Injury. 2025 May 7;56(7):112412. doi: 10.1016/j.injury.2025.112412. Online ahead of print.

ABSTRACT

BACKGROUND: Ferrous metal foreign bodies (FMFBs) are often the most common metallic foreign bodies for the widespread application and low price of ferrous metal, but these bodies are very tiny and with the uncertainty of the position, it is very difficult to find them and get them out without a hitch. Our aim was to evaluate the reliability of retrieval of FMFBs from limbs soft tissue aided by a permanent magnet. In addition, we sought to analyze the outcomes of retrieval of FMFBs from limbs soft tissue aided by a permanent magnet.

METHODS: twenty-two patients with FMFBs in limbs soft tissue who underwent surgical intervention were included between September 2022 and April 2024. Preoperative X-ray localization and intraoperative magnet assistance were performed on all patients. Clinical evaluations included operation time and postoperative complications. The mean follow-up period was 10 ± 2.4 months.

RESULTS: these FMFBs have been got out successfully in all the cases without complications. The average distance between the foreign body and the body surface measured before surgery was 2.35 cm.The operation time ranged from 30 s to 45 min, with an average operation time of 13.7 min.

CONCLUSIONS: Retrieval of FMFBs from limbs soft tissue aided by a permanent magnet is an effective and reliable treatment without postoperative complications.

PMID:40373363 | DOI:10.1016/j.injury.2025.112412

Injury. 2025 May 8;56(7):112410. doi: 10.1016/j.injury.2025.112410. Online ahead of print.

ABSTRACT

BACKGROUND: Cephalomedullary nails (CMN) are widely used for fixation of unstable pertrochanteric fractures. In 2018, the Depuy Synthes Trochanteric Fixation Nail - Advanced (TFNA) implant was introduced at a level I academic trauma center. Subsequently, clinical concerns were raised about the use of the TFNA due to reports of nail breakage. The purpose of this study was to investigate the risk of nail breakage between TFNA and other nail models. Long term outcomes following nail failure were evaluated.

METHODS: A retrospective cohort study was conducted using data of 1665 patients who had undergone a CMN procedure between 2014 and 2020. Data were handpicked from patient records. The nail breakage and breakage time of the TFNA were compared to the TFN, PFNA, Gamma3, and Intertan using cox regression analysis and logistic regression analysis. Long term outcomes were evaluated by assessing Oxford Hip Scores (OHS).

RESULTS: The number of cephalomedullary nails were as follows: TFNA 754 (45.3 %), Gamma3 462 (27.7 %), PFNA 234 (14.1 %), TFN 211 (12.7 %), and Intertan 4 (0.2 %). A total of 21 (1.3 %) nails broke during the follow-up period. The TFNA broke the most often with 15 cases (2.0 %), followed by the Gamma3 with five cases (1.1 %) and the PFNA with one case (0.4 %). Overall, the mean (SD) nail breakage time was 222 (148) days. However, for the TFNA, Gamma3 and PFNA, the mean breakage times were 177 days (110), 292 (153) and 545, respectively. In logistic regression analysis we observed significant difference between TFNA and non-TFNA group. The odds ratio (OR) for nail breakage in TFNA group was 2.66 [95 % Ci, 1.01-6.99, p = 0.047]. The mean (SD) one year OHS for Total Hip Arthroplasty after nail breakage and overall OHS for re-osteosynthesis was 38.6 (9.8) and 36.3 (7.8), respectively.

CONCLUSIONS: Our study provides evidence suggesting that the TFNA may be associated with an increased risk of nail breakage compared to other nail models. It should be noted that implant breakage is a relatively infrequent complication. Long-term outcomes following secondary procedures were comparable between THA and re-osteosynthesis.

LEVEL OF EVIDENCE: Level IV.

PMID:40367833 | DOI:10.1016/j.injury.2025.112410

Injury. 2025 May 8;56(7):112365. doi: 10.1016/j.injury.2025.112365. Online ahead of print.

ABSTRACT

PURPOSE: Fractures in infants younger than 1 year without an obvious accidental cause raise suspicion of child abuse, warranting a skeletal survey. However, adherence to child abuse screening guidelines remains suboptimal. This study aimed to identify factors associated with skeletal survey completion in infants with fractures in the absence of a clear accidental context.

METHODS: A retrospective chart review was conducted on children younger than 1 year with at least one fracture, identified over a 6-year period (2017-2023) at a French tertiary children's hospital. Infants with fractures due to obstetric trauma or road traffic accidents were excluded. Multivariate logistic regression was used to determine factors associated with skeletal survey completion.

RESULTS: A total of 312 children were included, of whom 97 (33%) underwent a skeletal survey. Among those children, additional fractures were detected in 16 (16.5%). Skeletal surveys were more frequently performed in boys (odds ratio [OR]: 3.82, 95% confidence interval [CI]: 1.66-8.84), younger infants, and those with an inconsistent or evolving trauma explanation (OR: 17.18, 95% CI: 1.86-158.26) or no reported explanation (OR: 16.56, 95% CI: 6.30-43.54).

CONCLUSIONS: Only one-third of infants were screened for occult fractures, but the factors associated with skeletal survey completion aligned with established clinical guidelines. Long-term follow-up is necessary to assess whether the two-thirds of children who were unscreened were later identified as victims of child abuse.

PMID:40354771 | DOI:10.1016/j.injury.2025.112365

Injury. 2025 May 6;56(7):112413. doi: 10.1016/j.injury.2025.112413. Online ahead of print.

ABSTRACT

INTRODUCTION: The impact of social determinants on clinical outcomes following surgeries for orthopaedic injuries are well-documented. In this study, we sought to quantify the representation of women, racial, and ethnic minorities in US-based clinical trials for hip fracture surgery.

METHODS: This was a cross-sectional analysis of patients enrolled in US-based, interventional clinical trials for hip fractures registered on ClinicalTrials.gov (2000-2022). Participation-to-prevalence ratios (PPRs) were calculated for demographic groups in clinical trials relative to their prevalence among patients receiving hip fracture surgery in the National Inpatient Sample (2006-2015). PPRs between 0.8-1.2 were considered equitable representation. PPRs<0.8 were considered underrepresentation and PPRs>1.2 were considered overrepresentation. Temporal trends were analyzed between previous (2000-2010) and contemporary (2011-2022) periods.

RESULTS: There were thirty-eight hip fracture clinical trials involving 6937 participants included in this study. All clinical trials reported sex, but only sixteen trials (42 %) reported race and ten trials (26 %) reported ethnicity. In total, trial participants were predominately White (89.3 %) and female (68.0 %). Few patients were non-White including Asian (7.2 %), Black (2.1 %), and Hispanic (0.8 %). Female (PPR=0.97) and male (PPR=1.07) patients had equitable representation. However, Hispanic (PPR=0.22), and African American (PPR=0.51) patients were underrepresented. White patients (PPR=1.00) had equitable representation while Asian patients were overrepresented (PPR=4.50). The rate of race (P < 0.001) and ethnicity (P = 0.010) reporting increased between previous and contemporary periods.

CONCLUSION: Recruitment of racial and ethnic minorities into hip fracture clinical trials remains limited. The impact of social determinants on outcomes after trauma surgery requires equitable representation of all groups in clinical trials to ensure translatability of results. Stakeholders across healthcare, industry, and government must work to address these disparities.

PMID:40354770 | DOI:10.1016/j.injury.2025.112413

Injury. 2025 May 5:112351. doi: 10.1016/j.injury.2025.112351. Online ahead of print.

ABSTRACT

BACKGROUND: Chest wall injury is common among trauma patients. Generally, patients with more medical problems tend to have worse outcomes with rib fractures. Our aim was to determine if surgical stabilization of rib fractures (SSRF) increases the likelihood of discharge to home.

METHODS: We performed a retrospective cohort study of patients with ≥1 comorbidity, aged 18-99 with rib fractures from five Chest Wall Injury Society (CWIS) Collaborative Centers. Discharge disposition of patients who underwent SSRF was compared to those who did not undergo surgery. Discharge to home was considered the ideal state to which other discharge dispositions were compared. For the model to estimate discharge to a rehabilitation hospital or skilled nursing facility, a multivariable logistic regression analysis was performed.

RESULTS: 790 patients with ≥1 comorbidities and rib fractures were identified, and 545 (61.8 %) patients were discharged to home. Logistic regression analysis demonstrated SSRF (0.33 (0.15 - 0.75)) and tobacco use (0.62 (0.39 - 0.96)) were independently associated with discharge to home.

CONCLUSION: In patients with rib fractures and at least one comorbid condition, SSRF is associated with discharge to home. Counterintuitively, tobacco use was also associated with discharge to home.

LEVEL OF EVIDENCE: Level II STUDY TYPE: Therapeutic/Care Management.

PMID:40350351 | DOI:10.1016/j.injury.2025.112351

Injury. 2025 Apr 29;56(7):112359. doi: 10.1016/j.injury.2025.112359. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency interhospital transfer can be conducted using either ground-based emergency medical services (GEMS) or helicopter emergency medical services (HEMS). The choice between these modes of transportation relies mostly on urgency and transfer distances, however they are further influenced by road traffic, weather and resource availability. While some studies suggest that HEMS may improve survival rates for severely injured patients, the time efficiency of HEMS versus GEMS across varying distances remains underexplored.

METHODS: This retrospective clinical cohort study analyzed 1784 emergency interhospital transfers from 11 hospitals to Innsbruck University Hospital in Austria, over a 10-year period (2013-2023), comparing efficiency of GEMS and HEMS across distances from 11 hospitals within a 115 km radius. Outcome assessment included time duration of distinct phases of transfer, including dispatch time, isolated transport duration, overall transfer duration, total resource occupancy time, and cost efficiency.

RESULTS: HEMS was primarily used for longer distances, while GEMS were almost exclusively used for transports <30 km. For hospitals >50 km away, the mean overall transfer duration was 58.1 (± 16.5) minutes for HEMS and 77.1 (± 20.3) minutes for GEMS (p < 0.001). For hospitals within 50 km, the mean overall transfer duration was 46.4 (± 13.9) minutes for HEMS and 44.0 (± 12.9) minutes for GEMS (p = 0.175). Cost analysis revealed that HEMS was significantly more expensive than GEMS, with a cost disparity of up to 17 times the cost per route.

CONCLUSION: GEMS is more efficient and should be considered for all transfers under 30 km, while HEMS offers a time advantage for distances exceeding 50 km, providing potentially crucial time savings in time-critical cases. For intermediate distances, HEMS may be justified when reducing treatment delays is essential. Decisions regarding transport modality should consider not only the distance but also urgency and the potential clinical benefits of faster treatment. Future studies should examine the clinical outcomes of different transfer modes to better guide transport decisions.

PMID:40349570 | DOI:10.1016/j.injury.2025.112359

Injury. 2025 Apr 30;56(7):112375. doi: 10.1016/j.injury.2025.112375. Online ahead of print.

NO ABSTRACT

PMID:40347809 | DOI:10.1016/j.injury.2025.112375

Injury. 2025 Apr 30;56(7):112373. doi: 10.1016/j.injury.2025.112373. Online ahead of print.

ABSTRACT

BACKGROUND: Furniture and television-associated injuries are prevalent in homes and schools, especially among young children. Collisions, tip-overs, and falls off these structures are common mechanisms of injury that often involve the head and face, resulting in emergency room visits. This study aims to estimate the number of craniofacial injuries resulting from furniture accidents in the pediatric population and offer guidance to parents and/or guardians on child safety and prevention strategies to mitigate these risks.

METHODS: The National Electronic Injury Surveillance System (NEISS) assessed furniture or television-related craniofacial injuries in children who presented to the emergency department (ED) from 2013 to 2022. Patients were included in this study if they were younger than 18 and evaluated for an isolated face, head, mouth, or neck injury. National estimates, demographics, diagnoses, location of the accident, and other clinical characteristics were analyzed. Linear regression was used to assess the incidence of injury over the 10-year period.

RESULTS: From 2013 to 2022, 1696 entries accounted for an estimated 41,914 injuries presenting to a NEISS-participating ED nationwide for pediatric craniofacial-related furniture injuries. A significant decrease in annual cases was seen over the 10-year period (R2 = 0.88, p < 0.001). The mean age of injury was 3.9 years, and most injuries were made up of toddlers aged 1-3 years old (53.3 %). Males were more frequently affected (55.8 %). The most common diagnoses were concussion/closed head injuries (48.5 %) and soft tissue injuries (24.6 %). Most children were treated and released (93.8 %), though some were hospitalized (3.03 %), and fatalities were rare (0.13 %). An estimated 21.0 % of craniofacial injuries were due to television tip-overs, and 43 % were accidents involving consumer storage units, such as furniture with drawers or hinged doors. Injuries were primarily at home (76.5 %) or at school (2.83 %).

CONCLUSION: Pediatric craniofacial injuries from furniture and television tip-overs remain a concern despite recent declines, particularly affecting infants and toddlers under four years old. Continued efforts are needed to address safety risks associated with tip-overs in the home and school settings.

PMID:40347808 | DOI:10.1016/j.injury.2025.112373

Injury. 2025 Apr 30;56(7):112370. doi: 10.1016/j.injury.2025.112370. Online ahead of print.

ABSTRACT

OBJECTIVES: Whilst the availability of clinical psychology is one of the key requirements for Major Trauma Centres (MTCs) outlined by NHS England, a previous study identified significant gaps in psychology provision across MTCs [1,2]. The present study aimed to understand whether MTC psychology services in England and Wales are fulfilling the section of the NHS standard contract for MTCs relating to psychology provision. It also sought to benchmark services against the relevant guidelines and standards published by the National Institute of Health and Care Excellence (NICE) and the Association of Clinical Psychologists UK (ACP-UK).

METHODS: All MTCs in England and Wales were contacted. Four told us that they have no specialist MTC psychology service. The remaining centres completed a questionnaire about their psychology service and rated whether it met, partially met, or did not meet the NHS standard contract and each of the NICE guidelines and ACP-UK standards. 25 MTC psychology services completed the questionnaire.

RESULTS: Variation was found across MTCs in the dedicated whole time equivalent (WTE) of psychology staffing, the banding of the most senior psychologist in each service, and the total percentage of MTC patients that are seen by psychology. Over half of services did not meet or only partially met the NHS standard contract. Many of the ACP-UK standards were either not met or only partially met by a majority of services.

CONCLUSIONS: The study indicates that significant variation in resource exists across MTC psychology services in England and Wales, leading to differences in the ability of services to meet standards and guidelines. Further work is indicated to address this variation and develop a minimum workforce model for MTC psychology services, to ensure equity of access to psychological support in MTCs across England and Wales.

PMID:40347807 | DOI:10.1016/j.injury.2025.112370

Injury. 2025 May 3;56(7):112402. doi: 10.1016/j.injury.2025.112402. Online ahead of print.

ABSTRACT

BACKGROUND: The trauma tertiary survey (TTS) is a critical step in identifying missed injuries following primary and secondary trauma assessment. The TTS is traditionally performed by junior medical professionals on a trauma unit. Despite this, increasing trauma caseloads have led to challenges with TTS adherence, missed injuries and overwork. This has prompted interest into delegating some of the TTS tasks to non-medical professionals, however the efficacy and safety of this approach is poorly characterised.

METHODS: A scoping review was conducted following Joanna Briggs Institute methodology following a comprehensive search in Medline, Embase, Emcare and CINAHL databases. The search encompassed terms related to TTS and non-medical professionals. Outcomes were related to safety and efficacy of TTS performed by non-medical professionals.

RESULTS: Four observational studies involving trauma nurses (n = 3) and midlevel providers (n = 1) as non-medical providers of the TTS were included. Overall, there was evidence to suggest TTS performed by non-medical providers had similar missed injury detection rates and saved up to 1802 h of time for trauma residents. However, non-medical professionals demonstrated variable knowledge of TTS protocols, with gaps identified in training and experience.

CONCLUSION: TTS performed by non-medical professionals appears feasible and yields comparable clinical outcomes to medical staff, with potential to alleviate medical workforce pressures. These findings are based on studies of high clinical heterogeneity and poor control for confounders.

PMID:40344858 | DOI:10.1016/j.injury.2025.112402

Injury. 2025 May 5;56(7):112400. doi: 10.1016/j.injury.2025.112400. Online ahead of print.

ABSTRACT

BACKGROUND: It is becoming increasingly important to evaluate the effectiveness of large language models (LLMs) and query-assisted platforms like Google and ChatGPT in providing clinically relevant and accurate information to patient-initiated inquiries. Limited studies have characterized the performance of these platforms on semi-elective orthopedic trauma surgeries. This study evaluates the function of both interactive online models on frequently queried patient searches on ankle and clavicle fracture operations.

METHODS: An inquiry set consisting of ten prevalent patient questions for each fracture type was extracted using Google and ChatGPT. Responses, alongside their source attributions, were curated for clinical relevance and accuracy. This assessment was conducted in a double-blind fashion. Grading was completed by two researchers with academic and clinical experience in orthopedic trauma (D.E.P, H.F.B), with oversight and validation provided by a board-certified orthopedic trauma surgeon (A.N.M). Descriptive and comparative statistics were used to understand the dataset.

RESULTS: ChatGPT performed better than Google in terms of clinical relevance (p = 0.001) and accuracy (p = 0.004) in ankle fracture patient queries. Clavicle fracture queries showed a significant difference favoring ChatGPT for accuracy (p = 0.04), though relevance did not reach statistical significance (p = 0.06). When answer ground-truth was analyzed, GPT outperformed Google by providing more academic sources (p < 0.05).

CONCLUSIONS: Large Language Models outperformed traditionally used online platforms in delivering clinically precise and contextually relevant information on semi-elective, common orthopedic trauma surgeries. The ability of LLMs to synthesize responses from credible medical sources significantly diminishes the variability and potential inaccuracies inherent in conventional web searches. These insights strongly suggest that LLMs could play a pivotal role in enhancing patient engagement and comprehension in trauma care, meriting further exploration of their integration within clinical frameworks.

LEVEL OF EVIDENCE: Therapeutic Level III.

PMID:40344857 | DOI:10.1016/j.injury.2025.112400

Injury. 2025 May 1;56(7):112374. doi: 10.1016/j.injury.2025.112374. Online ahead of print.

ABSTRACT

BACKGROUND: A small proportion of patients account for a disproportionate use of emergency healthcare services and exhibit an increased mortality. This group includes individuals with different conditions and risk-taking behaviors. Among them are persons diagnosed with personality disorders, who are particularly susceptible to injuries and intoxications-factors that contribute to an increased risk of premature death, especially from unnatural causes.. In this study in women with a personality disorder diagnosis, we hypothesized that the number of inpatient episodes due to injuries or intoxications would be independently related to the mortality risk for both natural and unnatural causes.

METHODS: A cohort of all women who received a personality disorder diagnosis in the Swedish National Patient Register during the years 1997-2015 (n = 44,221) was followed up until December 31, 2015. All inpatient treatment periods with diagnoses of injuries or intoxications were documented. Information on all deaths was obtained from The Swedish Cause of Death Register.

RESULTS: Multivariable Cox proportional hazards regressions, adjusted for relevant confounders revealed that the number of inpatient care episodes due to injuries or intoxications was independently related to later all-cause mortality, as well as mortality from unnatural and natural causes, and suicidal actions.

CONCLUSIONS: The results motivate particular attention to women with recurrent injuries or intoxications with an assessment of the need for non-emergent measures to decrease the risk of early death, including suicide.

PMID:40344856 | DOI:10.1016/j.injury.2025.112374

Injury. 2025 Apr 29;56(7):112364. doi: 10.1016/j.injury.2025.112364. Online ahead of print.

ABSTRACT

INTRODUCTION: The impact of reduction sequence on acetabular reduction quality in combined pelvic and acetabular fractures remains unclear. This study aimed to evaluate whether posterior ring reduction first improves acetabular reduction outcomes in these complex injuries.

METHODS: This retrospective cohort study included adult patients with combined pelvic and acetabular fractures treated at an urban level 1 trauma center between April 2018 and April 2024. Patients with nonoperative acetabular fractures, stable pelvic ring injuries, or nondisplaced acetabular fractures treated percutaneously were excluded. Postoperative CT scans assessed acetabular step-off and gapping. Patients were divided into two groups: the posterior-first group (posterior ring reduced first) and the non-posterior-first group (all other reduction sequences). Demographic data, fracture classification, and surgeon seniority were analyzed for potential confounding effects.

RESULTS: A total of 45 patients were included, with 22 in the posterior-first group and 23 in the non-posterior-first group. The posterior-first group demonstrated significantly higher rates of anatomical reduction for step-off (68.2 % vs 30.4 %, p = 0.017) and gapping (27.3 % vs 4.4 %, p = 0.047). There were no significant differences between groups in demographics, injury mechanism, fracture classification, Injury Severity Score (ISS), or surgeon seniority (p > 0.05). Surgeon seniority did not influence the quality of acetabular reduction (p > 0.05).

CONCLUSIONS: Posterior ring reduction first is associated with improved anatomical reduction in acetabular step-off and gapping in combined pelvic and acetabular fractures. These findings support prioritizing posterior ring reduction to optimize acetabular outcomes.

PMID:40344855 | DOI:10.1016/j.injury.2025.112364

Injury. 2025 May 1;56(7):112401. doi: 10.1016/j.injury.2025.112401. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal femur fractures (DFF) are orthopaedic injuries associated with poor outcomes, despite recent improvements in technology. Perhaps socioeconomic distress is a factor influencing DFF outcomes. The purpose of this study was to investigate the impact of social deprivation via the Area Deprivation Index (ADI) in the perioperative period after DFF.

MATERIALS AND METHODS: This was a retrospective review carried out at a Level I Academic Trauma Center of patients ≥ 55 years old with operatively treated distal femur fractures from 2000-2023. Demographic information, Charlson Comorbidity Index (CCI), Injury Severity Score (ISS), preoperative functional independence, ipsilateral or contralateral lower extremity fracture, mechanism of injury, fracture characteristics, discharge disposition, and length of stay were recorded. ADI was used to categorize patients into least deprived tercile (LDT, 0-33), intermediate deprived tercile (IDT, 34-67), and most deprived tercile (MDT, 68-100). Inpatient length of stay and discharge disposition were compared among LDT, IDT, and MDT.

RESULTS: A total of 427 patients were included in the study, 58 (13.5 %) MDT, 155 (36 %) IDT, and 214 (50.5 %) LDT. The mean age was 60.2+-18.2 years. In comparison to MDT, LDT were significantly more female (67.8 % v 53.4 %, p = 0.043), Caucasian (93.8 % v 68.4 %, P < 0.001), less likely to be injured from a fall from height (6.1 % vs 19.0 %, p = 0.032), have a prolonged length of stay (40.2 % vs 55.2 %, p = 0.041), and be a former smoker (17.7 % vs 27.8 %, p = 0.050). When controlling for gender, race, injury severity, and preoperative functional independence, MDT were 2.1 times more likely to have a prolonged hospital stay in comparison to LDT (95 % CI 1.0 - 4.5, p = 0.049). MDT were 2.9 times more likely to discharge to a skilled nursing facility or inpatient rehabilitation location (95 % CI 1.2 - 7.2, p = 0.019) in comparison to LDT after controlling for age, gender, race, alcohol use, mechanism of injury, and length of hospitalization.

CONCLUSION: Following distal femur fracture fixation, the most socially deprived patients are likely to have a longer stay in the hospital and a greater chance of non-home discharge. Future interventions should be aimed at minimizing socioeconomic barriers that impact discharge timing and location.

LEVEL OF EVIDENCE: III.

PMID:40344854 | DOI:10.1016/j.injury.2025.112401

Injury. 2025 Apr 25;56(7):112356. doi: 10.1016/j.injury.2025.112356. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare between single trans-iliac trans-sacral screw versus dual ilio-sacral screws in Management of unstable pelvic ring disruptions after achieving reduction, to facilitate union of the fracture and early mobilization.

METHODS: In a retrospective cohort study that was done in Assiut University hospital trauma unit between May 2018 to September 2020, 36 patients with unstable fracture pelvis were included in the study. Single trans-iliac trans-sacral screws were done in 16 cases while two ilio-sacral screws were done for the rest of cases. Age ranged from 18 to 57 years old, with exclusion of patients with spino-pelvic dissociation, comminuted fractures, chronic uncontrolled co-morbidities, bilateral sacral fractures. Follow up of the patients radiologically using plain X-ray and Computed Tomography scan to identify union of fractures were reported. Functional follow-up using Majeed score and Visual analogue scale were reported with allowance of weight bearing as tolerated.

RESULTS: The two groups were comparable in terms of baseline characteristics, including age, sex, and comorbidities. A significant difference was observed in Tile classification between the groups (P = 0.05), while there was no significant difference in Denis classification (P = 0.29). Operative parameters such as surgical time, fluoroscopy time, and blood loss were similar between the two groups (P > 0.05). Outcome analysis revealed that patients in the STITSS group experienced significantly less pain at six weeks post-surgery, with lower VAS scores (4.31 ± 0.87 vs. 6.38 ± 1.31; P = 0.000). However, by 3 and 6 months, the VAS scores showed no significant differences between the groups (P > 0.05). Additionally, functional outcomes measured by the Majeed score were significantly better in the STITSS group at six weeks (61.64 ± 8.55 vs. 53.15 ± 7.80; P = 0.037). Similar to pain scores, the Majeed scores equalized between the groups at 3 and 6 months, with no significant differences noted.

CONCLUSION: The study findings indicate that STITSS fixation offers better early outcomes in terms of pain relief and functional recovery compared to dual ilio-sacral screw fixation. Despite the technical challenges associated with STITSS, it allows for faster rehabilitation and a quicker return to functional activities. In the long term, however, both techniques demonstrate comparable results. Further research is needed to validate these findings and optimize fixation strategies for unstable pelvic fractures.

PMID:40344853 | DOI:10.1016/j.injury.2025.112356

Injury. 2025 May 6;56(7):112411. doi: 10.1016/j.injury.2025.112411. Online ahead of print.

ABSTRACT

INTRODUCTION: Ice hockey is a high-contact sport that can often endanger athletes' physical health, especially adolescents. Youth hockey players still learning to properly play the sport tend to be much more prone to serious injury. The goal of this study was to examine the frequency and trends of pediatric hockey-related injuries presenting to United States (US) emergency departments (EDs) amongst youth.

METHODS: Ice hockey-related injuries presenting to US EDs from January 1st, 2014 to December 31st, 2023 were queried using the National Electronic Injury Surveillance System (NEISS). For each injury, patient disposition, demographics, diagnosis, and site of injury were recorded. National estimates (NEs) were calculated using the NEISS statistical sample weights. Injury trends were evaluated by linear regression modeling.

RESULTS: There was a total of 3847 ED visits due to ice hockey-related injuries during the study period, resulting in an NE of 110,293 injuries. Linear regression analysis displayed no significant trend in annual injuries among females (p = 0.079) or males (p = 0.911). The frequency of injuries during 2014-2019 remained relatively steady, aside from a 46.0 % decrease from 2019 (n = 11,001) to 2020 (n = 5944), which returned to the original incidence level by 2022 (n = 12,963). A sudden increase in hospitalization rate post-pandemic was observed (p = 0.109), where the rate dramatically rose from 0.1 % to 5.6 %. Dislocations (8.5 %) had the highest rate of hospitalization amongst diagnoses. The most common injuries amongst all hockey players were injuries to the head (n = 37,816, 34.2 %) and shoulder (n = 16,836, 15.3 %). We observed a significant increase in head (p = 0.041) and shoulder (p = 0.020) injuries after 2020.

CONCLUSION: Although the overall number of injuries amongst youth hockey players did not change significantly over time, we saw a significant increase in head and shoulder injuries. Additionally, the hospitalization rate from these injuries has increased recently post-pandemic. The high and increasing frequency of head and shoulder injuries emphasizes the importance of proper protective equipment to these areas in pediatric athletes.

PMID:40344852 | DOI:10.1016/j.injury.2025.112411

Injury. 2025 Apr 22;56(7):112342. doi: 10.1016/j.injury.2025.112342. Online ahead of print.

ABSTRACT

BACKGROUND: The current standard of care for surgically managed tibia shaft fractures is intramedullary nailing. Chronic postoperative knee pain is the most common complication of the infrapatellar technique in intramedullary nailing. Literature suggests it may be related to infrapatellar nerve injury.

OBJECTIVE: This study compares the incidence of anterior knee pain after tibia nail insertion between conventional longitudinal and transverse incisions.

METHODS: This clinical trial study was conducted in our Level I trauma center from February 2022 to August 2024. Patients with closed diaphyseal tibia fractures were included in this study. All the cases were treated with reamed statically locked intramedullary nailing. The patients were randomly allocated to the longitudinal infrapatellar approach group (LIPAG) and transverse infrapatellar approach group (TIPAG). The primary outcomes measured at every follow-up included anterior knee pain by visual analog scale (VAS), numbness by monofilament test, range of motion, quality of life, and union success. Postoperative follow-up was performed at 2, 6, and 12 weeks and 6, and 12 months.

RESULTS: In our study, significant improvements in pain, quality of life, and functionality were observed in both groups; however, only the changes in numbness sensation and numbness pattern were significantly different between the two groups. TIPAG demonstrated earlier resolution of numbness compared to the LIPAG, and the numbness region significantly differed between the two groups, with LIPAG demonstrating more lateral numbness and TIPAG demonstrating more inferolateral numbness. However, no significant difference was observed between the two groups regarding operation time, length of stay, union outcome, pain, range of motion, or quality of life.

CONCLUSION: Transverse and longitudinal incisions for tibia IMN give comparable long-term results in pain relief, functional recovery, and quality of life.

PMID:40344851 | DOI:10.1016/j.injury.2025.112342

Injury. 2025 May 1;56(7):112371. doi: 10.1016/j.injury.2025.112371. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to estimate the burden of transport and unintentional injuries attributable to occupational injury from 1990 to 2021 and provided a 15-year forecast.

METHODS: Age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate (ASDR) attributable to occupational injury were analyzed using the estimated annual percentage change (EAPC) for transport and unintentional injuries from 1990 to 2021. Future injury forecasts were derived using Bayesian age-period-cohort (BAPC) model.

RESULTS: Between 1990 and 2021, ASMR and ASDR from occupational injury-related transport and unintentional injuries declined in most countries. The Republic of Korea saw the largest reductions, with EAPC for transport injuries at -12.40 (ASMR); and -12.01(ASDR), and for unintentional injuries at -10.65; -8.81, respectively. Males consistently had higher mortality and DALYs rates compared to females. Projections indicate that the mortality and DALYs rates will continue to decrease until 2036, suggesting improvements in occupational injury prevention.

CONCLUSIONS: This study found that ASMR and ASDR of occupational injury decreased. The prediction results show that the burden of occupational injury is still heavy and is a major public health problem, which highlights the need for regions to develop measures to reduce the burden of occupational injury.

PMID:40344850 | DOI:10.1016/j.injury.2025.112371

Injury. 2025 Apr 17;56(6):112346. doi: 10.1016/j.injury.2025.112346. Online ahead of print.

ABSTRACT

INTRODUCTION: Medial malleolar fractures are a common orthopedic injury, especially in osteoporotic bone. These fractures present unique challenges due to fragile tissues and reduced bone density, increasing the risk of fixation failure. This study aims to compare the biomechanical performance of single versus double bicortical screws in medial malleolar fractures in both healthy and osteoporotic bone.

DESIGN: Biomechanical study.

METHODS: Using fourth-generation composite Sawbones models, 32 tibias (16 osteoporotic, 16 healthy) were divided into four groups: one or two bicortical screws in either bone type. Fractures were simulated, and fixation was achieved in a lag-by-technique fashion. Specimens were subject to axial compression until failure, measuring load-to-failure and stiffness. Statistical analysis compared performance across groups.

RESULTS: Constructs with two bicortical screws demonstrated significantly higher load-to-failure in both healthy (mean: 1747 N vs. 1090 N, p = 0.02) and osteoporotic bone (mean: 935 N vs. 509 N, p = 0.01). Stiffness was also greater in two-screw constructs, though not statistically significant. We used a two-tailed t-test to compare the means of the two groups, with a p-value of <0.05, which is considered statistically significant. Osteoporotic bone exhibited lower overall performance than healthy bone, but the two-screw configuration partially mitigated these disadvantages.

CONCLUSION: Our study demonstrates that two bicortical screws provide superior biomechanical stability compared to one screw, particularly in osteoporotic bone. These findings underscore the importance of optimizing fixation strategies for osteoporotic fractures. While prior studies found minimal differences between single and double-screw constructs, our use of bicortical screws highlights their advantage in load distribution and resistance to failure. Implementing these findings in clinical practice could potentially reduce the risk of fixation failure and improve outcomes for patients with osteoporotic fractures.

PMID:40339356 | DOI:10.1016/j.injury.2025.112346

Injury. 2025 Apr 18;56(6):112352. doi: 10.1016/j.injury.2025.112352. Online ahead of print.

ABSTRACT

INTRODUCTION: Quantification of bone healing can be of interest for both clinical and research purposes. However, radiographic assessment of bone healing is challenging, especially in postoperative bone defects and non-union. Scores, such as the (modified) Radiographic Union Score for Tibial fractures ((m)RUST) are widely known. The Lane-Sandhu score, a lesser-known score for bone defects, may have benefits over the mRUST score. The aim of this study is to compare the inter- and intraobserver reliability of the Lane-Sandhu score with the mRUST in human non-unions.

METHODS: First, five postoperative radiographs were scored by five observers using both scores. Pitfalls of the scores were thereafter analyzed in a training session. Then, each observer scored ten new radiographs. The intraclass correlation coefficient was calculated to determine the intra- and interobserver reliability of the scores for each session.

RESULTS: The pilot session resulted in an interobserver reliability of 0.48 for the mRUST and -0.049 for the Lane-Sandhu score. During the training session, the interobserver reliability scores were 0.50 and 0.14 respectively. The final session resulted in a reliability score of 0.79 (95 % CI 0.60-0.91) for the mRUST and 0.76 (0.59-0.88) for the Lane-Sandhu.

CONCLUSION: Both scores are reliable scoring systems for the interpretation of postoperative bone defects and non-union. There is a slight preference for the mRUST because the reliability was less dependent on the training session. For future research, the interpretation of postoperative radiographs should be well described and a training session is recommended.

PMID:40339355 | DOI:10.1016/j.injury.2025.112352