Injury. 2025 Jul 11;56(8):112599. doi: 10.1016/j.injury.2025.112599. Online ahead of print.

ABSTRACT

INTRODUCTION: The optimal postoperative weight-bearing regimen for tibial plateau fractures (TPF) remains a topic of debate. It ranges from non- or touch down- weight bearing between 2-12 weeks. More recent studies suggest that early weight-bearing may not result in any loss of reduction or hardware failure.

OBJECTIVES: To describe orthopedic surgeons' preferences for postoperative regimens and factors that influence their decision making in relation to weight-bearing status after treating TPF.

METHODS: A web-based survey was developed by the authors regarding tibial plateau fractures. Participants were asked different questions about timing of weight bearing after osteosynthesis and factors that influenced the surgeon's decision-making process for 3 unicondylar and 3bicondylar tibial plateau fractures.

RESULTS: A web-based survey was developed and 151 surgeons answered our survey. 82 % were men and 62 % of respondents treated > seven tibial plateau fractures per year. In unicondylar fractures 19 % recommended full weight bearing and 81 % recommended restricted weight-bearing. In bicondylar fractures 89 % recommended restricted weight-bearing and 11 % full weight bearing. Restricted weight bearing was recommended for 2, 4, 6, 8, 10 or 12 weeks depending on the surgeon's preference. 73 % of the surgeons stated that the sense of stability in their own construction affects their postoperative weight-bearing plan and in 45 % the regimen was based on "gut feeling". Responders believed they get a stable osteosyntehsis in only 57 % of their own fixations and 48 % responded that they do not believe patients are following the postoperative weight bearing plan.

CONCLUSION: Our survey study demonstrated variability among orthopedic surgeons regarding postoperative weight-bearing in tibial plateau fractures. Further research is required to understand the stability of tibial plateau fractures and quantify whether we can allow patients to weight bear earlier safely.

PMID:40694897 | DOI:10.1016/j.injury.2025.112599

Injury. 2025 Jul 10;56(8):112600. doi: 10.1016/j.injury.2025.112600. Online ahead of print.

ABSTRACT

BACKGROUND: Missed injuries (MIs) remain a significant and potentially preventable complication in trauma care, often associated with increased morbidity, mortality, prolonged hospitalization, and legal consequences. Despite decades of recognition, MIs continue to challenge trauma teams, particularly in complex, multi-injury scenarios.

OBJECTIVE: This study aims to review the literature and identify the most relevant factors contributing to missed injuries in trauma patients, highlighting opportunities for prevention and clinical improvement.

METHODS: A systematic review was conducted according to PRISMA guidelines using PubMed. Inclusion criteria encompassed studies reporting on trauma patients with MIs, their risk factors, prevalence, and clinical outcomes. Exclusion criteria included non-trauma-focused studies, non-peer-reviewed articles, and case reports. Five key domains were assessed: trauma characteristics, injury-specific factors, diagnostic limitations, patient-related challenges, and human (physician) factors.

RESULTS: High Injury Severity Score (ISS), altered mental status (e.g., low Glasgow Coma Scale), polytrauma, and cognitive biases such as anchoring were consistently associated with higher rates of MIs. Non-spinal orthopedic injuries, abdominal and thoracic lesions, and retroperitoneal or diaphragmatic injuries were among the most frequently missed. Diagnostic limitations included false-negative imaging, misinterpretation of radiological exams, and inadequate protocols in unstable patients. Patient factors-such as obesity, advanced age, alcohol or drug intoxication, and pregnancy-also contributed to delayed diagnosis. Inexperience, fatigue, and poor communication were recurrent human factors linked to diagnostic failures. The implementation of Trauma Tertiary Surveys (TTS) significantly reduced MI incidence and improved detection of occult injuries.

CONCLUSION: Missed injuries are multifactorial events influenced by the complexity of trauma, diagnostic limitations, patient characteristics, and human error. Proactive strategies, including TTS, heightened awareness of injury-specific challenges, improved imaging protocols, and fostering a collaborative trauma culture, are critical to minimizing missed diagnoses and enhancing trauma care quality.

PMID:40690819 | DOI:10.1016/j.injury.2025.112600

Injury. 2025 Jul 8:112591. doi: 10.1016/j.injury.2025.112591. Online ahead of print.

ABSTRACT

PURPOSE: Post-traumatic stress disorder (PTSD) is a known potential sequel to physical trauma. PTSD in trauma patients has seldom been studied in New Zealand. This study aimed to measure the prevalence and predictors of PTSD among hospitalized trauma patients in Christchurch, New Zealand.

METHODOLOGY: Participants who presented to Christchurch Hospital and were included in the NZ Major Trauma Registry (Injury Severity Score ≥ 12) were recruited. Eligible participants were mailed a questionnaire containing a series of self-reported 5-point rating scales that assess DSM-5 symptoms of PTSD. Baseline characteristics and demographic data were obtained from the NZ Major Trauma Registry. PTSD caseness was determined at a cutoff score >30 and analyses were performed accordingly.

RESULTS: Among 203 patients with major trauma (24 % response rate), 37 (18 %) were classed as having PTSD. Questionnaires were completed at mean 2.75 (standard deviation = 0.67) years since the injury. In univariable analysis, crossing PTSD threshold was positively associated with younger age (p < 0.001); the presence of anxiety (p < 0.001) and depression (p < 0.001); higher Injury Severity Score (p = 0.004); vehicle related injury (p = 0.009); GCS <15 (p < 0.001); having an alcohol related injury (p = 0.025); and all subscales of perceived social support (p < 0.05). In a backwards stepwise multivariable model controlling for age and sex unconditionally, the variables predictive of PTSD were younger age; Glasgow Coma Scale <15; and vehicle-related trauma.

CONCLUSION: High rates of PTSD exist in patients following major trauma in NZ. Patients who are young; and those with initial Glasgow Coma Scale <15; and vehicle-related trauma are at a higher risk of developing PTSD following major trauma.

PMID:40683803 | DOI:10.1016/j.injury.2025.112591

Injury. 2025 Jul 15:112614. doi: 10.1016/j.injury.2025.112614. Online ahead of print.

ABSTRACT

INTRODUCTION: Minimizing crystalloid administration to hemorrhaging trauma patients has been shown to decrease morbidity and mortality. Iatrogenic harm from 'over-resuscitation' may be a concern for trauma patients undergoing prolonged EMS transport. Our primary objective was to quantify the volume of prehospital crystalloid administered to hypotensive trauma patients with at least 30 min of exposure to prehospital care for whom fluid administration was not indicated in the intervention arm of prior randomized trials of fluid restriction. In addition, we aimed to identify factors associated with crystalloid administration and determine if trends in administration were present across the study period.

STUDY DESIGN: The ESO Data Collaborative 2018-2022 annual datasets were used for this study. Trauma patients who received prehospital vascular access, had a minimum systolic blood pressure between 75 and 90 mmHg, a GCS ≥ 14, and were exposed to EMS care for >30 min (on-scene to destination arrival interval) were evaluated for inclusion. The primary outcome for this analysis was the documented volume of crystalloid administration. Logistic regression modeling was used to investigate factors associated with the administration of >500 mL of crystalloid.

RESULTS: After application of exclusion criteria, 26,447 patients treated by 1150 EMS agencies were evaluated. Patients received a median of 200 [10,500] mL of fluid in the prehospital setting, and 95 % of patients received <1010 mL. Overall, 5745 (21.7 %) patients received >500 mL of fluid. Factors associated with administration of >500 mL of fluid included increased 'EMS exposure' time (OR 1.01 [1.01, 1.01] per minute), IV cannula size (22 G OR: 0.5 [0.4, 0.6], 20 G OR: [reference], 18 G OR: 2.1 [2.0, 2.3], 16 G OR: 4.6 [4.1, 5.2]), age (0.996 [0.994, 0.997]) per year, female sex (0.72 [0.68, 0.77]), minimum SBP (0.95 [0.94, 0.96] per mmHg), and penetrating injury, (1.9 [1.7, 2.1]).

CONCLUSION: Overall, crystalloid volumes administered in the prehospital setting were low in this cohort of hypotensive trauma patients exposed to at least 30 min of prehospital care. This may suggest that the practice of fluid restriction for patients who are hypotensive following trauma has permeated into EMS practice nationwide.

PMID:40683802 | DOI:10.1016/j.injury.2025.112614

Injury. 2025 Jul 8;56(8):112594. doi: 10.1016/j.injury.2025.112594. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFP) pose significant challenges in geriatric care, with conservative management strategies remaining inconsistent. This scoping review aimed to map current trends in conservative treatment strategies for FFP and summarize associated clinical outcomes and complications.

METHODS: We examined (1) the types of conservative treatments used, (2) their temporal changes, and (3) their associated clinical outcomes. To visualize temporal trends, Pearson's correlation analysis was used to assess the frequency of reported interventions and outcomes over time.

RESULTS: A total of 75 studies were included. The most frequently reported conservative treatments were pain control (66 studies, 88.0 %), rehabilitation (52 studies, 69.3 %), and full-weight-bearing (22 studies, 29.3 %), all demonstrating significant increasing trends (p < 0.05). Outcomes were categorized into objective measures (e.g., mobility, hospitalization, mortality), subjective measures (e.g., Visual Analog Scale [VAS], functional scores), and complications (e.g., thromboembolic events, general infections). However, no statistically significant associations were found between specific conservative treatments and clinical outcomes.

CONCLUSION: Pain control, rehabilitation, and full-weight-bearing strategies have become increasingly central to conservative FFP management, particularly in osteoporotic populations. Evaluated outcomes included mobility, hospitalization, mortality, patient status, pain control, and complications such as infections and thromboembolic events. These findings underscore the variability in current practices and highlight the need for further research to develop a more structured evidence base for conservative FFP management.

PMID:40683060 | DOI:10.1016/j.injury.2025.112594

Injury. 2025 Jul 9;56(8):112592. doi: 10.1016/j.injury.2025.112592. Online ahead of print.

ABSTRACT

BACKGROUND: Abdominal solid organ (ASO) trauma of the spleen, kidney, and liver is common in children and often accompanies other traumatic injuries, posing significant clinical challenges. Non-operative management (NOM) is preferred according to current guidelines for both low- and high-grade lesions when hemodynamic stability is achievable. Aggressive surgical treatment can lead to chronic organ dysfunction, surgical related complications and long-term sequelae, while NOM failure may result in critical bleeding and multiorgan failure. This systematic review aimed to describe the prevalence of NOM failure in pediatric patients with traumatic ASO injuries and its predictors.

METHODS: A systematic literature search was conducted in PubMed, Scopus, and Cochrane Library from inception to August 2024. Studies were extracted for the prevalence of NOM failure and prespecified predictors. Study quality was assessed using the Joanna Briggs Institute's critical appraisal tool for prevalence reporting. A proportion meta-analysis provided a pooled estimate of NOM failure. Subgroup analysis for specific organs and meta-regressions for candidate predictors was performed. Multimodel inference estimated predictor importance in multivariable modeling.

RESULTS: The search yielded 67 studies evaluating the NOM course of 37,340 children. The pooled prevalence of NOM failure was 0.04 (95 % CI: 0.03-0.06). Multimodel inference showed that NOM failure prevalence increased with higher injury severity score (ISS), AAST grade, and age. The confidence in these results was rated moderate. Complications had a pooled prevalence of 0.09 and missed injuries 0.03.

CONCLUSIONS: NOM failure in pediatric post-traumatic ASO injuries is relatively infrequent, with high organ salvage rates achievable even in high-grade and multisystem trauma. Younger children achieve higher NOM success, suggesting potential for more conservative strategies. Complications requiring non-surgical interventions and missed injuries are not negligible, indicating the need for strict monitoring, in particular if aggressive preservation is the objective.

PMID:40683059 | DOI:10.1016/j.injury.2025.112592

Injury. 2025 Jul 16;56(8):112613. doi: 10.1016/j.injury.2025.112613. Online ahead of print.

ABSTRACT

CASE: Femoral shaft fractures with concomitant vascular injury requiring limb revascularization, although rare, are a limb-threatening condition. Historically, emergent external fixation of the femur fracture followed by vascular repair has been considered the standard of care. We discuss four cases of femoral fracture with an associated vascular injury amenable to nail fixation stabilized by expeditious intramedullary nailing (IMN), followed by limb revascularization. We discuss the timeline and duration of the procedure for this technique.

CONCLUSION: Expeditious femoral IMN prior to limb revascularization has multiple clinical advantages and has become our standard protocol for these injuries.

PMID:40683058 | DOI:10.1016/j.injury.2025.112613

Injury. 2025 Jul 11;56(8):112596. doi: 10.1016/j.injury.2025.112596. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma team activation criteria (TTAC) are used within Trauma Activation Systems (TAS) to facilitate the rapid identification of patients with major traumatic injuries requiring a hospital trauma system response, including the attendance of a multidisciplinary trauma team. The value of individual activation criteria available at the time a decision to activate the system response is made is uncertain. We conducted a systematic review to identify TTAC associated with the presence of major traumatic injuries in adult trauma patients.

METHODS: We searched MEDLINE, EMBASE, and CINAHL (01-01-2000 to 5-07-2024) for studies using multivariable methods to evaluate associations between physiological, anatomical and mechanism of injury variables available or obtained at emergency department triage and the presence of major traumatic injuries. Risk of bias was assessed using the QUIPs tool, meta-analysis was conducted using a random effects approach, and certainty of evidence assessed using GRADE.

RESULTS: We included 7 studies from major trauma centres in North America (n = 3), Australia (n = 2), Israel (n = 1) and Italy (n = 1). Studies were predominantly retrospective, evaluated a wide range of activation criteria, and used varying definitions of major trauma. We demonstrated with moderate certainty that low Glasgow Coma Score (OR 9.4 95 %CI 4.6-19.3), systolic hypotension (OR 4.4 95 %CI 2.2-8.8), abnormal vital signs (OR 3.7 95 %CI 2.6-5.3) and multi-region trauma (OR 4.7 95 %CI 3.5-6.5) were associated with the presence of major trauma. The certainty of evidence for the association between mechanism of injury and other physiological criteria and major trauma was low or very low.

CONCLUSION: Low GCS, systolic hypotension, abnormal vital signs at emergency department triage and the presence of multi-region trauma predict the presence of major trauma in adult trauma patients. These criteria could form the foundation of evidence-based TTAC. Remaining TTAC should reflect the trauma population and local major trauma response capabilities, with audit and revision necessary for optimal TTAC.

PMID:40683057 | DOI:10.1016/j.injury.2025.112596

Injury. 2025 Jul 13;56(8):112607. doi: 10.1016/j.injury.2025.112607. Online ahead of print.

ABSTRACT

INTRODUCTION: There is a strong demand for research on the long-term outcomes of tibial plateau fractures (TPFs) in large cohorts. Stringent data protection regulations and high ethical standards are essential for safeguarding participants' rights, but they can increase the logistical complexity of conducting multicentre studies. This study aims to evaluate clinical outcome data collected over more than a decade through a collaborative data network in surgically treated TPFs.

PATIENTS AND METHODS: This retrospective cohort study was conducted at two level-I trauma centers and included 364 adult patients with operatively TPFs, classified according to the Schatzker system. Eligible patients were treated between January 2010 and September 2022, were ≥18 years of age at the time of injury, resided in Germany, and had a minimum follow-up of 1.25 years with completed patient-reported outcome measures. Patients with cognitive or physical impairments preventing survey participation were excluded. Data collection occurred between September 2022 and January 2023. Outcome measures included the International Knee Documentation Committee (IKDC) form, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm Score. Multiple linear regression was used to assess associations between outcome scores, follow-up duration, and Schatzker classification.

RESULTS: Longer follow-up times were associated with significantly higher scores for IKDC (p < 0.05), KOOS Pain (p < 0.05), Activities of Daily Living (ADL) (p < 0.05), Sports (p < 0.05), and Quality of Life (QoL) (p < 0.00001). Complex fractures (Schatzker IV-VI) were consistently linked to worse outcomes, particularly in the KOOS Sports (p < 0.001) and Quality of Life (p < 0.00001) subscores. Adjusted R-squared values ranged from 2 % to 10 %, with the highest values observed in KOOS QoL scores.

CONCLUSIONS: Patient-reported outcomes (PROMs) were found to be positively associated with longer follow-up durations, up to 12 years postoperatively emphasizing the need for prolonged aftercare in TPFs. Complex fractures, in particular, might benefit from tailored, long-term follow-up. Given the severity of TPFs, it is crucial to manage patient expectations and address psychosocial factors to optimize the outcome. Collaborative data networks, like the one used here, hold promise for expanding research and improving treatment strategies across multiple centers.

PMID:40683056 | DOI:10.1016/j.injury.2025.112607

Injury. 2025 Jul 12;56(8):112606. doi: 10.1016/j.injury.2025.112606. Online ahead of print.

ABSTRACT

BACKGROUND: Indirect calorimetry (IC) is the gold standard method for measuring resting energy expenditure (REE). Although clinical guidelines recommend nutrition be delivered based on measured REE, easily applied predictive equations are most commonly used in practice, with potential for over-and under-estimation of energy needs. We aimed to 1) determine the feasibility and acceptability of using IC to measure REE and 2) compare measured to estimated REE in self-ventilating patients with a traumatic injury.

METHODS: In a single-centre prospective observational study, REE was measured using IC via a canopy hood in patients admitted to a trauma ward with ≥7day hospital stay. Feasibility was set at >50 % of IC measurements being valid (≥5 min with a respiratory quotient between 0.67 - 1.3, and ≤10 % variation in VO2 and VCO2). Following the measurement, patients and staff completed an acceptability survey. Measured REE (kcal) was compared to estimated REE (kcal) using predictive equations (Schofield, 25kcal/kg and 30kcal/kg), with ±10 % difference considered clinically significant.

RESULTS: Of 30 IC measurements, 25 (83 %) were valid. Measurements were not completed or valid in 5 (17 %) participants due to discomfort (n = 1), pain (n = 1), difficult bedspace (n = 1) and high CO2 variability (n = 2). Of those that completed the survey, 83 % of participants (n = 24) reported that the test was comfortable, and all staff (n = 11) agreed IC was acceptable to incorporate into usual care. Measured REE was within ±10 % of estimated REE with the Schofield equation, 25 kcal/kg and 30 kcal/kg in 44 %, 28 %, and 60 % cases, respectively.

CONCLUSION: Measured REE using IC is feasible and acceptable following traumatic injury. Estimated REE using predictive equations were not commonly within 10 % of measured REE, which may lead to under or over-feeding of patients following traumatic injury. Further research is warranted to evaluate whether IC-guided energy delivery improves patient outcomes.

PMID:40683055 | DOI:10.1016/j.injury.2025.112606

Injury. 2025 Jul 1;56(8):112570. doi: 10.1016/j.injury.2025.112570. Online ahead of print.

ABSTRACT

Artificial intelligence (AI) has emerged as a transformative technology in healthcare, with significant applications in orthopedic trauma. This comprehensive review analyzes 217 studies published between 2015 and 2025 to evaluate the current state, applications, and future directions of AI in orthopedic trauma. The field has experienced exponential growth, with 52.5 % of all studies published in 2024 alone. Deep learning approaches (43.3 %) and traditional machine learning methods (39.2 %) dominated the research landscape. Fracture detection (24.4 %) and classification (12.0 %) were the most common applications, followed by prediction (21.2 %) and segmentation (8.3 %). Hip/femur (19.4 %), spine (18.9 %), and wrist fractures (12.0 %) represented the most frequently studied anatomical sites. AI systems frequently matched or exceeded specialist performance in detection and classification tasks, with sensitivities and specificities above 90 % commonly reported. Predictive models for complications and mortality consistently outperformed traditional scoring systems, with improvements in AUC typically between 0.10-0.15. However, only 14.5 % of studies underwent external validation, and just 3.2 % reported prospective clinical validation. Despite remarkable progress in developing accurate AI systems for orthopedic trauma, significant challenges remain in clinical integration, data standardization, and validation across diverse populations. Future development should focus on multimodal approaches integrating diverse data sources, transparent algorithms providing rationales for predictions, and rigorous clinical validation. Point-of-care applications and integration with emerging technologies offer promising directions for clinical impact. As these challenges are addressed, AI has the potential to significantly enhance orthopedic trauma care by improving diagnostic accuracy, optimizing treatment selection, and identifying high-risk patients for targeted interventions.

PMID:40683054 | DOI:10.1016/j.injury.2025.112570

Injury. 2025 Jul 3:112586. doi: 10.1016/j.injury.2025.112586. Online ahead of print.

NO ABSTRACT

PMID:40681385 | DOI:10.1016/j.injury.2025.112586

Injury. 2025 Jul 8:112590. doi: 10.1016/j.injury.2025.112590. Online ahead of print.

NO ABSTRACT

PMID:40670206 | DOI:10.1016/j.injury.2025.112590

Injury. 2025 Jul 8:112603. doi: 10.1016/j.injury.2025.112603. Online ahead of print.

NO ABSTRACT

PMID:40670205 | DOI:10.1016/j.injury.2025.112603

Injury. 2025 Jul 15;56(8):112588. doi: 10.1016/j.injury.2025.112588. Online ahead of print.

NO ABSTRACT

PMID:40669261 | DOI:10.1016/j.injury.2025.112588

Injury. 2025 Jul 11;56(8):112610. doi: 10.1016/j.injury.2025.112610. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to compare the safety and efficacy of ultrasound-guided and arthrogram-guided techniques in the treatment of radial neck fractures in early childhood using the percutaneous leverage technique.

METHODS: This retrospective case series study included children under 7 years of age with closed radial neck fractures who underwent surgery between November 2015 and July 2021. Patients were divided into two groups based on the guidance techniques employed: the ultrasound guidance group (19 cases) and the arthrogram guidance group (14 cases). The primary outcomes included operative time, radiation exposure, and postoperative functional outcomes assessed using the Métaizeau criteria and the Mayo Elbow Performance Score (MEPS).

RESULTS: No statistically significant differences were observed between the two groups concerning age, gender, injured side, or type of fractures. The ultrasound guidance group had a significantly shorter operative time (23.7 ± 5.9 min) compared to the arthrogram guidance group (33.1 ± 10.0 min) (P < 0.05). The ultrasound guidance group did not require radiation exposure (mean 0), in contrast to the arthrogram guidance group (mean 60.55±46.46 mGy) (P = 0.000). According to the Métaizeau criteria, there were no significant differences in the postoperative anatomical reduction between the two groups. Similarly, no significant differences were observed in the functional outcomes based on MEPS, with excellent results in 94.7 % of the ultrasound guidance group and 85.7 % of the arthrogram guidance group (P = 0.380). Complications were comparable between the groups, with no cases of secondary displacement, pin tract infection, or nerve injury.

CONCLUSION: Ultrasound-guided reduction offers several distinct advantages, including enhanced real-time visualization, the absence of radiation exposure, and reduced operative times. Although outcomes are comparable, ultrasound may be considered a viable alternative to arthrogram for guiding percutaneous leverage reduction in the early childhood population.

LEVEL OF EVIDENCE: Therapeutic Level III.

PMID:40669260 | DOI:10.1016/j.injury.2025.112610

Injury. 2025 Jul 11;56(8):112580. doi: 10.1016/j.injury.2025.112580. Online ahead of print.

ABSTRACT

OBJECTIVES: Hardware removal is a common procedure performed by orthopaedic surgeons, yet there is not a consensus on the disposition of explanted hardware. There seems to be increasing discordance between institutional policy and surgeon or patient preference. The purpose of this study was to gain insight on hardware removal polices across North America and determine surgeons' opinions regarding the return of orthopedic fixation devices to patients and if these opinions are related to surgeon-specific demographic factors.

METHODS: A voluntary Qualtrics Survey was created and distributed to orthopedic surgeons with a self-identified substantial practice in trauma. Survey items included information about the surgeon's practice, hospital hardware removal policy, and personal opinion on institutional explant management. We also sought to evaluate variability in hospital policy among different geographic regions and types of hospitals/institutions.

RESULTS: One hundred forty-two surgeons met inclusion criteria for this survey. 88 % of respondents believe that patients should be entitled to keep their explanted hardware. Years in practice, frequency of hardware removal procedures, and subspecialty were not correlated with surgeon opinion. 66 % of hospitals have a policy allowing patients to keep their explanted hardware. There was no correlation between hospital policy and region or type of institution.

CONCLUSIONS: While 88 % of surgeons believe that patients should be allowed to keep their explanted hardware, only 66 % of hospitals currently allow this practice. Despite the clear consensus among orthopedic surgeons, hospital policy across North America is not standardized and does not correlate with the opinions held by the majority of surgeons.

PMID:40669259 | DOI:10.1016/j.injury.2025.112580

Injury. 2025 Jul 11;56(8):112608. doi: 10.1016/j.injury.2025.112608. Online ahead of print.

ABSTRACT

Eighty-eight patients with chronic wounds with financial difficulties were enrolled in a philanthropic programme implemented in Zhejiang Province (China) from August 1, 2021 to July 31, 2022. The patients were divided into surgical and non-surgical groups based on their demographic and wound characteristics, and the outcomes were then compared between the groups. In total, 54 (61.36 %) patients were males and 34 (38.64 %) females. The mean age of the patients was 55.27 ± 19.80 years, and the (81.82 %) had physical disabilities. The most common type of chronic wound was pressure injury (46.59 %), followed by traumatic wounds (19.32 %). In the surgical group, the average hospital stay was 24.50 days (range: 18.00-44.50 days), and the treatment efficacy rate was 76.92 %. In the non-surgical group, the average treatment duration was 35 days (range: 21.75-78.25 days), and the efficacy rate was 51.61 %. The overall wound healing rate was 60 % on the 1-year follow-up. In conclusion, most chronic wound patients were middle-aged or elderly, and pressure injury was the most common wound type. Although dressing change was the most common treatment, surgical treatment could get a better result in large and deep chronic wounds.

PMID:40669258 | DOI:10.1016/j.injury.2025.112608

Injury. 2025 Jul 8:112593. doi: 10.1016/j.injury.2025.112593. Online ahead of print.

ABSTRACT

INTRODUCTION: Management of patients after blunt splenic injury treated with Splenic Artery Embolisation (SAE) varies. This includes vaccination, post-procedure antibiotic use, and follow-up. This study aimed to assess current practice of management and infection prevention across Australia.

METHODS: A 29-question survey was sent via the Australian and New Zealand Trauma Registry to all 28 contributing trauma hospitals in Australia. Questions were based on data from the 2022 calendar year.

RESULTS: Responses were received from 12 sites (43 %) including 6 of 8 Australian regions (75 %). Of responding sites, 10 (83 %) offer SAE via a 24-hour 7-day rostered service. Of a total 568 splenic injuries, there were 177 SAE treatments with a median of 8 per site (range 0-65). SAE constituted 31 % of all splenic management, conservative management in 65 %, and splenectomy in 4 %. 8 sites (67 %) had a protocol for splenic trauma. Prophylactic SAE was performed for AAST IV-V injuries at 8 sites (67 %), which included 80 % of adult hospitals. Distal SAE was the predominant treatment type (70 %). Patients were routinely admitted for median 4 days after SAE (range 2-5). Routine inpatient antibiotics were administered to SAE patients at 2 sites (17 %) while 1 site (8 %) routinely recommended lifelong antibiotics after SAE. Routine inpatient vaccinations were used by 4 of 11 sites (36 %), while 3 sites (25 %) recommend vaccinations in the future. 11 sites (92 %) follow-up patients post-discharge. Written information on SAE was given to patients at 9 hospitals (75 %) while splenic function testing was performed at 5 sites (42 %), mostly assessment for Howell-Jolly Bodies (80 %). 11 sites (92 %) would change clinical practice in the future if evidence on splenic immune function evolved.

CONCLUSION: Across responding Australian hospitals, the use of vaccinations, antibiotics, and splenic function testing after SAE was low, which reflects existing evidence for preserved splenic function after SAE, plus unpublished experience of key stakeholders. Key societies should consider clinical practice guidelines that merge existing evidence with modern practice.

PMID:40664568 | DOI:10.1016/j.injury.2025.112593

Injury. 2025 Jul 4:112585. doi: 10.1016/j.injury.2025.112585. Online ahead of print.

NO ABSTRACT

PMID:40664567 | DOI:10.1016/j.injury.2025.112585