Injury. 2025 Sep 8:112758. doi: 10.1016/j.injury.2025.112758. Online ahead of print.

ABSTRACT

PURPOSE: Ecuador has seen a dramatic increase in violence, with homicides rising from 6.4 per 100,000 inhabitants in 2015 to 47.25 in 2023. In response, the government declared a state of internal armed conflict and a "state of emergency" This study aims to analyze the impact of this political measure on the admission of patients who are victims of violence to a hospital in the coastal region of the country.

METHODS: This is an analytical cross-sectional study conducted over nine months, from October 2023 to July 2024, divided into three-month periods. The independent variable was the period of surgical trauma: pre-exception, during the state of exception, and post-exception. The dependent variable was surgical trauma due to violence. A bivariate analysis was performed and a p-value of <0.05 was considered statistically significant.

RESULTS: The study included 160 cases of surgical trauma. Of the traumas reported during the nine months, 80 % (N=128) were due to violence. 78 % (N=125) of patients underwent surgery for penetrating trauma, with 77 % (96/125) of these due to firearms. The proportion of penetrating injuries due to firearms varied significantly according to period (p = 0.020). During the state of exception it fell to 60 % (21/35) from 79 % (31/39) pre-exception, but rose again in the post-exception period to 86 % (44/51).

CONCLUSION: The strategies implemented did not significantly reduce trauma admissions due to violence at this hospital, underscoring the imperative for additional interventions and a comprehensive understanding of the social determinants underlying this public health issue.

PMID:40946074 | DOI:10.1016/j.injury.2025.112758

Injury. 2025 Sep 8;56(11):112752. doi: 10.1016/j.injury.2025.112752. Online ahead of print.

ABSTRACT

The impact of gun violence on the well-being of children in the United States is a vital public health issue. Gaps remain in characterizing the population health burden, exacerbated by gun violence data limitations and research policy restrictions. This study explores the association between neighborhood-level gun violence and the general health status of children nationwide in the Environmental influences on Child Health Outcomes (ECHO) study. 13,450 children ages 0-17 and parents reported general health status. Gun violence incidents, defined as any death or injury caused by a gun, were extracted from the publicly available Gun Violence Archive by census tract between 2020 and 2023. Census tracts were categorized as low gun violence (< 2 incidents between 2020-2023) and high gun violence (≥ 2 incidents). A generalized estimating equation logistic model with robust variance was used to estimate the association between binary general health status (Good/Fair/Poor vs. Excellent/Very good) and neighborhood-level gun violence events adjusting for individual and census tract-level sociodemographic covariates. 11,329 (84 %) reported Excellent/Very Good general health and 2121 (16 %) reported Good/Fair/Poor general health. The adjusted odds of Excellent/Very Good general health were 20 % lower among children living in census tracts with high gun violence compared to low gun violence (OR 0.804; 95 % CI: 0.721, 0.897). When stratified by age group, the odds of Excellent/Very Good general health among younger children (ages 0 - 7) were 17.3 % lower (OR 0.827; 95 % CI: 0.687, 0.997) and 19.7 % lower among older children (ages 8 - 17) among those living in census tracts with high gun violence compared to those with low gun violence (OR 0.803; 95 % CI: 0.702, 0.919). Among children living in high socioeconomic vulnerability census tracts, the odds of Excellent/Very Good general health were 23 % lower in children living in census tracts with high gun violence compared to those with low gun violence (OR 0.767, 95 % CI 0.669, 0.880). Findings underscore the importance of community violence prevention efforts and the need to strengthen our understanding of community risk factors such as gun violence that hinder optimal child growth and development.

PMID:40945226 | DOI:10.1016/j.injury.2025.112752

Injury. 2025 Sep 9;56(11):112755. doi: 10.1016/j.injury.2025.112755. Online ahead of print.

ABSTRACT

INTRODUCTION: Obesity is a growing global concern. Bariatric surgery (BS) is the only intervention which leads to significant and long-lasting weight reduction. However, it has been associated with an increased risk of fracture. We aimed to investigate the association between BS and distal radius fractures (DRF).

METHODS: A retrospective cohort study of patients with obesity who underwent BS was conducted. The incidence of DRF and the non-osteoporotic scaphoid fracture in the six-years pre-and post-BS was compared. Sub-analysis for surgical type, weight loss, nutritional supplements, and treatment modality was conducted.

RESULTS: Seventeen-thousand, nine-hundred and four patients, aged 40 (SD 2.7) were included in the study, most of whom were females (71.2%). Most underwent restrictive gastric surgery (82.6%). The incidence of both fractures increased following BS (OR 2.091, 95% CI [1.524,2.896], p<0.001 for DRF and OR 6.013, 95% CI [2.819,14.720], p<0.001 for scaphoid fracturs). Women were affected more. DRFs were less common following restrictive surgery (0.6% versus 1.15% for gastric bypass surgery, OR 0.52 95% CI [0.35,0.79], p.=0.002), and their incidence was not associated with the time elapsed from BS. A greater weight reduction was not related with increased fracture risk, regardless of the fracture type, as was nutritional supplements consumption. DRF surgery rates were not affected by BS.

CONCLUSIONS: BS was found to relate with increased risk for DRFs. The risk was greater for gastric bypass patients and independent of the increasing cohort age, the amount of weight lost, the time elapsed from surgery, and the intake of nutritional supplements.

PMID:40945225 | DOI:10.1016/j.injury.2025.112755

Injury. 2025 Sep 5;56(11):112749. doi: 10.1016/j.injury.2025.112749. Online ahead of print.

ABSTRACT

BACKGROUND: Fracture related infection (FRI) is a serious complication of orthopedic trauma. The DAIR (Debridement, Antibiotics, and Implant Retention) approach has been used as a limb- and implant-sparing strategy in selected early infections, but the factors associated with clinical success and bone healing remain incompletely defined.

OBJECTIVE: To evaluate the effectiveness of DAIR in treating early FRI and to identify clinical, surgical, and microbiological factors associated with infection remission, recurrence and fracture consolidation.

METHODS: This retrospective cohort study included adult patients diagnosed with early FRI and treated with DAIR between 2017 and 2023. Clinical remission was defined as infection resolution without further surgery or suppressive antibiotic therapy at 12-month follow-up. Recurrence was defined as clinical or microbiological evidence of infection reappearance. Fracture consolidation was evaluated radiographically. Univariate analyses were performed using logistic regression, Fischer's exact text, chi-square, and t-test where appropriate.

RESULTS: A total of 59 patients were included. Clinical remission was achieved in 86.4 % of cases, while recurrence occurred in 32.2 %. All patients with recurrence had failed clinical remission (p < 0.001). Remission was significantly lower in patients with prior external fixation (72.7 % vs. 94.6 %; p = 0.031) and lower extremity infections (77.1 % vs. 100 % for pelvis and upper limb; p = 0.002). Fracture consolidation was observed in 86.4 % of patients. Although not statistically significant, trends indicated better consolidation in those with remission (90.2 % vs. 62.5 %) and lower healing in patients with comorbidities, or polymicrobial infections.

CONCLUSIONS: DAIR is effective treatment for early FRI, achieving high clinical remission and consolidation rates. Remission is a strong predictor of both infection control and bone healing. Prior external fixation and lower limb involvement were associated with reduced treatment success.

PMID:40945224 | DOI:10.1016/j.injury.2025.112749

Injury. 2025 Sep 5;56(11):112748. doi: 10.1016/j.injury.2025.112748. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to evaluate the efficacy of nail dynamization in patients with delayed union and nonunion of femur and tibia shaft fractures following intramedullary nailing, and systematically analyze the associated factors to guide surgeons.

METHODS: A comprehensive search of PubMed, EMBASE, and Cochrane Library databases was conducted to identify relevant studies. We screened the literature based on the eligibility criteria, extracted relevant data, and assessed the quality of the included studies. A single-arm meta-analysis using a random-effects model was conducted to estimate overall union rates, while meta-regression and subgroup analyses explored sources of heterogeneity and contributing factors. Sensitivity analyses were used to assess result stability.

RESULTS: 11 studies consisting of 318 patients met the inclusion criteria. The pooled union rate after nail dynamization was 77.2 % with significant heterogeneity. Meta-regression identified the time of dynamization, the method of dynamization, and Fracture Healing Index (FHI) as critical factors affecting union rates. Subgroup analysis revealed that dynamization within 6 months, preserving the dynamic locking screw, and an FHI >1.17 were significantly associated with higher union rates.

CONCLUSION: Nail dynamization is an effective treatment for delayed union and nonunion of femur and tibia shaft fractures following intramedullary nailing. Early dynamization (within 6 months), preserving the dynamic locking screw, and ensuring an FHI >1.17 are crucial strategies for maximizing union rates.

PMID:40929874 | DOI:10.1016/j.injury.2025.112748

Injury. 2025 Aug 29:112721. doi: 10.1016/j.injury.2025.112721. Online ahead of print.

ABSTRACT

BACKGROUND: Hemorrhage remains the principal cause of death on the battlefield. It is suggested that Tranexamic acid (TXA) can improve survival of severely-bleeding casualties. The intravenous approach is not always available in the pre-hospital setting. It was shown that for every 15 min delay, the efficiency of TXA decreases by 10 %. This study was designed to assess the pharmacokinetic, pharmacodynamic, and pre-clinical efficacy of a TXA autoinjector in uncontrolled hemorrhage in swine.

METHODS: Non-compressible hemorrhage was induced by laparoscopic partial liver resection. TXA was administered intramuscularly by autoinjector (n = 25) or intravenously (control, n = 5). Blood levels of TXA and dynamics of clot formation were determined. Euthanasia was performed ninety minutes after injury followed by a laparotomy for the measurement of free blood and clots in the abdomen.

RESULTS: The TXA levels in the autoinjector group exceeded the effective therapeutic threshold within <5 min and remained above the 10 mg/L threshold throughout the experiment. Intra-abdominal blood volumes, hemodynamic parameters, and indices of clot formation were similar between autoinjector-delivered and intravenouslyadministered groups.

CONCLUSIONS: Autoinjector-based TXA provides sustained, anti-fibrinolytic levels within 2-5 min of administration in a swine model of uncontrolled hemorrhage emphasizing its important.

PMID:40915868 | DOI:10.1016/j.injury.2025.112721

Injury. 2025 Sep 2;56(11):112746. doi: 10.1016/j.injury.2025.112746. Online ahead of print.

ABSTRACT

INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for Type 2 diabetes and obesity due to their cardiometabolic benefits. However, their effects on fracture healing remain controversial. This study investigates perioperative GLP-1 RA use and outcomes following surgical treatment of lower extremity (LE) fractures.

METHODS: A retrospective analysis utilizing a large multicenter database compared patients on GLP-1 RAs within one year prior to and after lower extremity index surgery (+GLP) with those not on GLP-1 RAs (-GLP). Propensity score matching was performed on 275,970 included patients, matching 1:1 on age, sex, tobacco use, diabetes mellitus, primary hypertension, hyperlipidemia, chronic ischemic heart disease, chronic lower respiratory disease, and body mass index (BMI), resulting in 6125 "best-matched" patients per group. This was conducted utilizing multivariate logistic regression with a 0.1 caliper. Outcomes were assessed at 1 month, 3 months, and 1 year.

RESULTS: At 1-year follow-up, GLP-1 RA users demonstrated a significantly higher rate of nonunion compared to matched controls (5.4% vs 4.4%, Risk Ratio 1.2, 95% CI 1.0-1.4, P < 0.05) when assessing patients who also continued GLP-1 RAs postoperatively. There were no significant differences in wound dehiscence, deep or superficial surgical site infections, or hematoma. Importantly, the +GLP group experienced significantly lower rates of cardiac arrest (0.8% vs 1.6%, RR 0.5, 95% CI 0.3-0.7, P < 0.01) and all-cause mortality (4.4% vs 8.0%, RR 0.5, 95% CI 0.4-0.6, P < 0.01).

CONCLUSIONS: Perioperative GLP-1 RA use was associated with a higher risk of nonunion following lower extremity fracture surgery, though without increased wound complication rates. Importantly, GLP-1 RA use was linked to reduced cardiac arrest and mortality within one year. These findings suggest that while the increased rate of nonunion is statistically significant, its clinically significance is limited. Thus, the mortality reduction may be more clinically meaningful for patient counseling and perioperative management. Further study is required to clarify the balance between systemic benefits and surgical outcomes of GLP-1 RAs in orthopedic trauma.

PMID:40915058 | DOI:10.1016/j.injury.2025.112746

Injury. 2025 Aug 28;56(11):112718. doi: 10.1016/j.injury.2025.112718. Online ahead of print.

ABSTRACT

BACKGROUND: Critical size bone defects represent a clinical challenge, associated with considerable morbidity, and frequently trigger the requirement of secondary procedure. To fill osseous gaps, multiple steps are required, such as proliferation and differentiation on the cellular level and the building of extracellular matrix. In addition, the osteogenic potential of cell-derived extracellular matrices (CD-ECM) is known to enhance bone healing. We therefore examined the osteogenic potential of fibroblast-derived ECM (Fibro-ECM) and assessed the influence of Dextran-sulfate (Dx-S) addition regarding the production of extracellular matrix (ECM).

METHODS: ECMs were generated by culturing human dermal fibroblasts, adipose-derived stromal cells (ASCs), and osteoblasts derived from ASCs (Osteo-ECM) for four days, with or without Dx-S supplementation. After decellularization, skeletal stem cells (SSCs) isolated from femoral head aspirations were seeded onto the ECMs and differentiated under osteogenic conditions for 17 days. Osteogenesis was assessed by Alizarin Red S staining for calcium deposition and RT-qPCR analysis of osteogenic marker genes.

RESULTS: SSCs cultured on Fibro-ECM exhibited enhanced osteogenesis compared to Osteo-ECM and ASC-derived ECM, as evidenced by increased calcium deposition. Notably, Dx-S supplementation further improved the osteoinductive capacity of Fibro-ECM, leading to an upregulation of osteocalcin (OCN) and bone morphogenetic protein 2 (BMP2). In contrast, Dx-S had no significant effect on Osteo-ECM.

CONCLUSION: The addition of Dx-S in autologous fibroblast-derived ECM induces an improvement in osteoinductivity. Addition of Dx-S may therefore be a useful adjunct in the in vitro bone generation models. Whether these results may represent a piece in the puzzle for difficult healing situations in patients with nonunions and bone defects should be subject to further study.

PMID:40915057 | DOI:10.1016/j.injury.2025.112718

Injury. 2025 Aug 26;56(11):112720. doi: 10.1016/j.injury.2025.112720. Online ahead of print.

ABSTRACT

BACKGROUND: Lateral-sided tibial plateau fractures are most common and can range from minor to very extensive injuries of the lateral plateau. The impact of fracture location and extent on functional outcomes remains unclear. This study aimed to investigate this relationship.

METHODS: A retrospective cross-sectional study was performed in 529 patients treated for a lateral tibial plateau fracture within 6 hospitals between 2003-2018. Patients were approached by posted mail and completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire after a median follow-up of six years (IQR: 4-9 years). Fractures were classified according to the Krause 'Ten segment method'. The seven most prevalent fracture patterns were identified and compared using descriptive statistics. Multivariate regression analysis, adjusted for age, sex, Schatzker classification, treatment, and residual incongruity, was performed to assess the association between fracture location, number of affected segments, and patient-reported outcome.

RESULTS: The most frequent lateral tibial plateau fracture patterns were: pattern 1 - two posterior segments (KOOS = 82, IQR:66-93); pattern 2 - four lateral segments (KOOS = 74, IQR:53-94); pattern 3 - two anterolateral and one posterior segment (KOOS = 82, IQR:62-93); pattern 4 - anterolateral involvement (KOOS = 87, IQR:59-97); pattern 5 - involvement of the entire lateral plateau (KOOS = 60, IQR:40-71); pattern 6 - two posterior and one anterolateral segment (KOOS = 81, IQR:67-93); and pattern 7 - isolated lateral involvement (KOOS = 60, IQR:46-84). Patterns 5 and 7 showed the lowest KOOS scores (p = 0.008). Overall KOOS declined by 2.59 points per additional segment involved (p = 0.010), with similar trends observed in the ADL, sport, and QoL subscales (p < 0.05).

CONCLUSION: Surgeons should be aware during management of lateral tibial plateau fractures that all regions of the plateau-anterior, medial, lateral, and posterior-are crucial in preserving function. Fractures involving the entire lateral plateau (pattern 5) and isolated lateral segments (pattern 7) result in worse functional outcomes, likely due to the severity of the injury and associated soft tissue involvement, especially in the meniscal area. Greater fracture extent, as indicated by increased segment involvement, correlates with worse patient-reported outcomes.

PMID:40913857 | DOI:10.1016/j.injury.2025.112720

Injury. 2025 Aug 25;56(11):112728. doi: 10.1016/j.injury.2025.112728. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to comprehensively describe the clinical characteristics of rib fractures in patients with traumatic thoracic vertebral fractures (TVFs), and to develop machine learning (ML) models for predicting the risk of rib fractures.

METHODS: We retrospectively reviewed patients diagnosed with TVFs at a single hospital between January 2007 and November 2024, enrolling 1420 patients and 20 variables. Chest CT scans were used to confirm the presence of rib fractures and to examine their distribution characteristics. Several ML models, including Support Vector Machine (SVM), XGBoost, Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Gradient Boosting Decision Tree (GBDT), Naive Bayes (NB), Neural Network (NN), and Ensemble Learning (EL), were applied. Model performance was evaluated using indicators such as area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, density, discrimination slope, and a scoring system. Additionally, the prediction performance of the ML models was compared with that of three experienced clinicians.

RESULTS: Rib fractures were identified in 222 patients (15.6 %), with a total of 1035 rib fractures recorded. Only 22.5 % were single rib fractures, and the distribution of unilateral and bilateral fractures was comparable (54.5 % vs. 45.5 %). Multivariate logistic regression revealed four significant predictors of rib fractures: gender (P = 0.004), cardiovascular disease (P = 0.003), trauma mechanism (P < 0.001), and the number of thoracic fractures (P < 0.001). Among all models, the EL model demonstrated the best predictive performance, achieving an accuracy of 0.920, F1 score of 0.767, sensitivity of 0.683, specificity of 0.977, PPV of 0.875, NPV of 0.928, and the highest overall score (48). Notably, its performance surpassed that of all three clinicians.

CONCLUSIONS: Rib fractures are relatively common in patients with TVFs and may be underdiagnosed, especially in the absence of clear symptoms. The EL model developed in this study offers strong predictive capability and may serve as a valuable clinical decision-support tool to identify high-risk patients and reduce the likelihood of missed diagnoses.

PMID:40913856 | DOI:10.1016/j.injury.2025.112728

Injury. 2025 Aug 23;56(11):112692. doi: 10.1016/j.injury.2025.112692. Online ahead of print.

ABSTRACT

INTRODUCTION: Mass casualty incidents (MCIs) involving extensive ballistic and explosive injuries place considerable pressure on healthcare resources. This study aimed to evaluate the rehabilitation resources required for individuals who sustained blast and ballistic injuries during an MCI.

METHODS: A retrospective review was conducted using Electronic Medical Records (EMRs) of patients admitted to Sheba Medical Center (SMC), Israel, following an MCI on 7 October 2023. Patients diagnosed with gunshot wounds (GSW), or blast injuries (BI) were included. Data were collected over an almost 7-month period, focusing on injury patterns, rehabilitation department admissions, total hospital length of stay, and associated budgetary requirements.

RESULTS: A total of 419 patients received rehabilitation at SMC: 205 with BI, 175 with GSW, 10 with both, and 9 with unknown injury causes. Two patients were under 18; the majority (76 %) of adults were aged 18-29. Military personnel comprised 90 % of the cohort, with 95 % male. Paediatric rehabilitation admitted the two minors, while adult patients were distributed across respiratory (n = 7), neurological (n = 32), head trauma (n = 44), and orthopaedic (n = 68) rehabilitation units. Additionally, 266 patients were treated in three newly established rehabilitation wards. BI patients experienced more complex, multi-trauma injuries, including traumatic brain injuries (11 %) and spinal cord injuries (11 %), underwent more surgical procedures, and had longer hospital stays. Consequently, the average rehabilitation cost per BI patient exceeded that of GSW patients.

CONCLUSION: Through strategic planning and multidisciplinary collaboration, SMC effectively managed a high volume of MCI-related injuries. BIs required significantly more rehabilitation resources than GSWs. These findings underscore the importance of preparedness, resource allocation, and interdepartmental coordination in managing rehabilitation during MCIs. SMC's experience offers valuable insights for global healthcare systems facing similar high-demand emergency scenarios.

PMID:40912126 | DOI:10.1016/j.injury.2025.112692

Injury. 2025 Aug 24;56(11):112716. doi: 10.1016/j.injury.2025.112716. Online ahead of print.

ABSTRACT

Pedestrian crashes are a global safety issue impacting all age groups, and despite extensive research, understanding the severity of crashes among different age groups has remained incomplete. Older and young pedestrians represent two distinct demographics with unique vulnerabilities. This paper examines the factors that impact the severity of pedestrian crashes resulting in Killed or Serious Injuries in South Australia over ten years (2012-2020) for two age groups, namely young pedestrians (age < 18) and older pedestrians (age > 65). The study employs several descriptive and analytical methods, including logistic and Classification and Regression Tree models. The findings reveal that older pedestrians are primarily involved in fatal crashes (32 %), while their young cohorts predominantly suffer from serious injuries (30 %). Young pedestrians experience more severe consequences when vehicle speeds are below 60 km/hr, but older pedestrians suffer a greater likelihood of harm at speeds beyond 60 km/hr. Age has a role in how unique elements, such as curving roadways and damp weather, affect the intensity of the impact. Young individuals are particularly drawn to motorways and one-way highways, which are prominent areas that underscore the necessity for action. Intersections, including crossroads and one-way highways, pose significant challenges for older pedestrians, underscoring the need for safety precautions. Also, there is a negative correlation between weekend crashes and log-odds of KSI compared to weekdays, which leads to lower severity for both age groups. Customizing safety protocols for distinct age cohorts is crucial for ensuring efficient crash mitigation.

PMID:40907272 | DOI:10.1016/j.injury.2025.112716

Injury. 2025 Aug 25;56(11):112727. doi: 10.1016/j.injury.2025.112727. Online ahead of print.

ABSTRACT

PURPOSE: Guidelines recommended early surgery for hip fracture to improve outcomes, yet it is often hindered by prehospital delays. However, it remains unclear whether prehospital delay independently leads to poor outcomes of the well-recognized impact of in-hospital delay for hip fracture surgery.

METHODS: We included patients aged over 60 years old who underwent surgery for their first acute hip fracture between 2000 and 2022 at a national trauma center in Beijing, China. Patients were categorized into short prehospital delay (time from injury to hospital admission ≤ 48 h) or long prehospital delay (> 48 h) groups. The primary outcome was a composite endpoint of postoperative complications, and the secondary outcome was 5-year all-cause mortality. Multivariate logistic and Cox regression models were used to assess the association between exposure and outcomes.

RESULTS: Among 3103 included patients (mean age, 78.1 ± 8.3 years; 69.1 % female), 1152 (37.1 %) experienced a long prehospital delay. Patients with long prehospital delay had a higher risk of postoperative complications (28.8 % vs. 16.8 %; adjusted odds ratio = 1.41, 95 % CI, 1.12-1.76, P < 0.01) and 5-year all-cause mortality (63.9 vs. 43.3 per 1000 person-years; adjusted hazard ratio = 1.25, 95 % CI, 1.01-1.57, P < 0.05) compared to those with short prehospital delay after adjusting for potential confounders including in-hospital delay.

CONCLUSION: Prehospital delays is associated with higher risk of postoperative complications and 5-year mortality in older adults with hip fractures, highlighting the need for public health policies to minimize such delays.

PMID:40907271 | DOI:10.1016/j.injury.2025.112727

Injury. 2025 Aug 28;56(11):112730. doi: 10.1016/j.injury.2025.112730. Online ahead of print.

ABSTRACT

BACKGROUND: Substance use disorders (SUD) are common and associated with trauma [1-5]. Despite the high frequency of patients with SUDs presenting with trauma and the ubiquitous concerns about compliance, follow-up, and complications amongst providers caring for these patients there has been little attempt to quantify outcomes in this everyday group of patients. The purpose of the current study was thus to document basic demographics, follow-up rates, and surgical outcomes in orthopedic trauma patients presenting with substance use disorders.

METHODS: A retrospective review of an observational cohort was performed. All skeletally mature patients younger than 70 and with insurance that allowed long term follow-up and surgically treated for orthopedic trauma by a single author at an urban level-1 trauma center between November 2019 and December 2024 were enrolled. 202 patients did not have a pre-existing substance use disorder (NO-SUD), 96 patients did (SUD). Basic demographic information, injury characteristics, follow-up rates, and surgical complication rates over the first post-operative year were compared.

RESULTS: Mean age and percentage of male/female did not differ between SUD and NO-SUD cohorts. There were more white and fewer Asian/Pacific Islanders in the SUD cohort. Of the 10 most common comorbidities, there was only a significantly higher rate of congestive heart failure (CHF) in the SUD cohort. Injury location did not differ between cohorts. Those in the SUD cohort more often had high grade open fractures. Follow-up rates in both groups were poor, but worse at all time points for those in the SUD cohort. The SUD cohort also had significantly longer lengths of stay and a higher mortality rate at 1 year. Infection, construct failure, and amputations rates were all higher in the SUD cohort.

CONCLUSIONS: Demographics between the SUD and NO-SUD populations were similar. Injury severity, follow-up rates, and complication rates were all significantly worse in the SUD cohort. Such data can be used by surgeons to council patients on prognosis and when discussing the risks and benefits of surgical intervention in the SUD population.

LEVEL OF EVIDENCE: III.

PMID:40902314 | DOI:10.1016/j.injury.2025.112730

Injury. 2025 Aug 24;56(11):112715. doi: 10.1016/j.injury.2025.112715. Online ahead of print.

ABSTRACT

BACKGROUND: Urban expansion into natural habitats has increased human interactions with wild terrestrial and aquatic species, leading to a rise in animal-related injuries. These incidents often result in complex infections, posing major public health challenges. This study examines the epidemiology, therapeutic interventions, and clinical outcomes of infections from non-domesticated animal injuries in the Mornington Peninsula, Australia.

METHODS: This retrospective study (February 2021-April 2024) evaluated medical records of patients presenting with injuries from wild species who subsequently developed infections. Selection criteria included only cases with confirmed infections determined by clinical assessment or positive microbial cultures. Injuries from domestic animals, insects, or humans were excluded. The analysis assessed timing of infection onset, microbial culture results, antibiotic sensitivity profiles, and postoperative trajectories.

RESULTS: A total of 52 bites from non-domesticated animals were documented, with 23 % (12/52) being infected. Most were males with an average age of 43 years. Among the 12 infected cases, Staphylococcus aureus was isolated in 3/12 (25 %), β-haemolytic streptococci in 2/12 (17 %), Enterococcus faecalis in 1/12 (8 %), Pseudomonas aeruginosa in 1/12 (8 %), Prevotella bivia in 1/12 (8 %), and Vibrio vulnificus in 1/12 (8 %); mixed coliform growth was observed in 3/12 (25 %). Compared to typical dog and cat bites, usually caused by Pasteurella multocida, streptococci, staphylococci and anaerobes, our series revealed a higher presence of marine-associated pathogens such as Vibrio species and environmental Gram-negative bacilli. Management involved wound debridement with adjunctive medical therapy (7/12), delayed primary closure (3/12), and medical management alone (3/12). All patients received empirical broad-spectrum antibiotics, which were later adjusted based on culture results. Most isolates were pan-sensitive, except for Vibrio vulnificus (ciprofloxacin-sensitive, resistant to penicillins/cephalosporins) and penicillin-resistant Staphylococcus aureus. All patients recovered without complications following comprehensive wound care and targeted antibiotic therapy. Notably, some marine-derived infections exhibited unique resistance patterns that required specific antimicrobial regimens.

CONCLUSIONS: The necessity for immediate comprehensive wound management and empirically guided antibiotic therapy, adjusted based on culture results, was essential for managing these complex infections. The data derived from this study provides essential insights into the microbial dynamics and clinical management of wild animal bite infections, emphasizing the need for individualized medical strategies.

PMID:40902313 | DOI:10.1016/j.injury.2025.112715

Injury. 2025 Aug 28;56(11):112729. doi: 10.1016/j.injury.2025.112729. Online ahead of print.

ABSTRACT

BACKGROUND: Major limb amputation salvage procedures exhibit an increased risk of failure when revascularization is delayed beyond 360 min. Institutional delays persist as critical barriers, even with advancements in surgical techniques.

METHODS: Retrospective cohort study (November 2022- December 2024) at Level I Trauma Center. We implemented a systematized emergency protocol featuring: Prehospital activation → Green channel → OR-direct transport Parallel processing → revascularization.

PRIMARY OUTCOME: Revascularization time (limb arrival → arterial flow).

RESULTS: 30 consecutive amputees (M: F = 21:9; mean age 43.6 ± 14.35 yrs). Included 21 upper limbs (6 wrist, 9 forearm, 6 upper arm) and 9 lower limbs (6 ankle, 3 calf). Revascularization achieved in 142.0 ± 21.17 mins. All cases (100 %) met the ≤180-min golden window. Key timings: Door-to-OR: 19.7 ± 3.2 mins, OR preparation: 20 ± 3.45 mins, Surgery start to revascularization: 102.3 ± 19.8 mins. Limb survival rate reached 96.7 % (29/30). Vascular bridging reconstruction was performed in 17 cases (including 5 cases with emergent anterolateral thigh (ALT) flap arteriovenous bridging). Vascular crisis occurred in 2 cases and was relieved after surgical exploration. The final limb amputation salvage rate was 96.7 % (29/30). One case of ankle-level salvage resulted in postoperative infection and necrosis. At 12-month follow-up, 80 % of upper limbs achieved grasp function (S2-S4 sensibility), and 89 % of lower limbs regained ambulation without prosthesis.

CONCLUSION: The multidisciplinary emergency protocol significantly reduced ischemia time, with rapid revascularization serving as the critical determinant of high limb amputation salvage rates. The protocol achieved functional limb salvage in 83 % of cases, demonstrating that rapid revascularization correlates with both viability and functional recovery.

PMID:40897128 | DOI:10.1016/j.injury.2025.112729

Injury. 2025 Aug 24;56(11):112717. doi: 10.1016/j.injury.2025.112717. Online ahead of print.

ABSTRACT

BACKGROUND: Coronoid fractures significantly impact elbow stability, yet limited biomechanical data exists comparing fixation methods for different fracture types. This study aimed to compare the biomechanical performance of threaded K-wire versus cortical screw fixation in O'Driscoll type 2 and 3 coronoid fractures.

METHODS: Twenty-eight synthetic ulnar bones were divided into four groups (n = 7 each): Type 2 with K-wire fixation, Type 2 with screw fixation, Type 3 with K-wire fixation, and Type 3 with screw fixation. Fractures were created, reduced, and fixed under fluoroscopic guidance. Specimens underwent biomechanical testing using a custom-made apparatus to evaluate load to failure (N), displacement (mm), and stiffness (N/mm). Two-way ANOVA and post-hoc Tukey's tests were used for statistical analysis.

RESULTS: Type 2 fractures with screw fixation demonstrated the highest load to failure (1392.59 ± 76.77 N), followed by Type 2 with K-wire fixation (1155.00 ± 200.81 N), Type 3 with K-wire fixation (1093.65 ± 248.68 N), and Type 3 with screw fixation (1058.54 ± 320.46 N), though differences were not statistically significant (p = 0.086). For stiffness, Type 2 fracture fixation fractures exhibited significantly higher values (∼256 N/mm) compared to Type 3 fractures (∼160 N/mm) regardless of fixation method (p = 0.002, Cohen's d = 1.55). The fixation method itself (K-wire vs. screw) did not significantly affect any biomechanical parameter (p > 0.05).

CONCLUSION: O'Driscoll Type 2 fracture fixation provide superior biomechanical stability compared to Type 3 fractures, primarily through enhanced stiffness. While Type 2 screw fixation demonstrated the highest load to failure values, K-wire fixation in Type 2 fractures offered comparable stiffness. These findings suggest that fracture type has a more profound impact on mechanical performance than the choice between K-wire and screw fixation, giving surgeons flexibility in fixation choice for Type 2 fractures while maintaining adequate stability for early rehabilitation.

PMID:40889444 | DOI:10.1016/j.injury.2025.112717

Injury. 2025 Aug 19;56(11):112686. doi: 10.1016/j.injury.2025.112686. Online ahead of print.

ABSTRACT

Percutaneous fixation of the pubic symphysis is a relatively novel treatment strategy in the management of pelvic ring injuries with symphyseal disruption. While the current gold standard for surgical treatment of pubic symphysis diastasis is open reduction and plate fixation, high rates of implant failure and recurrent diastasis persist. Furthermore, blood loss, operative time, and postoperative infection associated with open approaches to the pelvis should be considered. Percutaneous fixation of the posterior pelvic ring has proven to be safe and effective. Percutaneous fixation of the pubic symphysis has been described in China and Spain, with promising results. We present here our surgical technique for percutaneous reduction and fixation of the pubic symphysis with emphasis on the risks to nearby anatomic structures.

PMID:40889443 | DOI:10.1016/j.injury.2025.112686

Injury. 2025 Aug 25;56(11):112690. doi: 10.1016/j.injury.2025.112690. Online ahead of print.

ABSTRACT

BACKGROUND: The incidence of proximal humerus fractures is rising, with increasing use of reverse total shoulder arthroplasty (rTSA). This study analyzed treatment trends, readmission rates, and causes of readmission.

METHODS: The Nationwide Readmissions Database (NRD) was queried for admissions with a primary diagnosis of proximal humerus fracture in the U.S. (2016-2021) using ICD-10 codes. Patient demographics, comorbidities, facility characteristics, and 30-/90-day readmission rates were analyzed. Treatments included non-operative (Non-Op), hemiarthroplasty (HA), anatomic total shoulder arthroplasty (aTSA), rTSA, open reduction internal fixation (ORIF), and intramedullary nailing (IMN).

RESULTS: Among 218,425 admissions, rTSA use increased (20.27 % to 22.30 %), while ORIF decreased (20.77 % to 14.86 %). Non-Op had the highest readmission rates at 30- and 31-90 days (10.5 % and 8.9 %), even after adjusting for age/comorbidities. rTSA had the lowest readmission rates (5.9 % and 4.6 %), with instability being the most common cause.

CONCLUSION: There is a trend towards increased rTSA utilization for treating proximal humerus fractures. The readmission rate following rTSA was the lowest of all treatment modalities, including non-operative management.

LEVEL OF EVIDENCE: Level III Retrospective Cohort Comparison Using Large Database Prognosis Study.

PMID:40889442 | DOI:10.1016/j.injury.2025.112690

Injury. 2025 Aug 8:112677. doi: 10.1016/j.injury.2025.112677. Online ahead of print.

ABSTRACT

BACKGROUND: Vestibular dysfunction (resulting in dizziness and imbalance) is common in acute traumatic brain injury (aTBI). The most frequently diagnosed cause of peripheral vestibular dysfunction in aTBI is benign paroxysmal positional vertigo (BPPV). However, post-traumatic BPPV is often undiagnosed and left untreated in these patients.

OBJECTIVES: To investigate clinical risk factors for BPPV in patients experiencing aTBI.

METHODS: Patients were recruited from three Major Trauma Centres in London. Logistic regression was used to derive the adjusted odds ratio (aOR) of diagnosed BPPV for sex, categorised age, severity of traumatic brain injury (TBI), and site of skull fracture.

RESULTS: 166 patients with aTBI were included. Approximately a third (n = 55; 33.1 %) tested positive for BPPV. Compared to patients aged less than or equal to 40 years, those aged 41 to 64 years were more likely to experience BPPV (aOR=3.86; 95 % CI: 1.47 to 10.16; p = 0.006), as were those aged 65 years and above (4.41; 1.52 to 12.81; p = 0.006). Patients that experienced both facial and cranial skull fracture were more likely to experience BPPV than those that didn't have a skull fracture (23.64; 6.36 to 87.89; p < 0.001).

CONCLUSION: The risk of post-traumatic BPPV increased with increasing age, plus in those with combined skull and facial fractures when compared to those without a skull fracture. We advocate routine BPPV screening of those with aTBI, especially in older adults and those with combined facial and skull fractures.

PMID:40885629 | DOI:10.1016/j.injury.2025.112677