Injury. 2025 Jun 24:112551. doi: 10.1016/j.injury.2025.112551. Online ahead of print.

NO ABSTRACT

PMID:40610272 | DOI:10.1016/j.injury.2025.112551

Injury. 2025 Jun 25:112559. doi: 10.1016/j.injury.2025.112559. Online ahead of print.

NO ABSTRACT

PMID:40610271 | DOI:10.1016/j.injury.2025.112559

Injury. 2025 May 30:112467. doi: 10.1016/j.injury.2025.112467. Online ahead of print.

NO ABSTRACT

PMID:40610270 | DOI:10.1016/j.injury.2025.112467

Injury. 2025 Jun 21;56(8):112536. doi: 10.1016/j.injury.2025.112536. Online ahead of print.

ABSTRACT

OBJECTIVES: A tenet of open fracture management is timely administration of antibiotics to reduce risk of fracture-related infection (FRI). Trauma centers strive to administer intravenous antibiotics within one hour of patient arrival. The foundation for this recommendation is based on relatively few studies, which base their findings on time from hospital arrival to antibiotic administration. Little attention has been paid to the prehospital time course of open fracture patients. We hypothesized that a significant portion of open fracture patients arrive at the hospital greater than one hour after their injury, which would represent an opportunity for improved care.

METHODS: Design: Retrospective Case Series Setting: Urban/Suburban Academic Level I Trauma Center Patient Selection Criteria: Subjects were identified using a retrospective search for open fracture patients arriving via emergency medical services (EMS). Patients were included if they were age 18 or greater, presented with an open fracture, and had complete pre-hospital documentation, in-hospital documentation, and radiographs. Outcome Measures and Comparisons: Data collected included patient demographics, fracture location, Gustilo-Anderson classification, dispatch time, on scene time, enroute to hospital time, arrival at hospital time, transfer of care time, modality of transport, whether intravenous antibiotics were administered prior to arrival at the hospital, and development of FRI. Descriptive statistics were used to analyze the findings.

RESULTS: 454 patients met the inclusion criteria. Mean time from dispatch to transfer of care was 66.8 ± 26.9 min in all transports; 84.1 ± 25.6 min with helicopter EMS; and 64.8 ± 26.4 min with ground EMS. 239 patients (52.6 %) had transfer of care time greater than one hour after dispatch time. Only 3.7 % of open fracture patients received antibiotics prior to hospital arrival. There was a positive correlation with the development of FRI and prolonged pre-hospital time.

CONCLUSIONS: Many patients with open fractures had transfer of care more than one hour after dispatch. FRI was associated with increased prehospital time. These results suggest an opportunity for prehospital antibiotic administration to mitigate the risk of infection in patients with open fractures.

LEVEL OF EVIDENCE: Level IV.

PMID:40609244 | DOI:10.1016/j.injury.2025.112536

Injury. 2025 Jun 27;56(8):112567. doi: 10.1016/j.injury.2025.112567. Online ahead of print.

ABSTRACT

PURPOSE: To test the mechanical properties of novel design hook plates for fixation of the patellar fracture by finite element analysis.

METHODS: Finite element analysis was used to construct a model of transverse patellar fracture and inferior pole fracture of the patella (IPFP) based on the CT data of the knee joint of a healthy young male volunteer. For the transverse fracture, stress distribution within the winged hook plate fixation and displacement of the fracture was compared to that of tension-band wiring (TBW) fixation. For the IPFP, the stress distribution within the wingless plate and displacement of the fracture were calculated under the four different application methods. All the models were created by assuming the knee flexion in 45° during non-weight-bearing, and applying the quadriceps tension on the superior pole of the patella.

RESULTS: In the model of transverse patellar fracture: The displacement and stress incurred in the fixation of patellar fractures with winged hook plates are much less than with TBW fixation (0.05 mm vs 0.3 mm; 121 MPa vs 268 MPa). In the model of IPFP: The wingless hook plate-cable wire-screw construction resulted in the least amount of displacement, followed by the wingless hook plate-cable wire (0.18 mm vs 0.297 mm). Displacement of the inferior pole of the patella would be more obvious in the two constructions that did not combine cable wires, especially the construction with neither cable wires nor screws.

CONCLUSION: In consideration of improvement of mechanical rigidity, winged hook plate was superior to TBW technique when being used for fixation of transverse patellar fracture, while combination of cable wire should be recommended when wingless hook plate being used for fixation of IPFP.

PMID:40609243 | DOI:10.1016/j.injury.2025.112567

Injury. 2025 Jun 25;56(8):112556. doi: 10.1016/j.injury.2025.112556. Online ahead of print.

ABSTRACT

Distal biceps injuries frequently occur in middle-aged males after an eccentric load to the elbow in flexion. The diagnosis is often clinical with the aid of imaging where appropriate. Tears can be partial or full thickness. Surgery is the mainstay of treatment with non-operative management typically reserved for older, lower-demand patients. Those treated without an operation can expect a loss of a proportion of supination and flexion power. There are several surgical techniques described. In the acute setting, a repair may be performing using a number of available devices. In the chronic setting, reconstruction with a graft may be required. Surgical management carries with it complications such as damage to the surrounding structures, heterotopic ossification and re-rupture.

PMID:40609242 | DOI:10.1016/j.injury.2025.112556

Injury. 2025 Jun 27;56(8):112568. doi: 10.1016/j.injury.2025.112568. Online ahead of print.

ABSTRACT

OBJECTIVE: Displaced tibial avulsion fractures of the posterior cruciate ligament (PCL) significantly compromise knee stability; however, existing clinical data regarding treatment and prognosis are limited. There exists a paucity of biomechanical research concerning various surgical methods for tibial avulsion fractures of the PCL, and optimal management remains controversial. Therefore, the objective of this study was to investigate the biomechanical stability of displaced tibial avulsion fracture using suture bridge fixation, screw fixation, and TightRope fixation at varying flexion angles.

METHODS: Finite element analysis was employed to evaluate the biomechanical stability of three surgical approaches. A type III PCL tibial avulsion fracture model was established, followed by the assembly of models for suture bridge fixation, screw fixation, and TightRope fixation. Varying angles of knee flexion were simulated, and the stress distribution on the implant, the PCL, and the bone fragment, as well as the displacement of the fragment, were assessed.

RESULTS: The findings indicated that the peak stress distribution on the implant for screw fixation was the highest, occurring near the midsection and tail of the implant, followed by TightRope fixation, which occurred near both ends of the fixation. In contrast, suture bridge fixation exhibited the lowest stress, occurring near the junction between the anchor and the suture. The stress distribution of the PCL in screw and TightRope fixation was slightly higher than that observed with suture bridge fixation. This stress was primarily concentrated in the upper portion and gradually increased, reaching a maximum at 120° The peak von Mises stress (VMS) on the bone fragment in the suture bridge fixation group was the highest, followed by the screw fixation group, and subsequently the TightRope fixation group. Furthermore, the displacement of the bone fragment was comparable among the three fixation methods across various angles of knee flexion.

CONCLUSION: The biomechanical properties of suture bridge fixation are superior to those of both TightRope and screw fixation. They are all alternative surgical treatment methods for displaced tibial avulsion fractures of the PCL. The ideal surgical approach should be selected based on the clinical context and a comprehensive evaluation.

PMID:40609241 | DOI:10.1016/j.injury.2025.112568

Injury. 2025 Jun 24:112545. doi: 10.1016/j.injury.2025.112545. Online ahead of print.

NO ABSTRACT

PMID:40603238 | DOI:10.1016/j.injury.2025.112545

Injury. 2025 Jun 23:112546. doi: 10.1016/j.injury.2025.112546. Online ahead of print.

NO ABSTRACT

PMID:40603237 | DOI:10.1016/j.injury.2025.112546

Injury. 2025 Jun 25;56(8):112557. doi: 10.1016/j.injury.2025.112557. Online ahead of print.

ABSTRACT

The global rise in total knee arthroplasty (TKA), driven by an aging population, has led to an increased incidence of periprosthetic fractures (PPFs). Dual implants for distal femur periprosthetic fractures (PDFFs) are a growing area of interest for these challenging fractures with dual plating (DP) and plate-retrograde femoral intramedullary nail (PN) emerging as viable constructs for these injuries. However, dual implants have inherent limitations. Herein we focus on describing a modified PN fixation-retrograde tibial intramedullary nail (RTN) combined with a less invasive stabilization system (LISS) for PDFFs following TKA in elderly patients and providing the technical trick of this modified PN fixation.

PMID:40602036 | DOI:10.1016/j.injury.2025.112557

Injury. 2025 Jun 21:112542. doi: 10.1016/j.injury.2025.112542. Online ahead of print.

ABSTRACT

BACKGROUND: Suicide in older people is increasing. We know less about serious deliberate self-harm in this population or the impact of this on Major Trauma Centres (MTC).

OBJECTIVES: Investigate demographics, injury mechanism and outcomes in older people admitted with self-inflicted injury.

DESIGN: Retrospective service evaluation.

SETTING: Single MTC in London, UK.

SUBJECTS: 60 people aged 65 years and over admitted to a MTC with self-inflicted injury.

METHODS: Retrospective analysis of trauma registry data (February 2015-2022).

VARIABLES: age, sex, past medical and psychiatric history, home and marital status, injury type and narrative, injury severity score (ISS), critical care admission, length of stay, discharge status and destination.

RESULTS: Self-inflicted injury represented 1.5 % of trauma admissions aged 65 and over (80 % male, median age 73 years). Most females and over half of men had a psychiatric history (females n = 11, 91.7 %; males n = 28, 58.3 %). Depression was the most common psychiatric comorbidity (n = 15). Males were more likely to suffer penetrating injury (males n = 37, 77.1 %; females n = 4, 33.3 %). The most common injury mechanism was self-stabbing amongst males (n = 37, 77.1 %) and a jump from height amongst females (n = 6, 50.0 %). Median ISS (8.5) and mortality (n = 8, 13.3 %) was low across the cohort. The most common discharge destination was psychiatric admission (males n = 28, 58.3 %; females n = 6, 50.0 %).

CONCLUSION: Older people who present with traumatic self-inflicted injury are predominantly male, utilise violent methods, have significant psychiatric comorbidity and require psychiatric admissions.

PMID:40592662 | DOI:10.1016/j.injury.2025.112542

Injury. 2025 Jun 23;56(8):112543. doi: 10.1016/j.injury.2025.112543. Online ahead of print.

ABSTRACT

BACKGROUND: Tibial plateau fractures (TPFs) are complex injuries associated with significant postoperative complications including infection, deformity and wound healing disorders. Limited data exist on risk factors for complications following surgical treatment, particularly in large multicenter cohorts.

METHODS: This retrospective study analyzed 1027 patients with intra-articular TPFs treated surgically at two level-I trauma centers in Germany (2011-2020). Preoperative CT imaging and follow-up data were required for inclusion. Complications were categorized into seven groups (infection, deformity, wound healing disorders, postoperative compartment syndrome, range of motion deficit and others). Statistical analyses assessed associations with fracture type (Schatzker classification), surgical approach, duration, and patient factors (BMI, age, smoking).

RESULTS: Nineteen percent of patients required surgical revision, with deformity (5.7 %), infection (5.4 %), and wound healing disorders (3.3 %) being the most common complications. Complex fractures (Schatzker V-VI) and prolonged or multi-approach surgeries were associated with higher complication rates. Elevated BMI increased overall complication risk, while smoking was linked to wound healing disorders.

CONCLUSION: The 19 % revision rate highlights the challenges of managing TPFs. Surgical factors, including operative duration and approach, play a critical role in the occurrence of complications, emphasizing the need for tailored strategies based on fracture complexity and surgical considerations.

PMID:40577996 | DOI:10.1016/j.injury.2025.112543

Injury. 2025 Jun 23;56(8):112550. doi: 10.1016/j.injury.2025.112550. Online ahead of print.

ABSTRACT

Introduction Geriatric fractures are a major contributor of morbidity and mortality in elderly patients and represent a large resource burden on healthcare institutions across the United States. Elderly populations are predicted to increase in the coming decades, motivating epidemiological studies that may inform more effective and targeted prevention measures for these injuries. Methods Data analyzed in this study was extracted from the National Electronic Injury Surveillance System (NEISS), a public database representing approximately 100 US EDs to provide national injury estimates. NEISS was queried for all fracture ED admissions among patients age 65 and older. Fracture events were restricted to injuries from January 1, 2019 to December 31, 2023. Results A geriatric fracture NEISS query resulted in 82,953 ED visits, extrapolating to a total national estimate of 3852,261 fractures presenting to US EDs across the study period. The overall hospitalization rate was 54.8 %, increasing to 74.5 % by age 99. Linear regression of fractures rates by year demonstrated a significant increase in male fractures over time (p = 0.047, β = 7688). Compared to females, males were also more likely to sustain trunk fractures and become injured at sporting facilities. Older patients also saw higher rates of trunk fractures (including upper and lower trunk), while rates of extremity fractures (upper and lower extremities) decreased with age. Fractures in the home also decreased with age, while those occurring on public property (including assisted living facilities) increased with age. Conclusion Increasing fracture rates among males indicates an opportunity for improved prevention measures among men 65 and older. Males were also more likely to sustain fractures while participating in sports, and may therefore benefit from education programs on fracture risk. Geriatric fractures were more likely to occur on public property such as sidewalks and assisted living facilities as patients aged, demonstrating the need for improved precautionary measures such as low-floor beds, hip protectors, fall alarms, and wearable devices.

PMID:40577995 | DOI:10.1016/j.injury.2025.112550

Injury. 2025 Jun 17:112521. doi: 10.1016/j.injury.2025.112521. Online ahead of print.

ABSTRACT

INTRODUCTION: Over the past two decades, damage control laparotomy and resuscitation (DCL and DCR, respectively) have become the dominant paradigms for the management of exsanguinating trauma. Fascial complications are common after DCL. Minimizing crystalloid administration is a key component of DCR, but there is little direct evidence that it reduces fascial complications. This study was designed to test the hypothesis that lower crystalloid administration volume during the perioperative period for DCL is associated with an increase in fascial closure rates and a decreased rate of fascial dehiscence.

METHODS: This was a retrospective observational study at a single urban trauma center. Adult trauma patients who underwent emergent DCL between March 2019 - December 2022 were included. Patients who died within 7 days of definitive closure or underwent additional intracavitary operations (e.g., thoracotomy) before or concurrent with laparotomy were excluded. Risk factors for fascial dehiscence and planned ventral hernia (PVH) were evaluated using univariate and multiple logistic regression analysis.

RESULTS: Among 287 included patients, median age was 32 (IQR 23-44), median injury severity score (ISS) 25 (17-34), median base deficit 6 (2-9), and 56.1 % had penetrating mechanism. The median crystalloid intravenous fluid (IVF) received from prehospital period to 48 h after index operation was 16.3 L (13.0-20.1 L). ISS, base deficit, and vital signs (systolic blood pressure, heart rate, and respiratory rate) did not differ between patients discharged with PVH or primary fascial closure, nor between patients who experienced a documented dehiscence event versus those who did not. Crystalloid volume was statistically different across both comparisons (primary fascial closure vs PVH at discharge: 15.6 vs 20.5 L, p < 0.001; no dehiscence vs any dehiscence 15.0 vs 18.1 L, p < 0.001). By multiple logistic regression, early IVF administration was associated with both PVH at discharge (odds ratio (OR) 1.14, 95 %CI 1.07-1.23) and fascial dehiscence (OR 1.17, 95 %CI 1.04-1.20).

CONCLUSION: Increased volume of perioperative crystalloid is associated with higher risk of fascial complications among patients requiring DCL for trauma. The DCR paradigm may reduce surgical complications as well as mortality among patients with severe trauma requiring laparotomy.

PMID:40571541 | DOI:10.1016/j.injury.2025.112521

Injury. 2025 Jun 17;56(8):112528. doi: 10.1016/j.injury.2025.112528. Online ahead of print.

ABSTRACT

This study reported the development of a novel mouse model for full-thickness articular cartilage defects. A total of 120 C57BL/6 mice were assigned to a sham group and three defect groups. The defect groups included D0.1, D0.2, and D0.3 groups, with 0.1, 0.2, and 0.3 mm wide full-thickness defects in the femoral trochlear grooves, respectively. The reproducibility and consistency of full-thickness defects and cartilage repair were evaluated by histological examination. The mRNA and protein expression levels of cAMP response element binding protein (CREB), phosphorylated CREB (p-CREB), parathyroid receptor 1 (PTH1R), Sonic hedgehog (Shh), Smoothened (Smo), and Gli 1 were assessed by immunohistochemistry and qRT-PCR. The results showed that the full-thickness defects displayed good reproducibility and consistency. Injury widths of 0.1 and 0.2 mm presented superior repair abilities than 0.3 mm (p < 0.05). During cartilage repair, the expression levels of PTH1R, CREB, p-CREB, Shh, Smo, and Gli 1 in the three defect groups were significantly higher than in the sham group (p < 0.05). In addition, the PTH/PTHrP and Hh signaling pathways were activated. In conclusion, we successfully established a novel mouse model for full-thickness articular cartilage defects, which enables deeper exploration of the biological mechanisms involved in cartilage repair in mice.

PMID:40570648 | DOI:10.1016/j.injury.2025.112528

Injury. 2025 Jun 6;56(8):112440. doi: 10.1016/j.injury.2025.112440. Online ahead of print.

ABSTRACT

INTRODUCTION: Controversy surrounds the optimal surgical management of proximal humerus fractures (PHFs). The aim of this study was to evaluate and compare the anatomic and clinical outcomes of open reduction internal fixation (ORIF) of PHFs using FA or VA locking plates.

METHODS: This was a retrospective study of 85 patients (19 male, mean age 60.5 ± 14 years) with displaced surgical neck PHFs treated with VA (44 patients) or FA (41 patients) locking plates. Inclusion criteria were a minimum of 1 year postoperative follow up (mean 3.1 years) or earlier revision surgery. Outcome measures included active range of motion, American Shoulder and Elbow Surgeons (ASES) score, Oxford Shoulder Score (OSS), Single Assessment Numeric Evaluation (SANE), EuroQol-5D (EQ-5D), Visual Analog Scale Pain score (VAS pain) and radiographic assessments of reduction quality, screw position, avascular necrosis (AVN) and failure of fixation.

RESULTS: The initial reduction was anatomic in 47 (55 %), acceptable in 29 (34 %), and malreduced in 9 (11 %). 69 (81 %) met inclusion criteria with no differences in reduction quality between the VA and FA plates (p=.16). VA plating was associated with significantly greater plate height compared to FA plating (B = 4.94; p<.001). Additionally, VA plating was associated with better calcar screw placement in terms of both shorter calcar distance (difference in means =1.8 mm, p=.009) and head distance (difference in means=2.4 mm, p=.007). Reoperation was required in 15 (22 %) patients while AVN occurred in 13 (19 %) patients. Neither reoperation nor AVN differed by plate type (p=.75 and p=.99, respectively). Finally, there were no significant differences in PROMs or ROM at final follow up between groups (difference in mean ASES: 1.1, p=.69; OSS: 1.4, p=.76; SANE: 6.5, p=.07; VAS Pain: 0.1, p=.35; EQ-5D: 0.02, p=.68; Active Forward Flexion: 2.3 degrees, p=.77; Active External Rotation: 6.7 degrees; Active Internal Rotation: 0.8, p=.55).

CONCLUSIONS: ORIF of PHFs with VA locking plates yields comparable outcomes to FA plates while facilitating plate positioning and calcar screw placement. Optimizing fracture reduction and fixation when performing ORIF of displaced PHFs is crucial to reducing the incidence of AVN and reoperation.

LEVEL OF EVIDENCE: Level III, Comparative Cohort Series, Treatment Study.

PMID:40570647 | DOI:10.1016/j.injury.2025.112440

Injury. 2025 Jun 18:112527. doi: 10.1016/j.injury.2025.112527. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence-based clinical practice guidelines play a crucial role in supporting clinical decision-making among healthcare providers, policymakers, and administrators by offering structured, research-informed recommendations. Globally, numerous guidelines have been developed for the management of burn injuries, but they vary considerably in terms of quality, structure, and methodological rigor. This study aimed to critically evaluate the quality of existing burn care guidelines from an interprofessional perspective and assess their adaptability for use in low- and middle-income countries (LMICs).

METHODS: This appraisal study, conducted between 2024 and 2025, employed the AGREE II instrument to evaluate guideline quality through the lens of an interprofessional burn care team. The methodology involved a systematic search to identify relevant guidelines, the formation of a multidisciplinary panel of burn care professionals, and a final quality appraisal of the selected guidelines using the AGREE II framework.

RESULTS: Out of the 38 initially identified clinical guidelines, 31 were excluded due to failure to meet the preliminary thresholds for quality and methodological validity. The remaining seven guidelines were subjected to a comprehensive evaluation using the 23-item AGREE II instrument, encompassing six key quality domains. The appraisal revealed considerable variability across these domains, with particularly marked disparities in stakeholder involvement, methodological rigor, and practical applicability.

CONCLUSION: The findings revealed significant heterogeneity in both the structural and content quality of current burn care guidelines. Among the evaluated documents, the guideline developed by the International Society for Burn Injuries (ISBI) achieved the highest AGREE II scores, demonstrating a strong interprofessional focus and relevance to LMICs. The expert panel subsequently endorsed it as the most appropriate candidate for adaptation in resource-constrained settings. These results highlight the urgent need for more robust, interdisciplinary, and context-sensitive burn care guidelines to improve patient outcomes and healthcare delivery globally.

PMID:40562590 | DOI:10.1016/j.injury.2025.112527

Injury. 2025 Jun 18:112525. doi: 10.1016/j.injury.2025.112525. Online ahead of print.

ABSTRACT

BACKGROUND: Rib fractures are common after blunt chest trauma and are associated with significant morbidity, mortality, and prolonged hospital stays due to pulmonary complications. Effective pain management is crucial in preventing these complications. The 'STUdy of the Management of BLunt chest wall trauma' (STUMBL) score can identify patients with rib fractures at risk of complications and assist with Emergency Department (ED) disposition decisions. Its role in guiding Acute Pain Service (APS) and Intensive Care Unit (ICU) referrals was previously unexplored.

DESIGN AND OBJECTIVES: We conducted a retrospective cohort study on adults with radiologically confirmed rib fractures who presented to The Royal Melbourne Hospital between April 2021 and March 2022. We aimed to assess the association between STUMBL scores and advanced analgesia prescription or ICU admission. Participants were categorised into five STUMBL groups (<11, 11-20, 21-25, 26-30, ≥31). The primary outcome of interest was regional analgesia insertion. The secondary outcomes were patient-controlled analgesia (PCA) use, APS and ICU referrals, and medical emergency team (MET) calls within 48 h. Modified Poisson regression was used to analyse associations, with the <11 group used as the reference.

RESULTS: Among 344 participants, the median STUMBL score was 17 (interquartile range [IQR] 10-24). Higher STUMBL scores were strongly associated with regional analgesia insertion in the STUMBL 26-30 group (RR 15.3, 95 % CI 1.8-130.3, p = 0.013) and the STUMBL ≥31 group (RR 29.3, 95 % CI 4.0-212.5, p = 0.001). Significant associations were also observed for PCA prescription (RR 5.0, 95 % CI 2.6-9.7, p < 0.001), APS referral (RR 4.7, 95 % CI 2.7-8.1, p < 0.001), and ICU admission (RR 3.8, 95 % CI 2.0-6.9, p < 0.001) in the STUMBL ≥31 group.

CONCLUSION: The STUMBL score is a valuable tool for identifying patients likely to require advanced analgesia and APS input, with high scores strongly associated with regional analgesia insertion and PCA prescription. Additionally, patients with STUMBL scores ≥26 were more likely to require ICU admission. Incorporating STUMBL thresholds into rib fracture guidelines could facilitate early APS involvement, guide appropriate admission destinations, optimise hospital resource allocation and improve patient outcomes. Further studies should validate these findings in larger, multi centre cohorts and explore patient-reported outcomes.

PMID:40562589 | DOI:10.1016/j.injury.2025.112525

Injury. 2025 Jun 19;56(8):112538. doi: 10.1016/j.injury.2025.112538. Online ahead of print.

ABSTRACT

AIM: Friction burns are a common paediatric injury that can result in significant morbidity and long-term disability. This systematic review aimed to evaluate the management and outcomes of these injuries.

METHODS: A protocol was developed a priori and registered on the PROSPERO database (CRD42022376782). A comprehensive search of MEDLINE, EMBASE, CENTRAL, CINAHL and trial registries was conducted to identify studies evaluating the management and outcomes of paediatric upper limb friction injuries. Primary outcome measures were healing time, functional outcomes, and the need for surgical intervention. Secondary outcomes included complications such as problematic scarring and cost.

RESULTS: Twenty-two studies met the inclusion criteria, encompassing 842 paediatric patients with upper limb friction injuries, predominantly treadmill-related (95 %). Most injuries (58.7 %) were deep partial-thickness to full-thickness. Conservative management with dressings was the primary treatment in 70.4 % of cases, while 29.6 % underwent acute surgery, predominately full-thickness skin grafting followed by split-thickness skin grafting. Mean healing times ranged from 19.4 to 31.5 days. Problematic scarring affected 20.5 % of patients, with 38.3 % of this group undergoing further scar revision surgery. Functional outcomes were generally positive, with minimal long-term disability reported.

CONCLUSION: Paediatric upper limb friction injuries, particularly those caused by treadmills, have typically been managed conservatively, with good functional outcomes. However, deeper injuries and delayed healing increase the risk of problematic scarring and need for scar revision surgery. Further research is needed to standardise treatment protocols and minimise long-term complications.

PMID:40561811 | DOI:10.1016/j.injury.2025.112538

Injury. 2025 Jun 18;56(8):112526. doi: 10.1016/j.injury.2025.112526. Online ahead of print.

ABSTRACT

BACKGROUND: Displaced distal radial fractures are common among all age groups, but increasingly in older patients, and are frequently managed by emergency nurse practitioners. Most can be manipulated and reduced in the emergency department, often by procedural sedation and analgesia, which can be time consuming and often requiring multiple resources. Using haematoma blocks may offer advantages.

AIM: To examine the use and efficacy of haematoma blocks in managing close reduction of distal radial fractures by emergency nursing practitioners compared to procedural sedation.

DESIGN: Matched case-control study.

RESULTS: Compared to those who had procedural sedation and analgesia (n = 100), the haematoma block group (n = 100) had a shorter procedure time (0.4 hrs vs. 0.7 hrs, Z= -1.24, p < .001), time from reduction to discharge (1.5 hrs vs. 4.6 hrs, Z= -2.98, p < .001), overall ED length of stay (2.8 hrs vs. 4.9 hrs, Z= -3.49, p < .001) and minimal pain post reduction (0/10 vs. 4/10, Z= -2.6, p = .001). No adverse events were noted in the haematoma block group compared to 23 % in the procedural sedation and analgesia group.

CONCLUSION: Hematoma block is a safe, effective and efficient alternative to procedural sedation in the reduction of distal radial fractures by emergency nurse practitioners.

PMID:40561810 | DOI:10.1016/j.injury.2025.112526