trauma Center between September 2019 and January 2024. Patients were divided into three groups based on the surgical method: FNS group (327 cases), FNS+ARS group (120 cases), and MCS group (284 cases). Postoperative follow-up assessments included fracture healing time, functional scores (Harris Hip Score [HHS], Oxford Hip Score [OHS], Hip Outcome Score [HOS]), and complication rates (femoral neck shortening, femoral head necrosis, nonunion, and implant-related complications).

RESULTS: Key findings demonstrated the FNS+ARS group achieved significantly faster fracture healing (10.21 ± 1.33 weeks) versus FNS (12.52 ± 1.91) and MCS (13.57 ± 2.13 weeks; P = 0.036). Functional outcomes consistently favored FNS+ARS across all timepoints:3 months: HHS (61.54 ± 2.98 vs 58.15 ± 2.34 vs 54.43 ± 2.79, P < 0.001), OHS (37.19 ± 2.35 vs 43.20 ± 2.91 vs 42.89 ± 3.00, P < 0.001), HOS (33.59 ± 2.39 vs 32.21 ± 2.32 vs 30.39 ± 2.72, P < 0.001);6 months: HHS (87.35 ± 5.58 vs 81.95 ± 5.99 vs 76.54 ± 5.45, P < 0.001), OHS (22.66 ± 2.78 vs 25.96 ± 3.64 vs 27.66 ± 4.81, P < 0.001), HOS (76.02 ± 5.47 vs 75.42 ± 7.63 vs 73.38 ± 6.75, P < 0.001);Final follow-up: HHS (91.95 ± 9.06 vs 90.38 ± 11.21 vs 87.67 ± 11.71, P < 0.001), OHS (21.04 ± 8.71 vs 20.41 ± 7.88 vs 23.40 ± 10.18, P < 0.001), HOS (87.51 ± 12.93 vs 85.84 ± 16.22 vs 85.98 ± 15.00, P < 0.001);Complication rates were significantly lower with FNS+ARS, particularly for femoral neck shortening (2.50 % vs 8.87 % vs 5.28 %; P = 0.031) and avascular necrosis (6.67 % vs 10.92 %; P = 0.040).

CONCLUSION: FNS combined with ARS outperformed FNS and MCS in promoting fracture healing, reducing postoperative complication rates, and accelerating functional recovery.

PMID:40752181 | DOI:10.1016/j.injury.2025.112621

Injury. 2025 Jul 28:112625. doi: 10.1016/j.injury.2025.112625. Online ahead of print.

ABSTRACT

INTRODUCTION: Uncontrolled rib fracture pain can lead to hypoventilation, impaired airway clearance, and progression to respiratory failure and death. Pain control is a mainstay of treatment, but pain assessments are most commonly obtained while a patient is at rest. A novel approach is to assess movement-evoked pain in order to better capture pain that limits physical function. We hypothesized that movement-evoked pain scores (MPS) for patients with rib fractures would be higher than resting pain scores (RPS) and would better correlate with opioid administration.

METHODS: A retrospective observational study was performed at a single Level 1 trauma center. Adult trauma patients (≥18 years old) admitted between January and March of 2022 with at least one rib fracture were included. Patients with other significant injuries (non-chest AIS >2) or those unable to self-report pain scores were excluded. Pain was scored on a 0-10 scale, with 10 indicating the most severe pain. RPS and MPS obtained at the same time during the first ten hospital days were averaged, and the means were compared using paired t-tests. Additionally, mean daily morphine milligram equivalents (MME) were analyzed.

RESULTS: The cohort consisted of 80 patients (median age 69 [IQR 48-79]; 65 % male; 88 % white). The majority were involved in blunt trauma (95 %) with a median length of admission of 4 days (IQR 2-8). The median number of rib fractures was 4 (IQR 2-6), and the median injury severity score was 10 (IQR 9-14). A total of 1692 paired pain scores from 416 patient hospital days were analyzed with higher mean daily MPS across all hospital days (p < 0.001). MPS and RPS differed for 79 % of patient hospital days, with a mean difference of 2.3 (SD 1.4, p < 0.001). Higher mean daily MPS were correlated with higher mean daily opioid use (R2=0.54), and days with differing scores had higher mean MME [42.5 (SD 49.6) vs 23.6 (56.1)].

CONCLUSIONS: Resting and movement-evoked pain scores for patients with rib fractures varied significantly, and movement-evoked pain scores were consistently higher. Opioid use was positively correlated with movement-evoked pain scores. Utilization of movement-evoked pain scores may improve patient pain control and outcomes.

PMID:40750533 | DOI:10.1016/j.injury.2025.112625

Injury. 2025 Jul 27:112628. doi: 10.1016/j.injury.2025.112628. Online ahead of print.

NO ABSTRACT

PMID:40750532 | DOI:10.1016/j.injury.2025.112628

Injury. 2025 Jul 16:112617. doi: 10.1016/j.injury.2025.112617. Online ahead of print.

ABSTRACT

OBJECTIVE: Electrical burn injuries associated with copper wire theft represent a unique and dangerous subset of injuries observed in clinical practice. Economic hardship and the high value of copper wires drive some individuals to engage in the risky act of scavenging wires, often cutting them directly from live electrical poles. This study aims to investigate the prevalence and clinical outcomes of electrical burn injuries resulting from copper wire theft.

METHODS: This retrospective analysis reviewed medical records of patients presenting with electrical burns caused by contact with live electrical wires in urban settings. Cases were included if patient histories, eyewitness accounts, or police reports confirmed illegal wire cutting as the cause of injury. Data collected included demographic information, total body surface area (TBSA) burned, associated injuries such as fractures and amputations, creatine kinase (CK) levels, and mortality outcomes.

RESULTS: Thirty-six patients were included, with an average age of 27.72 (14.58) years, the majority of whom were male (97 %). The mean TBSA burned was 16.19 %. Fractures were reported in 22 patients (61 %), and 10 patients (28 %) underwent amputations of digits or limbs. Eight individuals (22 %) did not survive their injuries. Statistical analysis revealed a significant relationship between mortality and factors such as TBSA (P = 0.0001), amputation (P = 0.0001), CK levels, and ICU length of stay (P = 0.0001). Additionally, elevated CK levels were strongly correlated with longer ICU stays (P = 0.0001).

CONCLUSION: Electrical burn injuries linked to copper wire theft are severe and frequently lead to debilitating outcomes such as amputations, fractures, and high mortality rates. These injuries highlight the intersection of economic desperation and public health risk. Preventive efforts should prioritize educational campaigns, socio-economic interventions, and stringent measures to deter copper wire theft.

PMID:40744782 | DOI:10.1016/j.injury.2025.112617

Injury. 2025 Jul 27:112630. doi: 10.1016/j.injury.2025.112630. Online ahead of print.

ABSTRACT

BACKGROUND: Ideal blood transfusion practices have evolved over the last decade, with updated recommendations for the plasma:red blood cell (RBC) ratio. A ≥ 1:1 ratio of plasma:RBC has been associated with improved survival. The objective of the current study was to evaluate interhospital variation in plasma:RBC ratio and the associated inpatient mortality.

METHODS: All adult patients (≥18 years) with severe injuries undergoing transfusion within 4 hours of admission were identified in the 2020-2021 Trauma Quality Improvement Program database. Transfusion was considered balanced when whole blood or a ≥ 1:1 ratio of plasma:RBC units was administered. Multilevel mixed-effects models were utilized to generate empirical Bayesian estimates of random intercepts for risk-adjusted plasma:RBC ratio at each center, with centers in the highest quartile labeled High-Ratio Centers (HRC). Multivariable logistic regression was constructed to identify factors independently associated with mortality.

RESULTS: Of 35,215 patients receiving care across 424 facilities, 38.0% were admitted to HRC. An estimated 17% of plasma:RBC variation was attributable to hospital effects (intraclass correlation coefficient = 0.17). Following risk-adjustment, HRC (Adjusted Odds Ratio [AOR] 0.81, 95% Confidence Interval [CI] 0.76-0.86) and balanced transfusion (AOR 0.92, 95%CI 0.86-0.98) were associated with reduced odds of mortality. The association of HRC with lower odds of mortality persisted when examining only unbalanced transfusions (n = 28,280, AOR 0.84, 0.78-0.90 95%CI).

DISCUSSION: Care at centers with high plasma:RBC ratios was linked to reduced mortality, even among unbalanced transfusion. Our findings demonstrate the utility of this value as a hospital quality metric.

PMID:40744781 | DOI:10.1016/j.injury.2025.112630

Injury. 2025 Jul 26:112629. doi: 10.1016/j.injury.2025.112629. Online ahead of print.

NO ABSTRACT

PMID:40744780 | DOI:10.1016/j.injury.2025.112629

Injury. 2025 Jul 15;56(10):112615. doi: 10.1016/j.injury.2025.112615. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the economic burden of hip fracture hospitalizations associated with mental health and substance use (MHSU) disorder.

METHODS: We retrospectively analyzed the National Inpatient Sample 2016-2020. Patients 65 years and older with hip fracture-related ICD-10 diagnosis and discharge codes were selected. Pre-defined by Clinical Classification Software (CCS), we identified 34 MHSU groups. We analyzed MHSU disorders in two ways: first, we looked at patients with at least one MHSU disorder to compare demographic and clinical characteristics; and second, we examined individual MHSU categories separately to assess their prevalence and compare costs. The dependent variable was the hospitalization cost adjusted for 2024 inflation. Multiple regression analysis with a log transformation of costs was used to assess hospitalization costs by individual MHSU categories, adjusting for confounding factors.

RESULTS: Of 274,784 inpatient hip fracture admissions, 35 % had at least one diagnosis related to MHSU. Among the 34 MHSU categories, only five had a prevalence greater than 1 %: depression (15 %), anxiety or fear-related disorders (14 %), alcohol use (3 %), opioid use (3 %), and tobacco use (9 %). Patients with MHSU were younger and had longer hospital length of stay (LOS) than patients with no MHSU (NoMHSU) (median age 80 vs. 84 years, p < 0.001; median LOS 5 days vs. 4 days, p < 0.001). The total estimated cost of hospitalization for the cohort was $30.5 billion during the study period. Patients with MHSU incurred higher mean hospitalization costs compared to NoMHSU ($22,634 vs. $22,000, p < 0.001). After adjusting for demographic, regional, and clinical factors, costs were 4 % (p < 0.001) and 6 % higher (p < 0.001) for patients with alcohol-related and opioid-related disorders, respectively, compared to those without these conditions.

CONCLUSIONS: The economic burden of hip fractures in older adults is significant and exacerbated by the presence of substance use disorders, particularly alcohol- and opioid-related, underscoring the need for targeted policies and clinical interventions to optimize care and resource allocation for this population.

PMID:40743636 | DOI:10.1016/j.injury.2025.112615

Injury. 2025 Jul 3:112562. doi: 10.1016/j.injury.2025.112562. Online ahead of print.

ABSTRACT

Not available.

PMID:40738828 | DOI:10.1016/j.injury.2025.112562

Injury. 2025 Jul 22:112623. doi: 10.1016/j.injury.2025.112623. Online ahead of print.

ABSTRACT

PURPOSE: Inferior vena cava (IVC) filters are considered for preventing fatal pulmonary embolism (PE) in patients unable to undergo anticoagulant therapy. Trauma patients face a heightened risk of PE due to immobility and hypercoagulability. Although effective, IVC filters have long-term risks and should be removed when no longer indicated. A dedicated follow-up clinic can improve IVC filter retrieval rates and minimize complications. This study evaluates the impact of a dedicated clinic on retrieval rates, complications, and follow-up.

METHODS AND MATERIALS: A retrospective analysis was conducted on trauma patients with IVC filters inserted between October 2011 and October 2021. A dedicated trauma clinic, established in January 2018, followed discharged patients with inserted IVC filters. Inclusion criteria included prophylactic and therapeutic indications and emergent presentations. Patients who died during hospitalization or had filters retrieved at other hospitals were excluded.

RESULTS: During the pre-clinic period, 639 IVC filters were inserted, and 380 (59.5 %) were retrieved, with an average dwell time of 200 days. In the post-clinic period, 332 filters were inserted, and 278 (83.8 %) were retrieved, with a reduced average dwell time of 150 days. Complications decreased from 37 cases (average dwell time: 303 days) pre-clinic to 10 cases (average dwell time: 187 days) post-clinic.

CONCLUSION: The establishment of a dedicated follow-up clinic significantly improved IVC filter retrieval rates and reduced dwell times at this trauma center. This study highlights the value of follow-up clinics in ensuring timely IVC filter retrieval and minimizing complications when filters are no longer clinically required.

PMID:40738827 | DOI:10.1016/j.injury.2025.112623

Injury. 2025 Jul 24;56(10):112611. doi: 10.1016/j.injury.2025.112611. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize the mechanisms, distribution, and outcomes of traumatic limb amputations among military casualties during the Israel-Hamas War, and to evaluate the association between life-saving interventions and survival.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study analyzed data from the Israel Defense Forces Trauma Registry. The cohort included 3253 urgent battlefield casualties who sustained limb injuries and were treated by IDF medical forces between October 27th, 2023 and October 31st, 2024.

MAIN OUTCOMES AND MEASURES: The primary outcomes were anatomical distribution of amputations, mechanism of injury, application of life-saving interventions (tourniquet, whole blood, freeze-dried plasma), and survival on the way to hospital admission and during hospitalization.

RESULTS: Of 3253 casualties, 135 (4.2 %) were initially recorded as having amputations. After review, 112 cases were confirmed to involve at least one amputated limb. Explosive devices were the leading cause of injury among amputees (88.9 %). Among the 112 confirmed cases, 50 (44.6 %) survived until hospital admission, and 62 (55.4 %) were pronounced dead prior to hospital arrival; 4 of the survivors died during hospitalization. Tourniquets were applied in 90 % of survivors compared to 24.2 % of deceased (p < 0.001). Whole blood and FDP were administered more frequently in survivors (60 % and 40 %, respectively) than in deceased casualties (9.7 % and 4.8 %, respectively; p < 0.001 for both). Above-knee amputations were the most common anatomical level in both groups.

CONCLUSION AND RELEVANCE: Combat-related limb amputations during the Israel-Hamas War were primarily caused by explosions and were associated with high mortality. Prompt application of life-saving interventions, particularly tourniquets and early blood resuscitation, was strongly associated with survival. These findings emphasize the critical need for rapid hemorrhage control and trauma care readiness in modern military conflict settings.

PMID:40738012 | DOI:10.1016/j.injury.2025.112611

Injury. 2025 Jul 22:112622. doi: 10.1016/j.injury.2025.112622. Online ahead of print.

NO ABSTRACT

PMID:40731241 | DOI:10.1016/j.injury.2025.112622

Injury. 2025 Jul 10;56(10):112609. doi: 10.1016/j.injury.2025.112609. Online ahead of print.

ABSTRACT

INTRODUCTION: Intraarticular scapular fractures occur mostly in high-energy injuries in contrast to glenoid fractures, which occur mostly in humeral head dislocations. In addition to open repositioning and osteosynthesis, minivascular osteosynthesis under the control of fluoroscopy and arthroscopy has been also used. Arthroscopy allows debridement of the fracture line in the intraarticular area as well as its repositioning during repositioning maneuvers under direct visualization. Furthermore, arthroscopy allows full control over the placement of osteosynthetic material in the subchondral region.

MATERIAL AND METHODS: Between 2013 and 2020, we performed osteosyntheses of 15 intraarticular fractures of the scapula using arthroscopy in addition to perioperative fluoroscopy. Patients were followed up at regular intervals at a mean of 10 days, 4 weeks, 3, 6, 12 and 24 months and 5 years after surgery including radiographic follow-up. Clinical outcomes and signs of radiological fracture healing were assessed continuously. Additionally, at 2 and 5 years after surgery, we evaluated the results according to the Constant score system. In particular, we evaluated ventral flexion of the arm, which we consider the dominant indicator of shoulder joint function.

RESULTS: There were 11 males and 4 females, mean age 37.5 (24-52) years. Perioperatively, we achieved fracture reduction with dislocation in the intraarticular region up to a maximum of 2 mm, which was measured arthroscopically and on perioperative and postoperative radiographs. We did not observe any inflammatory complications in the postoperative period. The mean duration of fracture healing was 112 days. The mean Constant score at two years after surgery was 85 points, and at five years was 87 points.

DISCUSSION: There are relatively few papers on similar topics in the world literature, but those that exist present the benefits of arthroscopy in some types of osteosyntheses of intraarticular fractures of the scapula. The most reported are osteosyntheses of the anterior glenoid in bony Bankart lesions. The numbers of patients in each paper are comparable or smaller.

CONCLUSION: Minimally invasive osteosynthesis of intraarticular fractures of the scapula under arthroscopic control allows precise reduction of fragments. Our study demonstrated favourable outcomes of this method with minimal complications.

PMID:40729990 | DOI:10.1016/j.injury.2025.112609

Injury. 2025 Jul 21;56(10):112618. doi: 10.1016/j.injury.2025.112618. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFPs) in older adults are increasingly recognized as serious injuries with substantial morbidity. However, mortality after FFP has not been comprehensively quantified across timepoints or patient subgroups, limiting the ability to inform prognosis and guide clinical strategies. This systematic review and meta-analysis aimed to assess the 1-year mortality following FFP in patients aged ≥60 years. We also assessed the mortality at 30 days, 3 months, 6 months, 2 years, and 5 years after FFP, and the differences in mortality by geographic region, sex, fracture classification, or treatment modality.

METHODS: We conducted a systematic review and meta-analysis of studies published from inception to May 2024 in MEDLINE, Embase, and CENTRAL databases. Eligible studies reported mortality outcomes in patients aged ≥60 years with FFP. A random-effects model was used to estimate pooled mortality at prespecified time points. We assessed the risk of bias using the Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool. Subgroup analyses were conducted to assess differences by region, sex, fracture classification, and treatment modality. We conducted a sensitivity analysis including only the high-quality studies according to the JBI assessment. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS: The pooled 1-year mortality was 17 % (95 % confidence interval, 14 %-19 %). The certainty of this evidence was rated as low because of publication bias and heterogeneity. The mortality at 30 days, 3 months, 6 months, 2 years, and 5 years were 5 %, 10 %, 14 %, 26 %, and 46 %, respectively. Mortality was lower in studies from Asia than in those from Europe or North America. Male sex, lower-grade FFPs, and nonoperative management showed numerically higher mortality, though not statistically significant.

CONCLUSION: FFPs are associated with substantial short- and long-term mortality, warranting their recognition as high-risk injuries in older adults. Regional and treatment-related variation highlights the need for individualized management. Future research should clarify causal mechanisms and assess targeted interventions to reduce mortality risk.

PMID:40714375 | DOI:10.1016/j.injury.2025.112618

Injury. 2025 Jul 19:112619. doi: 10.1016/j.injury.2025.112619. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite evidence of frequent adverse psychological reactions including PTSD in major trauma survivors, psychological support represents a frequent gap in UK major trauma care pathways. North Bristol Trust Major Trauma and Plastics Psychology Service has been newly developed in response at an NHS Major Trauma Centre (MTC). The service aims to address patients' psychological needs early on and throughout recovery from major trauma, alongside physical and functional recovery. Thus, a qualitative service evaluation was conducted. It aimed to explore major trauma clinicians' perspectives and experiences of the psychology service and to identify areas of strength and opportunity for development.

METHOD: Semi-structured interviews were conducted with a purposive sample of seven major trauma clinicians working at the MTC who make referrals to, and interact with, the psychology service. Data were thematically analysed using a codebook approach.

RESULTS: Thematic analysis of qualitative data revealed five themes: (1) Necessity of specialist psychology for major trauma patients; (2) Psychological involvement facilitates patients' recovery; (3) Psychologists have an important role in supporting clinicians; (4) Requirement for service expansion; (5) Importance of psychologists' integration within a multidisciplinary team. Overall, the importance of the psychology service in facilitating patients' holistic recovery was emphasised, as well as its role in emotionally and professionally supporting major trauma clinicians. Service expansion was suggested to better meet patients' needs by permitting increased provision of training and formalised support sessions for clinicians, greater involvement of psychologists in rehabilitation, and psychological support for patients' families.

CONCLUSIONS: Findings highlighted a perceived positive impact of integrated, specialist psychological support on the recovery of major trauma patients and the psychological wellbeing of major trauma clinicians. A need for future service expansion to overcome current capacity pressures and permit suggested developments was also emphasised. Replication of the psychology service in additional NHS MTCs to reach patients in other regions offers a potential solution to current inequities in post-major trauma psychological care in the UK.

PMID:40713353 | DOI:10.1016/j.injury.2025.112619

Injury. 2025 Jul 16:112612. doi: 10.1016/j.injury.2025.112612. Online ahead of print.

ABSTRACT

BACKGROUND: Shock index (SI) has been used to identify patients at risk for severe injury and predict those who require an emergent intervention. In adults, SI > 0.9 is considered elevated. Shock index pediatric age-adjusted (SIPA) modifies this threshold based on patients' age. This analysis leverages a large dataset to empirically identify threshold values of SI using a composite outcome capturing patients' need for emergent intervention.

METHODS: Pediatric patient data was abstracted from the Trauma Quality Improvement Program Participant Use Files from 2013 - 2020. 484,586 patients were included in the analysis. Area under the receiver-operator characteristic curve (AUROC) was used to empirically derive optimal cutoffs by age group. Need for emergent intervention included craniotomy, thoracotomy, laparotomy, chest tube, angioembolization, endotracheal intubation, and blood transfusion within 24 h of arrival or use of mechanical ventilation or admission to an intensive care unit.

RESULTS: Empirically derived SIPA-E cutoffs (1.23, 1.05, 0.95, and 0.85 for ages 1-3, 4-6, 7-12, and 13-17 years, respectively) were similar to established SIPA-L cutoffs (1.22, 1.22, 1.00, and 0.90). Overall accuracy was consistent between the two cutoffs with nearly equal trades of sensitivity for specificity but remain low overall (empirical cutoff sensitivity = 33.8 %, specificity = 79.5 %; established cutoff sensitivity = 26.5 %, specificity = 86.8 %).

CONCLUSIONS: Empirically derived cutoffs agreed with established cutoffs for SIPA, but overall accuracy is low. Rather than predicting broad outcomes, SIPA seems better suited to narrow cases where it has shown greater accuracy, such as the need for urgent blood transfusion.

LEVEL OF EVIDENCE: Prognostic/epidemiological; Level III.

PMID:40713352 | DOI:10.1016/j.injury.2025.112612

Injury. 2025 Jul 8;56(8):112578. doi: 10.1016/j.injury.2025.112578. Online ahead of print.

ABSTRACT

PURPOSE: Acetabular fractures remain one of the most complex injuries in orthopedic trauma surgery. Although the Judet-Letournel classification is widely accepted, it is predominantly descriptive and may offer limited intraoperative guidance. This study aims to present a simplified framework based on functional fracture orientation, distinguishing between column and transverse fracture families. Through this lens, surgical planning, reduction strategy, and fixation method selection can be facilitated.

METHODS: A five-step interpretation model was developed to classify and manage acetabular fractures. The model includes: (1) identification of primary and secondary fracture lines, (2) radiographic analysis from AP and Judet views, (3) axial CT orientation to determine fracture trajectory, (4) identification of the constant fragment, and (5) evaluation of endo-pelvic and exo-pelvic accessibility. Each fracture family was analyzed to correlate fracture morphology with specific reduction maneuvers, clamp positioning, and definitive implant placement.

RESULTS: Column fractures follow a coronal orientation when viewed on an axial CT, while transverse and T-type fractures propagate in a sagittal plane and often involve both columns. T-type fractures present an additional vertical component requiring dual-column reduction. For each fracture pattern, tailored reduction tools and implant configurations are proposed according to anatomical accessibility and biomechanical demands.

CONCLUSION: This structured approach offers a reproducible analytical tool for preoperative planning and intraoperative execution. By simplifying fracture type interpretation and aligning morphology with fixation strategy, it supports accurate surgical decision-making, enhances training for orthopedic trauma surgeons and improves fixation outcomes.

PMID:40706357 | DOI:10.1016/j.injury.2025.112578

Injury. 2025 Jul 8:112601. doi: 10.1016/j.injury.2025.112601. Online ahead of print.

ABSTRACT

BACKGROUND: Controversies remain about the decision to proceed to aortic occlusion (AO) using either REBOA or resuscitative thoracotomy (RT) in severely injured patients worldwide. Present study aims to identify and evaluate the differences in AO technique use related to patients' conditions.

MATERIAL AND METHODS: This was a comparative study using a multicenter registry of postinjury AO (October 2013-February 2022). AO via REBOA was compared with RT performed in the emergency department of facilities experienced in both procedures and documented in Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry. Participants were adult trauma patients 16 years or older who experienced AO via REBOA zone 1 vs RT. The primary outcome was to identify the differences between patients treated with RT or REBOA. Ethical committee study approval number (Maryland IRB #HCR-HP-00,055,545-11).

RESULTS: 1937 patients were included. Median age: 34 (25-49), 1599 (82.5 %) were men. Penetrating trauma: 52.4 %. REBOA was adopted in 501 (25.9 %) patients, RT in 1436 (74.1 %). Patients treated with REBOA were older (40vs32 years, p < 0.001), suffered more frequently blunt trauma (76.3 %vs37.7 %, p < 0.001) and had higher ISS (33vs26, p = 0.003). Fewer of them underwent prehospital cardio-pulmonary-resuscitation (23.2 %vs49.8 % p < 0.001); had higher median SBP and HR (83vs0, p < 0.001 and 106vs0, p < 0.001 respectively), serum lactate levels were lower (7.5vs10.3 p < 0.001). SBP≥ 60 mmHg pre-hospital and at-admission (OR 2.27) and GCS>8 at admission (OR 2.24), trauma cases admitted/year (>4000/year, OR 4.41), transfer from another trauma center (OR 1.94) were related to the use of REBOA. Higher Injury severity score (ISS >55, OR 0.66), lower number of trauma treated (<4000/year, OR 0.66) and penetrating trauma (OR 0.24) were related to the use of RT.

CONCLUSION: REBOA was more frequently used for older patients with blunt trauma, higher prehospital systolic blood pressure, and Glasgow Coma Scale scores above 8. RT was more commonly performed in penetrating trauma, lower injury severity scores, and facilities with fewer annual trauma admissions. These findings suggest that patient characteristics and institutional factors significantly differed between patients treated with REBOA or RT, underscoring the need for further research.

PMID:40701854 | DOI:10.1016/j.injury.2025.112601

Injury. 2025 Jul 8;56(8):112602. doi: 10.1016/j.injury.2025.112602. Online ahead of print.

ABSTRACT

BACKGROUND: Cork University Hospital (CUH) is a model 4 tertiary referral centre in the south of Ireland. A robust Orthopaedic - Orthogeriatric co-management service manages close to 500 hip fractures per year. At CUH all adults aged 60 years or older admitted with hip fracture receive comprehensive geriatric assessment (CGA) and documentation of their frailty status.

OBJECTIVE: This study aims to review the clinical epidemiology of hip fractures in a specialist orthopaedic unit in Ireland, while examining the association between CFS and prespecified patient outcomes.

DESIGN & METHODS: Utilising the Irish hip fracture database (IHFD), we collected data between 1st July 2019 to September 30th 2021. Eligible cases were all adults aged 60 years and older admitted to CUH with hip fracture as defined by IHFD. Prespecified outcomes included Length of Stay (LOS), inpatient mortality and new admission to nursing home care and these were analysed in relation to a patients CFS.

RESULTS: 1132 adults met fracture criteria and were included in the study. Increasing frailty, specifically moderate to severe frailty was associated with increased LOS, inpatient mortality and increased likelihood of discharge to nursing home care when compared to those were not frail or who had very mild to moderate frailty.

CONCLUSIONS: People living with very mild to moderate frailty and severe frailty are at significant risk of hip fracture following low volume trauma. With approximately two years of hip fracture data, we found visible, generalizable data demonstrating the association between frailty and clinical outcomes.

PMID:40700919 | DOI:10.1016/j.injury.2025.112602