Injury. 2026 Mar 19;57(4):113160. doi: 10.1016/j.injury.2026.113160. Online ahead of print.

ABSTRACT

BACKGROUND: Limb rotations of the upper arms frequently happen during daily activities, and these actions can produce significant torsional forces which aggravate patients' conditions. However, there is limited research concerning the impact of humerus rotation on the initial stability of locking plate fixation after proximal humerus fracture reconstruction. The current study conducted a biomechanics analysis to investigate this important issue.

METHODS: Dynamic mechanical tests with repetitive torsional loads were executed in six fracture-model specimens. The mechanical behaviors of resistance to torque, maximum torque, and energy dissipation were recorded. A new surveillance system of digital image correlation (DIC) technology was used to observe the continuous strains of the fixation system in real time.

RESULTS: Mean resistance to torque was significantly reduced when the rotation exceeded 3.2°. Beyond 3.2° of rotation, the mean energy dissipation increased by approximately fourfold. DIC observations showed large strains concentrated around the screw holes at the proximal shaft and waist of the plate.

CONCLUSIONS: Under our experimental conditions, we observed a marked rise in non-elastic energy dissipation beyond 3.2° of rotation, which indicated the onset of permanent construct deformation in vitro. Surgeons should remind patients that daily upper extremity torques may affect the initial rotational stability of fixation system after surgery.

PMID:41887084 | DOI:10.1016/j.injury.2026.113160

Injury. 2026 Mar 21;57(4):113170. doi: 10.1016/j.injury.2026.113170. Online ahead of print.

ABSTRACT

INTRODUCTION: Vertebral compression fractures are common and incur significant healthcare costs. Orthotic bracing is a frequently used treatment; however, studies have shown uncertainty regarding its effectiveness. Upright radiographs after brace placement are recommended to assess fracture stability, but there is lack of research on the ideal timing of these radiographs. The primary purpose of this study was to determine the amount of compression change in post-brace radiographs in the ED and whether this changed clinical management.

METHODS: We performed a retrospective cross-sectional study of compression fractures over an eight-year period. Vertebral height loss was calculated using the formula (1 - [A ÷ B]) x 100, where A is the shortest portion of the fractured vertebral body and B is the tallest portion of the unfractured vertebral body. Multinomial logistic regression was used to predict post-brace height change based on acuity, spinal level, and the covariate of age in years. Adjusted odds ratios with corresponding 95 % confidence intervals (CIs) were calculated.

RESULTS: 125 patients with 212 fractures were identified. 69 % of fractures were deemed acute; 31 % were deemed chronic or of uncertain age. Change in height loss ranged from 16 % improvement to a 33 % worsening after brace placement. However, the median change was 0 % (interquartile range -4 % to 2 %). Thoracic fractures were statistically less likely than lumbar fractures to have a height decrease, relative to no height change, after brace placement (adjusted odds ratio 0.36 (95 % CI 0.16-0.79)). No patients had change in management from brace to surgery on the initial visit.

CONCLUSIONS: Post-orthotic brace imaging in the emergency setting for thoracolumbar compression fractures did not demonstrate significant compression worsening and did not change patient management.

PMID:41887083 | DOI:10.1016/j.injury.2026.113170

Injury. 2026 Mar 20;57(4):113182. doi: 10.1016/j.injury.2026.113182. Online ahead of print.

ABSTRACT

BACKGROUND: Many studies have attempted to define which injured children should undergo computed tomography (CT) imaging. Specifically, the Pediatric Emergency Care Applied Research Network (PECARN), a conglomerate of pediatric trauma centers, prospectively collected data on a large population of patients and have published multiple studies with recommendations on when to image based on the likelihood of a clinically important injury. Using these data and others, the Utah Pediatric Trauma Network (UPTN) created guidelines to help determine when imaging of injured children should be performed at our participating non-pediatric hospitals (non-PED1). The purpose of this study was to evaluate compliance to these guidelines.

METHODS: The UPTN REDCap® database was retrospectively reviewed between 1/2019-12/2022. An analysis of injured Utah children who underwent CT imaging based on UPTN guidelines was performed.

RESULTS: Of the 5224 cases reviewed, 4162 (80 %) underwent CT scan for evaluation, of which 3275 (79 %) received CT imaging at a non-PED1 center. Those treated at a non-PED1 hospital tended to be older (mean 10.2 v. 9.1 years, p = 0.002) and more likely to be ≥ 14 years (33 %v.28 %,p = 0.003). They were also less likely to have a traumatic brain injury (81 %v.91 %,p < 0.0001) or an orthopedic injury (14 %v.21 %,p < 0.0001). Children treated at non-PED1 hospitals were less likely to undergo a CT of the head (59 % v. 88 %,p < 0.0001) and abdomen (18 % v. 32 %,p < 0.0001), but more likely of the chest (17 %v.11 %,p = 0.01) or a pan scan (13 %v.8 %,p = 0.001). Compliance to guidelines was lower compared to the PED1 center for CT of the head (67 %v.87 %,p < 0.0001). Overall, compliance increased in the later years of the study for cervical spine and abdomen/pelvis (p = 0.0002,p < 0.0001 respectively), and decreased for head (p = 0.001).

CONCLUSIONS: Across Utah, CT imaging is highly utilized in the evaluation of injured children. Non-compliance to imaging guidelines was found to be highest for imaging of the cervical-spine, chest, and abdomen.

STUDY TYPE/LEVEL OF EVIDENCE: Level III, Prognostic/epidemiological.

PMID:41887082 | DOI:10.1016/j.injury.2026.113182

Injury. 2026 Mar 23;57(4):113186. doi: 10.1016/j.injury.2026.113186. Online ahead of print.

ABSTRACT

OBJECTIVE: Despite one-third of all trauma admissions occurring over the weekend in Australia, most acute trauma patients only receive allied health input within traditional Monday to Friday service models. This study aimed to determine the acceptability, fidelity and feasibility of a new seven-day allied health model of care within one of Australia's busiest trauma hospitals.

METHODS: An implementation study evaluated the commencement of a new model of care with an additional seven full-time-equivalent, predominantly senior, allied health clinicians over seven days. Acceptability was evaluated through surveys completed by medical, nursing and allied health staff working in the trauma service (n = 151), pre- and post-implementation. Fidelity was evaluated by reviewing referral response time, weekend occasions of service, and at pre-implementation (n = 484 patients), 6-months (n = 456) and 18-months (n = 532) post-implementation. Feasibility was evaluated through practicality and limited efficacy testing (changes in length of stay and Monday discharges) using the Mann-Whitney U or chi-squared tests.

RESULTS: Survey results indicated improved accessibility, adequacy, and continuity of staffing. Recruitment and work-life balance were cited as practical challenges. There were significant reductions in referral response times across allied health (from median 17.0 [IQR 6.0- 25.0] hours to median 12.0 [5.0-21.0] hours, p < 0.001), a 53% increase in weekend occasions of service, and although length of stay remained unchanged, the proportion of Monday discharges increased (13% to 18%, p = 0.02).

CONCLUSION: A seven-day allied health trauma service was successfully implemented with outcomes indicating it will be sustainable. Findings are useful for scalability to other hospitals and clinical specialties.

PMID:41887081 | DOI:10.1016/j.injury.2026.113186

Injury. 2026 Mar 20;57(4):113173. doi: 10.1016/j.injury.2026.113173. Online ahead of print.

ABSTRACT

BACKGROUND: Fracture-related infection (FRI) remains a major complication after Tibial Plateau Fracture (TPF) fixation, particularly in high-energy injuries. The efficacy of locally applied antibiotic-impregnated calcium sulfate as infection prophylaxis is unclear.

METHODS: A retrospective study was conducted on 209 adult patients treated surgically for TPF from March 2010 to December 2023 at a major trauma centre. The exclusion criteria were defined as: patients under the age of 18, open fractures, compartment syndrome, pathological fractures and conservative treatment. Patients were administered either vancomycin-gentamycin impregnated calcium sulfate (Stimulan ®; n = 75) or no local antibiotic (n = 134) during fracture fixation. Infection rates (FRI Consensus Group Criteria), demographics and fracture characteristics were compared. Univariate and multivariate logistic analysis models were used to investigate the potential risk factors.

RESULTS: Mean follow-up period was 21 months. FRI occurred in 18.9 % of the antibiotic group and 18.2 % of non-antibiotic group (p = 0.896). A statistically significant difference for FRI was identified between high-energy fractures (Schatzker IV-VI) and low-energy fractures (27.9 % vs 6.9 %; p < 0.001). Diabetes showed a trend toward increased FRI (p = 0.051) but was not independently significant. No calcium sulfate related complications were observed.

CONCLUSION: Local use of vancomycin and gentamycin loaded calcium sulfate in TPF fixation did not significantly reduce postoperative infection rates. High-energy fractures have been identified as the primary predictor for FRI. Further prospective studies are required to delineate the role of local antibiotic bone substitutes for infection prophylaxis after TPF fixation.

PMID:41887080 | DOI:10.1016/j.injury.2026.113173

Injury. 2026 Mar 20;57(4):113183. doi: 10.1016/j.injury.2026.113183. Online ahead of print.

ABSTRACT

BACKGROUND: Malnutrition is common in orthopaedic trauma and may increase postoperative morbidity. This study evaluated the association between laboratory-defined malnutrition and 90-day medical complications and 2-year fracture-related complications after femoral shaft fracture fixation.

METHODS: Using the TriNetX Research Network (112 healthcare organizations), adults (≥18 years) undergoing operative fixation of femoral shaft fractures were identified. Malnutrition was defined as albumin ≤ 3.5 g/dL and/or leukocytes ≤ 1.5× 10³ /µL measured within 1 year before the index procedure; patients without documented laboratory-defined malnutrition served as controls. Cohorts were propensity score-matched 1:1 on demographics, comorbidities, and selected laboratory measures. Complications were assessed from postoperative day 1 through 90 days (acute respiratory failure/mechanical ventilation, DVT/PE, transfusion, postoperative infection, wound disruption, myocardial infarction, sepsis, acute kidney injury, and emergency department visit) and through 730 days (nonunion/malunion, osteomyelitis, revision fixation, and hardware removal). Risk ratios (RR) with 95 % confidence intervals (CI) were reported.

RESULTS: After matching, 10,943 patients remained in each cohort with good covariate balance (all standardized mean differences <0.10). Within 90 days, malnutrition was associated with higher risk of acute respiratory failure/mechanical ventilation (21.7 % vs 9.5 %; RR 2.29 [95 % CI 2.14-2.45]), sepsis (6.1 % vs 2.9 %; RR 2.09 [1.84-2.39]), DVT/PE (9.7 % vs 5.8 %; RR 1.68 [1.53-1.85]), acute kidney injury (12.8 % vs 8.3 %; RR 1.55 [1.44-1.68]), postoperative infection (4.4 % vs 2.6 %; RR 1.68 [1.46-1.94]), wound disruption (3.1 % vs 1.9 %; RR 1.68 [1.42-2.00]), transfusion (10.9 % vs 8.5 %; RR 1.29 [1.19-1.40]), myocardial infarction (2.4 % vs 1.8 %; RR 1.30 [1.08-1.56]), and emergency department visit (16.4 % vs 14.3 %; RR 1.15 [1.08-1.23]) (all p ≤ 0.005). At 2 years, malnutrition was associated with higher risk of osteomyelitis (1.1 % vs 0.4 %; RR 2.43 [1.74-3.38]), revision fixation (5.9 % vs 4.0 %; RR 1.47 [1.31-1.66]), and hardware removal (9.3 % vs 8.1 %; RR 1.15 [1.06-1.26]) (all p ≤ 0.001), while nonunion/malunion did not differ (3.0 % vs 2.9 %; RR 1.06 [0.91-1.23]; p = 0.472).

CONCLUSIONS: Laboratory-defined malnutrition was independently associated with substantially increased 90-day morbidity and higher 2-year infectious and reoperative complications after femoral shaft fracture fixation. These findings support nutritional risk stratification and motivate prospective studies evaluating targeted perioperative optimization.

PMID:41887079 | DOI:10.1016/j.injury.2026.113183

Injury. 2026 Mar 15;57(4):113161. doi: 10.1016/j.injury.2026.113161. Online ahead of print.

ABSTRACT

BACKGROUND: Extra-articular distal tibial fractures treated with locked intramedullary nails present a high rate of malunion, particularly rotational deformities. Concomitant fibular fixation has been associated with a reduction in malalignment; however, some studies suggest it may increase nonunion and complication rates, including infection. There is currently no consensus regarding the influence of fibular stabilization in these fractures.

OBJECTIVE: To compare radiographic outcomes, functional results, and complication rates of extra-articular distal tibial fractures treated with locked intramedullary nails, with or without concomitant fibular fixation.

METHODS: A randomized prospective study was conducted including patients aged 18-60 years with displaced extra-articular distal tibial fractures, including open fractures up to Gustilo type IIIA, associated with fibular fractures located below the middle third. Patients lost to follow-up or who did not complete all radiographic or functional assessments were excluded. Primary outcomes included fracture union assessed by a modified RUST score ≥ 11 at 12 months, malalignment assessed by postoperative radiographs and CT scan at one year, functional evaluation of the knee and ankle using the Lysholm and AOFAS scores, respectively, and complication rates.

RESULTS: At the end of follow-up, 43 patients without fibular fixation (HIMB group) and 34 with fixation (HIMBF group) were analyzed. The nonunion rate was 4.7 % in the HIMB group and 5.9 % in the HIMBF group, with no significant difference. Fracture healing progression was similar between groups. Malunion occurred in 18.6 % of the HIMB group and 11.8 % of the HIMBF group, without statistical significance. There were no significant differences in complication rates or in knee and ankle functional outcomes at one year.

CONCLUSION: Concomitant fibular fixation does not influence nonunion or malunion rates, does not increase complication rates, and does not affect knee or ankle function in the treatment of extra-articular distal tibial fractures stabilized with locked intramedullary nails.

PMID:41861501 | DOI:10.1016/j.injury.2026.113161

Injury. 2026 Mar 13;57(4):113156. doi: 10.1016/j.injury.2026.113156. Online ahead of print.

ABSTRACT

BACKGROUND: Appropriate triage is essential to reducing preventable deaths and optimizing the allocation of limited medical resources in trauma care. Although the mechanism of injury (MOI) has been incorporated into prehospital triage protocols, its predictive accuracy remains controversial. This study aimed to investigate the association of MOI and anatomical injury sites with the need for emergency procedures and in-hospital outcomes using a nationwide trauma registry in Japan.

METHODS: This retrospective cohort study analyzed data from the Japan Trauma Data Bank (JTDB) between 2019 and 2021. Adult trauma patients (age ≥18 years) directly transported from the scene were included. The primary outcome was the implementation of emergency procedures upon hospital arrival, and the secondary outcome was in-hospital mortality. Multivariable logistic regression was performed to calculate odds ratios (OR) with 95% confidence intervals (CI). Discriminatory ability was evaluated using the area under the receiver operating characteristic curve (AUC).

RESULTS: Among 42,124 eligible patients, 16,580 (39.3%) underwent emergency procedures. Railway-related trauma (OR, 95% CI: 5.50, 3.73-8.11), crush injuries (2.03, 1.50-2.75), head injuries (4.35, 4.12-4.59), and abdominal injuries (20.06, 16.66-24.16) were significantly associated with emergency procedures. The AUCs for predicting emergency procedures were 0.57 for MOI and 0.72 for injury sites, and 0.53 and 0.77, respectively, for in-hospital mortality.

CONCLUSIONS: Anatomical injury sites demonstrated greater discriminative performance than MOI in predicting the need for emergency procedures and in-hospital mortality. These findings highlight the limitations of mechanism-based triage and suggest that incorporating anatomical assessment may improve triage accuracy and resource utilization.

PMID:41861500 | DOI:10.1016/j.injury.2026.113156

Injury. 2026 Feb 16;57(4):113121. doi: 10.1016/j.injury.2026.113121. Online ahead of print.

ABSTRACT

PURPOSE: Tibial plateau fractures are often surgically treated to restore native joint congruity and articular alignment. While these injuries portend an increased risk for end stage knee osteoarthritis, it is unknown whether the fixation constructs contribute to the development of osteoarthritis by influencing articular stress distribution following instrumentation.

METHODS: We conducted a cadaver study measuring resultant intra-articular stresses of the native knee due to physiological levels of ex-vivo loading, after instrumentation with plate and screw fixation, and after implant removal. To account for variable subchondral bone density, we used 3D printed bone with osteoporotic and normal cancellous bone volume fraction, and SawBones where there is no appreciable cancellous bone.

RESULTS: There was no statistical difference in peak, average, or total contact pressures following implant fixation and removal from the preimplantation articular pressure states in all loads and all models (p > 0.05). There was also no difference between the pressure changes of the cadaveric and Sawbones models. There were statistically significant pressure changes between cadaveric and 3D printed models following fixation, however these changes were within previously described physiologic loads (<10 MPa).

CONCLUSIONS: Subchondral instrumentation of tibial plateau fractures did not materially alter articular pressures. These findings suggest that the development of end-stage knee osteoarthritis may not be a result of altered biomechancial stresses from the instrumentation. Further, elective removal of implants is not supported by biomechanical reasons alone to reduce future risk. Supplementing cadaveric studies with patient-specific models while tuning variables can enhance the fidelity of these investigations.

STATEMENT OF CLINICAL RELEVANCE: The findings may guide surgeons in their operative indications and clinical decision making as well as guide future biomechanical research on periarticular implant effects.

PMID:41855643 | DOI:10.1016/j.injury.2026.113121

Injury. 2026 Mar 13:113151. doi: 10.1016/j.injury.2026.113151. Online ahead of print.

ABSTRACT

BACKGROUND: Severe hand injuries with extensive soft-tissue loss present a significant reconstructive challenge. Achieving stable coverage while preserving hand function often necessitates the combined use of regional and local flaps. The posterior interosseous artery (PIA) flap, in combination with regional flaps harvested from non-salvageable digits, may offer an effective solution.

METHODS: A retrospective analysis was performed on patients with severe hand injuries who underwent reconstruction using a PIA flap between 2022 and 2025. Patients were treated with either an isolated PIA flap or a PIA flap combined with local flaps, including fillet flaps harvested from non-salvageable digits or rotational flaps, depending on the extent and location of the defect. Demographic characteristics, injury mechanisms, defect locations, and surgical details were recorded. Postoperative complications and functional outcomes were assessed using fingertip-to-palm distance, Quick DASH score, and VAS for pain.

RESULTS: Fourteen patients with severe hand injuries were included in the study. The mean age was 39.4 years, and the mean follow-up period was 19.7 months. Five patients with complex, multi-site defects underwent combined reconstruction using a PIA flap with local flaps (four with fillet flaps, one with a rotational flap), while nine patients were treated with an isolated PIA flap. Successful soft-tissue coverage was achieved in all patients without total flap loss. Partial distal flap necrosis occurred in two patients due to venous congestion and was managed with wound care followed by split-thickness skin grafting. At final follow-up, the mean fingertip-to-palm distance was 2.07 cm, the mean Quick DASH score was 21.89, and the mean VAS pain score was 2.07. All patients achieved stable wound healing and were able to perform daily activities without the need for further reconstructive procedures.

CONCLUSION: The PIA flap, either alone or in combination with local flaps, provides reliable soft-tissue coverage and favorable functional outcomes in patients with severe hand injuries. Combined reconstruction strategies should be considered based on defect characteristics, with acceptable complication rates and good functional recovery. This technique represents a valuable option in complex hand trauma reconstruction.

LEVEL OF EVIDENCE: IV.

PMID:41850965 | DOI:10.1016/j.injury.2026.113151

Injury. 2026 Mar 12;57(4):113152. doi: 10.1016/j.injury.2026.113152. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency Spinal Stabilization (ESS) represents a cornerstone of contemporary polytrauma management, yet its independent impact on respiratory outcomes remains a subject of ongoing debate. This study investigates whether tracheostomy (TS) rates and duration of mechanical ventilation (DMV) are primarily driven by the surgical intervention itself, neurological impairment, or overall injury severity.

METHODS: We retrospectively analyzed 914 severely injured patients (ISS≥16) admitted to a Level I trauma center. Primary outcomes were TS rate and DMV. Multivariate logistic and linear regression models were employed to isolate the independent effects of ESS, injury severity (ISS, AIS), and neurological status. A dedicated subgroup analysis of operated patients (n = 85) evaluated surgical technique (e.g., ventral stabilization) and physiological severity scores (SAPS2, TISS-10).

RESULTS: ESS patients demonstrated a significantly elevated TS rate (39.5% vs. 20.6%, p < 0.001) despite being younger and exhibiting lower physiological severity at admission (SAPS2 28.0 vs. 33.5, p = 0.013). In the total cohort, thoracic injury (OR 1.99, p < 0.001) and ISS (OR 1.04, p = 0.002) independently predicted TS; ESS was not an independent predictor (p = 0.27). Within the ESS subgroup, spinal cord injury (SCI) emerged as the strongest predictor for TS (OR 3.33, p = 0.032), whereas surgical invasiveness (ventral stabilization) exerted no independent impact (p = 0.520). DMV was exclusively determined by ISS (p < 0.001); neither neurological status nor surgical technique independently influenced ventilation duration.

CONCLUSIONS: ESS serves as a reliable clinical marker for increased TS requirements but does not independently prolong mechanical ventilation. TS necessity is primarily dictated by SCI and overall injury burden rather than surgical invasiveness. Early TS in ESS patients with SCI appears to effectively compensate for physiological deficits, aligning ventilation durations with those of non-neurologically impaired patients. ESS should therefore be recognized as a clinical "red flag" prompting proactive multidisciplinary airway management to optimize respiratory weaning strategies.

PMID:41850132 | DOI:10.1016/j.injury.2026.113152

Injury. 2026 Mar 17;57(4):113162. doi: 10.1016/j.injury.2026.113162. Online ahead of print.

NO ABSTRACT

PMID:41850131 | DOI:10.1016/j.injury.2026.113162

Injury. 2026 Mar 13:113153. doi: 10.1016/j.injury.2026.113153. Online ahead of print.

ABSTRACT

BACKGROUND: The role of diagnostic laparoscopy in adults with blunt abdominal trauma and the effect of negative laparoscopy on mortality is not well delineated.

METHODS: We reviewed the National Trauma Data Bank (2007-2019) for adults sustaining blunt abdominal trauma who underwent operative intervention. We performed a doubly robust, augmented inverse propensity weighted multivariable logistic regression to estimate the effect of a negative diagnostic laparoscopy on mortality in adults with operative blunt abdominal trauma.

RESULTS: 87,864 patients met the inclusion criteria. Diagnostic laparoscopy occurred in 6.6% (n = 5816) of patients, with a 21.1% (n = 1226) conversion to laparotomy rate. The rate of negative diagnostic laparoscopy was 28.6% (n = 1665). Negative laparoscopy patients had a 49% reduction in odds of mortality (OR 0.51, 95%CI 0.47 - 0.56, p < 0.001) compared to negative laparotomy patients. Patient's that underwent laparoscopy, found to have intra-abdominal injury, had a similar reduction in odds of mortality compared to negative laparotomy patients (OR 0.54, 95% CI 0.51 - 0.57, p < 0.001).

CONCLUSION: Diagnostic laparoscopy may be safe for adults with blunt abdominal trauma and prevent significant morbidity and mortality from a negative laparotomy.

PMID:41846201 | DOI:10.1016/j.injury.2026.113153

Injury. 2026 Mar 9;57(4):113148. doi: 10.1016/j.injury.2026.113148. Online ahead of print.

NO ABSTRACT

PMID:41843999 | DOI:10.1016/j.injury.2026.113148

Injury. 2026 Mar 11;57(4):113096. doi: 10.1016/j.injury.2026.113096. Online ahead of print.

NO ABSTRACT

PMID:41818861 | DOI:10.1016/j.injury.2026.113096

Injury. 2026 Feb 27;57(4):113138. doi: 10.1016/j.injury.2026.113138. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate intraoperative assessment of fracture reduction is essential in trochanteric fracture surgery to prevent mechanical failure. Although restoration of anteromedial cortical support, particularly in the sagittal plane, has been recognized as a critical factor, standard lateral views may fail to detect malreduction because the shadow of the greater trochanter overlaps and obscures the anteromedial cortical line. This study aimed to evaluate the clinical utility of a novel intraoperative anteromedial cortex (AMC) view for assessing fracture reduction.

METHODS: This prospective multicenter observational study included 135 trochanteric fractures (AO/OTA 31A1.2, 31A1.3, and 31A2) surgically treated between June 2022 and December 2023. In addition to standard AP and lateral fluoroscopic views, an AMC view was obtained intraoperatively. Reduction on the lateral and AMC views was categorized as anterior malreduction, anatomic reduction, or posterior malreduction. The primary outcome was the concordance rate between the lateral and AMC views.

RESULTS: Discordances between lateral and AMC views were observed in 26 of 135 cases (19.3%). Notably, among fractures classified as anatomic reduction on the lateral view, 12 cases (19.4%) were reclassified as anterior malreduction on the AMC view, representing "hidden" anterior malreduction. In 7 of these 12 cases (5.2% of the total cohort), the AMC view findings directly led to a change in the surgical strategy, requiring direct reduction through a small incision.

CONCLUSIONS: Approximately one-fifth of trochanteric fractures showed inconsistent reduction patterns between the standard lateral the AMC views. The AMC view provides a more precise intraoperative assessment of the anteromedial cortex and is particularly effective in identifying hidden anterior malreduction that may be overlooked on standard fluoroscopy.

PMID:41818860 | DOI:10.1016/j.injury.2026.113138

Injury. 2026 Mar 11;57(4):113137. doi: 10.1016/j.injury.2026.113137. Online ahead of print.

NO ABSTRACT

PMID:41818859 | DOI:10.1016/j.injury.2026.113137

Injury. 2026 Feb 28;57(4):113144. doi: 10.1016/j.injury.2026.113144. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate outcomes of a series of consecutive, atypical femur fractures (AFFs) treated exclusively with closed reduction and reamed, statically locked intramedullary nailing.

METHODS: Design: Retrospective review.

SETTING: Single North American Level I trauma center. Patient Selection Criteria: All skeletally mature patients treated between 2012 and 2024 with closed reduction and reamed, statically locked IMN of a complete AFFs (OTA/AO 32) with > 6 months follow-up were eligible. Radiographic inclusion required fractures distal to the lesser trochanter and proximal to the supracondylar flare that met ≥4 of 5 American Society for Bone and Mineral Research (ASBMR) major criteria Outcome Measures and Comparisons: Primary outcome was radiographic and clinical union. Secondary measures included time to union, alignment quality, implant failure, and the relationship of neck-shaft angle (NSA) restoration with union.

RESULTS: There was a total of 52 AFFs with a mean age of 68 years (52-89 years). Overall, 46 (88%) patients were female and 6 (12%) were male. The mean BMI was 25.6 ± 4.51 kg/m2 and 52 (100%) patients reported bisphosphonate use. The mean follow-up was 21 months (range, 6-102). Thirty-nine (75%) were subtrochanteric and 13 (25%) were diaphyseal femur fractures. Overall, fracture union occurred in 49 AFFs (94%) at a mean of 6 months (range, 3-14). Three fractures (6%) progressed to nonunion. Notably, 7 AFFs were incompletely healed at 6 months, but 6 of 7 united by 12 months. Reduction quality was excellent in 98% of cases. Restoration of native NSA was significantly associated with union; nonunion cases demonstrated greater deviation from the contralateral NSA (p = 0.034). Implant-related variables (nail type, diameter, interlocking configuration) were not associated with union. Complications were limited to two cases of broken distal interlocking screws and one superficial surgical site infection.

CONCLUSIONS: Treatment of atypical femur fractures with solely closed reduction and reamed, statically locked intramedullary nailing provides reliable healing, with a 94% union rate.

PMID:41795353 | DOI:10.1016/j.injury.2026.113144

Injury. 2026 Feb 27;57(4):113141. doi: 10.1016/j.injury.2026.113141. Online ahead of print.

ABSTRACT

Taylor Spatial Frame (TSF) is a hexapod circular external fixator, i.e. built with six struts connecting two rings to support bone fragments by fixating them to the rings by wires or pins. Struts are length adjustable and have universal joints (U-joints) at both ends which attach to the rings. Behaviour of struts is crucial to the biomechanics of the TSF. However, no study on struts' mechanical characteristics has been reported. In this work, TSF struts and their components and pieces of materials were tested and their mechanical properties are reported. For doing so, the followings tests were conducted: 1) three sizes of TSF Fast-FX struts at different lengths in axial compression, 2) three short struts in oblique compression, 3) two long struts, gripped at and after their U-joints, in axial tension, and 4) two pairs of separated U-joints in compression. Pieces of the strut body and threaded rod were also machined out and tested for material properties. All tests continued till failure and their load-deflection data are plotted. Curve-fitting was applied to the plot of the average load-deflections (of strut sizes at their minimum length). The stiffness characteristics, buckling failure loads and failure load of the universal joints are also reported. Results show that the preponderance of deflections occurs in universal joints, which makes the results relevant to all strut types using the same U-joints.

PMID:41795352 | DOI:10.1016/j.injury.2026.113141

Injury. 2026 Feb 20;57(4):113128. doi: 10.1016/j.injury.2026.113128. Online ahead of print.

ABSTRACT

BACKGROUND: The period following orthopedic trauma is a critical window for developing psychological burden, prolonged opioid use, and opioid-related stigma. Stigma refers to shame or perceived judgment related to opioid use, which may impair postoperative pain management and patient-provider trust. Although stigma is increasingly recognized as a recovery barrier, its relationship to pain, psychological factors, and opioid use duration remains poorly understood.

OBJECTIVE: To characterize patterns of psychological factors, substance use, concerning opioid use (opioid misuse), and stigma by opioid use duration (0-29 days, 30 -59 days, and ≥ 60 days) during the three-month period following hospitalization for musculoskeletal trauma.

METHODS: In this prospective observational cohort study, 170 adults hospitalized for orthopedic traumatic injuries were enrolled and followed for three months post-discharge. Clinical data were obtained from electronic health records and the state prescription drug monitoring program, and participants completed validated assessments of pain, psychological symptoms, opioid misuse, and stigma. Participants were categorized by opioid use duration into 0-29 days, 30-59 days, and ≥ 60 days.

RESULTS: Of the 170 participants, 135 (79 %) completed follow-up. Longer opioid use duration was significantly associated with greater inpatient pain intensity, depression, anxiety, pain-related anxiety, and traumatic distress. These trends persisted at follow-up, where participants with longer use demonstrated higher pain intensity, greater opioid exposure, and worse psychological and functional outcomes. Indicators concerning opioid use (opioid misuse) were common; the most frequently endorsed behaviors included running out of medication early (33 %) and anxiety when medication ran out (36 %). Experiences of stigma were reported by 17 % of participants and increased to 52 % among those using opioids for ≥ 60 days (p < .001). Internalized stigma (31 %) and stigma-related behaviors, including taking less medication than needed (24 %), also increased with longer opioid use duration.

CONCLUSIONS: Prolonged opioid use after traumatic musculoskeletal injury was associated with greater pain, psychological burden, concerning opioid use, and experiences of stigma. Findings underscore the interrelated nature of pain, mental health, and stigma in post-injury recovery and highlight the need for integrated interventions targeting pain-related distress, effective coping, and stigma reduction to support safer opioid use and improved functional outcomes.

PMID:41785541 | DOI:10.1016/j.injury.2026.113128