Injury. 2025 Dec 11;57(2):112968. doi: 10.1016/j.injury.2025.112968. Online ahead of print.

ABSTRACT

BACKGROUND: The epidemiology of traumatic spinal injuries (TSI) differs across various regions and is influenced by national income, infrastructure, and culture. TSIs are a source of high morbidity and mortality, requiring considerable resource allocation. Saudi Arabia's 2018 decision allowing women to drive introduced a new demographic element, potentially shifting TSI epidemiology. In this paper, we aimed to study patterns and outcomes of TSIs, including sex-based analyses, and to identify demographic, injury-related, and in-hospital factors associated with length of hospital stay, neurological severity, and spinal surgery requirement.

METHODS: This is a retrospective observational study conducted in a tertiary center between 2018 and May 2025. A total of 5380 computed tomography scans were screened. All patients with a diagnosis of spinal injury caused by a traumatic mechanism were included. Patients' demographics, mechanism of injury, injury level, associated injuries, AIS grade, hospital course, and disposition were collected and analyzed.

RESULTS: 623 TSI patients were included. Most of them were males (78.5 %) and Saudi nationals (74.2 %), with a male-to-female ratio of 3.7. The average age was 32.5 (±15.9) years. Substance use was documented in 7.4 % of cases. Four-wheel motorized-vehicle accidents (Four W-MVA) predominated (57.6 %) and were more common among Saudis (68.4 %), whereas falls from height (36.0 %), pedestrian injuries (21.1 %) were more common among non-Saudis. The most common injury was at the lumbar region (53.9 %), and most patients were neurologically intact (AIS E 93.7 %). Female sex and older age were associated with longer length of stay (LOS). Longer LOS was independently associated with prior psychiatric illness (RR=3.77), higher AIS severity (RR=1.22), pulmonary infection (RR=3.11), and ICU admission (RR=2.01). Higher AIS severity was linked to cervical involvement (per injured level RR=1.10) and vertebral subluxation/dislocation (RR=1.24).

CONCLUSION: The epidemiology of TSIs has demonstrated notable shifts in demographics, patterns of injury, and outcomes. This study highlights the need for targeted interventions, including intensified efforts to enforce traffic regulations, addressing health disparities experienced by non-Saudi residents, and an expansion of mental health services.

PMID:41422673 | DOI:10.1016/j.injury.2025.112968

Injury. 2025 Dec 11;57(2):112969. doi: 10.1016/j.injury.2025.112969. Online ahead of print.

ABSTRACT

Orthopedic injuries during pregnancy pose unique risks to maternal and fetal health. This review identifies different epidemiological data, maternal physiological changes, imaging considerations, pain management strategies, and operative considerations. Motor vehicle accidents, falls, and domestic violence contribute to fractures, emphasizing the need for tailored management. Special attention is given to imaging modalities, with a focus on fetal safety. Pain management strategies balance effective analgesia with fetal well-being, emphasizing the cautious use of opioids. Perioperative fetal monitoring and anticoagulation considerations address the intricacies of managing orthopedic injuries during pregnancy. Prevention strategies, such as promoting seat belt use and intimate partner violence screening, are crucial for minimizing risks. This concise review serves as a comprehensive guide for healthcare professionals managing orthopedic injuries in pregnant patients.

PMID:41421319 | DOI:10.1016/j.injury.2025.112969

Injury. 2025 Dec 13;57(2):112956. doi: 10.1016/j.injury.2025.112956. Online ahead of print.

ABSTRACT

BACKGROUND: Acute total hip arthroplasty (THA) plays an increasing role in the management of acetabular fractures in elderly patients. However, there is no consensus on the need for column fixation during primary THA, especially for the anterior column. This study aimed to assess the biomechanical impact of column stabilization during acute THA using a Burch-Schneider anti-protrusion cage (BSC) for a typical geriatric acetabular fracture.

METHODS: A finite element model of a hemipelvis with an anterior column posterior hemi-transverse fracture was developed to compare four treatment strategies during acute THA with BSC: anterior and posterior column plating (CAP), posterior column plating (CnP), anterior column plating (CAn), and BSC alone (Cnn). During peak load walking, we analyzed the pelvis displacement, fracture relative motion, bone strain around screws, and metal stress.

RESULTS: Pelvis displacement was lowest for CAP and highest for Cnn, while CnP and CAn showed intermediate values slightly higher than CAP. Fracture relative motion, bone strain, and metal stress followed similar patterns. Fracture relative displacement was around 1 mm on average, and below 5 mm, except for Cnn, where it exceeded this value on 22 % of the fracture surface. Peak strain far exceeded 1 % for Cnn, predominantly concentrated at screw tips and screw-plate junctions, as did peak metal stress.

CONCLUSION: This biomechanical analysis indicates that CnP alone provides mechanical stability comparable to isolated or additional anterior column plating. These findings support the single posterior approach concept for acute THA in the management of acetabular fractures in elderly patients.

PMID:41421318 | DOI:10.1016/j.injury.2025.112956

Injury. 2025 Dec 11;57(2):112962. doi: 10.1016/j.injury.2025.112962. Online ahead of print.

ABSTRACT

INTRODUCTION: A notable anatomic feature of the facet joint is the lateral mass, which is comprised of the superior and inferior articular processes of the vertebral body. A unique fracture pattern involves a lamina fracture and ipsilateral pedicle fracture resulting in a separation of the lateral mass from the vertebral body, called a floating lateral mass fracture (FLM). FLMs commonly co-occur with vertebral artery or neurologic injury and is usually managed surgically. Few studies have focused on FLMs alone; thus, the objective of the current study is to provide a systematic review regarding the epidemiology and management of FLM.

METHODS: A retrospective protocol was used to search Medline (via PubMed) and Embase to identify all studies focused on floating lateral mass fractures. "floating lateral mass fracture" and "cervical" or "spine" were used in conjunction with boolean terms to find related articles. Single-case studies, unpublished articles, non-English articles, and other systematic reviews were excluded. Studies focusing on C1 lateral mass fractures were also excluded. Data regarding patient characteristics, injury characteristics, diagnostic imaging, and treatment were gathered.

RESULT: A total of 332 patients were identified with floating lateral mass fractures (FLM) of the subaxial cervical spine. There were 217 men (63.4 %) and 68 women (20.5 %) and 47 participants with gender not reported. The mean age was 41.8 ± 7.98 years. The most common levels of injury C6 and C5. Motor vehicle accidents (MVAs) were the most reported index event. Cervical collars were the most used non-operative treatment modality, with most studies specifying the use of hard cervical collar or a halo vest. Vertebral subluxation was later identified in 22 (31 %) patients treated nonoperatively. Anterior cervical discectomy and fusion (ACDF) was the most performed procedure including a one level, with 67 patients (28.2 %) and two-level fusions with 55 patients (23.2 %), totaling to 122 patients (51.4 %). Minimal reports of subluxation post-operatively were reported.

CONCLUSION: Floating lateral mass fractures are an uncommon, but severe, subtype of cervical facet fractures. FLM inherently results in spinal instability, and as a result surgical management is preferred versus non-surgical.

PMID:41418386 | DOI:10.1016/j.injury.2025.112962

Injury. 2025 Dec 11;57(2):112970. doi: 10.1016/j.injury.2025.112970. Online ahead of print.

ABSTRACT

OBJECTIVE: Pelvic fractures are associated with substantial morbidity and mortality, yet the prognostic value of initial fibrinogen levels remains underexplored.

METHODS: We conducted a global retrospective cohort study using data from the TriNetX Global Collaborative Network (2005-2025), with ≥30 days of follow-up. Patients with pelvic fractures and fibrinogen data were included. Propensity score matching adjusted for age, sex, race, ethnicity, comorbidities, and labs. Primary outcomes were mortality and complications in patients with fibrinogen ≤200 mg/dL compared to >200.01 mg/dL. Relative risks (RR) and number needed to harm (NNH) were calculated at 1, 3, 7, 14, and 30 days. Subgroup and sensitivity analyses tested robustness.

RESULTS: 10,552 patients were included after matching, with 5276 patients in each cohort. The low fibrinogen group exhibited significantly higher risks of adverse outcomes at 30 days, including acute kidney injury (RR, 1.30; 95 % CI, 1.21-1.41; NNH: 18), shock (RR, 1.51; 95 % CI, 1.40-1.85; NNH: 12), respiratory failure (RR, 1.29; 95 % CI, 1.24-1.34; NNH: 9), acute respiratory distress syndrome (RR, 1.28; 95 % CI, 1.08-1.52; NNH: 84), disseminated intravascular coagulation (RR, 2.06; 95 % CI, 1.70-2.47; NNH: 32), and all-cause mortality (RR, 1.90; 95 % CI, 1.70-2.14; NNH: 15). These associations were consistent across subgroups stratified by age and sex, and held steady in sensitivity analyses using lower fibrinogen thresholds.

CONCLUSION: A fibrinogen level of ≤ 200 mg/dL is associated with increased mortality and acute organ dysfunction in patients with pelvic fractures.

PMID:41418385 | DOI:10.1016/j.injury.2025.112970

Injury. 2025 Dec 12;57(2):112963. doi: 10.1016/j.injury.2025.112963. Online ahead of print.

ABSTRACT

BACKGROUND: High-energy pelvic ring injuries (PRIs) are increasingly observed in the elderly, a population with unique physiological vulnerabilities. However, outcome data in patients aged ≥75 years remain scarce.

METHODS: In this retrospective cohort study, 331 patients with high-energy PRIs over 11 years at a Level 1 trauma centre were analysed. Using 1:1 propensity score matching, outcomes in patients aged ≥75 years were compared with younger patients (<75), adjusting for injury severity and baseline characteristics.

RESULTS: Twenty-eight patients aged ≥75 were matched to 28 younger counterparts. Mortality was significantly higher in the elderly group (32 % vs. 7 %, p = 0.006), despite comparable injury severity scores. Elderly patients were less likely to be admitted to the intensive care unit (ICU) (29 % vs. 64 %, p = 0.007), with shorter ICU stays, though total hospital length of stay did not differ. Fracture morphology and mechanisms of injury also varied by age, with older adults showing simpler patterns but higher mortality.

CONCLUSION: Elderly patients with high-energy PRIs exhibit distinct injury mechanisms and patterns, experience a five-fold higher mortality despite less frequent ICU admission and matched injury severity. These findings highlight the urgent need for age-adapted trauma protocols and proactive perioperative strategies in managing pelvic trauma in the elderly.

PMID:41418384 | DOI:10.1016/j.injury.2025.112963

Injury. 2025 Dec 11;57(2):112961. doi: 10.1016/j.injury.2025.112961. Online ahead of print.

ABSTRACT

INTRODUCTION: Proximal humerus fractures are common, especially in older adults, and often result in complications such as varus collapse after open reduction and internal fixation (ORIF). Despite successful surgical methods, complication rates remain significant, with varus collapse being a primary cause of failure. Ensuring proper screw placement, particularly the calcar screw, is vital to prevent this issue. This study introduces a modified calcar ratio (MCR) that combines two key measurements - tip distance and calcar distance - to predict varus collapse and improve surgical outcomes.

METHODS: This retrospective study analyzed patients treated for proximal humerus fractures from September 2022 to June 2024. Inclusion criteria were adults with 3- or 4-part fractures who underwent ORIF with a proximal humerus plate within two weeks of injury. Preoperative and postoperative radiographs were evaluated to determine fracture classification, reduction quality, and radiological parameters, including MCR. MCR was calculated as the sum of the tip distance and calcar distance divided by the humeral head radius. Statistical analysis, including ROC curve analysis, assessed MCR's ability to predict varus collapse.

RESULTS: A total of 108 patients were included. MCR was significantly higher in patients who experienced varus collapse (median MCR: 0.7) compared to those who healed (median MCR: 0.5). Varus collapse occurred in 17.6 % of patients, with a median onset time of 8 weeks post-surgery. Statistical analysis showed a strong correlation between higher MCR and varus collapse, with a sensitivity of 100 % and a specificity of 47 %, at a cut-off point of 0.46 for predicting failure. The ROC curve demonstrated 78 % discriminatory ability for MCR.

CONCLUSION: The MCR is a reliable, practical tool for predicting varus collapse following ORIF in proximal humerus fractures. By considering both the tip and calcar distances, MCR provides a single, effective measure to optimize surgical outcomes. An intraoperative MCR value below 0.46 demonstrated high sensitivity for predicting lower risk of varus collapse, and may serve as a useful intraoperative reference.

PMID:41411836 | DOI:10.1016/j.injury.2025.112961

Injury. 2025 Dec 11;57(2):112967. doi: 10.1016/j.injury.2025.112967. Online ahead of print.

ABSTRACT

INTRODUCTION: Posterior iliac crescent fracture-dislocations (PICFDs) were originally considered rotationally unstable and vertically stable injuries, strongly associated with lateral compression (LC) mechanism. However, it is currently recognized that PICFDs may exhibit variable injury patterns and result from different mechanisms. The purpose of this study was to evaluate relevant morphological aspects and the mechanism of injury of PICFDs in a cohort of patients presenting unstable pelvic ring injuries (PRIs) PATIENTS AND METHODS: Patients presenting unstable PRIs that underwent surgical treatment at two level 1 trauma centers from January 2019 to December 2024 were retrospectively reviewed. Individuals presenting PICFDs were recorded, and relevant morphological aspects scrutinized.

RESULTS: 363 unstable PRIs were identified and a PICFD was present in 29 (8.0%) individuals. Among these, 23 (79.3%) were attributed to LC, 4 (13.8%) to APC (anteroposterior compression) and 2 (6.9%) to CCM (complex/combined mechanism). According to Day's classification, PICFDs were categorized as type I (n=8, 27.6%), type II (n=16, 55.2%), and type III (n=5, 17.2%). Most PICFDs (n=26, 89.6%) were displaced, 72.4% (n=21) exhibited posterior dislocation and 96,5% (n=28) presented associated ipsilateral anterior pelvic ring disruption. Comminution of the crescent-shaped fragment was seen in 13.8% (n=4) patients and vertical instability was observed in 34.5% (n=10) PICFDs.

CONCLUSION: This investigation reinforced modern concepts regarding PICFDs, suggesting that the understanding of this infrequent injury pattern warrants constant refinement. Morphological aspects of PRIs presenting with PICFDs were detailed, exhibiting variable deformity, displacement and comminution. Furthermore, PICFDs can be caused by different injury mechanisms and carry the potential to cause vertical instability.

PMID:41411835 | DOI:10.1016/j.injury.2025.112967

Injury. 2025 Dec 4:112942. doi: 10.1016/j.injury.2025.112942. Online ahead of print.

NO ABSTRACT

PMID:41407605 | DOI:10.1016/j.injury.2025.112942

Injury. 2025 Dec 11;57(2):112971. doi: 10.1016/j.injury.2025.112971. Online ahead of print.

ABSTRACT

BACKGROUND: The gull sign was described as a radiographic marker of superomedial dome impaction in acetabular fractures and was considered predictive of failure after osteosynthesis in older patients (≥ 60 years).

AIM: To determine whether the radiographic gull sign is associated with higher conversion rates to total hip arthroplasty (THA) within 24 months after open reduction and internal fixation (ORIF) for displaced acetabular fractures in patients aged ≥ 60 years.

METHODS: In this retrospective cohort study, 126 patients aged ≥ 60 years (mean 76 years, range 60.1-93.6) underwent ORIF for displaced acetabular fractures via the Pararectus approach between 2009 and 2020. Preoperative pelvic radiographs were assessed for the presence of the gull sign, and CT scans were evaluated for dome impaction. Failure was defined as conversion to total hip arthroplasty (THA) within 24 months after ORIF. Kaplan-Meier analyses with log-rank tests were performed on the entire cohort, and diagnostic performance was analysed in the subset with complete two-year follow-up (n = 93).

RESULTS: At two years, 20 of 93 patients (22 %) had undergone THA, occurring on average 12.1 months after the index surgery (range 2-45 months). A radiographic gull sign was identified in 21 patients (23 %). The subsequent THA conversion rate was similar between those with and without the sign (5/21 [24 %] vs 15/72 [21 %]; p = 0.99). Concordance between radiographs and CT was limited: only 12 of 21 gull-positive patients (57 %) showed a true dome impaction on CT, while CT nevertheless revealed impaction in 21 of 72 gull-negative patients (29 %). Among patients with CT-confirmed impaction, 8 of 33 (24 %) underwent THA within 24 months, compared with 12 of 60 (20 %) without impaction (p = 0.79). Kaplan-Meier analysis of the entire cohort (n = 126) likewise showed no difference in THA-free survival between groups.

CONCLUSION: Neither a radiographic gull sign nor CT-confirmed dome impaction predicted early conversion in our series of acetabular fractures managed via Pararectus approach; overall conversion rates were acceptable. Accordingly, the gull sign is not a harbinger per se for failure of osteosynthesis in older adults.

PMID:41406758 | DOI:10.1016/j.injury.2025.112971

Injury. 2025 Dec 11;57(2):112957. doi: 10.1016/j.injury.2025.112957. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the diagnostic performance of ChatGPT in identifying acute shoulder dislocations and to compare its accuracy with that of orthopedic specialists and emergency medicine residents.

METHODS: A total of 250 anteroposterior (AP) shoulder radiographs were included. All images were evaluated for the presence or absence of dislocation and for dislocation subtype (anterior, posterior, inferior) by four groups: orthopedic specialists (n = 10), orthopedic residents (n = 10), emergency medicine residents (n = 10), and ChatGPT. ChatGPT-4o (OpenAI, May 2024) and ChatGPT-5.1 (OpenAI, July 2025) were accessed through the web interface using a standardized single image + text-based prompt. The models had no prior training with radiological images. Diagnostic performance was assessed using sensitivity, specificity, positive and negative predictive values, overall accuracy, area under the ROC curve (AUC), F1 score, and Cohen's kappa for inter-reader agreement.

RESULTS: In the detection of shoulder dislocation (yes/no), orthopedic specialists demonstrated the highest accuracy (95.0 %), whereas ChatGPT-4o showed the lowest (72.4 %). Orthopedic residents achieved 90.1 % accuracy, emergency medicine residents 89.0 %, and ChatGPT-5.1 78.0 %. When subtype classification (anterior, posterior, inferior) was included, orthopedic specialists again performed best (89.7 %), while ChatGPT-4o had the lowest accuracy (68.0 %). Orthopedic residents (84.7 %) outperformed emergency medicine residents (76.7 %), while ChatGPT-5.1 achieved 69.6 % accuracy. Internal-rotation AP images of nondislocated shoulders were frequently misinterpreted as posterior dislocations.

CONCLUSION: This study demonstrates that the diagnostic accuracy for acute shoulder dislocation varies according to the clinicians' level of experience. The use of a single AP shoulder radiograph alone is not sufficient for diagnosing shoulder dislocation. Clinicians most frequently misinterpreted internally rotated AP shoulder radiographs as posterior dislocations. ChatGPT models showed moderate performance and are not yet suitable as standalone diagnostic tools in clinical decision-making. However, with further development of artificial intelligence-based systems, these models may serve as rapid preliminary screening aids in emergency settings.

PMID:41406757 | DOI:10.1016/j.injury.2025.112957

Injury. 2025 Dec 10;57(2):112951. doi: 10.1016/j.injury.2025.112951. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical spine (c-spine) injuries can lead to significant disability and mortality. Although stabilization is the primary management for suspected c-spine injuries, lapses in stabilization frequently occur during trauma resuscitation. To facilitate evaluation of c-spine management, we developed a computer vision system to detect stabilization techniques. This system would enable scalable monitoring, including the timing and duration of c-spine stabilization.

METHODS: We developed a 2-stage computer vision system to detect prehospital rigid c-collar, hospital semi-rigid c-collar, and manual in-line stabilization. The system was trained, tested, and validated using image frames extracted from 86 pediatric trauma resuscitation videos at a level 1 pediatric trauma center from October 2022 to May 2023. The first stage identified the patient in each image, and the second stage classified the stabilization technique. A 5-fold cross-validation was performed on the first 68 resuscitation videos for training/testing, with the latest 18 cases reserved for validation. System performance was evaluated using accuracy, precision, recall, F1 score, and Matthews correlation coefficient (MCC). To assess system potential for manual in-line detection, 10 simulation videos were added (eight for training, two for testing).

RESULTS: In the 18 validation cases, the system achieved high accuracy for binary classification (0.91) and for detecting specific stabilization techniques: prehospital rigid c-collar (0.95), hospital semi-rigid c-collar (0.93), and manual in-line stabilization (0.97). The precision scores were 0.89 for binary classification of any stabilization method, 0.71 for prehospital rigid c-collar, 0.89 for hospital semi-rigid c-collar, and 0.04 for manual in-line. Recall, F1, and MCC scores aligned with these findings, with the highest values observed for detecting the hospital semi-rigid c-collar among the stabilization techniques. Adding simulation videos improved manual in-line stabilization detection, with accuracy 0.62, precision 0.88, recall 0.58, F1 score 0.70, and MCC 0.27.

CONCLUSION: The 2-stage computer vision system showed excellent performance for detecting c-spine stabilization, with limitations for manual in-line stabilization due to its rarity. Simulation data improved manual in-line detection, highlighting potential benefits of a more balanced dataset. The computer vision system may serve as a prototype for automated monitoring of trauma resuscitation using the camera infrastructure in the resuscitation room.

PMID:41401500 | DOI:10.1016/j.injury.2025.112951

Injury. 2025 Dec 11;57(2):112965. doi: 10.1016/j.injury.2025.112965. Online ahead of print.

ABSTRACT

BACKGROUND: Acetabular fracture with concomitant hip dislocation (dislocation-fracture) is a high-energy injury requiring urgent management. Although less life-threatening than pelvic ring fractures, these injuries are often associated with ipsilateral knee trauma, which may be overlooked in the acute setting. Delayed recognition can lead to secondary meniscal and chondral damage.

PURPOSE: To investigate whether hip dislocation in the setting of acetabular fracture is an independent risk factor for ipsilateral knee injury.

METHODS: We retrospectively reviewed 180 patients (146 men, 34 women; mean age, 57.3 ± 19.8 years) admitted with acetabular fractures between July 2006 and December 2024. Clinical variables included age, sex, mechanism of injury, concomitant upper extremity injuries, initial knee evaluation, and the presence of ipsilateral knee injuries. Knee injury was defined as ligament injury, tibial plateau fracture, or meniscal injury. Notably, tibial plateau fractures that were not clearly identified on radiographs were diagnosed by MRI. Patients were stratified according to the presence of hip dislocation, and logistic regression analysis was performed to identify independent risk factors for knee injury.

RESULTS: Mechanisms of injury included falls (25.6 %), traffic accidents (69.4 %), and tumbling (5.0 %). Concomitant upper extremity injuries were found in 21.7 % of patients. Ipsilateral hip dislocation-fracture occurred in 46 patients (25.6 %), with directions and fracture types recorded as Thompson and Epstein classification. Knee injury was significantly more frequent in Group pH (12/46, 26.1 %) than in Group AH (5/134, 3.7 %) (P < 0.001). Logistic regression showed that age, sex, mechanism of injury, and upper extremity injuries were not independent predictors of knee or PCL injury, whereas hip dislocation-fracture significantly increased the risk (OR 7.25; 95 % CI, 2.30-22.9; P < 0.001). Among knee injuries, posterior cruciate ligament (PCL) injury was most common (41.2 %), followed by meniscal injury (17.6 %) and anterior cruciate ligament (ACL) injury (5.6 %). Concomitant tibial plateau fractures were observed in 23.5 % of cases, all confirmed by MRI. Soft-tissue-only knee injuries (ligament and/or meniscus without fracture) accounted for 10 cases.

CONCLUSION: Hip dislocation-fracture significantly increases the risk of ipsilateral knee injury, particularly PCL injury. Clinicians should maintain a high index of suspicion and perform systematic knee evaluation, including MRI when feasible, to enable early diagnosis and prevent secondary joint deterioration.

PMID:41401499 | DOI:10.1016/j.injury.2025.112965

Injury. 2025 Dec 5:112948. doi: 10.1016/j.injury.2025.112948. Online ahead of print.

NO ABSTRACT

PMID:41391987 | DOI:10.1016/j.injury.2025.112948

Injury. 2025 Dec 11:112954. doi: 10.1016/j.injury.2025.112954. Online ahead of print.

ABSTRACT

BACKGROUND: Significant inter-hospital variation in potentially low-value operative management of blunt solid organ injuries (SOI) has been observed but data on the impact on patient outcomes is lacking. Our primary objective was to estimate the association between potentially low-value operative management of blunt SOI and hospital mortality, complications, and length of stay (LOS). A secondary objective was to identify determinants, independent of patients' health status on arrival.

METHODS: We conducted a retrospective cohort study using the National Trauma Data Bank (2016-2019). We included adults admitted with blunt SOI eligible for nonoperative management (grade I-IV spleen/liver and grade I-III kidney, hemodynamically stable, no blood products within 6 hours). We used propensity scores to generate adjusted odds ratios (OR) of mortality and complications and geometric mean ratios (GMR) of LOS.

RESULTS: We included 62,601 adults, of whom 1,683 (2.7%) had potentially low-value operative management. Adjusted ORs were 1.92 (95% CI 1.25-2.96) for mortality and 2.39 (1.99-2.87) for complications. The adjusted GMR was 1.52 (1.38-1.68) for LOS. Low-value operative management was more frequent in males, White non-Hispanics versus African Americans, Medicaid versus private insurance, and American College of Surgeons (ACS) level II/III and state-designated hospitals versus ACS level I.

CONCLUSIONS: In this retrospective cohort study, potentially low-value operative management of SOI was infrequent but was associated with increased mortality, complications, and LOS and was influenced by sex, race and ethnicity and insurance status. Results suggest that interventions designed to reduce low-value operative management may improve patient outcomes.

PMID:41391986 | DOI:10.1016/j.injury.2025.112954

Injury. 2025 Dec 10;57(2):112950. doi: 10.1016/j.injury.2025.112950. Online ahead of print.

ABSTRACT

BACKGROUND: Spinal fractures represent a significant cause of morbidity, requiring both acute and long-term care. Data on their epidemiology in small state settings are limited. This study aimed to describe the population burden, clinical characteristics, and healthcare impact of spinal fractures in Malta over a five-year period.

METHODS: A retrospective analysis was conducted using the Hospital Activity Analysis (HAA) database of Mater Dei Hospital, Malta, between 2019 and 2024. Data included demographics, fracture type (ICD-10), length of stay (LOS), admission and discharge source, mechanism of injury, need for intensive care unit (ITU) admission, spinal cord injury, and co-morbidities. Fracture types were grouped as cervical, thoracic, lumbar single-level, or multi-level fractures. Descriptive statistics, chi-square, t-tests, and logistic regression were applied, with p<0.05 considered significant.

RESULTS: A total of 640 spinal fractures were recorded (56% males, 44% females). Lumbar single-level fractures were most common (38%), followed by multi-level fractures (30%). Falls were the predominant mechanism (53%). While 90% were admitted directly from home, only 70% were discharged home, with 16% requiring transfer to rehabilitation. The longest LOS was for cervical single-level fractures (15.7 days, p=0.019). ITU admission was uncommon (4%), predominantly in multi-level fractures, which also had the highest spinal cord injury prevalence (36%). Co-morbidities were frequent (71%), particularly cardiovascular disease (49%). Logistic regression showed multimorbidity was positively associated with single-level fractures (OR 1.66, 95% CI: 1.04-2.67, p=0.035).

CONCLUSIONS: Spinal fractures in Malta impose a substantial burden, extending beyond acute care into rehabilitation. Falls were the leading cause, and multimorbidity significantly influenced fracture patterns. These findings underscore the need for integrated fall-prevention strategies, chronic disease management, and strengthened rehabilitation services in small-state healthcare systems.

PMID:41391271 | DOI:10.1016/j.injury.2025.112950

Injury. 2025 Dec 6;57(2):112945. doi: 10.1016/j.injury.2025.112945. Online ahead of print.

ABSTRACT

PURPOSE: Zone 2B flexor tendon injuries present unique surgical challenges, with ongoing debate regarding optimal management of concurrent flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) ruptures. This study compared functional outcomes between isolated FDP repair versus combined FDS-FDP repair in Zone 2B injuries..

METHODS: We retrospectively analyzed 69 patients (97 fingers) with complete Zone 2B flexor tendon injuries between January 2017 and December 2020. Group 1 underwent isolated FDP repair (35 patients, 49 fingers) while Group 2 received combined FDS-FDP repair (34 patients, 48 fingers). Primary outcomes included total active motion (TAM), deformity rates, and functional assessment using Tang grading at 12-month follow-up.

RESULTS: Group 1 demonstrated significantly superior outcomes across multiple parameters. Deformity occurrence was markedly lower in Group 1 (28.6% vs 68.8%, p<0.001), with reduced deformity angles (p=0.008). Total active motion was significantly higher in Group 1 (p<0.001), alongside improved TAM percentages (p=0.033) and total passive motion (p<0.001). While not statistically significant, Group 1 showed trends toward higher rates of excellent outcomes (55.1% vs 33.3%) and reduced reoperation rates (8.2% vs 16.7%).

CONCLUSION: Isolated FDP repair in Zone 2B injuries yields superior functional outcomes with significantly reduced deformity rates compared to combined tendon repair. When FDS repair compromises FDP gliding, selective FDS excision appears beneficial. This supports the selective excision of FDS when FDP gliding is compromised, streamlining surgical strategy in this anatomically constrained zone.

PMID:41391270 | DOI:10.1016/j.injury.2025.112945

Injury. 2025 Dec 4:112931. doi: 10.1016/j.injury.2025.112931. Online ahead of print.

ABSTRACT

BACKGROUND: Electric bicycles (e-bikes) are becoming increasingly popular, offering higher speeds compared to traditional pedal bicycles. Despite their growing use, there is limited data on the epidemiology of e-bike related injuries in the pediatric population. Specifically, previous studies have not adequately explored the injury circumstances regarding e-bikes, particularly concerning loss of control due to speed. This study aims to assess the patterns and outcomes of e-bike injuries in children, hypothesizing that speeds higher than 20 miles per hour (MPH) result in more internal injuries necessitating hospital admission.

METHODS: This retrospective cross-sectional study analyzed data from the National Electronic Injury Surveillance System, specifically targeting pediatric ages 0-18 e-bike injuries recorded between 2019 and 2023. We utilized natural language processing techniques to extract narratives from the database, identifying words related to the circumstances of injury, and distinguishing between speed-related incidents vs. non-speed-related incidents. The cohort was divided into two groups based on the identified cause: injuries due to increased speed and injuries attributed to other causes. We then conducted bivariate analyses to compare the characteristics and outcomes between these groups, focusing on the type of injury, its severity, and the need for hospital admission.

RESULTS: A national estimate of 15,121 pediatric patients with injuries related to e-bikes (79.7% males and 71.3% adolescents aged 13-18) were identified. Injuries attributed to speed were associated with a higher incidence of head, neck, or facial injuries (49.1%¦vs 28.7%) compared to those resulting from other causes. A greater proportion of children with speed-related injuries sustained internal organ injuries (24.1%¦vs. 10.4%) and were admitted to the hospital (7.3%¦vs.4.7%). Of those injuries specified as "internal" 96.7% were head and neck injuries compared to 3.3% other anatomic sites. Over the five-year study period, the frequency of e-bike injuries showed a sharp increase, with 4.18% occurring in 2019 and 49.8% in 2023.

CONCLUSION: Pediatric e-bike injuries have increased in frequency and can be severe, requiring hospitalization. The findings highlight the risks associated with speeds higher than 20 MPH on e-bikes and the need for targeted safety measures and legislation especially related to prevention of head injuries. Future research should focus on the effectiveness of safety interventions, including helmet usage and speed control features on e-bikes.

TYPE OF STUDY: retrospective cross-sectional study.

PMID:41390298 | DOI:10.1016/j.injury.2025.112931

Injury. 2025 Dec 6;57(2):112928. doi: 10.1016/j.injury.2025.112928. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric trauma care has traditionally utilized a Face-to-Face (F2F) model of outpatient care. The authors hypothesized that most pediatric minor trauma care could be managed definitively on initial contact within the Pediatric Emergency Department (PED), with subsequent confirmation of treatment at an orthopedics Virtual Fracture Clinic (VFC). We describe the experience of our first 10,763 children managed via a VFC pathway in the setting of a pediatric trauma service.

MATERIALS AND METHODS: Data was prospectively collected on all patients referred to the VFC from the PED. Outcome data included referral for surgery, referral to a F2F clinic, referral back to PED for further evaluation and discharge. Cost analysis was performed using established costing for a VFC within the local healthcare system.

RESULTS: A total of 10,763 consecutive patients were referred to the VFC from the PED over a 4-year period. There were 6012 (56 %) males and 4751 (44 %) females. The average age was 9.4 years (0.5 -17 years). A total of 0.5 % (n= 56) were referred from the VFC for immediate operative treatment, 25.2 % (n= 2706) were referred to a F2F clinic, and 69.8 % (n= 7517) of children were discharged via the VFC. 4.5 % (n= 484) were referred back to the PED. 3.5 % (n= 383) of the discharged patients required an unplanned F2F evaluation. We calculated a net saving delivered from implementation of the VFC as €704 667.

CONCLUSION: This prospective evaluation, of our first 10,763 children, has demonstrated that a VFC pathway for minor pediatric trauma is safe, effective and brings significant cost savings.

PMID:41389429 | DOI:10.1016/j.injury.2025.112928

Injury. 2025 Dec 4;57(2):112935. doi: 10.1016/j.injury.2025.112935. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify and characterize space-time clusters of road traffic collisions (RTCs) involving older adults in Taiwan, with emphasis on spatial and temporal features that may inform targeted prevention strategies.

METHODS: We analyzed nationwide RTC data from Taiwan's Police Traffic Accident Report (PTAR) registry from 2014 to 2023, including 145,450 older adult victims aged ≥65 years. Six variables, including three spatial (urbanization level, crash location, and type of traffic signal) and three temporals (monsoon season, day of the week, and time of day), were selected to perform latent class analysis (LCA) for identifying distinct spatiotemporal crash clusters. Model fit indices (AIC, BIC, CAIC, ABIC, and entropy) guided the selection of the optimal number of clusters. Demographic and road user characteristics across clusters were compared using bivariate analyses.

RESULTS: Three distinct clusters were identified: (1) urban intersection crashes, (2) intersection crashes in medium- and low-urbanized areas, and (3) crashes on unsignalized road segments. Collisions were more likely to occur at intersections (n = 85,247, 58.6 %) and in highly urbanized areas, (n = 61,432, 42.2 %). Most incidents took place on weekdays (n = 103,441, 71.1 %) and during morning hours (n = 70,382, 48.4 %). Significant differences across clusters were found in age, sex, road user role, and vehicle type (all p < 0.001).

CONCLUSION: This study demonstrates the heterogeneity in spatiotemporal patterns of RTCs involving older adults in Taiwan. These findings highlight areas where further investigation into context-specific traffic safety measures could inform efforts to enhance mobility and reduce injury risk among older adults.

PMID:41389428 | DOI:10.1016/j.injury.2025.112935