Injury. 2026 Jan 9;57(3):113018. doi: 10.1016/j.injury.2026.113018. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: To compare the effectiveness of platelet-rich plasma (PRP) injection, corticosteroid injection, and wrist splinting in patients with bilateral moderate carpal tunnel syndrome (CTS) using clinical, electrophysiological, and radiological parameters.

MATERIAL AND METHODS: This randomized controlled study included 45 patients with bilateral moderate carpal tunnel syndrome, divided equally into three groups: PRP + splint, steroid + splint, and splint-only (control). Assessments were conducted pre-treatment and at 1 and 6 months post-treatment using VAS scores (pain and numbness), pinch and grip strength, QuickDASH questionnaire, EMG, and MRI.

RESULTS: VAS scores significantly improved in all groups at both follow-ups, with greater reductions in night pain and numbness in the PRP and steroid groups versus control. All groups showed improved strength at month 1; by month 6, grip strength improved only in the PRP group, while pinch strength improved in both PRP and steroid groups. While A significant reduction in the Quick DASH symptom score was observed in the PRP and steroid groups, EMG findings improved significantly in all groups. MRI showed a significant decrease in palmar bowing in the PRP and steroid groups.

CONCLUSION: While both PRP and steroid injections were more effective than splinting alone in improving symptoms and function, PRP demonstrated some indications of more sustained benefits, particularly at the 6-month follow-up.

PMID:41548406 | DOI:10.1016/j.injury.2026.113018

Injury. 2026 Jan 10;57(3):113043. doi: 10.1016/j.injury.2026.113043. Online ahead of print.

ABSTRACT

Skin flaps are widely used in plastic and reconstructive surgery. However, inadequate blood perfusion during flap mobilization can trigger an ischemic process that may lead to tissue necrosis in the absence of effective management of the inflammatory process. In this context, the search for new biocompatible strategies to ensure the viability of ischemic skin flaps (ISFs) remains necessary. Therefore, this study evaluated novel alginate-ZIF-8 (ALG-ZIF-8) hydrogel systems with Rhizophora mangle (R. mangle) extract and tannic acid (TA) to assess their potential in preventing necrosis in ISF. Twenty-two male Wistar rats underwent the surgical creation of ISF and were divided into four groups: 0.9% saline (negative control - NegC), placebo alginate hydrogel (pALGgel), ALG-ZIF-8 hydrogel system with 5% TA (ALGzTA), and finally, ALG-ZIF-8 hydrogel system with 5% R. mangle (ALGzRm). Flap outcomes were evaluated through macroscopic observation, followed by morphometric analysis of viable and necrotic areas, and histomorphometric analysis of fibroblasts, blood vessels, and leukocytes, using ImageJ and PrimeCam 5.1 software. Statistical analysis was performed using IBM SPSS software (version 27). The results suggest that the formulations produced divergent outcomes by differentially modulating inflammatory and angiogenic responses. The ALGzRm formulation tended to show a protective profile, associated with a significant reduction in leukocyte infiltration (p < 0.001), while the ALGzTA formulation was linked to a detrimental response, including exacerbated inflammation and a pathologically high blood vessel count (p = 0.015). In conclusion, findings suggest that the ALGzRm-gel has a potential for tissue repair, mediated by the modulation of inflammatory and angiogenic responses.

PMID:41548405 | DOI:10.1016/j.injury.2026.113043

Injury. 2026 Jan 11;57(3):113039. doi: 10.1016/j.injury.2026.113039. Online ahead of print.

ABSTRACT

BACKGROUND: Acute Compartment Syndrome (ACS) is a severe condition that can threaten limb viability, particularly in patients who experience prolonged immobility, such as in the found-down phenomenon. Inadequate removal of nonviable muscle after fasciotomy increases the risk of infection. While non-invasive imaging modalities have been explored for early ACS diagnosis, no tools currently exist to guide precise debridement intraoperatively. Existing technologies are limited by susceptibility to interference, lack of standardized thresholds and insufficient real-time surgical utility. This study aimed to evaluate the association between muscle perfusion, quantified by indocyanine green (ICG)-based dynamic contrast-enhanced fluorescence imaging (DCE-FI), and the degree of muscle necrosis in ACS, assessed via histopathological analysis, to explore the potential of DCE-FI to guide intraoperative muscle debridement.

METHODS: A total of 15 adults (aged 18 years or older) undergoing ACS surgical treatment were included in this study between 2023 and 2024. DCE-FI imaging was performed and eight muscle specimens spanning the entire length of the incision were obtained for each patient. Necrosis percentage was assigned to each sample based on histopathological evaluation by a pathologist. Patients were then classified into high necrosis (HN) and low necrosis (LN) groups based on their average necrosis scores from these eight samples, using 50 % necrosis as a cutoff. Perfusion-related kinetic parameters derived from DCE-FI, including maximum fluorescence intensity (Imax) and blood flow (BF), were evaluated and compared between the two groups.

RESULTS: The HN group exhibited significantly lower Imax (p < 0.001) and BF (p < 0.001), compared to those in the LN group, indicating substantially reduced muscle perfusion. The HN group had significantly lower median values (Imax 23.0 RFUs, BF 1.9 mL/min/100g) compared to the LN group (Imax 32.4 RFUs, BF 3.1 mL/min/100g).

CONCLUSIONS: ICG-based DCE-FI demonstrated strong potential for intraoperative identification of muscle damage resulting from ACS. This technique may serve as a valuable adjunct for guiding surgical debridement which may minimize complications and reduce the number of debridement procedures required, particularly in challenging cases of delayed or missed diagnosis of compartment syndrome.

PMID:41548404 | DOI:10.1016/j.injury.2026.113039

Injury. 2026 Jan 10:113034. doi: 10.1016/j.injury.2026.113034. Online ahead of print.

ABSTRACT

BACKGROUND: Post-burn elbow flexion contractures significantly impair upper-limb function by restricting the essential functional arc of motion required for activities such as self-care, feeding, hygiene, and vocational tasks. Standard management using contracture release and skin grafting is limited by high rates of recontracture due to secondary graft contraction. Locoregional perforator flaps based on the radial recurrent or ulnar recurrent vessels are often missed, even though they offer thin, pliable, and durable tissue. This study evaluates the flap surface area required to resurface the elbow flexure crease and analyzes postoperative functional outcomes using the Mayo Elbow Performance Score (MEPS).

METHODS: A prospective observational study was conducted over a three-year period in a tertiary care plastic surgery department. Patients aged 12 years and older presenting with post-burn elbow flexion contractures and with either the radial or ulnar border of the arm unaffected were included. Flap area was estimated from the contralateral limb or an age- and sex-matched individual in bilateral cases. Radial recurrent artery perforator (RRAP) or ulnar recurrent artery perforator (URAP) flaps were harvested based on perforator availability. MEPS was recorded preoperatively and at 6 weeks postoperatively. Early mobilization was initiated within 48 h, and donor sites were grafted as needed.

RESULTS: Twelve patients out of 38 (31%) (eight males, four females; mean age, 34 years) met the inclusion criteria. Flame burns accounted for 9 cases, and scald injuries for 3. The mean flap area required to reconstruct the flexure crease was 39 cm². Preoperatively, elbow function was markedly limited, with a mean MEPS of 60 (range 45-70). Following contracture release and flap resurfacing, early mobilization was achieved in all patients without the need for postoperative splinting. At 6 weeks, the mean MEPS improved significantly to 98 (range 95-100), confirmed by Wilcoxon rank-sum testing (p< 0.05). No flap failures, wound complications, or early recontractures were noted.

CONCLUSION: Radial and ulnar recurrent artery perforator flaps provide reliable, thin, and contour-appropriate tissue for resurfacing the elbow flexure crease after burn contracture release. Their ability to permit early mobilization and prevent recontractures makes them an effective primary reconstructive option in about 31% of cases.

PMID:41547588 | DOI:10.1016/j.injury.2026.113034

Injury. 2025 Dec 17;57(3):112960. doi: 10.1016/j.injury.2025.112960. Online ahead of print.

ABSTRACT

INTRODUCTION: The treatment paradigm of pelvic ring injuries has undulated over recent decades. Open reduction and internal fixation (ORIF) became more common in the 1990s and early 2000s followed by a decline in the late 2000s and 2010s, in favor of nonoperative management. Recently, minimally invasive pelvic stabilization using percutaneous pelvic fixation (PFF) has gained popularity. The trends of ORIF, PPF, and nonoperative management of pelvic ring injuries over the last decade is not well described. This study aims to characterize such trends among early-career orthopaedic trauma surgeons from 2003 to 2023.

METHODS: Data was collected from the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List database for Candidates who indicated that their subspecialty was trauma over a time period involving 20 years of Case List submissions (2003-2023). Pelvic ring fixation was identified using CPT codes for ORIF (27,217, 27,218) and PPF (27,216). Total case volumes and trends in fixation type were analyzed, including an age-based subgroup analysis of younger (age 18-50) and older (age ≥65) adults, RESULTS: Of 15,164 total ABOS Part II Candidates, 795 indicated a trauma subspecialty and performed at least one pelvic ring fixation, with a total of 7311 pelvic fixation cases (3317 ORIF; 3994 PPF). Annual pelvic ring injury fixations increased five-fold during the study period, from 110 in 2003 to 592 in 2023. The proportion of ORIF decreased from 70 % to 40 %, while PPF increased from 30 % to 60 %. The share of early-career surgeons' practice dedicated to percutaneous fixation tripled. Operative fixation (both PPF and ORIF) of pelvic ring injuries in older adult patients became more common over this period.

CONCLUSION: Percutaneous stabilization of pelvic ring injuries is increasing over time, reflecting evolving practice patterns among early-career trauma surgeons. Future studies should evaluate the clinical implications of this trend, including the impact on fellow and resident training.

PMID:41547086 | DOI:10.1016/j.injury.2025.112960

Injury. 2026 Jan 9;57(3):113024. doi: 10.1016/j.injury.2026.113024. Online ahead of print.

ABSTRACT

BACKGROUND: Prehospital management of suspected spinal injury has long relied on routine full immobilization. In recent years, several studies have questioned its benefit and highlighted possible adverse effects. The aim of this scoping review is to describe the evidence on the management of patients with suspected spinal injury, focusing on models based on full immobilization with rigid devices and a cervical collar, and on strategies of selective spinal motion restriction (SMR).

METHODS: A scoping review was conducted according to JBI methodology and PRISMA-ScR guidance, with a protocol registered on the Open Science Framework. The literature search was carried out in the PubMed, Scopus and Web of Science databases. Studies on adults or children with suspected traumatic spinal injury managed in the out-of-hospital setting were included when strategies of full immobilization, selective SMR or no immobilization were described or compared.

RESULTS: Twenty-seven studies met the inclusion criteria, including observational cohorts, experimental studies on volunteers, simulation studies and qualitative research. Overall, no clear advantage of routine full immobilization over more selective strategies emerges. Selective SMR based on clinical assessment and decision rules appears to reduce the use of rigid devices without evidence of increased missed unstable injuries. Prolonged immobilization is instead associated with pain, discomfort, alterations in tissue perfusion and greater use of imaging examinations. The overall body of evidence is heterogeneous and largely based on observational studies, in which the influence of confounding factors cannot be fully ruled out.

CONCLUSIONS: The available evidence supports moving away from routine full immobilization towards selective SMR in the prehospital setting. Emergency medical services should update protocols and training accordingly and promote prospective studies focused on clinical outcomes and patient experience.

PMID:41547085 | DOI:10.1016/j.injury.2026.113024

Injury. 2026 Jan 13;57(3):113029. doi: 10.1016/j.injury.2026.113029. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to hierarchically analyse the fixation effects of single and multiple screws on quadrilateral fractures in the acetabular region using finite element technology.

METHODS: A three-dimensional finite element model of the normal pelvis was constructed based on normal adult CT data using Mimics, Geomagic, SolidWorks, ANSYS. Six transverse equidistant fracture lines were designed for the hierarchical analysis, and five simulated human body positions were considered.

RESULTS: We compared the mechanical properties of single and multiple screws used for fixation under various operating conditions. The results indicated a layer-by-layer decrease in the relative displacement of the fracture lines from top to bottom under different strength conditions in the standing position and the lumbar spine. In the lateral decubitus position, fracture lines 1-5 decreased layer by layer, whereas fracture line 6 increased. Moreover, in the multiple-screw model, posterior column corridor screw experienced lower stress than in the single-screw model, while blocking screws bore significantly higher stress than posterior column corridor screw. Additionally, pronounced displacement occurred along the anterior and posterior columns sides of the quadrilateral region, while the central segment showed only minor shifting under different loading states in the standing and lumbar postures; in contrast, such behavior was not observed in the lateral decubitus position.

CONCLUSION: Multiple-screw fixation suggests better stability with smaller relative displacement than single-screw fixation under different loading conditions in the finite element analysis.

PMID:41547084 | DOI:10.1016/j.injury.2026.113029

Injury. 2026 Jan 8;57(2):113014. doi: 10.1016/j.injury.2026.113014. Online ahead of print.

NO ABSTRACT

PMID:41546990 | DOI:10.1016/j.injury.2026.113014

Injury. 2026 Jan 10:113044. doi: 10.1016/j.injury.2026.113044. Online ahead of print.

ABSTRACT

INTRODUCTION: As screening protocols for blunt cerebrovascular injuries (BCVI) have improved, the incidence of these injuries has increased among trauma patients. Grade 2 BCVIs represent a heterogeneous group of vascular injuries and include injuries with thrombus. We hypothesize that the presence of intraluminal thrombus in patients with grade 2 BCVI is associated with a higher incidence of stroke compared to those without thrombus.

METHODS: We conducted a single-center retrospective review of trauma patients diagnosed with BCVI at a Level I Trauma Center from November 2015 to October 2023. Demographic and injury characteristics were obtained from the institutional trauma registry. Detailed chart reviews were performed to assess imaging findings, stroke incidence, interventions, and follow-up outcomes. Additionally, all grade 2 BCVIs underwent secondary review by neuroradiologists to confirm grade and to identify whether thrombus was present.

RESULTS: We identified a total of 39 patients with at least one grade 2 BCVI. The overall stroke rate among those with grade 2 BCVI was 23% (n = 9). Intraluminal thrombus was present in 31% of patients (n = 12); however, the stroke rate among these patients was similar (25%, n = 3). Incidence of stroke did not significantly differ based on whether patients received an intervention, anti-platelet therapy, or no therapy. Follow-up imaging was performed in 64% of patients (n = 25), demonstrating that 24% of injuries resolved, 24% improved, 40% remained stable, and 16% progressed. Nearly two-thirds of patients (n = 25) underwent at least one repeat CTA during their hospitalization or outpatient follow-up with a median number of 38 days to repeat imaging when performed.

CONCLUSION: Although grade 2 BCVIs are often considered lower risk injuries, our findings indicate that over 20% of affected patients experience a stroke. The presence of intraluminal thrombus was not associated with an increased risk of stroke. These findings support the early initiation of antithrombotic therapy in patients with grade 2 BCVI to mitigate stroke risk.

PMID:41545242 | DOI:10.1016/j.injury.2026.113044

Injury. 2026 Jan 10:113020. doi: 10.1016/j.injury.2026.113020. Online ahead of print.

ABSTRACT

BACKGROUND: Gamified virtual patients (VPs) can enhance motivation and learning in military trauma management. However, there is a need to better understand design preferences and expectations regarding VP features and game elements. This study explores how such elements are experienced and interpreted by military trauma care professionals.

METHODS: This qualitative study applied systematic text condensation to analyze the shared experiences of 17 participants, consisting of military medics and instructors, who interacted with a gamified VP system.

RESULTS: Five main themes were identified: Feeling Challenged; Supporting Reflection and Learning; Realism Matters; Developing Confidence; and Balancing Learning and Playing. Participants expressed mixed views on game rewards, competition, and time-pressure, with instructors warning that such features could detract from learning objectives. Instructors emphasized the value of feedback that explains consequences, while both instructors and medics highlighted the importance of immediate corrective feedback.

DISCUSSION: Gamified VPs can support military trauma training by enhancing engagement, building confidence, and supporting reflection and learning. However, the inclusion of game elements requires careful consideration. Elements that contribute to realism and immersion, such as narrative, multimedia, and tactical challenges, were viewed as valuable for maintaining authenticity and contextual relevance. Hints and progressive difficulty levels were also perceived as beneficial for supporting gradual skill development. Features such as scoring, competition, rewards and time-pressure elicited mixed responses. While some participants found these elements engaging, others perceived them as distracting or misaligned with the goal of acquiring life-saving skills. Instructors were critical of mechanisms that induced artificial stress or rewarded speed over reasoning, warning that such features could shift focus from learning to performance. Therefore, rather than adopting gamification features uncritically, designers and educators should carefully evaluate which elements enhance learning in high-stakes environments and which risk undermining it.

PMID:41545241 | DOI:10.1016/j.injury.2026.113020

Injury. 2025 Dec 10;57(2):112955. doi: 10.1016/j.injury.2025.112955. Online ahead of print.

ABSTRACT

BACKGROUND: The posterior cervical canal plays a critical role in the protection and function of the cervical nerve roots, particularly the C5 nerve root. Variations in its anatomical structure, notably the number of single-door segments, may impact the traction forces experienced by the C5 nerve root during surgical interventions or pathological conditions. This study aims to quantify how the number of single-door segments affects traction forces on the C5 nerve root.

METHODS: A biomechanical model was developed to simulate traction forces on the C5 nerve root based on varying anatomical configurations of the posterior cervical canal. MRI scans from 60 patients were analyzed, and traction forces were calculated for different segmental configurations, specifically focusing on the number of single-door segments.

RESULTS: The study revealed a statistically significant correlation between the number of single-door segments and the traction force on the C5 nerve root. As the number of segments increased from one to three, traction forces increased by 25%, with the mean force rising from 12.5 N to 17.2 N (p < 0.05). Furthermore, the force increased by an additional 6% when the number of segments reached four, reaching a maximum traction force of 18.3 N. These findings suggest that anatomical variations in the posterior cervical canal influence the magnitude of traction forces and could potentially alter surgical outcomes, especially in nerve root preservation during decompression procedures.

CONCLUSION: This study underscores the significant role of single-door segments in the posterior cervical canal in modulating traction forces on the C5 nerve root. These biomechanical insights offer valuable information for preoperative planning, particularly in surgeries involving cervical spine decompression. Understanding these dynamics could enhance the preservation of nerve root integrity and improve patient outcomes in cervical spine surgeries.

PMID:41544535 | DOI:10.1016/j.injury.2025.112955

Injury. 2026 Jan 11;57(3):113045. doi: 10.1016/j.injury.2026.113045. Online ahead of print.

ABSTRACT

PURPOSE: The sural flap is widely recognized as an effective method for soft tissue coverage in severe lower limb trauma or sequelae. This retrospective cohort study investigates the impact of vascular pedicle length in reverse sural fasciocutaneous flaps on vascular complications, specifically whether longer pedicles are associated with increased complications.

METHODS: We included patients with distal third leg and foot soft tissue defects, treated between March 2008 and March 2021, with a minimum follow-up of 1 year. The cohort was divided into two groups based on the location of the flap: those with flaps above the ankle joint (short pedicle) and those below (long pedicle). Patient demographics, comorbidities (e.g., diabetes, peripheral vascular disease, smoking), and the causes of defects (including fractures, ulcers, and degloving injuries) were assessed. The occurrence of complications, including epidermolysis, partial necrosis, and total necrosis, were compared between groups using bivariate linear regression.

RESULTS: A total of 44 patients received flaps above the ankle joint, while 34 had flaps below the ankle joint. Overall, 35% of patients experienced complications: 5% epidermolysis, 20% partial necrosis, and 10% total necrosis. In the short-pedicle group (flaps above the ankle), 13 complications were observed: 3 cases of epidermolysis, 5 of partial necrosis, and 5 of total necrosis. In the long-pedicle group (flaps below the ankle), 15 complications occurred: 1 case of epidermolysis, 11 of partial necrosis, and 3 of total necrosis. Although complication rates were similar between the two groups, a trend toward a higher incidence of partial necrosis was observed in the longer pedicle group. Statistical analysis using bivariate linear regression found no significant difference in complication rates based on pedicle length (p=0.407). For individual complications, there were no statistically significant differences: epidermolysis (p=0.504), total necrosis (p=0.808), and partial necrosis (p=0.098).

CONCLUSION: Flap rotation points positioned 5-6 cm above the lateral malleolus, with a wide, short pedicle, may reduce vascular complications. For defects beyond the ankle joint, careful surgical planning is crucial, to minimize the risk of partial necrosis and other complications.

PMID:41544493 | DOI:10.1016/j.injury.2026.113045

Injury. 2026 Jan 10;57(3):113048. doi: 10.1016/j.injury.2026.113048. Online ahead of print.

ABSTRACT

BACKGROUND: Posterior pelvic ring injuries, including sacral fractures and sacroiliac (SI) joint disruption, can have potentially serious sequelae and are becoming increasingly common. Management, especially in the setting of instability, consists of internal fixation to decrease the risk of complications. Placement of SI screws requires a thorough knowledge of normal pelvic anatomy and the available osseous fixation pathways. The aim of this study was to define the prevalence of individual features of sacral dysmorphism in the general population.

METHODS: We conducted a retrospective review of standard and 3D-reconstructed computed tomography (CT) images of the pelvis to record the presence or absence of each dysmorphic feature. All adult trauma patients who presented within a 5-year period at a single, academic, Level I trauma center were eligible for inclusion. Patients <18 years of age, without advanced pelvic imaging, or who presented with any current or prior pelvic ring injury, tumor, or instrumentation were excluded. The prevalence of each dysmorphic feature was calculated and associations between dysmorphism and demographic factors were investigated.

RESULTS: A total of 2667 patients were eligible for inclusion and the first 1000 were selected for review. Six subjects were excluded during review of CT images. One or more dysmorphic feature was seen in 96.8% of subjects. Each subject displayed an average of 2.7 abnormal features. Residual S1 discs were the most prevalent feature (72.2%). While tongue-in-groove (TIG) sacroiliac (SI) joints were the rarest (7.7% prevalence), they were associated with a significantly higher average number of concurrent dysmorphic features (3.29, P < .0001). Demographic subgroup analysis demonstrated a significantly higher prevalence of S1 discs (P = .0007), TIG SI joints (P < .0001), and colinear upper sacra (P < .0001) in women. Residual S1 discs were also significantly more common in White patients (P < .0001).

CONCLUSIONS: Sacral anatomy exists on a spectrum from normal to dysmorphic. This study demonstrates that completely "normal" sacral morphology is seen in <4% of patients. TIG sacroiliac joints may serve as a quick indicator for a higher degree of dysmorphism which may complicate or preclude transiliac-transsacral screw placement.

PMID:41544492 | DOI:10.1016/j.injury.2026.113048

Injury. 2025 Dec 13;57(3):112966. doi: 10.1016/j.injury.2025.112966. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the clinical application value of a novel tappable, lateral-hole, variable-angle bone grafting tool for injured vertebra bone grafting combined with screw placement in the injured vertebra, in the context of short-segment fixation via an intermuscular approach for thoracolumbar fractures.

METHODS: A retrospective study was conducted on 74 patients treated between January 2022 and June 2024. Patients were divided into three groups: Group A (n = 25) received conventional bone grafting without screw placement in the injured vertebra; Group B (n = 26) received conventional bone grafting with screw fixation; Group C (n = 23) received grafting with the novel tool plus screw fixation. Vertebral kyphosis angle (VKA), local kyphosis angle (LKA), superior endplate displacement (SED), Visual Analog Scale (VAS) scores, and complications were analyzed preoperatively, postoperatively, and at 3-month follow-up. Bone defect volume in Groups B and C was assessed using Mimics software on CT 3D reconstructions.

RESULTS: There were no significant differences in sex, age, operative time, or hospital stay among the three groups (P > 0.05). Preoperative and 1-week postoperative VAS scores were similar among the groups (P > 0.05). At 3 months postoperatively, VAS scores in Group C were significantly lower than in Groups A and B (P < 0.05). Groups B and C exhibited significantly less loss of vertebral kyphosis angle (VKAloss) compared to Group A (p = 0.011). There were no significant differences in LKA among the three groups before surgery, after surgery, or at the 3-month follow-up (P > 0.05). Changes in SED values before and after surgery were consistent with VKA, and the SEDloss value in Group C was significantly lower than in Groups A and B at 3 months postoperatively (p < 0.001). Compared to Group B, Group C showed a significant reduction in fracture defect volume at 3 months postoperatively (p = 0.006).

CONCLUSION: The novel bone grafting tool provides effective vertebral support with high grafting efficiency, reduced pedicle damage, and improved postoperative outcomes. Its ease of use makes it a valuable addition to thoracolumbar fracture treatment via the intermuscular approach.

PMID:41544491 | DOI:10.1016/j.injury.2025.112966

Injury. 2026 Jan 8;57(3):113015. doi: 10.1016/j.injury.2026.113015. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic femoral fractures (PFFs) are increasingly common as arthroplasty rates rise, with incidence projected to double in the next two decades. Mortality approaches that of hip fractures, with 1-year rates of 22-27 % reported in multicentre datasets. While favourable outcomes are often described from high-volume centres, most PFFs present to secondary care, where resources and surgical expertise may be limited. This study evaluates whether a structured multidisciplinary team (MDT) pathway with a weekly dedicated periprosthetic theatre list can achieve outcomes comparable to national and international benchmarks in a UK district hospital.

METHODS: We retrospectively reviewed all PFFs managed between 2013 and 2024 at a district hospital (n = 258) in a trauma unit with fellowship trained arthroplasty surgeons, a dedicated Orthogeriatric team and weekly periprosthetic lists. Demographics, comorbidities (Charlson Comorbidity Index, ASA), fracture type (Vancouver classification), surgical management (fixation vs revision), and outcomes were analysed. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes included discharge destination, restoration of mobility, complications, and reoperation rates. Results were compared with national and international studies.

RESULTS: Mean age was 80 years (median 82) with majority (60 %) being female. 213 (82.8 %) patients were managed operatively after multidisciplinary discussions. In-hospital mortality was 1.2 % (n = 3), 30-day mortality 3.5 %(n = 9) and one year mortality rate was 19.8 %. Mean CCI was 4.8 and one-year mortality was markedly higher in patients with CCI ≥4. Length of hospital stay increased progressively with surgical delay. Among those managed operatively, 63.5 % (n = 87) returned to their original place of residence.

CONCLUSION: A weekly dedicated periprosthetic list with MDT involvement allowed a district hospital to achieve mortality and functional outcomes equal to, or better than, those reported from high-volume centres. These findings highlight that system-level interventions, not hospital size, are the decisive factor in PFF outcomes, and provides a scalable model for hospitals globally.

PMID:41544490 | DOI:10.1016/j.injury.2026.113015

Injury. 2026 Jan 9;57(3):113022. doi: 10.1016/j.injury.2026.113022. Online ahead of print.

ABSTRACT

OBJECTIVES: To biomechanically compare triangular osteosynthesis (TOS) and a minimally invasive triangular spinopelvic stabilization (TMSS) technique for Type IV fragility fractures of the pelvis (FFP) in a cadaveric model.

METHODS: Six fresh-frozen lumbopelvic specimens (L3-pelvis; mean age 61.5 ± 11.5 yrs) with simulated Type IV U-shaped sacral fractures were sequentially instrumented with TOS (bilateral iliosacral screws + lumbopelvic fixation) and TMSS (bilateral iliac screws with transverse connecting rod + lumbopelvic fixation). Constructs were cyclically loaded (200-430 N; 25,000 cycles or 1 cm axial displacement) to simulate postoperative single-leg stance loading. Fracture displacement was quantified using a motion capture system.

RESULTS: All but one TOS specimen completed 25,000 cycles. Bone mineral density had no effect on displacement. TMSS showed lower maximum fracture displacement (6.05 mm) than TOS (12.12 mm; p= 0.071). Displacement after 1000 cycles averaged 56% (TOS) and 62% (TMSS) of the maximum.

CONCLUSIONS: TMSS provided comparable or improved stability versus TOS and, with its minimally invasive design, may offer a viable alternative for FFP Type IV treatment. Further clinical validation is warranted.

PMID:41544489 | DOI:10.1016/j.injury.2026.113022

Injury. 2025 Dec 3;57(2):112925. doi: 10.1016/j.injury.2025.112925. Online ahead of print.

ABSTRACT

INTRODUCTION: Comparative data describing patterns of injury occurring in the home and in the community across ages are limited yet may guide family- and community-based interventions. We sought to assess potential differences in patient characteristics, injury mechanisms, and outcomes, as well as between injuries occurring at home compared to those in the community across all ages.

METHODS: Patients from a level I pediatric and level I adult trauma center who resided and were injured in a single metropolitan county from 2016 - 2022 were included. Demographics, mechanism of injury, and outcome measures were compared. The top three injury mechanisms (falls, motor vehicle crash (MVC), and firearm) were included for analysis. Patients' residential address and injury location were geocoded. Injuries that occurred at home were those <0.1miles from the patient's residence. Statistical analysis included Kruskal-Wallis and Wilcoxon rank-sum tests, and Spearman correlation to evaluate the relationship between age and distances (straight line and driving) from residence to injury location.

RESULTS: There were 1235 and 7680 patients in the pediatric and adult registries, respectively. Male patients accounted for the majority of those <65 years. Trends emerging in the 10-14-year-old age group continued through the 25-44-year-old group; these include increased firearm and MVC injury, injury among Black individuals, assaultive injuries, worse injury severity, and injury in the community. Falls were most prevalent among those aged <10 and >44 years. White children and adults were more likely to be injured at home; other races were disproportionately injured in the community. Injury in the community was more likely to result in higher injury severity in both adults and children.

CONCLUSION: Mechanism-specific injury trends emerging in children and youth that occur in the community continue into adulthood. Community-based intervention strategies are needed. Injuries at home, however, occur in a bimodal age-related pattern and may inform interventions and family-based education initiatives.

PMID:41518851 | DOI:10.1016/j.injury.2025.112925

Injury. 2025 Dec 12;57(2):112964. doi: 10.1016/j.injury.2025.112964. Online ahead of print.

ABSTRACT

INTRODUCTION: The ideal fixation construct for treatment of stress-positive lateral compression type 1 (LC1) pelvic ring injuries is controversial. The purpose of this study was determine if anterior and posterior fixation (AF+PF) versus posterior fixation only (PF) of patients with LC1 pelvic ring injuries is associated with home discharge.

PATIENTS AND METHODS: A multicenter retrospective review was performed at eight level one trauma centers of adult patients with stress-positive minimally displaced LC1 pelvic ring injuries (OTA/AO 61B) treated with AF+PF versus PF. Outcomes included length of stay, maximum feet ambulated with physical therapy (PT) while hospitalized, discharge disposition, independent ambulation at last follow-up, and mortality. AF+PF versus PF patients were compared in terms of age, sex, Charleston Comorbidity Index (CCI), injury mechanism, and Beckman score. Propensity-matching was used to control for group differences.

RESULTS: There were 434 patients included; 64.5% (n = 280) treated with AF+PF and 35.5% (n = 154) with PF. Patients treated with AF+PF, versus PF, were older (47.0 vs. 38.0 years; p = 0.01), had a higher CCI (0 vs 0; p = 0.02), a higher Beckman score (8.0 vs. 7.0; p = 0.04), more low-energy falls (18.6% vs. 8.4%; p = 0.004), less independent ambulators (92.1% vs 97.4%; p = 0.03), and more rami fractures with 100% displacement (26.8% vs. 12.3%; p = 0.0004). The groups did not differ in gender, complete sacral fractures, days to surgery, or follow-up duration (p > 0.05). Propensity-matching resulted in two groups of 141 patients, similar in age, CCI, Beckman score, low-energy falls, 100% rami fracture displacement, and follow-up duration (p > 0.05). On matched analysis, patients treated with AF+PF, versus PF, spent fewer days in the hospital (7.0 vs. 8.0; p = 0.03) and were more likely to discharge home (76.6% vs. 63.1%; p = 0.0005). There was no observed difference between groups in terms of feet ambulated with PT, independent ambulation at last follow-up, or mortality (p > 0.05).

CONCLUSION: Matched patients with stress-positive minimally displaced LC1 injuries treated with AF+PF compared to PF spent fewer days in the hospital and were more likely to discharge home.

LEVEL OF EVIDENCE: Therapeutic Level III.

PMID:41500149 | DOI:10.1016/j.injury.2025.112964

Injury. 2025 Dec 11;57(2):112958. doi: 10.1016/j.injury.2025.112958. Online ahead of print.

ABSTRACT

BACKGROUND: Isolated anterior wall acetabulum fracture (AWF) represents a rare injury. There is a paucity of information available about this fracture and no classification has been proposed so far. The aim of this study was to analyse the various possible fracture patterns, related treatment approaches and to develop a new classification system.

METHODS: Common search engines were systematically searched, according to the PRISMA guidelines. Data relating to the studies that reported surgical approaches and results about isolated AW fractures were included. Data quality was also assessed. We topographically subdivided the fractures, according to the percentage of the anterior wall involved, location of the fracture, and the degree of comminution. The mean follow-up was 38.8 months (6-240).

RESULTS: 17 papers were eligible for this study. The ilio-inguinal (ILI) approach was the most used one (58.2 %). Different reconstruction techniques were deployed. Anatomical reduction was obtained in 46.6 % of the cases. 3 patients required hip prosthesis within 18 months. Based on the evidence gathered the anterior wall was divided into 3 segments (proximal, (P) middle (M) and distal (D)1/3 segment. Based on the area of involvement in each zone was also divided into Type I < 25 %; Type II 25-50 % and Type III >50 %. Comminution (C) was also assigned if present in any of the 3 zones.

CONCLUSION: Isolated anterior wall acetabulum fracture is an uncommon injury. The IIL approach was the most used for fixation. A new classification system was developed to guide surgical approach and fixation techniques.

PMID:41494481 | DOI:10.1016/j.injury.2025.112958

Injury. 2025 Dec 24;57(2):113010. doi: 10.1016/j.injury.2025.113010. Online ahead of print.

ABSTRACT

INTRODUCTION: Effective trauma triage relies on accurate trauma team activation (TTA) criteria to balance resource allocation and patient outcomes. Current guidelines prioritize high-risk of severe injury (HRSI) criteria, while moderate-risk of severe injury (MRSI) criteria are associated with high over-triage rates. Using data from the TraumaRegister DGU® (TR-DGU), this study evaluates the impact of different TTA criteria on patient outcomes and trauma system efficiency.

METHODS: A retrospective cohort study was conducted using TR-DGU data from 2018 to 2023, including patients aged ≥16 years with trauma team activation, emergency room treatment, and intensive or intermediate care admission. Patients were categorized based on TTA criteria: HRSI, MRSI, or provider decision ("None"). Injury severity, mortality, emergency interventions, intensive care unit (ICU) stay, and hospital length of stay were analyzed. Statistical comparisons utilized chi-square and Mann-Whitney-U tests, with significance set at p < 0.05.

RESULTS: The final cohort included 97,295 patients: 42 % met HRSI criteria, 38 % MRSI, and 20 % were assigned due to provider decision. Patients in the HRSI group had the highest injury severity (ISS=23.5), mortality (19.3 %), and need for emergency interventions (31 %). In contrast, the MRSI group had significantly lower severity (ISS=12.5), mortality (1.6 %), and intervention rates (13 %). The "None" group, comprising mostly elderly patients with ground-level falls, had a higher mortality rate (8.5 %) despite a comparable ISS (13.5).

CONCLUSION: Findings highlight the limitations of MRSI-based TTA criteria, which contribute to resource overutilization without improving patient outcomes. A tiered activation strategy prioritizing HRSI while refining MRSI criteria may enhance triage efficiency. The high mortality rate in the "None" group suggests the need for additional triage parameters, particularly for geriatric patients. These insights support recent guideline revisions and are the basis for further evaluations.

PMID:41494480 | DOI:10.1016/j.injury.2025.113010