Injury. 2026 Feb 28;57(4):113140. doi: 10.1016/j.injury.2026.113140. Online ahead of print.

ABSTRACT

STUDY TYPE: Retrospective cohort.

PURPOSE: Complex regional pain syndrome (CRPS) is a rare but debilitating complication that may develop following distal radius fracture (DRF). Concomitant nerve-related injury may increase risk. The current study aimed to evaluate the incidence and odds of developing CRPS following DRF with or without need for open reduction and internal fixation (ORIF) and/or carpel tunnel release (CTR).

METHODS: Unilateral DRF patients between 2010-2022 were abstracted from the PearlDiver M170 Ortho database. Cohorts were defined as: (1) DRF managed non-operatively, (2) DRF treated with ORIF without same-day CTR, and (3) DRF treated operatively with ORIF and same-day CTR. ICD-10 laterality coding was used to ensure side-specific matching of DRF and CRPS diagnoses. Management cohorts were matched 1:1:1 based on patient age, sex, and Elixhauser Comorbidity Index (ECI). Monthly incidence of CRPS diagnosis through 1-year post-injury was determined for each matched cohort. Multivariable regression was performed to identify factors independently associated with CRPS.

RESULTS: After matching, there were 7656 patients in each management cohort. At 1 year, the incidence of CRPS was 24 (0.31 %) in the non-operative group, 44 (0.57 %) in the ORIF-only group, and 110 (1.44 %) in the ORIF+CTR group. Compared with non-operative management, ORIF-only was associated with an odds ratio for CRPS of 2.19 at 3 months and 1.84 at 1 year, while ORIF+CTR demonstrated an odds ratio for CRPS of 6.42 at 3 months and 4.60 at 1 year. A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73).

CONCLUSIONS: Patients undergoing ORIF with concomitant CTR demonstrated the highest odds of CRPS at both early and late timepoints, likely related to median nerve injury or irritation at the time of injury in cases requiring acute CTR.

LEVEL OF EVIDENCE: III.

PMID:41785540 | DOI:10.1016/j.injury.2026.113140

Injury. 2026 Feb 27;57(4):113143. doi: 10.1016/j.injury.2026.113143. Online ahead of print.

NO ABSTRACT

PMID:41780467 | DOI:10.1016/j.injury.2026.113143

Injury. 2026 Feb 27;57(4):113142. doi: 10.1016/j.injury.2026.113142. Online ahead of print.

ABSTRACT

INTRODUCTION: Fragility fractures of the pelvis (FFP) from low-energy trauma are increasingly frequent in older patients. FFP type IIIa, with displaced posterior ilium fracture, usually needs surgical treatment and its optimal fixation technique is unclear. Here, construct stiffness and failure load after fixation of an FFP type IIIa with anterior plate osteosynthesis (PO) with an additional lateral compression 2 (LC2) screw, was compared with PO alone under weight-bearing conditions.

MATERIALS AND METHODS: Twelve artificial left hemipelvises with simulated FFP type IIIa fractures were assigned into the PO (for fixation with an anteriorly fixed 3.5-mm plate) or PO with a 7.3-mm fully threaded antegrade LC2 screw (POLC2) groups (n = 6 per group). All specimens underwent ramped loading (at 18 N/s) from 20 N (preload) to 200 N, followed by progressively increasing cyclic testing at 2 Hz until failure, performed at 0.05 N/cycle on a servohydraulic material test system. Relative displacements and bone fragment angles were monitored using motion tracking.

RESULTS: Initial stiffness (N/mm) did not differ significantly in the PO vs POLC2 group (139.8 ± 31.7 vs 140.1 ± 27.0). After 5000 cycles, dynamic stiffness was significantly higher in the POLC2 group than in the PO group (199.0 ± 20.4 vs 163.8 ± 25.2, p = 0.041) while fracture displacement, torsional fracture displacement, and gap angle were significantly increased in the PO group than in the POLC2 group (p < 0.0001). Cycles to failure and load to failure were higher in the POLC2 group (6922 ± 1133 and 892.2 ± 113.3 N, respectively) when compared with the PO group (4979 ± 943 and 697.9 ± 94.3 N, respectively) (p = 0.015).

CONCLUSION: Compared with plate osteosynthesis alone in an FFP type IIIa model, antegrade LC2 screw augmentation demonstrated significantly increased stability against axial and torsional loading. The combined plate-LC2 screw construct might be an ideal fixation option for posterior iliac fracture of FFP, safely allowing early weight bearing and rehabilitation.

PMID:41780466 | DOI:10.1016/j.injury.2026.113142

Injury. 2026 Feb 27;57(4):113139. doi: 10.1016/j.injury.2026.113139. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal femoral periprosthetic fractures following TKA are increasingly common in elderly patients. Surgical management most commonly involves either open reduction and internal fixation (ORIF) or distal femoral replacement (DFR); however, comparative data regarding short-term and long-term complications remain limited. As such, this study compared complications between ORIF and DFR in elderly patients with distal femoral periprosthetic fractures following TKA.

METHODS: A retrospective cohort study was performed using the TriNetX Research Network. Patients aged ≥65 years with distal femoral periprosthetic fractures were identified and categorized by operative treatment. Propensity score matching was performed to balance cohorts. Short-term complications were assessed at 90 days, and long-term complications were evaluated at 1 and 5 years. Complications were compared using risk differences and risk ratios with 95% confidence intervals, and Kaplan-Meier survival methods.

RESULTS: After matching, 698 patients remained in each cohort. Most 90-day complications were similar between groups. However, DFR was associated with higher rates of wound disruption (7.6% vs 2.7%, RR 2.79 [95% CI 1.67-4.66], p<0.001) and transfusion (17.5% vs 13.0%, RR 1.34 [1.04-1.72], p=0.021). At 5-year follow-up, DFR demonstrated higher risks of periprosthetic joint infection (22.5% vs 5.3%, RR 4.24 [3.01-5.98], p<0.001), revision TKA (15.5% vs 3.3%, RR 4.70 [3.03-7.27], p<0.001), and subsequent knee procedures (24.4% vs 14.9%, RR 1.64 [1.31-2.04], p<0.001). Conversely, repeat periprosthetic fractures were more frequent following ORIF (55.3% vs 44.8%), with DFR demonstrating a lower relative risk (RR 0.81 [0.73-0.90], p<0.001). Similarly, additional fixation procedures occurred more often after ORIF (4.9% vs 1.6%), while DFR was associated with a reduced relative risk (RR 0.32 [0.17-0.63], p<0.001). Mortality was similar between approaches at both 30 days (2.2% vs 2.2%, RR 1.00 [0.48-2.08], p=1.00) and 5 years (16.0% vs 15.4%, RR 1.04 [0.81-1.33], p=0.764).

CONCLUSION: Short-term systemic complication rates were comparable between approaches, although DFR was associated with greater perioperative morbidity. Over longer follow-up, DFR demonstrated higher implant-related infection and revision risks, whereas ORIF carried higher risks of refracture and secondary fixation. These findings highlight a tradeoff between the immediate stability and mobilization of DFR and longer-term implant-related complications, supporting individualized treatment selection based on patient-specific risk factors.

PMID:41780465 | DOI:10.1016/j.injury.2026.113139

Injury. 2026 Feb 23;57(4):113119. doi: 10.1016/j.injury.2026.113119. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric supracondylar humeral fractures (SCHFs) with coronal obliquity pose unique intraoperative challenges and are believed to carry a higher risk of postoperative loss of reduction and delayed functional recovery. However, high-quality evidence supporting this association remains limited.

METHODS: This retrospective comparative study analyzed pediatric patients under 16 years of age who underwent closed reduction and percutaneous pinning for Gartland type III or IV SCHFs between 2016 and 2022. Based on preoperative radiographs, patients were classified into transverse or coronal oblique groups, with coronal obliquity defined as >10° on the anterior-posterior view. Postoperative radiographic parameters, complications, and recovery of elbow range of motion (ROM) were compared between groups.

RESULTS: Among 88 patients, 52 had transverse and 36 had coronal oblique fractures. The coronal oblique group showed significantly higher rates of reduction outliers (anterior humeral line non-intersection: 36.1 % vs. 13.5 %, p = 0.013; malrotation: 22.2 % vs. 3.8 %, p = 0.008), loss of reduction (LOR) requiring reoperation (13.9 % vs. 0 %, p = 0.006), and delayed ROM recovery (19.4 % vs. 1.9 %, p = 0.011). No significant differences were observed in cosmetic or functional outcomes at six months (p = 0.311).

CONCLUSIONS: Coronal obliquity in pediatric SCHFs is significantly associated with a higher incidence of reduction outliers and postoperative LOR. Consequently, these fractures are more likely to require revision surgery and demonstrate slower functional recovery of elbow motion during the early postoperative period compared with transverse-type fractures.

PMID:41780464 | DOI:10.1016/j.injury.2026.113119

Injury. 2026 Feb 23;57(4):113127. doi: 10.1016/j.injury.2026.113127. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate whether preoperative use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) is associated with increased risk of reoperation, nonunion, infection, hospital readmission, or emergency department (ED) visits following operative fixation of isolated long bone fractures.

METHODS: This retrospective, multicenter cohort study was conducted using the TriNetX Research Network. Adults (≥18 years) who underwent operative fixation of isolated tibial, femoral, or humeral shaft fractures between 2012 and 2024 were included. Patients prescribed an SSRI or SNRI within 180 days prior to fracture and within 12 months after surgery were compared with controls without antidepressant prescriptions before or within 12 months after fracture. Polytrauma, pathologic fractures, and prior surgery at the same site were excluded. Propensity score matching (1:1) was performed for demographics, fracture location, and relevant medical and psychiatric comorbidities. The primary outcome was reoperation within 12 months. Secondary outcomes included nonunion, infection, hospital readmission, and ED visits. Analyses were stratified by fracture type (open vs closed) and location.

RESULTS: A total of 5293 SSRI/SNRI users were matched to 5293 controls. In closed fractures, antidepressant use was associated with higher rates of nonunion (5.2% vs 4.0%; RR 1.29, 95% CI 1.06-1.56). Open fractures demonstrated a trend towards greater rates of nonunion (4.8% vs 3.1%) and reoperation (15.2% vs 13.9%); however, this was not significant. 30-day ED visits, 30-day surgical site infection, and 90-day readmissions were comparable between groups.

CONCLUSIONS: Preoperative SSRI or SNRI use was associated with increased risk of nonunion following operative fixation of closed long bone fractures. Outcomes following open fractures were largely unaffected, likely due to the dominant biological and mechanical risks inherent to open injuries. These findings suggest the need for increased clinical vigilance in patients with closed fractures receiving serotonergic antidepressants and highlight the importance of prospective studies to further clarify causality and guide management strategies.

PMID:41775053 | DOI:10.1016/j.injury.2026.113127

Injury. 2026 Feb 27;57(4):113126. doi: 10.1016/j.injury.2026.113126. Online ahead of print.

NO ABSTRACT

PMID:41764816 | DOI:10.1016/j.injury.2026.113126

Injury. 2026 Feb 16;57(4):113112. doi: 10.1016/j.injury.2026.113112. Online ahead of print.

ABSTRACT

BACKGROUND: Polytrauma requiring intensive care remains a leading cause of morbidity and mortality, particularly among patients with orthopedic injuries. Despite advances in trauma systems and surgical management, outcomes for this cohort are influenced by complex interactions between injury burden, physiological status, and pre-existing comorbidities. There remains limited evidence focused specifically on predictors of outcome within orthopedic trauma patients admitted to the intensive care unit (ICU).

METHODS: This retrospective cohort study analyzed all adults (≥18 years) admitted with orthopedic trauma to the ICU of a major Irish tertiary trauma centre between January 2011 and December 2020. Orthopedic injuries included fractures, dislocations, or musculoskeletal trauma requiring specialist management. Demographic, clinical, and injury-related data were extracted from institutional databases. Outcomes assessed were 30-day, 90-day, and 1-year mortality, complication burden (graded by the Adapted Clavien-Dindo in Trauma [ACDiT] score), and discharge destination. Multivariate regression was used to identify independent predictors of adverse outcomes.

RESULTS: Of 720 trauma patients admitted to the ICU over 10 years, 458 with orthopedic injuries were included. The mean age was 56.2 years; 63.8 % were male, and two-thirds had at least one comorbidity. The most common mechanisms were low-level falls and road traffic accidents. The median Injury Severity Score was 16, and 23.4 % required mechanical ventilation. One-year survival was 79.7 %. Key predictors of mortality and complications included advanced age, cervical spine injury, lower Glasgow Coma Scale, higher ASA and ISS, mechanical ventilation, malignancy, and polytrauma. Most patients returned home at discharge, though a significant minority required institutional care or died in-hospital.

CONCLUSIONS: Orthopedic polytrauma patients admitted to ICU represent a high-risk group with substantial mortality and complication rates, particularly among the elderly and those with severe physiological compromise. Early identification of prognostic factors such as age, ISS, GCS, ASA, and need for ventilation may inform tailored management strategies and support improved risk stratification in this vulnerable population.

PMID:41764815 | DOI:10.1016/j.injury.2026.113112

Injury. 2026 Feb 21;57(4):113130. doi: 10.1016/j.injury.2026.113130. Online ahead of print.

ABSTRACT

BACKGROUND: Rigid intramedullary (IM) fixation is avoided in skeletally immature patients because of the risk of physeal injury, causing subsequent growth disturbances. However, with the increasing numbers of high-energy injuries and complex fractures in older adolescents, suprapatellar rigid IM nailing (RIMN) has emerged as an alternative. This study evaluated whether RIMN in skeletally immature adolescents results in coronal or sagittal deformities and to evaluate the clinical outcomes.

METHODS: We retrospectively reviewed skeletally immature patients who underwent suprapatellar RIMN for tibial shaft fractures between January 2014 and October 2024. The inclusion criteria were an open proximal tibial physis, a diaphyseal fracture pattern, and > 12-month follow-up. Radiographic parameters, including the mechanical medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA), were measured twice on standardized anteroposterior and lateral radiographs by a single senior pediatric orthopaedic surgeon. Malalignment was defined as a deviation greater than 5° in the coronal plane or 10° in the sagittal plane relative to the contralateral side. Discrepancies in limb length were considered significant when exceeding 2 cm. Statistical comparisons between the immediate postoperative and final radiographs were performed using the paired t-test and equivalence test.

RESULTS: Twenty-four patients (mean age 15.9 ± 1.3 years) were included, and 17 (70.8%) were classified as having proximal tibial ossification stage III and seven (29.2%) as stage II. All fractures achieved union at a mean of 14.3 ± 5.3 weeks. No significant changes were observed in MPTA or PPTA. Two patients with open fractures developed nonunion requiring secondary surgery. Mild anterior knee pain occurred in ten patients (41.7%) without activity limitation, and four (16.7%) experienced compartment syndrome requiring fasciotomy. No patient demonstrated coronal or sagittal deformity, limb-length discrepancy, or growth disturbance.

CONCLUSIONS: Although physeal preservation remains fundamental in pediatric fracture management, suprapatellar RIMN can provide stable fixation and satisfactory outcomes in adolescents nearing skeletal maturity. For selected patients in whom plating or flexible nailing are suboptimal, rigid IM fixation represents a reasonable alternative.

LEVEL OF EVIDENCE: Level IV, retrospective cohort study.

PMID:41764814 | DOI:10.1016/j.injury.2026.113130

Injury. 2026 Feb 19;57(4):113124. doi: 10.1016/j.injury.2026.113124. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic distal femoral fractures after total knee arthroplasty (TKAPF) are challenging in very elderly patients. This study aimed to identify the incidence and risk factors for post-operative complications in patients aged over 80 years surgically treated for these fractures.

METHODS: A multicentre SOFCOT database (2012-2019) was analyzed. Patients aged >80 years with TKAPF were compared to a < 80 control group. Outcomes included complications, reoperation, mortality, and operative delay. Multivariable logistic regression was used to identify independent risk factors for reoperation and mortality.

RESULTS: Among 376 patients aged >80 (mean age 87.5 ± 4.4 years; 87.5% female), 359 patients (95.5%) were surgically treated, the reoperation rate was 10.0%, the complication rate was 19.5%, and mortality at two-year follow-up reached 29.5%. Mortality was independently associated with ASA score (p = 0.0096), but not with age, fracture pattern, or surgical approach. Operative delay (mean 2.9 days) had no impact on mortality or reoperation but was associated with more infections and implant loosening (p < 0.001).

CONCLUSIONS: In patients over 80 years, systemic frailty, reflected by ASA score, was the main determinant of mortality, while delayed surgery (>72 h) increased local complications, supporting an individualized surgical approach, based on general conditions rather than fracture morphology or surgical preference.

PMID:41762854 | DOI:10.1016/j.injury.2026.113124

Injury. 2026 Feb 21;57(4):113122. doi: 10.1016/j.injury.2026.113122. Online ahead of print.

ABSTRACT

INTRODUCTION/OBJECTIVES: Increased BMI has been linked to increased risk of meniscal tears, yet outcomes following meniscus repair in these patients remain unclear. This study aims to compare post-traumatic meniscus repair failure rates and return to sport outcomes in pediatric and adolescent populations based on weight, BMI, BMI percentile, and CDC BMI Category.

METHODS: This retrospective cohort study included patients aged <19 years who underwent meniscus repair at our multi-center institution between 2017 and 2023, including both isolated and concomitant repairs. The primary outcome was meniscus repair failure, defined as clinical, radiographic, and/or intraoperative evidence of meniscal pathology, or the need for additional surgical intervention at the meniscus. Secondary outcomes included Return to Sport (RTS) and Return to Sport at Pre-Injury Level (RTSPIL). An analysis of outcomes by weight, BMI, BMI percentile, and weight category was performed.

RESULTS: 203 patients were included (54.0% female, mean age 15.7 ± 1.7 years, weight 69.8 ± 19.7 kg, and BMI 24.3 ± 5.5 kg/m²), with a mean follow-up of 23.3 ± 13.9 months. Overall repair failure rate was 24.6%. Patients with meniscus failure were significantly heavier (p < .05) with higher BMIs (p < .001) than those without, but they did not differ in BMI percentile (p = .10). There were no significant differences in weight, BMI, or BMI percentile for those who failed to RTS or RTSPIL, compared to those who successfully returned. Increasing BMI categories showed higher rates of failure, failure to RTS, and failure to RTSPIL. Meniscus failure and failure to RTS did not vary based on age, follow-up, or gender.

CONCLUSIONS: This study identifies elevated rates of meniscal repair failure in pediatric and adolescent patients who have increased weight and BMI. Notably, this association was not demonstrated for BMI percentile. None of these measures predicted return to sport, suggesting functional recovery depends on factors beyond body composition. Thus, surgeons must retain a heightened clinical awareness and perform close postoperative monitoring following meniscus repair in patients with elevated weight and BMI.

LEVEL OF EVIDENCE: III, Retrospective Cohort.

PMID:41762853 | DOI:10.1016/j.injury.2026.113122

Injury. 2026 Feb 16:113106. doi: 10.1016/j.injury.2026.113106. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe the outcomes of a protocol using ultrasound-guided pericardiocentesis with pericardial drain placement as definitive treatment for penetrating cardiac injury with tamponade in a resource-limited war zone setting, where emergency thoracotomy is often unavailable.

DESIGN: Single-center prospective case series.

SETTING: Nasser Medical Complex, a major tertiary trauma center in southern Gaza, over a period of 24 months during active conflict.

PARTICIPANTS: 25 patients (21 male, 4 female), aged 4-65 years, not in cardiac arrest, with traumatic pericardial effusions and hematoma caused by penetrating injury presenting within approximately 3 hours.

INTERVENTIONS: Ultrasound-guided pericardiocentesis via a large-bore 16 gauge dialysis catheter, aggressive aspiration of fresh blood, instilling 1 gram of intrapericardial tranexamic acid (TXA) and pericardial drain placement for 48 hours with serial echocardiographic monitoring.

MAIN OUTCOME MEASURES: Survival to hospital discharge, need for subsequent thoracotomy and complications.

RESULTS: This study demonstrated a high survival rate of 96%, with 24 out of 25 patients surviving to hospital discharge (the sole non-survivor died from other injuries). The protocol successfully prevented the need for thoracotomy in 100% of cases, establishing it as a definitive treatment. A recurrence rate of 8% was observed, requiring repeat drainage in two patients, while follow-up was maintained for 83% of survivors.

CONCLUSIONS: In a warzone setting, a protocol of pericardiocentesis with pericardial drain placement and intrapericardial TXA served as definitive management for selected patients with penetrating cardiac tamponade, resulting in high survival and avoiding the need for thoracotomy. This approach challenges current practice and offers a life-saving alternative in resource-constrained environments.

PMID:41760498 | DOI:10.1016/j.injury.2026.113106

Injury. 2026 Feb 13;57(4):113100. doi: 10.1016/j.injury.2026.113100. Online ahead of print.

ABSTRACT

INTRODUCTION: Transporting injured patients to an appropriate level of care remains a complex challenge. In our trauma system, paramedics are mostly limited to basic life support and perform field triage guided by an algorithm that considers the type of injury and the estimated transport time to a Level 1 Trauma Center (L1TC). This study evaluates the effect of this triage protocol by comparing patient mortality between those transported directly to a L1TC and those initially transferred from another facility.

METHODS: This retrospective study queried a Canadian L1TC trauma registry, which included all adult trauma patients who were admitted or died in the emergency department, between 2016 and 2022. Isolated burns, hanging, isolated hip fractures, arrival ≥ 72 h post-injury, death within 2 h of arrival at L1TC, or direct ward admissions were excluded from the study. We used multivariable logistic regression to compare in-hospital mortality between direct transport and interfacility transfer cohorts. Sensitivity and subgroup analyses were performed to further aid in refining triage criteria.

RESULTS: Of 9488 registry patients, 1645 were excluded, leaving 4702 direct transports and 3141 interfacility transfers. Transferred patients were younger (median 59 vs. 67 years, p < 0.001), more severely injured (44.1 % vs 31.1 % ISS>15, p < 0.001) and had longer times to definitive care (9.32 h vs 1.15 h, p < 0.001). Overall, interfacility transfer was associated with a decreased odds of in-hospital mortality [aOR 0.54 (95 % CI 0.42-0.69)]. However, in our sensitivity and subgroup analyses, interfacility transfer was associated with an increased odds of mortality [aOR 4.17 (95 % 1.02-17.1)] if time to definitive care was <1 h.

CONCLUSION: The application of a provincial prehospital triage criteria translates to improved survival for select patients through interfacility transfers. However, our results support direct transport to a L1TC if the time to definitive care can be achieved within an hour. These findings should be used to further refine prehospital triage protocols and interfacility transport policies.

PMID:41759436 | DOI:10.1016/j.injury.2026.113100

Injury. 2026 Feb 22;57(4):113129. doi: 10.1016/j.injury.2026.113129. Online ahead of print.

ABSTRACT

BACKGROUND: Nutritional Vulnerability may increase complications and reintervention after calcaneus fracture care. This study compared 90-day and 2-year outcomes among malnourished adults treated with closed management, percutaneous fixation, or open reduction and internal fixation (ORIF).

METHODS: Adults (≥18 years) with calcaneus fracture and laboratory-defined nutritional vulnerability (albumin ≤3.5 g/dL and/or leukocytes ≤1.5 × 10³/µL within 1 year pre-index) were identified. Three independent 1:1 propensity score-matched comparisons were performed (closed vs ORIF, percutaneous vs ORIF, and closed vs percutaneous). Outcomes were assessed at 90 and 730 days.

RESULTS: Matched cohorts included 981 per group (closed vs ORIF), 403 per group (percutaneous vs ORIF), and 386 per group (closed vs percutaneous). At 90 days, closed treatment had higher acute respiratory failure/mechanical ventilation than ORIF (11.5% vs 7.7%, P=.005); otherwise no differences were detected. Percutaneous fixation had lower wound disruption than ORIF (6.2% vs 10.4%, P=.03) but higher acute respiratory failure/mechanical ventilation (13.4% vs 8.2%, P=.017); no differences were detected between closed and percutaneous. By 2 years, subsequent fixation was higher after closed reduction compared to ORIF (6.9% vs 3.8%, P=.002) and percutaneous vs ORIF (9.5% vs 4.0%, P=.002), and salvage procedures were lower after closed reduction compared to ORIF (2.9% vs 4.6%, P=.035); otherwise no differences were detected.

CONCLUSION: Among malnourished adults with calcaneus fracture, less invasive strategies were associated with lower short-term wound disruption compared with ORIF but higher subsequent fixation by 2 years, highlighting clinically important management tradeoffs. These findings underscore the importance of preoperative host optimization and individualized strategy selection in high-risk patients, weighing early soft-tissue morbidity against the potential need for later conversion to ORIF and downstream reintervention in routine practice.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.

PMID:41747641 | DOI:10.1016/j.injury.2026.113129

Injury. 2026 Feb 16;57(4):113107. doi: 10.1016/j.injury.2026.113107. Online ahead of print.

ABSTRACT

PURPOSE: The primary aim of this study was to present an up-to-date overview of postoperative complications during hospitalization of patients undergoing hip fracture surgery in a Western European country. The secondary aim of this study was to evaluate clinical outcomes (length of hospital stay and mortality) in relation to postoperative complications.

PATIENTS AND METHODS: A prospective proximal femoral fracture database was used to obtain data. In total, 2603 patients older than 18 years undergoing hip fracture surgery between January 2018 and January 2021 were included. Baseline characteristics, clinical outcomes and postoperative complications were retrospectively analyzed. Complications were categorized as minor or major (requiring medical intervention and prolonged hospital stay).

RESULTS: Of 2603 patients, 51% experienced at least one complication. Major complications occurred in 30% of all cases. The most frequent major complications were delirium (16%), pneumonia (9%), and urinary tract infections (UTI) (8%). Minor complications occurred in 19% of all cases. The most frequent minor complication was anemia requiring transfusion (19%). Of all major complications delirium, pneumonia, and acute kidney injury (AKI) were significantly associated with increased 30-day and 1-year mortality (p < 0.001).

CONCLUSION: Proximal femoral fractures are associated with a high overall incidence of complications. Most complications are associated with either a significantly longer hospitalization or higher 30-day and 1-year mortality rates.

LEVEL OF EVIDENCE: Level II prospective multicenter cohort study.

PMID:41747640 | DOI:10.1016/j.injury.2026.113107

Injury. 2026 Feb 18;57(4):113118. doi: 10.1016/j.injury.2026.113118. Online ahead of print.

ABSTRACT

INTRODUCTION: The axillary nerve is a crucial peripheral branch arising from the posterior cord of the brachial plexus. It provides both motor and sensory innervation to the shoulder girdle, enabling essential movements such as abduction and external rotation-functions that are crucial for daily activities and various athletic movements. Despite its significance, detailed documentation of the axillary nerve's branching patterns remains limited. This study aimed to examine the branching configurations of the axillary nerve in a South African cadaveric sample.

MATERIALS AND METHODS: Thirty adult cadavers (15 females and 15 males) were examined. To minimise the risk of damaging the axillary nerve during dissection, key surface anatomy landmarks-including the acromion and coracoid process-were identified and marked, enabling accurate location of the nerve as it traversed the deltoid muscle. Dissection followed established protocols, involving careful incision and reflection of the deltoid and pectoral muscles to expose the axillary nerve and associated neurovascular structures.

RESULTS: The study identified and classified four distinct axillary nerve branching patterns. Type 1, in which the nerve branches before entering the quadrangular space, was observed in 16.67% of cases. Type 2, characterized by branching within the quadrangular space, was noted in 18.33%. Type 3, where branching occurred after exiting the quadrangular space, was observed in 25.00%. Type 4, a combination of the previous three patterns, was the most prevalent, occurring in 40.00% of specimens. No significant differences were observed between the left and right shoulders regarding branching pattern (p = 0.9998). However, a significant difference was found in the overall distribution of branching types across all categories (p = 0.01299).

CONCLUSION: These findings suggest that the axillary nerve does not exhibit a definitive branching pattern, highlighting the anatomical complexity and variability of this structure. This underscores the need for a more nuanced and comprehensive classification system when analyzing the axillary nerve morphology.

PMID:41747639 | DOI:10.1016/j.injury.2026.113118

Injury. 2026 Feb 13;57(4):113101. doi: 10.1016/j.injury.2026.113101. Online ahead of print.

ABSTRACT

BACKGROUND: Pretibial lacerations are a common and costly injury in elderly patients. At present, no standardised evidence-based guidelines exist to aid in their management. This systematic review aims to collate and evaluate all available evidence on the assessment and management of pretibial lacerations, including outcomes such as wound healing time, complications and mortality.

METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, CENTRAL, and clinicaltrials.gov was conducted from inception to November 2024. Studies were eligible if they investigated patients with pretibial lacerations and reported at least one clinical outcome.

RESULTS: Twenty-nine studies published between 1973 and 2023 were included. This included 11 case series, 12 cohort studies and six randomised controlled trials, with a total of 2893 patients. The weighted mean age for patients was 75.4 years. For studies that reported gender data, 85.1% were female. Management strategies varied widely, with 12 studies reporting operative management, four reporting non-operative management and 13 reporting both. Operative management was associated with shorter healing times compared to non-operative management. Infection was the most common complication across both groups (0% to 63%). One month mortality rates were as high as 15%. Risk of bias was high in the majority (55%) of studies.

CONCLUSION: Considerable variability exists in the assessment and management of pretibial lacerations, with a lack of high-quality evidence to inform clinical practice. Further research is required to establish best practice for this common injury within our ageing population.

PMID:41747638 | DOI:10.1016/j.injury.2026.113101

Injury. 2026 Feb 17;57(4):113123. doi: 10.1016/j.injury.2026.113123. Online ahead of print.

ABSTRACT

Mesenchymal stromal cells (MSCs) have been used for inducing skin regeneration in patients with severe cutaneous wounds. However, transportation of these cells from cellular therapy units to hospitals is an important issue for clinical use. Several types of synthetic biomaterial scaffolds have been used for carrying different type of cells. Among them, polyethylene terephthalate (PET) scaffolds have shown that maintains the viability and biological functionality of MSCs. Here, we aimed to evaluate the viability and functionality of MSCs seeded on PET membranes, maintained under different cell culture conditions, as a possible system for cell transportation. In this work, human MSCs were seeded and cultured on PET membranes (MSCs/PET) at 37 °C or room temperature (RT) for 24 h. Adhesion, viability, proliferation, migration and multipotential differentiation were evaluated in all experimental conditions. MSCs survival, viability, proliferation and multipotential differentiation were similar on both PET membranes and plastic culture dishes, after 24 h of culture at 37 °C or RT. Microscopic observation of MSCs seeded on PET membranes or plastic culture dishes showed their characteristic fibroblastoid morphology at both temperature conditions. Our results show that PET membranes constitute an optimal scaffold for MSCs transportation. The MSCs-PET system might be used not only for transporting MSCs to health center but also as cell-based wound dressing system for inducing skin regeneration in patients with cutaneous wounds such as burned patients.

PMID:41747637 | DOI:10.1016/j.injury.2026.113123

Injury. 2026 Feb 17;57(4):113103. doi: 10.1016/j.injury.2026.113103. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFP) are increasing with the aging population and differ from high-energy pelvic trauma. The Rommens classification and the more recent OF classification guide treatment decisions. The OF pelvis score aims to objectify therapy choice by integrating fracture type, mobility, and pain among other variables. However, the rationale behind key thresholds, such as the VAS cut-off of 5 and the emphasis on mobilization remains unclear. This study seeks to define evidence-based thresholds to improve treatment decision-making.

MATERIAL AND METHODS: This retrospective single-center study includes all patients ≥65 years with an FFP treated as inpatients between 2018 and 2023. Demographics, comorbidities, diagnostics, treatment type, pain level (VAS), mobility, and length of stay are demonstrated. A custom Likert-based mobility score is calculated for each patient. Statistical analysis is performed on pain level and mobilization between conservatively and operatively treated patients.

RESULTS: Totally 428 patients were included in the study. The median age was 85 (80-90) years. While 60.0% (n=257) were treated conservatively, 40.0% (n=171) underwent surgical treatment. The median time to decision for surgical treatment was 3 (2-7) days. At the third day of inpatient stay conservatively treated patients had a significantly better mobilization level (p<0.01) and lower pain level (p=0.015) than patient treated surgically. The suggested Likert Score for mobilization showed a cut-off value of <4 for operative treatment. Patients with a VAS >4 at the third day of the inpatient stay were more likely to be treated surgically. There was no significant difference in proportions of analgesics. Classification, mobilization and pain level had significant influence on the choice of treatment, with classification having the most impact.

CONCLUSION: This study presents comprehensive demographic data and inpatient information on pain level, analgesia, and mobility in FFP patients. A novel Likert-based mobility score is introduced to objectively quantify mobilization. For the first time, the typical timing of surgical decision-making is determined and used to compare pain level and mobility levels between treatment groups. Multivariable analysis identifies and weighs key factors influencing treatment decisions.

PMID:41740217 | DOI:10.1016/j.injury.2026.113103

Injury. 2026 Feb 18;57(4):113102. doi: 10.1016/j.injury.2026.113102. Online ahead of print.

ABSTRACT

INTRODUCTION: Venous thromboembolism (VTE) is a major contributor to morbidity and mortality following traumatic injury. The optimal pharmacological VTE prophylaxis (VTEp) regimen is uncertain. There are limited data on VTE events and VTEp practice, particularly in the trauma population requiring admission to an intensive care unit (ICU).

OBJECTIVE: To describe the incidence and timing of VTE events, VTEp regimens, and associated risk factors for VTE in a severe trauma cohort requiring ICU admission.

METHODS: Retrospective cohort study of all trauma patients (n = 969) admitted to the ICU of the Royal Brisbane and Women's Hospital between 1/2/19 and 31/12/23. Data collected included baseline characteristics, VTEp administered, VTE investigations and outcomes including VTE events, length of stay, and mortality. Competing risks survival analysis was used to describe the association between baseline characteristics and risk of VTE development.

RESULTS: The median injury severity score was 22 (IQR 16-29). The incidence of new VTE events, as diagnosed on imaging, within 28 days of injury was 12 %. The median time to first VTE event was 9 days (IQR 4.8-13.1), and 5 of the 121 (4 %) events occurred within 24 h of injury. In the group that were admitted within 24 h of injury, the median time to VTEp commencement was 48 h (IQR 29-71) and 74 % received unfractionated heparin as the first VTEp administered. In those that had not experienced the competing risks of death or hospital discharge, only the presence of a severe lower extremity injury (cause specific HR 1.81, 95 % CI 1.19-2.76, p= 0.005) and increasing weight (cause specific HR 1.02, 95 % CI 1.01-1.03) were associated with an increased adjusted rate of developing a VTE by day 28.

CONCLUSIONS: Although the incidence of VTE in our cohort was lower than reported in international studies, it remains a significant burden of disease. These data can be used to inform the design of clinical trials that seek to address the evidence gaps in the optimal post-trauma VTEp regimen in the severely injured trauma population.

PMID:41740216 | DOI:10.1016/j.injury.2026.113102