Injury. 2025 May 7:112358. doi: 10.1016/j.injury.2025.112358. Online ahead of print.

NO ABSTRACT

PMID:40335386 | DOI:10.1016/j.injury.2025.112358

Injury. 2025 Apr 29;56(7):112368. doi: 10.1016/j.injury.2025.112368. Online ahead of print.

ABSTRACT

BACKGROUND: Sports-related injuries (SRIs) are a significant cause of public health concern. This study aimed to identify risk factors for spine fracture injuries in sports, focusing on sport type, injury location, and demographic patterns.

METHODS: A retrospective analysis of prospectively collected registry data from the "National Electronic Injury Surveillance System (NEISS)" database was performed for spine injuries. A total of 138,268,340 hospital emergency department records between 1/2/2011 and 12/29/2020 resulted in a weighted national estimate of 29,148 spine fracture injuries (19,791 males and 9357 females) associated with sports.

RESULTS: There were 10,530 (36 %) injuries at sports venues and 5755 (20 %) on the streets. The most prevalent sports activities leading to spine fractures were motorsports/cycling in males (60.4 %) and horseback riding in females (31.2 %). Fractures at the lumbar (40.6 %) and cervical (33.9 %) spine were the most common diagnoses. Males were more likely to have cervical fractures (40.5 % vs. 19.9 %), while females more frequently had lumbosacral injuries (66.4 % vs. 40.8 %) (all p < 0.001). Multivariate regression analysis revealed that ball sports (OR=4.2), water sports (OR=3.89), and trampoline (OR=1.88) significantly increased the risk for cervical fracture. Adults (OR=2.69), males (OR=2.31), and Asians (OR=3.66) were at higher risk for cervical spine fractures. African Americans had a greater risk of spinal cord injuries, particularly among adolescents.

CONCLUSIONS: Specific sports activities and injury locations were identified as primary risk factors for different types of spine fractures. Demographic patterns provide context for targeted prevention strategies. These findings can inform the development of sport-specific safety measures and injury prevention programs across diverse populations.

PMID:40334430 | DOI:10.1016/j.injury.2025.112368

Injury. 2025 Apr 25;56(7):112361. doi: 10.1016/j.injury.2025.112361. Online ahead of print.

ABSTRACT

BACKGROUND: The rise in scooter, skateboard, and e-scooter use in the U.S. has led to increased injuries, with distinct fracture patterns across vehicle types. This study aims to identify trends and patterns in fractures and injuries.

METHODS: This study used the PearlDiver database to examine skateboard, scooter, and e-scooter injuries and associated fractures across the United States from 2010 to 2022, categorized by anatomical site using ICD-9 and ICD-10 codes. E-scooter data were analyzed separately for 2020-2022. Injury and fracture rates were analyzed by age, sex, and state, with annual trends compared over the study period. Fracture incidence was calculated per 100,000 individuals and per 100 injuries.

RESULTS: From 2010 to 2022, skateboards accounted for the highest injury rates, with a rate of 8.72 per 100,000 individuals in 2022. Male injury rates consistently exceeded female rates across all vehicles during the study period. In 2022, late adolescents (15-19 years) had the highest rate of skateboard injuries (43.84), early adolescents (10-14 years) led in scooter-related injuries (32.01), and young adults (20-24 years) were most affected by e-scooter injuries, with a rate of 6.19 per 100,000 individuals. During the study period, 115,783 fractures were recorded for skateboard (56,632), scooter (56,607), and e-scooter (2544) injuries across the United States. In 2022, the fracture rates were 35.39 for skateboards, 35.21 for scooters, and 34.33 for e-scooters per 100 vehicle injuries. Forearm fractures were the most common injury type across all vehicles. In 2022, large states reported the highest number of injuries, with New York leading in e-scooter injuries (381) and California topping both skateboard (1066) and scooter injuries (827), highlighting geographic disparities. E-scooter injuries exhibited a 1310 % increase from 2020 to 2022, underscoring this rising public health burden.

CONCLUSIONS: Skateboards are the leading cause of vehicle-related injuries and fractures. Injury demographics are shifting, with e-scooters affecting a broader, older population, but males remain the most affected group across all vehicle types.

LEVEL OF EVIDENCE: Level III.

PMID:40328080 | DOI:10.1016/j.injury.2025.112361

Injury. 2025 Apr 29;56(7):112357. doi: 10.1016/j.injury.2025.112357. Online ahead of print.

ABSTRACT

Heterotopic ossification (HO) is a frequent complication following spinal cord injury (SCI), yet evidence regarding the efficacy of bisphosphonates in managing this condition remains limited. This systematic review aims to evaluate the role of bisphosphonates in the prevention and treatment of HO in patients with SCI. A comprehensive search of PubMed, CINAHL, ScienceDirect, Cochrane Library, and the Centre for Reviews and Dissemination databases was conducted to identify studies meeting predefined inclusion criteria. Relevant articles were also identified through bibliographic references. A total of 11 studies were included: nine investigating etidronate, one on alendronate, and one on pamidronate. Bisphosphonate administration varied, with oral etidronate provided for a minimum of 12 weeks and intravenous pamidronate given for up to 14 days. Bisphosphonates were used either prophylactically or therapeutically to delay the progression of HO. Findings across all studies highlighted the preventive role of bisphosphonates in reducing the occurrence of HO in SCI patients and demonstrated their therapeutic potential, as evidenced by less extensive heterotopic bone formation. However, the available evidence remains insufficient to draw definitive conclusions about the optimal use of bisphosphonates in this population. Further well-designed clinical trials are required to elucidate their preventive and therapeutic efficacy in managing HO after SCI.

PMID:40328079 | DOI:10.1016/j.injury.2025.112357

Injury. 2025 Apr 28:112363. doi: 10.1016/j.injury.2025.112363. Online ahead of print.

NO ABSTRACT

PMID:40320354 | DOI:10.1016/j.injury.2025.112363

Injury. 2025 Apr 29;56(7):112369. doi: 10.1016/j.injury.2025.112369. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the association of safe firearm storage and reduced risk of injury and death, many children live in homes with unsecured firearms. The Child Opportunity Index (COI) assesses neighborhood resources that impact health; lower COI levels have been linked to higher rates of firearm-related injuries. This study examined the relationship between COI and firearm ownership and storage practices.

METHODS: This was a cross-sectional survey study that took place between November 2022 and October 2023 in two geographically separate Level 1 Emergency Departments in Texas. English and Spanish speaking patients assigned triage acuity levels of 3, 4, or 5 were included, and survey questions were derived from the National Health Interview Survey to examine firearm injury ownership and storage practices.

RESULTS: 4,248 patient families were approached, with 2,882 (68 %) participating. 690 (23.9 %) self-reported as firearm owners, 541(78.4 %) reported storing guns locked and 392(56.8 %) reported keeping the firearm unloaded. Over half (50.4 %) of respondents were in the very low (692) or low COI (750) quintiles. Participants in the very high COI levels were associated with a higher risk of living in a home with firearms compared with those in the very low COI levels (very high COI RR 1.81, p < 0.001, 95 % CI [1.39, 2.37]). There was no association between a respondent's COI level and the method or rates of firearm storage.

DISCUSSION AND CONCLUSIONS: While children in higher COI quintiles were more likely to live in homes with firearms, storage practices are suboptimal across all COI quintiles. Future work should focus on creating effective and consistent messaging on the importance of firearm storage practices across individuals in all COI quintiles.

PMID:40319572 | DOI:10.1016/j.injury.2025.112369

Injury. 2025 May 2;56(7):112360. doi: 10.1016/j.injury.2025.112360. Online ahead of print.

ABSTRACT

Distal radius fractures are common injuries often requiring surgical intervention for effective management. This study compares the biomechanical stability of two osteosynthesis configurations using a palmar locking plate with either four or two epiphyseal screws for extra-articular distal radius fractures. Finite element analysis (FEA) was performed on nine antomical radius models to evaluate displacement, axial stiffness, peri‑implant stresses, and fracture risk using the Mohr-Coulomb criterion. Results demonstrated minimal differences in displacement between the two groups, with both configurations maintaining acceptable levels of stability under a 250 N load. Assemblies with four screws exhibited slightly higher axial stiffness (average 4362 N/mm) compared to two screws (average 3080 N/mm). Peri-implant stresses were generally higher in the two-screw models, yet remained within tolerable ranges. This study is the first to analyze a two-epiphyseal screw configuration, offering insight into the feasibility of reducing screw count without compromising stability. Potential benefits include fewer surgical complications, reduced material use, and lower costs. However, limitations such as the small sample size, simplified loading conditions, and absence of osteodensitometry warrant further experimental validation. The findings suggest that a two-epiphyseal screw assembly could serve as an effective alternative for distal radius fracture management, supporting its potential integration into clinical practice following experimental corroboration.

PMID:40318434 | DOI:10.1016/j.injury.2025.112360

Injury. 2025 Apr 27;56(7):112362. doi: 10.1016/j.injury.2025.112362. Online ahead of print.

ABSTRACT

BACKGROUND: The KNEE Study is a prospective multicentre service evaluation examining the current UK management of fragility fractures around the knee. It aims to describe operative decision making, causes of treatment delays, weight-bearing strategies, and post-operative management.

METHODS: Data were prospectively collected across a 4-month period via a collaborative approach. All patients aged >60 with a fracture of the proximal tibia or distal femur were included. Data collected include injury classification, operative vs non-operative management, time to theatre, post-operative weight bearing, and post-operative optimisation as per BOAST guidelines for frail older patients.

RESULTS: Data were available for 459 patients across 39 centres. This included 252 distal femoral fractures, and 207 proximal tibial fractures. Distal femoral fractures were significantly older (81.5 vs 73.3), had poorer mobility (42 % mobile ≤1 stick vs 79 %), and were more comorbid (median charlson co-morbidity index 5 vs 3) than proximal tibial fractures. Operative management was undertaken in 292/459 cases (198/252 femur, 94/207 tibia). When operative management was undertaken, there was a delay >36 hours to theatre in 62.8 % of cases. The main reasons for this were theatre capacity (42.6 %) and availability of a specialist surgeon (25.1 %). Only 11.5 % of cases were delayed pending medical optimisation or anticoagulant reversal. Patients managed operatively were significantly more likely to weight-bear on the first day post treatment (69.5 % vs 55.8 %). Operatively managed patients were significantly more likely to receive post-operative standards of care including Geriatric review, physio assessment, and bone health assessment.

CONCLUSION: Early return to weight bearing and ongoing secondary prevention are core tenants in the management of fragility fractures. Management of fragility fractures around the knee continues to lag behind that of hip fractures, with lower rates of weight bearing, slower access to theatre, and poorer post-operative care.

PMID:40318433 | DOI:10.1016/j.injury.2025.112362

Injury. 2025 Apr 23:112330. doi: 10.1016/j.injury.2025.112330. Online ahead of print.

ABSTRACT

BACKGROUND: Patients surviving major traumatic injury involving the chest wall experience unpredictable recovery trajectories, typically extending over 12 months or more. While some recover well, others experience ongoing physical and mental health difficulties and reduced quality of life. A nuanced understanding of the meaning and process of recovery is needed to inform the development of interventions to enable patients to access the right help, at the right time. Hence, we examined the experience of recovery and the bio-psycho-social factors shaping recovery in the months after traumatic injury resulting in admission to intensive care.

METHODS: This qualitative inquiry was underpinned by philosophical pragmatism, an approach which promotes development of knowledge that can be applied to solve problems. Participants recruited from a tertiary hospital completed semi-structured interviews encompassing perceived recovery, health as reflected in the EQ-5D-5 L, and factors influencing recovery. Qualitative data were analysed using the framework approach enabling the team to focus on matters pertinent to participants while addressing research questions. EQ-5D-5 L data were analysed descriptively.

RESULTS: Fourteen participants including 13 men, aged 19 to 67 years were interviewed by telephone, video-conference or in-person four- to seven-months post-injury. Duration of interviews was, on average, 50 min. Participants understood recovery as a non-linear process with progress assessed against pre-injury 'normal'; some acknowledged the need to develop and adapt to a new 'normal'. Engagement in the recovery process ranged along a spectrum anchored by passivity and proactivity, with approach taken reflecting the participant's characteristic way of being, and investment in a 'reason to recover'. Recovery was a function of interlinked factors categorised as 'pre-injury life circumstances', 'recovery mindset', 'recovery behaviours' and 'recovery resources'. While EQ-5D-5 L scores indicated substantial impairment across domains, participants generally regarded themselves as recovering well 'given the circumstances'.

CONCLUSIONS: Findings highlight the need for care to be grounded in an appreciation of the 'person' of the patient because pre-injury circumstances inexorably shape approach to recovery, engagement in recovery behaviours and access to resources. The model of recovery developed in this study can guide clinicians undertaking the comprehensive assessment that is fundamental to provision of personalised care, and ongoing evaluation of recovery, potentially using patient-generated outcome measures.

PMID:40312173 | DOI:10.1016/j.injury.2025.112330

Injury. 2025 Apr 15;56(6):112333. doi: 10.1016/j.injury.2025.112333. Online ahead of print.

ABSTRACT

Trauma accounts for around 4.4 million deaths annually and is among the leading causes of death, disproportionately affecting low- and middle-income countries. Trauma quality improvement programmes may reduce adverse patient outcomes but lack robust evidence. This study assessed the effect of implementing a trauma quality improvement programme using audit filters on health-related quality of life in adult trauma patients in urban India. We conducted a controlled interrupted time series study (ClinicalTrials.gov ID NCT03235388) across four tertiary care university hospitals. Adult (≥18 years) trauma patients, who were alive at 90 days post-admission, were included. After a 14-month observation phase, two hospitals were randomized to the intervention arm and implemented the trauma quality improvement programme, while two control hospitals did not implement any interventions. The study spanned from 2017 to 2022. Health-related quality of life was assessed 90 days post-admission using the EuroQol 5-dimensions (EQ-5D) questionnaire. The main outcome was EQ-5D health status, scaled from 0 to 100, analyzed using a difference-in-differences (DiD) approach. Descriptive analysis was performed for the five individual EQ-5D dimensions. 2307 participants were eligible for the analyses. The DiD analysis showed a statistically significant reduction in the EQ-5D health status score in the intervention arm (DiD estimate -4.07 [95 % CI:-7.00; -1.15]). For the 819 patients with major trauma, there was a more pronounced, but statistically non-significant reduction (DiD estimate -4.86 [95 % CI:-9.87; 0.15]). In the intervention arm, mobility, self-care, and pain/discomfort improved, while usual activities and anxiety/depression worsened. Implementing trauma quality improvement programmes using audit filters may reduce the average health-related quality of life of trauma patients if more severely injured patients survive, highlighting the importance of assessing quality of life after the implementation of such programmes and ensuring adequate rehabilitation resources to support long-term recovery.

PMID:40311153 | DOI:10.1016/j.injury.2025.112333

Injury. 2025 Apr 18;56(6):112350. doi: 10.1016/j.injury.2025.112350. Online ahead of print.

ABSTRACT

BACKGROUND: Avascular necrosis (AVN) of the femur head (FH) is an incapacitating disease caused by chronic overconsumption of alcohol and corticosteroids. AVN impairs blood circulation to the FH, causing varying degrees of cell death. AVN progressively reduces the macroscopic mechanical strength of the bone's necrotic area, leading to FH collapse.

MATERIAL AND METHOD: This study aims to comprehend the efficacy of core decompression (CD) on biomechanical, microstructural, and compositional determinants of bone quality. In this work, 30 FH are taken of the patients who underwent total hip replacement due to AVN. These 30 samples are categorized into two groups (15 each), i.e. with CD (individuals who underwent core decompression treatment at the early stages of AVN) or without CD (individuals who did not receive any invasive therapy in the past following a hip fracture due to AVN). Bone morphometry, biomechanical, material, and nano-level properties are analyzed across necrotic and sclerotic zones of FH through micro-CT scanning, histo-pathology, Uni-axial compression, and Nano-indentation tests.

RESULTS: The obtained results demonstrated a notable increment in bone volume fraction, ultimate strength, and osteocytes of the sclerotic zone of both groups compared to the necrotic region. A significant improvement was observed in the quality of trabecular bone at multiple scales of human bone tissue including higher bone volume fraction (22.87 %, P < 0.05), increased Young's modulus (28.80 %, P = 0.0183) and increment in Mineral/Matrix ratio (53.20 %, P = 0.0429) and reduction in % of empty lacunae (22.39 %, P < 0.01) in the necrotic region of patients with core decompression compared to patients without any invasive treatment.

CONCLUSION: The optimum core decompression enhances the stability of the femur head by increasing the macroscopic mechanical strength of necrotic bone and decreasing the strength of sclerotic bone. This brings the strength of both bones nearly equal, further reducing the stress gradient and probability of collapse of the AVN femur head.

PMID:40306042 | DOI:10.1016/j.injury.2025.112350

Injury. 2025 Apr 4;56(6):112281. doi: 10.1016/j.injury.2025.112281. Online ahead of print.

ABSTRACT

Management with a functional brace results in successful union in the majority of patients with a humeral shaft fracture. An important factor in a patient's decision for operative vs. nonoperative management is how long it will take to know if the fracture will unite if treated nonoperatively. In this prospective multicenter evaluation subset analysis, we sought to address the following: (1) What is the positive and negative predictive value of gross motion at the fracture site on physical exam at 8 weeks post-injury for union in patients with humeral shaft fractures treated nonoperatively? (2) does callus present on radiographs correlate with clinical exam findings in terms of gross motion?

METHODS: We performed a prospective multicenter observational trial to evaluate the PPV and NPV of gross motion at 8 weeks on the outcome of union. There was a proscription against surgery for a minimum of 12 weeks. We additionally evaluated the presence of callus on each cortex for those with gross motion.

RESULTS: Of those available from the enrolled 101 patients, 62 (77 %) had no gross motion at 8 weeks following injury and went on to union (PPV=100 %). and 18 (23 %) patients had gross motion at the fracture site and 9 went on to nonunion (NPV =56 %), Callus was present on 3 of 4 cortices in 6 of the 7 patients with gross motion who went on to union and only 3 of the 9 who went on to nonunion (p = 0.06).

CONCLUSIONS: The lack of gross motion at the fracture site in patients treated nonoperatively for a humeral shaft fracture is highly predictive of union. The presence of gross motion does not predict nonunion as well, especially if callus is present on at least 3 of the 4 cortices. This information can be used to counsel patients at the inception of treatment and at 8 weeks.

LEVEL OF EVIDENCE: II.

PMID:40294453 | DOI:10.1016/j.injury.2025.112281

Injury. 2025 Apr 18;56(6):112347. doi: 10.1016/j.injury.2025.112347. Online ahead of print.

ABSTRACT

Finding a suitable replacement tissue for bone loss in comminuted fractures and bone tumors with large bone defect or for treatment of delayed unions and non-unions is still the main challenge for orthopedic surgeons. The present study has been designed in vivo to evaluate the effects of xenogenic calf fetal bone and cartilage grafts in treatment of experimental critical bone defect in a rabbit model. 30 native male rabbits, 12 months old, weighing 3.0±0.5 kg were used in this study. Rabbits were randomly divided into five groups of six (negative control (NC), osteochondral group (OstCar), bone group (Ost), cartilage group (Car), and positive control (PC)). In the NC group the created empty space was left intact. In the OstCar group the osteochondral fragment of the same size as the expulsion was inserted into place. In the Ost group, the bone fragment of the fetal calf replaced the extracted bone fragment from the radius bone. The created defects were filled in 6 rabbits of the Car group with cartilage fragments of the fetal calf. In the PC group, after separating the fragment of radius bone midsection and removing from the site, it was re-placed at the site. This study investigated three types of replacement tissue for the missing bone and compared the results of radiology, CT scan, biomechanics and histopathology evaluations with positive and negative control groups. In conclusion, this study demonstrated that the calf's fetal bone fragment could promote bone regeneration in the long bone defects like the autograft in the rabbit model.

PMID:40294452 | DOI:10.1016/j.injury.2025.112347

Injury. 2025 Apr 17:112353. doi: 10.1016/j.injury.2025.112353. Online ahead of print.

ABSTRACT

INTRODUCTION: Ophthalmic care of incarcerated individuals is understudied, particularly in the inpatient setting. We evaluated ophthalmic consultation findings, interventions and outcomes at a tertiary care center.

METHODS: For this retrospective noncomparative cohort study, data were collected on demographics, diagnoses, interventions, and outcomes for incarcerated patients for whom ophthalmic consultation was ordered at an academic medical center between December 2011 and December 2022.

RESULTS: The study cohort included 163 patients (mean age = 38 years) in custody at Maryland state correctional facilities. The majority of patients were male (95.7 %) and/or Black (71.8 %). The most common reason for consultation was trauma (135 of 163, 82.8 %). Among patients presenting for trauma, the mechanism of injury was documented as assault in 117 cases (86.7 %). Among trauma patients, 56 (41 %) required surgical intervention. In total, 20 open reduction and internal fixation of orbital fractures, 11 open globe repairs, and 36 eyelid laceration repairs, as well as 3 other surgeries (anterior chamber washout, vitrectomy, and placement of an orbital implant after autoenucleation) were performed. Loss to follow-up was high; 68 patients (42 %) had no follow-up visits despite recommendations for follow-up at discharge.

CONCLUSION: Ocular trauma was the most common reason for ophthalmic consultation for incarcerated patients in the hospital setting, accounting for >80 % of consults. Over 40 % of prisoners presenting for ocular trauma required surgery. Even in the custody of the state, inmates are not protected from ocular trauma. These findings suggest a need for creative, humane interventions and policy initiatives to address violence in correctional facilities.

PMID:40280775 | DOI:10.1016/j.injury.2025.112353

Injury. 2025 Apr 15;56(6):112349. doi: 10.1016/j.injury.2025.112349. Online ahead of print.

ABSTRACT

BACKGROUND: Radial nerve injury is one of the most common peripheral nerve injuries and can be effectively treated with nerve grafting. However, the efficacy of nerve grafting combined with exercise therapy for the treatment of radial nerve injury remains unclear.

METHODS: In this study, we conducted a follow-up of at least one year in 40 patients with radial nerve injuries who received nerve grafting combined with exercise therapy, to evaluate their rehabilitation outcomes and identify the prognostic factors influencing the combined treatment.

RESULTS: 62.5 % (n = 25) patients achieved M3+ extension strength. Shorter defect length and delayed repair time and more cables of nerve graft were significantly associated with the recovery of finger extension. Moreover, multivariate analysis showed that defect length and delay in repair were the independent predictors of extensor digitorum communis reinnervation. Additionally, receiver operating characteristic (ROC) curve suggested that both delay in repair (AUC = 0.808) and cables of nerve graft (AUC = 0.837) had a high accuracy in predicting the prognosis of nerve graft combined with exercise therapy, while delay in repair+cables of nerve graft (AUC = 0.960) had the highest accuracy. The optimal time for transplantation is 6.89 months (sensitivity = 86.7 %, specificity = 58.7 %) post-injury, and the optimal number of nerve grafts is 2.5 (sensitivity = 80 %, specificity = 53.3 %).

CONCLUSION: We demonstrated that the effectiveness of nerve grafting combined with exercise therapy in treating radial nerve injury, and delay in repair and cables of nerve graft may act as the prognostic predictors of nerve graft combined with exercise therapy. These findings may provide a novel therapeutic method for radial nerve injury.

PMID:40279806 | DOI:10.1016/j.injury.2025.112349

Injury. 2025 Apr 18;56(6):112348. doi: 10.1016/j.injury.2025.112348. Online ahead of print.

ABSTRACT

BACKGROUND: Distal radius diaphyseal-metaphyseal junction (DRDMJ) fractures in children often require surgical intervention due to the unique anatomical characteristics and high failure rate of nonoperative treatment. However, the choice of internal fixation remains a challenge for pediatric orthopedic surgeons. Traditional fixation methods, including plate and screw fixation, crossed Kirschner wires (K-wires), and external fixators, have drawbacks such as extensive local trauma and the risk of physeal injury. This study evaluates the clinical efficacy of antegrade elastic stable intramedullary nailing (ESIN) for DRDMJ fractures in children, comparing it with the crossed K-wire technique.

METHODS: A retrospective analysis was conducted on 47 pediatric patients with DRDMJ fractures treated between June 2018 and January 2023. Patients were divided into an antegrade ESIN group (n = 20) and a crossed K-wire group (n = 27). Demographic data, perioperative parameters (operative time, radiation exposure), and postoperative recovery indicators (duration of internal/external fixation, radiographic healing time, wrist function recovery) were collected. All patients were followed up for at least 12 months, and complications were recorded. The Garland-Werley score was used to assess wrist function. Additionally, a cadaveric study was performed to validate the neurovascular safety of antegrade ESIN insertion via the middle third of the radial head-radial tuberosity axis within the Kocher interval.

RESULTS: All patients achieved radiographic union, with no cases of dorsal interosseous nerve injury, tendon rupture, or refracture. There were no significant differences between the two groups in terms of radiographic healing time or wrist function scores at 12 months postoperatively (P > 0.05). However, compared to the crossed K-wire group, the antegrade ESIN group demonstrated a significantly shorter operative time by 10.71 min (P = 0.002), reduced fluoroscopy use by 2.74 exposures (P = 0.001), and a shorter postoperative cast immobilization duration by 9.11 days (P < 0.001). Additionally, the antegrade ESIN group exhibited a higher rate of excellent wrist function scores at the 3-month follow-up. The cadaveric study confirmed that needle insertion through the middle third of the Kocher interval safely avoided the dorsal interosseous nerve, with no risk of nerve injury in either pronation or supination positions.

CONCLUSION: Antegrade ESIN and crossed K-wire fixation provide comparable long-term functional and radiographic outcomes for pediatric DRDMJ fractures. The antegrade ESIN technique, performed through the middle third of the radial head-radial tuberosity axis within the Kocher interval, effectively avoids dorsal interosseous nerve injury while significantly reducing operative time, minimizing intraoperative radiation exposure, and promoting early functional recovery. This technique may serve as a valuable surgical option for treating DRDMJ fractures in children.

PMID:40279805 | DOI:10.1016/j.injury.2025.112348

Injury. 2025 Apr 8;56(6):112304. doi: 10.1016/j.injury.2025.112304. Online ahead of print.

ABSTRACT

BACKGROUND: Standard antibiotic therapy for abdominal gunshot wounds (GSWs) with hollow viscus injury involves up to 24 h of prophylactic broad-spectrum antibiotics. However, antibiotic management strategies are poorly defined in treating gunshot wounds with bowel-to-bone trajectories. These injuries threaten fracture-related infection as missiles can carry contaminating material along their intracorporeal trajectory. This study seeks to determine whether the duration of prophylactic antibiotic therapy used in bowel-to-bone injuries is associated with fracture-related infection prevention or overall infectious sequelae.

METHODS: This six-year retrospective review identified all patients experiencing abdominal GSWs with a trajectory causing bowel injury and simultaneous fracture. Patient demographics, duration of antibiotic therapy, and subsequent infectious complications were compared with nonparametric tests as indicated.

RESULTS: 140 patients experienced GSWs with bowel-to-bone trajectory; the median duration of prophylactic antibiotic therapy was four days (IQR 2 - 5 days); two patients were diagnosed with fracture-related infection and 65 patients experienced an infectious complication during their index hospitalization. Duration of prophylactic antibiotic therapy was not associated with the development of overall infection (p = 0.31). Comparing three days of prophylactic antibiotic therapy to more than three days of therapy, no difference occurred in overall infection (p = 1.0).

CONCLUSION: The development of fracture-related infections in bowel-to-bone gunshot wounds is rare. The duration of prophylactic antibiotic therapy in bowel-to-bone injuries did not correlate with an increase in overall infectious complications. Notably, three days of prophylactic antibiotic therapy was not inferior compared to longer-duration therapy in the development of infectious sequelae. Thus, patients with a bowel-to-bone gunshot trajectory likely do not require extended antibiotic coverage for prevention of fracture-related infections.

PMID:40279804 | DOI:10.1016/j.injury.2025.112304

Injury. 2025 Apr 18;56(6):112355. doi: 10.1016/j.injury.2025.112355. Online ahead of print.

ABSTRACT

BACKGROUND: Blunt mechanism chest wall injury (CWI) is a common traumatic presentation to acute hospitals globally and it is associated with high levels of mortality and morbidity. The role of the physiotherapist in the management of this injured population needs clearer definition.

AIM: To synthesise existing evidence relating to the 'work' of physiotherapists in the assessment, management and evaluation of patients with blunt mechanism CWI.

DESIGN: A systematic integrative review of relevant literature with a narrative synthesis.

DATA SOURCES: Embase (Ovid), MEDLINE (Ovid), CINAHL Plus with Full Text (EBSCO), Cochrane Central Register of Controlled Trials (Wiley), PEDro (Physiotherapy Evidence Database), AMED (Ovid). Further searches for grey literature and hand searches were applied. Databases were searched from their inception to December 2024. Analysis and data integration was undertaken through narrative synthesis following a process of thematic coding.

RESULTS: From 7433 identified papers, 92 were included in the final evidence synthesis. Fifty were full published empirical studies, 14 were evidence reviews, 19 were conference abstracts, three were case presentations and six were opinion pieces. Analysis identified the broad scope of clinical care provided by physiotherapists covering (i) initial assessment and emergency care; (ii) acute care priorities and care planning; (iii) patient education and optimising patient self-management; and (iv) post-acute care and follow-up.

CONCLUSION: There is a need for a more standardised approach to the care provided to this patient group. Clinicians need to acquire and develop formal competencies and capacities and knowledge in a more structured approach.

PMID:40279803 | DOI:10.1016/j.injury.2025.112355

Injury. 2025 Apr 10;56(6):112339. doi: 10.1016/j.injury.2025.112339. Online ahead of print.

ABSTRACT

AIMS: A soft-tissue sparing posterior surgical approach (SPAIRE) for hip hemiarthroplasty after femoral neck fractures is hypothesized to provide better functional results than the standard direct lateral approach, while maintaining a low dislocation rate. The aim of this study was to compare rate of complications and functional results between these approaches in a clinical cohort.

METHODS: Prospectively collected registry data on all femoral neck fracture cases treated with hemiarthroplasty between September 2018 and November 2022 in a single Norwegian hospital were analyzed grouped by SPAIRE versus direct lateral approach. Outcomes were prosthesis dislocation, surgical site infection, 30-day mortality, and tests of function three months postoperatively. Linear regression was used for continuous outcomes, and dichotomous outcomes were analyzed by logistic regression and contingency tables.

RESULTS: Of 858 cases, 430 were operated using SPAIRE, and 428 using direct lateral approach. There were no group differences in prosthesis dislocation rate (SPAIRE 0.7 % vs direct lateral 0.9 %, p = 0.725), and no differences in surgical site infections or 30-day mortality. In the patients with three months follow-up (total n = 372; SPAIRE n = 192; direct lateral n = 180) the SPAIRE group had better functional outcomes; New Mobility Score: 6.1 vs 5.0 (difference 1.1, p < 0.001), New Mobility Score change from preoperative: -1.3 vs -1.8 (difference 0.5, p = 0.024), Short Physical Performance Battery: 7.3 vs. 5.9 (difference 1.4, p < 0.001), Walking speed: 0.8 vs 0.7 m/s (difference 0.1, p < 0.001).

CONCLUSION: We found no differences in the rate of prosthesis dislocations, infections, or mortality between the SPAIRE and the direct lateral approach. Functional outcomes were better in patients operated with the SPAIRE approach.

PMID:40279802 | DOI:10.1016/j.injury.2025.112339

Injury. 2025 Apr 8;56(6):112337. doi: 10.1016/j.injury.2025.112337. Online ahead of print.

ABSTRACT

BACKGROUND: Intra-abdominal injuries (IAIs) are often associated with thoracic or lumbar flexion distraction injuries (TLFDIs) or Chance fractures. The incidence ranges from 10 to 50 % in previous literature.

AIM: To synthesize data about the incidence of IAIs associated with TLFDIs.

METHODS: We searched PubMed, WOS, and Cochrane databases for all studies reporting the incidence of IAIs associated with TL FDIs. The primary outcome was the overall pooled incidence of IAIs, surgical intervention, and specific organ injuries. A subgroup analysis was done for studies that included adults, pediatrics, and mixed populations. We assessed the methodological quality of the included studies using the Newcastle-Ottawa Scale. We used A random effects model to calculate pooled incidence rates and heterogeneity. This systematic analysis followed PRISMA guidelines.

RESULTS: A total of eight retrospective studies with 652 patients met the inclusion criteria. The pooled incidence of overall IAIs associated with TLFDIs was 36.2 % (95 % CI: 32.2 % %-57.2 %), with high heterogeneity (I² = 90.71 %, p = 0.0001). The incidence of surgical interventions was 29.03 % (95 % CI: 22.0 %-48.3 %), with high heterogeneity (I² = 92.3 %, p < 0.0001). Small bowel injuries occurred in 19.17 % of cases, large bowel injuries in 10.92 %, liver injuries in 7.6 %, splenic injuries in 7.2 %, kidney injuries in 5.36 %, and pancreatic injuries in 3.7 %. Pediatric populations showed significantly higher rates of IAAs (55.8 % vs. 23.03 %) and surgical intervention (45.5 % vs.10.6 %) than adults.

CONCLUSION: The pooled incidence of IAAs associated with TL FDIs is 36.2 %, and surgical intervention is 29.03 %. Small bowels, large bowels, liver, and splenic injuries were the most frequent injuries. These rates are probably overestimated due to the retrospective design of studies and the variability in the definition of TLFDIs. Therefore, prospective, well-designed studies are needed to estimate the true incidence of IAAs associated with TLFDIs accurately.

PMID:40273660 | DOI:10.1016/j.injury.2025.112337