Injury. 2026 Feb 17;57(4):113125. doi: 10.1016/j.injury.2026.113125. Online ahead of print.

ABSTRACT

BACKGROUND: Acromioclavicular joint (ACJ) injuries, accounting for approximately 12 % of all shoulder ligament injuries, are common. Conservative treatment is recommended for Rockwood type Ⅰ and Ⅱ dislocations, while the optimal treatment for type Ⅲ remains debated. For Rockwood type Ⅳ, Ⅴ, and VI dislocations, most scholars advocate surgical treatment. However, other studies have found no significant difference in clinical outcomes between conservative and surgical treatments for Rockwood type Ⅴ dislocations.

METHODS: This systematic review and meta-analysis, conducted following PRISMA guidelines, evaluated randomized controlled trials using the PICO framework. Searches were conducted across four databases: PubMed, Cochrane Library, Embase, and Web of Science. Data were extracted and assessed after evaluating the evidence levels in the selected articles. This study was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY).

RESULTS: The study included 367 patients with Rockwood type Ⅲ-Ⅴ ACJ dislocations: 193 underwent surgical treatment and 174 received conservative treatment. Analyses of three outcomes-Constant Score (CS), complications, and delayed additional surgical treatment-revealed no significant differences in functional outcomes or the necessity for additional surgeries. However, the surgical group exhibited a significantly higher complication rate compared to the conservative treatment group. Notably, for Rockwood type Ⅲ dislocations, complication rates did not differ between the treatment modalities.

CONCLUSION: This systematic review and meta-analysis, encompassing patients with an average age ranging from 30 to 54 years, found no evidence of superiority for surgical intervention over conservative management in treating Rockwood type Ⅲ ACJ dislocations concerning functional outcomes, rates of delayed surgical interventions, or complications. Nonetheless, additional evaluations targeting other age demographics or patients with specific athletic requirements remain necessary. Furthermore, evidence concerning Rockwood type Ⅳ dislocations is notably insufficient, and available data on type Ⅴ dislocations remain limited. Given the paucity of comprehensive imaging studies and objective functional assessments, coupled with a limited number of high-quality studies, further randomized controlled trials focusing explicitly on Rockwood types Ⅲ (including subtypes ⅢA and ⅢB), Ⅳ, andⅤ are urgently warranted. Future research should particularly emphasize functional comparisons relative to pre-injury status and contralateral shoulder performance to enhance the objectivity and clinical applicability of the findings.

PMID:41724020 | DOI:10.1016/j.injury.2026.113125

Injury. 2026 Feb 17;57(4):113108. doi: 10.1016/j.injury.2026.113108. Online ahead of print.

ABSTRACT

BACKGROUND: Although various dermal substitutes are available, their use in the acute setting or for extensive surface areas is often constrained by high costs and labor-intensive application procedures. Despite these challenges, they have proven effective in treating different skin and soft tissue defects.

METHODS: In this prospective case series, 26 adults with acute complex deep soft tissue defects resulting from different etiologies were treated with Glyaderm. Glyaderm is a low-cost acellular dermal substitute and can be applied in either a one- or two-stage procedure with a split skin graft for epidermal coverage. Primary outcomes were graft take in percentage of the total covered wound area and time to complete wound closure.

RESULTS: In total, 25 patients with an average age of 55.9 years completed the follow-up period. Etiologies of the acute complex wounds consisted of defects after oncological surgery (28%), debridement of soft tissue infections (28%), trauma (24%), donor site defects after free flap reconstruction (16%), and other (4%). Mean affected Total Body Surface Area was 2.2%, the mean size was 203 cm2. At 5 to 7 days post-application, the mean graft take rate was 89.7%. The average time for wound closure was 30 days. A complication occurred in 16% of cases: three patients developed wound infection resulting in incomplete graft loss, while one patient experienced complete graft loss without an identifiable cause. All cases were regrafted using Glyaderm and subsequently healed without complications.

CONCLUSION: Glyaderm appears to be a valid and effective reconstructive option for acute complex wounds.

PMID:41724019 | DOI:10.1016/j.injury.2026.113108

Injury. 2026 Feb 14;57(4):113099. doi: 10.1016/j.injury.2026.113099. Online ahead of print.

ABSTRACT

BACKGROUND: Avalanches present a significant risk in mountainous environments, frequently causing severe trauma and death. While asphyxia is often the primary cause of mortality (65-100 %), the incidence of traumatic injuries, particularly bone fractures, may be increasing due to evolving recreational practices and climate change. This study aims to characterize the distribution and types of fractures in avalanche fatalities.

METHODS: We conducted a retrospective study at Grenoble Alpes University Hospital from April 2023 to April 2025. It included deceased adult avalanche victims with post-mortem computed tomography (CT) scans showing at least one bone fracture. MPR, MIP, and 3D reconstructions were used for image analysis.

RESULTS: Thirteen individuals were included (61.5 % male; mean age 37 years). The thorax was the most affected region (92 % of cases). Analysis of 265 fractured bones (79 distinct bones) showed primary fracture distribution in the thorax (52 %), spine (21 %) and skull (14 %). A strong correlation existed between external trauma signs and vital skull lesions, but vital spinal and thoracic lesions often lacked clear external indicators.

CONCLUSION: These preliminary findings contribute to a better understanding of avalanche-specific bone injuries, which could optimize initial management strategies. While extremity fractures are important due to their potential contribution to non-traumatic death and ease of on-site detection, thoracic, spinal and pelvic fractures are challenging to detect in the field. Their accurate identification is yet essential for determining appropriate hospital destination. This exploratory work highlights the need for further larger-cohort studies to establish robust correlations between traumatic mechanisms and avalanche characteristics.

PMID:41724018 | DOI:10.1016/j.injury.2026.113099

Injury. 2026 Feb 16;57(4):113104. doi: 10.1016/j.injury.2026.113104. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional fracture fixation has long provided reliable mechanical stability, yet it remains largely passive in the biological process of healing. The persistence of nonunion, delayed union, and implant-related complications reveals the limitations of a fixation-centric paradigm. Emerging advances in materials science, biology, digital technologies, and implant design have progressively challenged this model, opening the door to a broader reframing of fracture management.

PURPOSE: To propose a conceptual and strategic reframing of fracture management-shifting emphasis from mechanical support alone toward a dynamic, multidimensional dialogue where implants actively sense, respond, and adapt to the biological environment.

METHODS: A narrative and conceptual synthesis of contemporary literature integrating evidence from materials science, biomechanics, bioengineering, immunology, and digital health. Core design principles and translational pathways are identified to outline how modern technologies support a biologically centred reframing of fracture care.

FINDINGS: Five foundational principles - designed temporality, biological integration, mechanical modulation, therapeutic multifunctionality, and feedback intelligence - underpin a framework for a dynamic host-implant dialogue. Ten technological pathways demonstrate how this interactive paradigm translates into practice, encompassing material, mechanical, biological, and data-enabled strategies that integrate mechanical, biological, and digital intelligence.

CONCLUSIONS: This evolution reframes fracture care: from fixing bones to orchestrating healing. It marks a genuine philosophical shift - from implants as static hardware to treatment as a dynamic partnership between biology, technology, and clinical judgement.

PMID:41724017 | DOI:10.1016/j.injury.2026.113104

Injury. 2026 Feb 13;57(4):113097. doi: 10.1016/j.injury.2026.113097. Online ahead of print.

ABSTRACT

OBJECTIVE: Quadriceps tendon rupture is a rare disabling injury, predominantly affecting older males. Prompt surgical intervention is essential to restore knee extensor mechanism. Patellar trans-osseous tunnels technique is considered the treatment of choice, however recently suture anchors technique is suggested as a comparative method to restore the integrity of the quadriceps tendon. This study aimed to compare patient-reported outcomes, operative times, and complication rates between trans-osseous tunnel and suture anchor fixation techniques for acute quadriceps tendon rupture.

METHODS: A retrospective, IRB-approved cohort study was conducted at an academic level I trauma center. Eighty-five patients who underwent surgical repair for acute quadriceps tendon rupture using either trans-osseous tunnels (n=46) or suture anchors (n=39) were included, with one-year follow-up. Demographic, clinical, and surgical data were extracted from electronic medical records. Patient-reported outcome measures (PROMs) assessed at one year included the International Knee Documentation Committee (IKDC) score, Lysholm score, and Visual Analog Scale (VAS) for pain. Operative times and complications were also analyzed.

RESULTS: There were no significant differences in age or gender distribution between groups. The anchor group demonstrated a significantly shorter mean operative time. At one-year follow-up, no statistically significant differences were observed in PROMs: IKDC, and VAS. Complication rates were similar between groups, with two fixation failures (anchor group) and two infections (one per group), all managed successfully.

CONCLUSION: Both trans-osseous tunnel and suture anchor techniques yield comparable functional outcomes and complication rates in the surgical management of acute quadriceps tendon rupture. Suture anchors offer reduced operative time significantly.

PMID:41724016 | DOI:10.1016/j.injury.2026.113097

Injury. 2026 Feb 16;57(4):113113. doi: 10.1016/j.injury.2026.113113. Online ahead of print.

ABSTRACT

Acute Respiratory Distress Syndrome (ARDS) remains a major cause of morbidity and mortality in trauma patients, rising from a complex interplay of direct lung injury, systemic inflammation, transfusion and mechanical ventilation-related factors. Optimal management requires a multifaceted approach that balances lung-protective ventilation strategies, hemodynamic stability and supportive interventions. Positive end-expiratory pressure (PEEP) and prone positioning improve alveolar recruitment, ventilation homogeneity and oxygenation, moderating ventilator-induced lung injury (VILI). Extracorporeal membrane oxygenation (ECMO), particularly veno-venous ECMO, provides a rescue strategy in refractory hypoxemia but carries significant bleeding risks in multi-trauma patients due to necessary anticoagulation. Fluid management remains critical: both overload and excessive restriction can exacerbate pulmonary compromise or hemodynamic instability. Transfusion practices, including the timing and volume of blood products, significantly influence ARDS development, with blunt thoracic trauma, emergent surgery and high BMI identified as independent risk factors. Despite the progress that has been made, the heterogeneity of ARDS pathophysiology and patient's specific variables necessitate individualized, multidisciplinary management to optimize outcomes in critically ill, trauma patients.

PMID:41724015 | DOI:10.1016/j.injury.2026.113113

Injury. 2026 Feb 16:113114. doi: 10.1016/j.injury.2026.113114. Online ahead of print.

ABSTRACT

OBJECTIVE: Brachial plexus injuries (BPIs) in adults can lead to significant disability and substantial healthcare demands. Despite their profound impact, key predictors of inpatient outcomes, such as discharge disposition, complications, and resource utilization, remain understudied. This study examines demographic, clinical, and injury-related factors influencing these outcomes in hospitalized adults with BPIs.

METHODS: A retrospective analysis of 2292 adult BPI patients admitted between 2019 and 2021 was conducted using the American College of Surgeons Trauma Quality Program database. Patients were stratified into three age groups (18-39, 40-69, ≥70 years). Multivariable logistic regression models identified predictors of home discharge, complications, ICU admission, and mechanical ventilation. Linear regression models assessed factors associated with hospital length of stay (LOS).

RESULTS: The cohort included predominantly males (77.1 %) with a mean age of 38.7 years. Older adults (≥70 years) had significantly reduced odds of home discharge (OR 0.2, 95 % CI 0.1-0.3, p < 0.001) and increased complication rates (OR 2.6, 95 % CI 1.5-4.8, p = 0.001). Severe injuries, particularly to the spine (OR 0.6, p = 0.002) and lower extremities (OR 0.4, p < 0.001), further decreased discharge odds. Medicare/Medicaid insurance was associated with lower odds of home discharge (OR 0.7, p = 0.013), while self-pay increased discharge likelihood (OR 1.9, p < 0.001). ICU admission (60.5 %) and mechanical ventilation (33.6 %) were strongly linked to polytrauma and low GCS scores. Hospital LOS was significantly prolonged by age, female sex, and Injury Severity Score.

CONCLUSIONS: Age, injury severity, and socioeconomic factors critically influence inpatient outcomes in BPI patients, underscoring the need for age-specific care protocols and resource allocation strategies. Future research should explore long-term recovery trajectories and functional outcomes to guide management of this complex injury population.

PMID:41723012 | DOI:10.1016/j.injury.2026.113114

Injury. 2026 Feb 13;57(4):113098. doi: 10.1016/j.injury.2026.113098. Online ahead of print.

ABSTRACT

INTRODUCTION: Acromioclavicular dislocations account for 9 % of all dislocations. Although numerous treatment techniques have been described, there is still no universally recognized gold standard. Stabilization with Tight-Rope® (TR) represents one of the most effective methods for restoring the normal alignment of the AC joint, ensuring early mobilization and good functional outcomes. Purpose of this study is to review our results using TR to treat high-grade acromioclavicular dislocations, analyzing complications, functional and radiological results.

MATERIALS AND METHODS: This is a retrospective analysis of patients treated with Tight-Rope® between August 2016 and June 2024 for high-grade acromioclavicular dislocation. In 42 cases, only TR stabilization was performed, while in 36 cases, a K-wire was used to enhance stability. Clinical and radiographic evaluations were conducted during outpatient visits. No patients were lost to follow-up. Every kind of complication was assessed. Radiographic results were assessed by measuring Coracoid-Clavicle Distance (CCD) on the X-Rays between the last follow-up and the postoperative control. To evaluate functional outcomes, two scores were used: the ASES and the Constant-Murley Score.

RESULTS: Seventy-eight patients with an average age of 41 years (range, 17 -75 y) were evaluated. There were a total of 46 Rockwood III, 10 Rockwood IV, and 22 Rockwood V dislocations. At an average follow-up of 48,72 months (range, 6- 98 m), two cases (2.5 %) of reduction loss occurred, associated with functional limitation and pain, leading to reoperation. In seven patients, the reduction loss exceeded 25 % but no further treatments were necessary. Functional results were excellent in most cases (97,4 %), with mean CSS of 90 (min 55 - max 100), CSn and CSi of 96 %, ASES score of 96 (range, 65 - 100).

DISCUSSION: In patients treated with this technique, the initial dislocation grade does not seem to affect clinical results. Reduction loss was very limited with system settling in most cases. According to this study, reduction loss over time seems to result in a worse clinical outcome. The use of a K-wire is useless to increase the stability and guarantee the same results as the traditional technique.

CONCLUSIONS: The treatment of acromioclavicular dislocations with Tight-Rope® represents a valid option based on excellent clinical, functional, radiographic results, and a low incidence of complications.

PMID:41722264 | DOI:10.1016/j.injury.2026.113098

Injury. 2026 Feb 16;57(4):113111. doi: 10.1016/j.injury.2026.113111. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic vertebral artery injury (TVAI) is a rare yet clinically significant condition, carrying a high risk for posterior circulation stroke. Endovascular therapy (EVT) is increasingly used in selected cases. This systematic review and meta-analysis aimed to assess the effectiveness and safety of EVT in patients with TVAI.

METHODS: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted for articles published up to October 2025. Eligible studies included clinical trials, cohort studies, and case series investigating EVT in TVAI. Primary outcomes included angiographic success, mortality, and stroke. Quality assessment was conducted using the Newcastle-Ottawa Scale and Joanna Briggs Institute tools. We performed proportional meta-analysis, with subgroup analyses stratified by injury mechanism and EVT indication. A random-effects model was used to account for heterogeneity.

RESULTS: Fourteen studies (n = 174 patients) were included for meta-analysis. Overall, the pooled rates were 99 % [95 % CI: 95 % to 100 %; I2 = 19 %] for angiographic success, 2 % [95 % CI: 0 % to 6 %; I2 = 0 %] for mortality, and 2 % [95 % CI: 0 % to 5 %, I2 = 0 %] for stroke. Secondary outcomes included clinical complications (1 % [95 % CI: 0 % to 6 %]), procedural complications (1 % [95 % CI: 0 % to 6 %]), surgical intervention (6 % [95 % CI: 0 % to 21 %; I2 = 58 %]), and clinical improvement (95 % [95 % CI: 81 % to 100 %; I2 = 66 %]). The overall quality of the included studies scored moderate to high.

CONCLUSION: In our analysis, EVT has demonstrated high technical success and low rates of stroke, complications, and mortality, which may support its use as an effective, safe alternative option for selected patients with TVAI. However, the available evidence is limited, and further well-designed prospective and comparative studies are needed to clarify its optimal role among other treatment options, including medical treatment and surgery.

PMID:41722263 | DOI:10.1016/j.injury.2026.113111

Injury. 2026 Feb 16;57(4):113115. doi: 10.1016/j.injury.2026.113115. Online ahead of print.

ABSTRACT

INTRODUCTION: Pelvic ring injuries (PRI) are complex and potentially life-threatening lesions requiring precise classification and timely management. The increasing reliance on computed tomography (CT) imaging has led some institutions to bypass standard pelvic x-rays, potentially missing crucial diagnostic information. This study aimed to evaluate whether standard anteroposterior (AP) pelvic x-rays, particularly when obtained with and without a pelvic binder (PB), alter injury classification and treatment plans in comparison to CT imaging alone.

METHODS: A retrospective cohort study was conducted at a level 1 trauma center, including all adult patients (≥18 years) with surgically treated PRI between January 2012 and December 2023. Inclusion required a complete imaging set (CT, AP x-ray with PB and AP x-ray without PB). An international PRI expert group independently assessed each patient's imaging in sequential order (CT alone, then additional AP x-ray with PB, then additional AP x-ray without PB). After each step, they provided injury classifications (Young and Burgess, AO/OTA) and a treatment plan. Changes in classification and treatment at each step were recorded and compared to surgical reports. Interobserver reliability was assessed using Fleiss' kappa.

RESULTS: Among 28 patients with complete imaging sets, classification or treatment changes occurred in 60.7% and 42.9% of cases, respectively. Agreement with the baseline classification improved by 35.7% with sequential imaging. A direct correlation with treatment changes was found in 58% of classification changes. Interobserver reliability was slight to fair (k = 0.192-0.300), with modest improvement in Young and Burgess agreement (k = 0.192 to 0.261) but limited change in AO/OTA agreement.

CONCLUSION: Sequential imaging that includes standard AP pelvic x-rays, both with and without a PB, provides additional diagnostic clarity and can influence PRI classification and treatment planning for PRI. These findings support the continued use of standard AP pelvic x-rays alongside CT in acute trauma evaluation.

PMID:41722262 | DOI:10.1016/j.injury.2026.113115

Injury. 2026 Feb 16:113105. doi: 10.1016/j.injury.2026.113105. Online ahead of print.

ABSTRACT

INTRODUCTION: The pre-hospital care and transport of trauma patients by trained providers remains a cornerstone of practice in the United States. Some studies suggested a survival benefit for patients transported via police or private vehicles, particularly in severe penetrating injuries. Prior work has focused on penetrating trauma and relied on outdated data. Further, most studies compare EMS with police, often excluding private transport.. This study evaluates whether non-EMS transport offers a risk-adjusted mortality or length of stay benefit using a large regional dataset across an entire decade.

METHODS: This retrospective cohort study utilized the Michigan Trauma Quality Improvement Program data (2014-2024). Adults with trauma activation were included; transfers, direct admissions, air transport, and dead on arrival were excluded. 69,092 patients met our eligibility criteria. We used demographic data and measures of injury severity to assess for differences between the groups, and then multivariable logistic regression to assess risk-adjusted outcomes of interest.

RESULTS: The mean age of our population was 50.5 (S.D 21.3) years, and the mean New Injury Severity Score was 13.3 (S.D 9). The cohort was predominantly male (67.3 %) and White (67.6 %), with the majority sustaining blunt trauma (87.3 %). In the cohort, 87.6 % were transported by EMS, 0.4 % by police, and 12 % by private vehicles. Police transported patients were significantly more in shock, (mean shock index=0.8). Private transport had lower odds of mortality than ground EMS (OR 0.35, CI 0.29-0.43). Both private (LOS ratio 0.69, 95 % CI 0.67-0.70) and police transport (LOS ratio 0.81, 95 % CI 0.74-0.90) were associated with shorter LOS.

CONCLUSION: In our region, private transport of injured patients is associated with substantially lower odds of mortality and shorter length of stay compared to EMS. It is difficult to dismiss the idea that if it can be done safely, private transport should be considered as part of stakeholder discussions to improve trauma outcomes, particularly in urban settings. Police transport demonstrated a shorter length of stay, though its impact on mortality was not clear. Future research should address gaps in prehospital timing, evaluate specific EMS interventions, and explore how system-level adaptations can optimize outcomes across different transport modalities.

PMID:41720739 | DOI:10.1016/j.injury.2026.113105

Injury. 2026 Feb 9;57(3):113092. doi: 10.1016/j.injury.2026.113092. Online ahead of print.

ABSTRACT

The utility of using the patient's native fracture hematoma as an autograft after performing open reduction and internal fixation (ORIF) for fractures is highlighted. The fracture hematoma may be effectively used in closed fractures as a standalone autograft for filling in or around the fracture site, or used in combination with other structural autografts, allografts, or bioceramics to potentially enhance fracture healing. We advocate surgeons to support and consider in their practice the 'Save The Haematoma Campaig'.

PMID:41719885 | DOI:10.1016/j.injury.2026.113092

Injury. 2026 Feb 10;57(4):113093. doi: 10.1016/j.injury.2026.113093. Online ahead of print.

NO ABSTRACT

PMID:41719763 | DOI:10.1016/j.injury.2026.113093

Injury. 2026 Feb 10;57(4):113094. doi: 10.1016/j.injury.2026.113094. Online ahead of print.

NO ABSTRACT

PMID:41713206 | DOI:10.1016/j.injury.2026.113094

Injury. 2026 Feb 11;57(3):113095. doi: 10.1016/j.injury.2026.113095. Online ahead of print.

NO ABSTRACT

PMID:41713157 | DOI:10.1016/j.injury.2026.113095

Injury. 2026 Feb 6:113090. doi: 10.1016/j.injury.2026.113090. Online ahead of print.

ABSTRACT

BACKGROUND: Major trauma centres generally deliver better outcomes than non-specialist centres, but whether this association holds true in New Zealand, a country with challenging geography and a dispersed population, is uncertain.

AIMS: The aim of this study was to determine whether definitive care at a tertiary trauma hospital compared with a regional (non-tertiary) hospital was associated with improved survival in patients with major trauma in New Zealand. We also aimed to identify factors that predict transfer from a regional hospital to a tertiary centre.

METHODS: A registry-based cohort study of adults with major trauma was conducted using data from the New Zealand Trauma Registry. All patients who were in a tertiary hospital at any time during their hospitalisation were considered to have received definitive care in a tertiary centre. The primary outcome was in-hospital mortality during the index hospitalisation episode (including where a hospitalisation episode included care in multiple hospitals). Secondary outcomes were 30 and 90-day mortality, requirement for secondary transfer, and discharge destination. Multivariable logistic regression analysis was used to assess the association between definitive care hospital level and in-hospital mortality, and to identify factors associated with secondary transfer.

RESULTS: 10,001 major trauma patients were identified, with inpatient case fatality rate of 11.1% (regional hospitals 12.7%, tertiary hospitals 10.5%; P = 0.001). After risk adjustment, definitive care at a tertiary trauma hospital was associated with substantially lower odds of in-hospital death compared with regional hospitals (adjusted odds ratio 0.68 [95% CI, 0.57-0.82]; P < 0.001). Factors associated with secondary inter-hospital transfer included intubation, injury due to falls, Māori ethnicity, higher injury severity, and younger age.

CONCLUSION: Definitive care provided at a tertiary trauma hospital was associated with decreased odds of mortality in major trauma patients in New Zealand, indicating the importance of improving equity of access to specialised trauma care for patients suffering from serious injuries.

PMID:41690826 | DOI:10.1016/j.injury.2026.113090

Injury. 2026 Feb 6:113091. doi: 10.1016/j.injury.2026.113091. Online ahead of print.

ABSTRACT

INTRODUCTION: Injury-related readmissions related to an index injury admission impose significant burden on patients, families, and health systems. Understanding predictors of short-, medium-, and long-term injury-related readmissions can inform strategies to mitigate risk and guide early interventions. This study examines injury-related readmission patterns and predictors among transport-injured patients in Queensland, Australia.

METHODS: A population-based, epidemiological data-linkage study was conducted using hospital administrative records for transport-related injury admissions between 2011 and 2021. Index admissions were identified, and subsequent injury-related readmissions were classified using time- and diagnosis-based logic. Outcomes included three time frames for readmissions: within 31-days, 90-days, and 1-year post-discharge. Parametric survival analysis with a Gompertz distribution assessed predictors of injury-related readmission, and dominance analysis quantified the relative importance of these predictors. Predictors spanned six domains: sociodemographic factors, healthcare funder, hospital characteristics, injury-specific attributes, injury mechanism, and geographic factors.

RESULTS: Among 89,611 patients with transport-related injury admissions, 7.2% were readmitted for injury-related conditions within 31 days, 10.5% within 90 days, and 17.2% within one year. Mean time-to-readmission was 11, 25, and 92 days for the respective timeframes. Motor vehicle crashes were the most common transport-related injury mechanism, but had the lowest injury-related readmission rates compared to bicycle, motorcycle, and pedestrian injuries. Dominance analysis indicated that injury characteristics, particularly nature of injury, were the strongest predictors of injury-related readmission, with nature, body region and injury mechanism collectively explaining 67.5% to 83.2% of variation across timeframes.

CONCLUSION: Injury-related readmissions after transport-related injury occur most frequently within the first month post-discharge but persist up to one year. Injury characteristics dominate predictive influence, suggesting that interventions targeting these factors may reduce both short- and long-term injury-related readmission risk. These findings highlight opportunities for tailored discharge planning and early intervention strategies to alleviate patient and system burden.

PMID:41688229 | DOI:10.1016/j.injury.2026.113091

Injury. 2026 Feb 7;57(4):113086. doi: 10.1016/j.injury.2026.113086. Online ahead of print.

ABSTRACT

INTRODUCTION: Bloodstream infections (BSIs) are an important complication among injured patients, yet existing studies have focused on selected populations or specific settings, limiting the generalisability of the findings. In this study, we conducted a population-based study to examine the incidence, demographic and clinical variation of injury-related BSIs.

METHODOLOGY: The study population consisted of all residents of Queensland, Australia, who developed an injury-related BSI identified between 1 January 2000 and 31 December 2019. The linked data used for this study consisted of three statewide databases of all public and private hospital admissions, public pathology data and deaths. ICD-10 AM codes for injuries (S00-T75 and T79) were used to identify hospitalisations for index injuries. Incidence rates were calculated by age, sex, geographic remoteness and socio-economic status using estimated residential population data and aggregated acute injury hospital episodes.

RESULTS: Across 20 years, a total of 3205 injury-related BSI episodes occurred among 3188 individuals. The median age of this cohort was 63 years, with males accounting for 65 % of the population. The overall 30-day case-fatality rate was 13 %. During the study period, age-standardised rates increased from 2.47 to 4.62 per 100,000 population, with males experiencing higher rates than females. Patients from remote areas in Queensland had significantly higher rates compared to those from other regions. Additionally, age-specific rates increased with advancing age. Approximately two-thirds of the injury-related BSI episodes were hospital-onset. The most commonly identified pathogens among these patients were Staphylococcus aureus and Escherichia coli.

CONCLUSION: This world-first population-based study on injury-related BSIs provides a comprehensive understanding of the incidence and variation by demographic and clinical characteristics. Injury-related BSIs differed across subgroups: males, remote area residents and older people had higher rates than females, urban/regional area residents and younger individuals. These findings provide a foundation for further work to target treatment and interventions to minimise the burden of injury-related BSIs.

PMID:41687278 | DOI:10.1016/j.injury.2026.113086

Injury. 2026 Feb 6;57(4):113085. doi: 10.1016/j.injury.2026.113085. Online ahead of print.

ABSTRACT

INTRODUCTION: Healthcare workers performing fluoroscopy-guided procedures are at an elevated risk for work-related musculoskeletal disorders (WMSD) due to prolonged, maladaptive postures, further aggravated by the physical burden of lead aprons. Despite growing awareness, few studies have continuously assessed posture risk with task-level contributors to poor ergonomics in surgical settings.

OBJECTIVES: To quantify the proportion of time that healthcare workers spend in medium-to high-risk postures during fluoroscopic procedures in Interventional Cardiology and Orthopaedic Trauma to identify WMSD risk. A secondary aim categorizes specific tasks through qualitative video analysis of the high-risk postures in Orthopaedic Trauma.

METHODS: A mixed-methods cohort study was conducted for 23 participants over 47 procedures (22 in Interventional Cardiology and 25 in Orthopaedic Trauma). Participants included nurses, physicians and trainees, all of whom wore standard lead aprons during procedures. Postures were continuously assessed using three inertial measurement units attached on the spine to derive real-time Rapid Upper Limb Assessment (RULA) scores. Medium-to high-risk postures were defined as RULA scores ≥5, known to contribute to WMSD risk. For Orthopaedic procedures, synchronized audiovisual data from an Operating Room Black Box® was analyzed using open and focused coding to identify task-related contributors to posture.

RESULTS: Healthcare workers spent more than 50% of procedural time in medium-to high-risk postures. Physicians in Orthopaedics demonstrated the highest risk activity, with 38.9% of time in RULA 6+ postures. Task-based contributions were categorized using the novel POSTURE framework: Pressure, Operations, Sight Technology, Uneven Demographics, Reaching and Exceptions. This framework revealed role-specific ergonomic risks that traditional RULA score alone could not differentiate.

CONCLUSIONS: This study highlights a concerning prevalence of high-risk postures among healthcare workers in fluoroscopy-dependent procedures. The integration of continuous IMU-based RULA monitoring with qualitative task analysis offers a scalable and clinically relevant approach to posture assessment. The POSTURE framework extends existing ergonomic tools by contextualizing task-specific risks, providing actionable insights to guide ergonomic interventions, institutional policy, and training aimed at reducing WMSDs in surgical environments.

PMID:41679115 | DOI:10.1016/j.injury.2026.113085

Injury. 2026 Feb 6:113089. doi: 10.1016/j.injury.2026.113089. Online ahead of print.

ABSTRACT

OBJECTIVE: Neuroworsening portends poor outcomes after traumatic brain injury (TBI) and is protocolized in intensive care unit (ICU) settings. The utility of neuroworsening assessments in non-ICU settings for intervention and prognostication requires further understanding. This study assessed relationships among neuroworsening in the emergency department (ED), clinicoradiological injury, blood-based biomarkers, neurosurgical interventions, and outcomes in TBI patients without Glasgow Coma Scale-Motor Score (GCS-M) impairment at ED arrival.

METHODS: Adult subjects from the 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI; ClinicalTrials.gov #NCT02119182) Study with ED arrival GCS-M = 6 and ED disposition GCS-M were analyzed. Neuroworsening was defined as ED disposition GCS-M < 6. Subjects received clinically-indicated head computed tomography (CT) scan within 24-hours (h) post-TBI. Clinical characteristics, acute plasma TBI biomarker levels (glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase-L1 (UCH-L1); pg/ml), neurosurgical procedural interventions, hospital outcomes, and 3- and 6-month outcomes (Glasgow Outcome Scale-Extended (GOSE)) were compared. Multivariable logistic regressions examined predictors of neurosurgical interventions and unfavorable outcomes (GOSE ≤ 4) using adjusted odds ratios (AOR [95 % confidence intervals (CI)]). Cox proportional hazards model examined hospital discharge rate over time using adjusted hazard ratios (AHR).

RESULTS: In 1210 subjects, 36 (3.0 %) had ED neuroworsening. Neuroworsening was associated with features of more severe injuries, including ICU admission (91.7 % vs. 30.3 %, p < 0.0001), post-traumatic amnesia duration (>24 h: 26.7 % vs. 4.2 %, p < 0.0001), and traumatic intracranial injuries on CT (72.2 % vs. 39.7 %, p = 0.00020). Neuroworsening subjects had higher GFAP (median = 1400 [Q1-Q3:864-3663] vs. 306 [82-839], p < 0.0001) and UCH-L1 (median = 459 [287-1036] vs. 170 [94-322], p < 0.0001), neurosurgical procedural interventions (38.9 % vs. 2.1 %, p < 0.0001), in-hospital mortality (8.6 % vs. 1.0 %, p = 0.018), hospital length of stay (6.9 days [Q1-Q3:4.8-16.8] vs. 2.2 days [1.3-4.0], p < 0.0001), and 3- and 6-month unfavorable outcomes (26.1 % vs. 3.5 %, p = 0.00040; 26.1 % vs. 3.7 %, p = 0.00050). Neuroworsening independently predicted neurosurgical interventions (AOR = 18.7 [95 % CI: 7.9-44.1], p < 0.0001), lower discharge rate [AHR = 0.35 [0.24-0.50], p < 0.0001), 3-month unfavorable outcome (AOR = 9.8 [3.0-31.9], p = 0.00010), and 6-month unfavorable outcome (AOR = 11.0 [3.1-38.7], p = 0.00020).

CONCLUSIONS: ED neuroworsening is an early indicator of clinicoradiological TBI severity, and predicted neurosurgical procedural interventions, longer hospitalizations, and 3- and 6-month unfavorable outcomes. Higher blood-based TBI biomarker levels were associated with ED neuroworsening, suggesting their potential role to aid in the assessment of TBI patients at high risk of neurological deterioration.

PMID:41672813 | DOI:10.1016/j.injury.2026.113089