Injury

Nationwide analysis of pelvic and acetabular fracture surgeries in Japan: The impact of aging and healthcare resources

Injury. 2025 Apr 2;56(6):112316. doi: 10.1016/j.injury.2025.112316. Online ahead of print.

ABSTRACT

PURPOSE: This study investigates Japanese trends in Open Reduction and Internal Fixation (ORIF) surgeries for acetabular and pelvic fractures, focusing on age, gender, regional disparities, and how orthopedic surgeon distribution affects surgical volumes, aiming to identify factors contributing to geographic variations.

METHODS: Surgical volumes for acetabular (K124-2) and pelvic (K125) fractures were categorized by age, gender, and prefecture in the National Database of Health Insurance Claims and Specific Health Checkups of Japan (2016-2022). Correlation analyses assessed relationships between surgical volumes, aging populations, and orthopedic surgeon availability.

RESULTS: Surgical volumes of the elderly increased among individuals over 65, with a notable rise in female pelvic fractures. Acetabular fractures were more prevalent in younger males. Urban areas with more orthopedic surgeons showed higher surgical volumes (p < 0.0001), while aging population rates correlated negatively (p < 0.0001).

CONCLUSION: ORIF for acetabular and pelvic fractures is increasing in Japan's aging population. Surgeon distribution influences surgical volumes, highlighting the need for treatment guidelines in primary care and telemedicine-based strategies.

PMID:40209612 | DOI:10.1016/j.injury.2025.112316

Biomechanical comparison of different double plate constructs for distal supracondylar comminuted femur fractures (AO/OTA 33-A3)

Injury. 2025 Apr 1;56(6):112324. doi: 10.1016/j.injury.2025.112324. Online ahead of print.

ABSTRACT

INTRODUCTION: Dual plating for distal femoral fractures, especially with a metaphyseal comminution, is biomechanically superior compared to single lateral plating, promotes fracture union and prevents complications. However, the optimal placement and length of the additional medial plate are still unknown. Thus, we aimed to biomechanically compare three different double plate constructs for distal femoral fractures.

MATERIALS AND METHODS: A distal femoral fracture with a metaphyseal comminution (AO/OTA 33-A3) was created in synthetic femora and stabilized according to the following groups of 6 specimens each: Single lateral plate (SP), double plate with anteromedial oblique locking plate (DPOB), double plate with parallel medial locking plate with 4 screws (DP4S) and double plate with parallel medial locking plate with 6 screws (DP6S). Afterwards, the femora were tested axially with a quasi-static load of 400 N as well as torsionally with 5 Nm of internal and external rotation. Interfragmentary motion and rotation were measured with an optical 3D motion analysis system.

RESULTS: Fracture gap motion and varus-valgus tilt under axial testing were significantly lower with DPOB, DP4S and DP6S than with SP (p = 0.02) without a significant difference between the double plate constructs. DP4S and DP6S showed a significant lower anteroposterior tilt under axial loading than SP (p = 0.02), whereas DPOB showed no significant difference compared to SP but had a significantly higher anteroposterior tilt than DP6S (p = 0.02). Under internal and external rotation testing, anteroposterior shift was significantly different, and axial rotation was significantly lower with DPOB, DP4S and DP6S compared to SP (p = 0.02) without a significant difference between the double plates.

CONCLUSION: Dual plating is biomechanically superior under axial and torsional loading compared to the traditional single lateral plating for distal femoral fractures with metaphyseal comminution. A parallel arrangement of double plates is biomechanically more effective in resisting anteroposterior tilt, whereas the length of parallel medial plates (with 4 or 6 screws) has no influence on the biomechanical performance.

PMID:40203770 | DOI:10.1016/j.injury.2025.112324

Description and prognostic factors of a cohort of polytraumatized patients with spinal injury in a level I trauma center

Injury. 2025 Apr 1;56(6):112319. doi: 10.1016/j.injury.2025.112319. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic spinal injuries are a significant public health issue due to their high frequency and severity, impacting the entire healthcare system, especially when neurological sequelae are involved. These injuries require comprehensive resuscitative management, prioritizing spinal injuries within the context of associated injuries. Understanding the epidemiology of spinal fractures in polytraumatized patients is essential for improving care planning, primary prevention methods, and hospital management.

METHODS: This retrospective, single-center, observational study used the TRAUMABASE database from 2018 to 2022 to provide an epidemiological overview of polytraumatized patients with spinal fractures treated in a level I trauma center. Patients admitted to the Post-Anesthesia Care Unit (PACU) with at least one spinal fracture were included, excluding those with isolated transverse process fractures or incomplete clinical files. Data collected included demographics, injury mechanism, Injury Severity Score (ISS), type of spinal lesion, Glasgow Coma Scale (GCS), surgical management, length of hospital stay, and mortality.

RESULTS: From 2018 to 2022, 561 patients with spinal fractures in the context of polytrauma were treated, with 386 patient records analyzed after exclusions. The mean age was 43 years, with a majority being male (75.1 %). The main injury mechanisms were falls from height (47.7 %) and traffic road accidents (46.4 %). Spinal surgery was performed on 53 % of patients, with a mean delay of 2.8 days from trauma to surgery. The overall mortality rate was 14.8 %, with neurological impairment, higher age, higher ISS score, lower GCS score, and absence of spinal surgery as unfavorable prognostic factors. The mean cost of hospitalization per patients was 76.854 ± 53.719 euros [3.502; 65.6623].

DISCUSSION: This study highlights the severity of polytraumatized patients with spinal lesions, with a mean ISS score of 24.4 and frequent associated severe traumatic brain injuries. The main injury mechanisms were falls from height and traffic road accidents, with a high representation of self-inflicted injuries. Overall, the study provides valuable insights into the management and outcomes of polytraumatized patients with spinal injuries.

PMID:40203769 | DOI:10.1016/j.injury.2025.112319

Unmasking the subtle clues of hip dislocation: Air bubble and notching sign as CT-based indicators

Injury. 2025 Mar 24;56(6):112294. doi: 10.1016/j.injury.2025.112294. Online ahead of print.

ABSTRACT

BACKGROUND: Spontaneously reduced hip dislocation or reduced hip dislocation with a missing reduction history are challenge to the treating surgeon as the signs are usually subtle in such cases. The purpose of this study is to investigate and report on the incidence of the signs of femoral head notching and the presence of intracapsular air bubble in the computed tomography (CT) scans of hip dislocation cases in our center.

METHODS: Cases of traumatic hip dislocation, either without associated acetabular fractures or with acetabular fractures that did not require surgery from 2002 to 2021 were included retrospectively. Their CT scan films were analyzed to look for the presence and direction of femoral head notching and appearance of intracapsular air-bubble.

RESULTS: 30 hips with traumatic hip dislocation and 28 hips with acetabular posterior wall fracture without dislocation were included in this study. We noted notching on the femoral head in the CT axial scans of 23 of 30 hips (76.7 %). 17 cases of notching were noted in association with posterior dislocation, and there were 6 cases associated with anterior dislocation (p = 0.543). We observed intracapsular air bubbles in the CT scans of 28 of the 30 hips in our series (93.3 %). The sensitivity and specificity of notching sign were 56.7 % (95 % CI 37.4∼74.5 %) and 100 % (95 % CI 87.7∼100 %), respectively. For the bubble sign, the sensitivity and specificity were 90 % (95 % CI 73.5∼97.9 %) and 100 % (87.7∼100 %), respectively.

CONCLUSION: We recommend an early CT scan in patients presented with a history of suspected hip dislocation without an obvious finding on plain radiography. The presence of femoral head notching or intracapsular air-bubble would strongly suggest a history of hip dislocation.

LEVEL OF EVIDENCE: Diagnostic Level III, Retrospective cohort study.

PMID:40198971 | DOI:10.1016/j.injury.2025.112294

Open fractures of the lower leg: Outcome and risk-factor analysis for fracture-related infection and nonunion in a single center analysis of 187 fractures

Injury. 2025 Mar 25;56(6):112303. doi: 10.1016/j.injury.2025.112303. Online ahead of print.

ABSTRACT

BACKGROUND: Open fractures of the lower extremity have a higher risk of fracture-related infections (FRI) or nonunion. The purpose of this study was to identify risk factors for complications and evaluate outcomes.

METHODS: In this retrospective, single center study, we identified and included 187 patients with extraarticular and intraarticular fractures of the tibia or fibula between 2010 and 2018. Patient characteristics, treatment protocols, and complications were assessed, with a focus on soft tissue management and timing of wound closure versus fracture fixation. To analyze risk factors for FRI and nonunion, a univariate logistic regression model was used.

RESULTS: The open fractures included were 52 Gustilo-Anderson type-I (28 %), 99 type-II (53 %), and 36 type-III (19 %) fractures. The mean time from admission to first surgical intervention was 3.47 h (SD 1.4), with 122 (60 %) patients treated within 3 h and 182 (97 %) patients, within 6 h. During primary surgery, definitive fracture fixation was carried out in 112 (60 %) patients and wound closure in 122 (65 %) patients. FRI was reported in 27 (14 %) patients with the highest prevalence in type-III fractures (31 %). Secondary wound closure was associated with a significantly higher risk for FRI than primary wound closure (odds ratio [OR] = 3.3; p = 0.004). Nonunion was reported in 37 (20 %) patients. Significant risk factors for nonunion were FRI (OR=11.9, p < 0.001) and definitive fracture fixation before wound closure compared to fracture fixation and wound closure at the same time (OR = 8.2, p < 0.001). Gustilo-Anderson type-IIIb and -IIIc fractures had a significant lower FRI-free survival compared to other fractures. No patient underwent amputation during the follow-up.

CONCLUSION: Open fractures of the tibia and fibula are associated with a high risk of FRI and nonunion. FRI is the strongest predictor of nonunion in open fractures of the lower extremity. Primary wound closure and simultaneous definitive fracture fixation are protective even in higher Gustilo-Anderson fracture types and prevent complications. Early antibiotic therapy and surgical treatment are crucial, as evidenced by all cases receiving treatment within 6 h post trauma.

PMID:40198970 | DOI:10.1016/j.injury.2025.112303

Increasing incidences of acetabular, pelvic, and proximal femur fractures in The Netherlands

Injury. 2025 Apr 2;56(6):112322. doi: 10.1016/j.injury.2025.112322. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to investigate incidence rates of acetabular, pelvic, and proximal femur fractures in The Netherlands over a 10-year period (2012-2022). With an aging population, understanding trends in these osteoporotic fractures is essential for improving patient outcomes and guiding healthcare strategies.

METHODS: A retrospective cohort study was conducted using data from two national databases, forming a 'hospitalised' and an 'all patients' cohort. The study population included patients diagnosed with acetabular, pelvic, and proximal femur fractures in The Netherlands during the study period. Incidence rates were calculated per 100,000 person-years and linear regression was used to assess temporal trends. Age-adjustments were performed using Dutch population data from the Central Bureau of Statistics (CBS). Comparative analyses between the two cohorts were conducted to identify discrepancies.

RESULTS: A total of 283,991 patients were identified (12,020 acetabular, 70,595 pelvic and 201,376 proximal femur fractures). Of these patients, 159,563 were hospitalised (7123 acetabular, 24,192 pelvic, and 128,252 proximal femur fractures). Incidence rates of acetabular fractures increased by 26 % (hospitalised) and 98 % (all patients), while pelvic fractures showed stagnation in hospitalised patients (-0.13 %) but a 44 % rise in all patients. Proximal femur fractures increased by 5 % (hospitalised) and 15 % (all patients). Significant differences between the databases were noted across all fracture types.

CONCLUSION: The incidence of acetabular, pelvic, and proximal femur fractures has significantly increased in the last decade, most notably in acetabular and pelvic fractures. Furthermore, a shift toward out-patient treatment of acetabular and pelvic fractures was found. These findings highlight the need for improved fracture prevention and out-patient management strategies, while also underscoring the need for a nationwide registration for these injuries.

PMID:40198969 | DOI:10.1016/j.injury.2025.112322

A comparison of anterior ring fixation constructs in Young-Burgess lateral compression type 2 and 3 (LC2, LC3; AO/OTA 61-B2/B3) pelvic ring injuries: does fixation matter?

Injury. 2025 Apr 1;56(6):112320. doi: 10.1016/j.injury.2025.112320. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare outcomes of lateral compression LC2 and LC3 pelvic ring injuries when posterior ring fixation is applied and different anterior ring constructs are used.

METHODS: A retrospective analysis from two Academic Level I Trauma Centers of all operatively treated LC2 and LC3 (AO/OTA 61-B2/B3) pelvic ring injuries from January 2019-January 2024. A comparison of anterior ring constructs was made: no fixation vs. fixation; indirect fixation (external fixators and InFix)) vs. internal fixation; long vs. short percutaneous screws. Long percutaneous screws were defined as either bicortical bypassing all 3 Nakatani zones or bypassing the fracture by 2 Nakatani zones with intramedullary juxtacortical or bicortical finishing. A short screw was defined as all other screws, regardless of direction. Primary outcome measure was >1 cm of pelvic ring displacement from post-operative to final radiographs showing fracture healing with sufficient callus. Secondary outcomes were unplanned major reoperation, removal of implants or non-union repair, and other surgical complications.

RESULTS: 67 patients met inclusion criteria. Most were female (n = 35, 52 %), mean age was 48.3 (SD 21.7) and most injuries were LC3 (n = 39, 58 %). All cases had posterior ring fixation. Twelve (18 %) had no anterior ring fixation and there was a statistically higher rate of deformity compared with patients with anterior ring fixation (n = 55, 82 %) (58 % vs. 16 %, p = 0.005). Indirect fixation (n = 12, 18 %) had a statistically higher rate of deformity compared with internal fixation (n = 43, 64 %) (50 % vs. 7 %, p = 0.002). There was a statistically higher rate of deformity when a short percutaneous screw (n = 6, 9 %) rather than long screw was used (n = 26, 39 %) (50 % vs. 0 %, p = 0.004).

CONCLUSIONS: Routine anterior ring fixation in conjunction with posterior ring fixation is strongly encouraged for LC2 and LC3 injuries. A long percutaneously-applied anterior screw provides optimal stability to maintain reduction and prevent deformity.

LEVEL OF EVIDENCE: Therapeutic Level 3.

PMID:40198968 | DOI:10.1016/j.injury.2025.112320

Comparing the effects of curvilinear position and micromovement on prevention of intraoperative acquired pressure injuries among patients undergoing surgery in the supine position: A randomized controlled trial

Injury. 2025 Apr 5;56(6):112327. doi: 10.1016/j.injury.2025.112327. Online ahead of print.

ABSTRACT

BACKGROUND: Patients undergoing surgery are at significant risk of developing pressure injuries due to immobility and fixed positioning on the operating table, particularly during lengthy procedures. Therefore, implementing effective prevention strategies for pressure injuries should begin as early as the surgical phase. This study aims to compare the two methods of curvilinear position and micromovement in preventing pressure injuries among patients undergoing general surgery in the supine position.

METHOD: This was a double-blind, prospective, randomized, controlled trial conducted from October 2024 to January 2025. The study included a sample size of 120 patients randomly divided into three groups: control (n = 40), micromovement (n = 40), and curvilinear (n = 40). Skin assessments were conducted using the National Pressure Ulcer Scale immediately after surgery and again one day later.

RESULTS: A total of 114 patients were included in the analysis: 39 in the control group, 38 in the micromovement group, and 37 in the curvilinear group. A significant difference was found between the three groups regarding the incidence of pressure injuries (p < 0.05). However, there was no considerable difference regarding the location and stage of the pressure injury between groups (p > 0.05).

CONCLUSION: Micromovement and curvilinear supine position can significantly reduce the incidence of intraoperative acquired pressure injuries. Therefore, it is recommended that these methods be utilized as an effective intervention by the surgical team, especially for high-risk patients and those undergoing prolonged surgeries.

PMID:40194328 | DOI:10.1016/j.injury.2025.112327

Traumatic gallbladder injury and its treatment: Changing management of a rare injury

Injury. 2025 Apr 1:112313. doi: 10.1016/j.injury.2025.112313. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic gallbladder injury has historically been associated with high morbidity and mortality. Whether treatment patterns have changed over time as non-operative management has been adopted for abdominal trauma care remains unclear. We sought to evaluate trends in cholecystectomy as a treatment for traumatic gallbladder injury and estimate the association between operative or non-operative management of traumatic gallbladder injury and patient outcomes.

METHODS: Retrospective cohort analysis of the National Trauma Data Bank from 2007-2021 evaluating patients with traumatic gallbladder injury and determining whether they received no intervention, endoscopic retrograde cholangiopancreatography (ERCP), or cholecystectomy. The probability of a patient receiving cholecystectomy or operative intervention was evaluated with an adjusted multivariable logistic regression model. To estimate the effect of intervention choice on in-hospital mortality, length of stay, and intensive care unit (ICU) length of stay, an adjusted multivariable logistic regression model was used, treating the year as a fixed effect.

RESULTS: There were 6160 traumatic gallbladder injuries recorded from 2007-2021. 3909 (63.5 %) of these patients underwent some form of intervention (drainage or cholecystectomy), including 3722 (60.4 %) undergoing cholecystectomy. The odds of cholecystectomy compared to non-operative management were decreased in several, but not all, years of study as time progressed. There was no statistically significant difference in the odds of ERCP over time. Cholecystectomy was associated with decreased odds of in-hospital mortality (aOR 0.26, 95 % CI 0.22, 0.30; p < 0.001) and 16.5 % longer length of stay (coefficient 0.15, 95 % CI 0.10-0.20; p < 0.001) compared to non-operative management.

CONCLUSIONS: Cholecystectomy use for traumatic gallbladder injury has decreased from 2007-2021 without a concurrent increase in ERCP. Patients who underwent cholecystectomy had lower odds of mortality in adjusted models. The increasing use of non-operative management for traumatic gallbladder injury may carry greater risk to patients, and operative intervention should remain the standard of care.

PMID:40189437 | DOI:10.1016/j.injury.2025.112313

Trends in bicycle related injuries in children 0-9 years of age in an urban Danish population 1980-2023

Injury. 2025 Mar 26;56(6):112290. doi: 10.1016/j.injury.2025.112290. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of the study is to describe the development of bicycle related injuries over the last four decades among young children and to describe their role as a passenger or cyclist.

METHODS: Retrospective study of 7368 children aged 0-9 years that sustained a bicycle related injury in the period 1980-2023. Incidence rates (IR) where analyzed in three age groups; 0-2 years, 3-5 years and 6-9 years. Data was analyzed in regards to age, gender, severity of injury, usage of bicycle helmet and whether the child was a cyclist or a passenger on a bike.

RESULTS: Bicycle related injury accounted for 74.5 % of all traffic related injuries for children 0-9 years treated at Odense University Hospital, Denmark 1980-2023. There was a decrease in IRs for all age groups and both genders in the study period with an overall IR decrease by 69.0 %. The IR for major and minor injury decreased for all age groups and both genders with an overall decrease of 75.6 % and 84.8 %, respectively. In the study period, 85.0 % of children were injured as cyclists and 15.0 % as passengers.

CONCLUSIONS: The study showed a significant decrease in overall IR when stratifying by age, gender, injury severity and the role of the child as cyclist or passenger. The study provides useful information for future studies and campaigns regarding children's bicycle safety.

PMID:40188610 | DOI:10.1016/j.injury.2025.112290

Rib fixation in severe isolated chest trauma with pulmonary contusion: Rib fixation in pulmonary contusion

Injury. 2025 Apr 5;56(6):112292. doi: 10.1016/j.injury.2025.112292. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary contusion (PC) is considered a relative contraindication to surgical stabilization of rib fractures (SSRF). This study compared outcomes in patients undergoing SSRF vs. non-operative management (NOM).

METHODS: ACS-TQIP 2017-2020 was queried to identify patients with PC and severe chest wall injuries admitted to the intensive care unit (ICU). Outcomes included mortality, length of stay (LOS), and in-hospital complications. Subgroup analyses stratifying patients according to PC severity and institutional SSRF volume were performed. Multivariable logistic regression was used to adjust for confounders.

RESULTS: A total of 17,344 were included; 1789 (10.3 %) underwent SSRF, and 15,555 (89.7 %) did not. SSRF was associated with lower mortality (OR: 0.47, 95 % CI: 0.33-0.68, p < 0.001) but increased ventilator-associated pneumonia, tracheostomy, unplanned ICU admissions, and intubations. It was also associated with increased hospital LOS by 3.46 days (95 % CI: 2.94-3.98) and ICU LOS by 2.33 days (95 % CI: 1.99-2.68). Institutional volume above the median level of 7 SSRF cases was associated with reduced ventilator days by 1.3 days (95 % CI:2.54 to -0.05), hospital LOS by 1.7 days (95 % CI:2.58 to -0.82), and ICU LOS by 1.4 days (95 % CI:2.11 to -0.64), with no significant effects on other outcomes.

CONCLUSIONS: In patients with severe chest wall injury and PC, SSRF is associated with lower mortality at the expense of longer LOS.

PMID:40188608 | DOI:10.1016/j.injury.2025.112292

Board sport injuries among pediatric patients: A ten year epidemiologic analysis

Injury. 2025 Mar 26;56(6):112280. doi: 10.1016/j.injury.2025.112280. Online ahead of print.

ABSTRACT

BACKGROUND: Snowboarding, skateboarding, and water surfing have emerged as popular pediatric sports. While prior work has examined differences among some types of board sports in certain populations, no prior study has directly compared pediatric injury patterns in board sports with similar techniques but on different terrains. The aim of this study was to compare the frequency and severity of orthopedic and craniofacial trauma sustained by pediatric skateboarders, snowboarders, and surfers. These injury types were selected as they encompass the majority of board sport-related trauma, providing a broad overview of injury patterns across different terrains.

HYPOTHESIS: We hypothesized that pediatric skateboarders and snowboarders sustained more fractures and strains/sprains to the upper extremity, while pediatric surfers sustained more injuries to the head and neck.

METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for orthopedic and craniofacial trauma related to unpowered skateboarding, snowboarding, and surfing between 2014 and 2023. Annualized trends in injury type, injury location, and injury prevalence were examined over the study period and across sport type. Univariate analyses were utilized to compare injury characteristics and patient demographics across board sport cohorts.

RESULTS: NEISS case criteria identified an estimated 546,231 board sport injuries over the study period. Early-adolescent males were the most commonly injured cohort (76.0 %; CI: 73.8-78.2 %). Fractures to the upper extremity were the most common orthopedic injury among skateboarders (31.6 %; CI: 24.8-38.4 %) and snowboarders (45.7 %; CI: 38.9-52.5 %), while lacerations to the head and neck were the most common injury among surfers (24.5 %; CI: 22.0-26.95 %). Pediatric snowboarders sustained more upper extremity fractures and concussions, but sustained less trauma to the lower extremity.

CONCLUSIONS: Findings from this study indicate that pediatric board sport athletes sustain injuries that are analogous but unique. Upper extremity fractures are common in skateboarding and snowboarding. While surfing has a higher incidence of laceration injuries, snowboarding has a higher incidence of concussions but lower incidence of lower extremity injuries. It is important for healthcare personnel to be aware of these injury patterns, especially in settings where immediate healthcare is limited.

PMID:40187108 | DOI:10.1016/j.injury.2025.112280

Evaluation of topical vitamin k cream on repair of full thickness wound in diabetic rat

Injury. 2025 Mar 17;56(6):112081. doi: 10.1016/j.injury.2024.112081. Online ahead of print.

ABSTRACT

BACKGROUND: diabetic Wound is one of the most common complications throughout the world. .This experiment was conducted in order to study the effects of vitamin k cream on repair of full thickness wound in diabetic rat.

METHODS: 75 adult Male Wistar rats were randomly divided into five groups of equal numbers; each group consists of 15 animals. After diabetes induction, full thickness wound in the shape of 2.25 CM2 square was created on the back of the rats. Group one was not treated and served as control. The woud areas in the second, third and fourth groups were covered twice a day with phenytoin (PHT) cream,0.05 and 1 % vitamin k creams, respectively. Group five treated with eucerin(vichel group) The size of wound area were measured in the 1, 4, 7, 10, 14, 18 and 21 days after wound induction. and histopathological observation and tissue parameters (hydroxyprolin(HP), collagen, glutation(GSH), malondialdeid (MDA), superoxiddesmutase(SOD), glutation peroxidase(GPX), catalase(CAT),tumor necrosis factor alpha (TNF-α), interlukin 1 bata(IL-1β)) were analysed as onther indicators of wound healing on days of 7, 14 and 21.

RESULTS: the findings indicated that PHT and 1 % vitamin k creams significantly elevated HP and collagen in contrast with control group. furthermore, in all time points, the average wound size in PHT and 1 % vitamin k groups was significantly greater than other groups (P < 0.05). Also, PHT and vitamin K 1 % creams improved oxidative and inflammatory stress parameters at all times courses. Theses findings were confirmed by histological examination.

CONCLUSION: The findings showed that 1 % vitamin k creams have potential effects on wound healing. Vitamin K exerts this effect through its antioxidant and anti-inflammatory properties, as well as stimulating collagen synthesis.

PMID:40187107 | DOI:10.1016/j.injury.2024.112081

Infectious complications after traumatic spine injury requiring surgery in a French level-1 trauma center: An observational study

Injury. 2025 Mar 30;56(6):112305. doi: 10.1016/j.injury.2025.112305. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic spine injury (TSI) is a prevalent condition that often requires surgical intervention. Two serious infectious complications after surgery are surgical site infections (SSI) and lower respiratory tract infections (LRTI). Yet, studies on SSI and LRTI on trauma patients, particularly with a specific focus on microbiology are lacking. The primary aim of this study is to investigate the prevalence rate of early SSI, occurring within one month of surgery or three months when instrumented, and LRTI in level-1 trauma center patients requiring surgery after TSI.

METHODS: This monocenter retrospective observational study was conducted at an academic level-1 trauma center, including patients with TSI requiring surgery. Data on patients' baseline characteristics, trauma related information, initial and intra-operative management, infectious complications data and hospitalization outcomes were collected. The two primary outcomes were the prevalence of early SSI and LRTI. Secondary outcomes included the identification of factors associated with developing these infections, analysis of identified organisms, and assessment of clinical outcomes.

RESULTS: A total of 2606 patients were screened between May 2018 and October 2022, 194 were included. Most of them were polytrauma patients defined by Injury Severity Score ≥ 16 (71 %). Early SSI occurred in 20 patients (10 %) and LRTI occurred in 58 patients (30 %). The number of vertebral levels instrumented (odds ratio [OR] 1.24, 95 % confidence interval [95 % CI] 1.01-1.52) was associated with SSI. The causative organisms were predominantly Gram-positive cocci (19/36 identified organisms). Factors associated with LRTI were an injury severity score ≥ 25 (OR 7.41; 95 % CI, 3.28-17.99), spinal injury at levels C3-C7 (OR 2.24; 95 % CI 1.01-5.14) and antibiotics during initial management (OR 7.09; 95 % CI, 2.71-20.49). The causative organisms were predominantly Gram-negative bacilli (58/80 identified organisms). Patients with LRTI experienced longer hospital stays, extended durations of mechanical ventilation, and higher mortality rates at 30 days and one year than those without.

CONCLUSION: Early SSI and LRTI are underestimated complications in severe trauma patients with TSI requiring surgery. Identifying risk factors and causative organisms is an important step for advancing research on targeted prevention and treatment of SSI and LRTI after trauma.

PMID:40187106 | DOI:10.1016/j.injury.2025.112305

Ten-year patterns of emergent concussion injuries among various martial arts disciplines

Injury. 2025 Mar 25;56(6):112289. doi: 10.1016/j.injury.2025.112289. Online ahead of print.

ABSTRACT

BACKGROUND: Martial arts participation appears to be increasing in the US, and along with benefits to health and wellbeing, the sport carries musculoskeletal and neurological injury risks which differ among disciplines. Evidence is limited regarding the burden of concussion injuries in many martial arts disciplines, particularly among female athletes and outside of competitions. The purposes were: 1) to characterize injury patterns over 2013-2022 for concussion injuries treated in emergency departments (ED) related to martial arts; and 2) to compare the number of concussions by mechanism, circumstance, sex and martial art discipline.

METHODS: This was a retrospective, epidemiological study of National Electronic Injury Surveillance System (NEISS) data from patients who sought ED care for martial arts-related concussions (N = 581; 29.1 % female). Annual concussion case numbers compared over time and by sex using linear regression. Concussion case numbers were compared by major discipline (Karate, Jiu-Jitsu, Taekwondo, Mixed martial arts [MMA], kickboxing, Judo, and other forms) and sex. Mechanisms (fall, kicked, tackled/thrown, punched-hit-struck, weapon, unspecified) and circumstances (practice, competition) were compared by discipline and sex.

RESULTS: Regressions indicated that year or sex were significant contributors to annual concussion case numbers (both p>.05). The number of concussions was highest for Karate for males (p < .05). A greater proportion of cases occurred in males than females in MMA, Taekwondo, Jiu-Jitsu, and other forms (p = .031). Falls and being punched-hit-struck were the most commonly-documented mechanisms of concussion (23 % and 20 %, respectively). For females, more concussions were incurred during competition for Judo and Taekwondo than in other disciplines (p = .002). For males, more concussions occurred in class/practice with Judo and Karate than in other disciplines (p = .018). 96.4 % of cases were treated and released, and 3.1 % were hospitalized.

CONCLUSION: Since 2020, the concussion burden in martial arts has grown, particularly among males, which may be related to overall greater participation in the sport, especially karate and other forms. Prospective injury surveillance, better uptake of safety gear and implementation of skills risk into routine sport participation that minimize head injury, and careful documentation of injury circumstance could help advance martial arts safety.

PMID:40187105 | DOI:10.1016/j.injury.2025.112289

A review of recent advances in tissue engineering scaffolds for meniscus repair

Injury. 2025 Mar 26;56(6):112283. doi: 10.1016/j.injury.2025.112283. Online ahead of print.

ABSTRACT

The meniscus, a critical load-bearing structure between the femur and the tibia, plays a key role in the functioning of the knee joint by distributing mechanical stress and minimizing friction. A brief overview of the anatomical characteristics and biomechanical functions of the meniscus is provided in this review, followed by a discussion of recent developments in tissue engineering scaffolds for meniscus repair over the past five years. The classification of scaffolds is based on the materials with an analysis of their respective advantages and limitations. The challenges associated with meniscal tissue engineering are summarized and potential research directions are proposed to guide the development of more effective regenerative strategies.

PMID:40184758 | DOI:10.1016/j.injury.2025.112283

Health behavior, health, and socioeconomic background in adolescence as risk factors for traumatic brain injuries: A longitudinal study

Injury. 2025 Mar 23;56(6):112293. doi: 10.1016/j.injury.2025.112293. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic brain injuries (TBI) are a considerable health burden on adolescents and young adults. This study aims to assess the influence of health compromising behavior, poor perceived health, poor school success, and low family socioeconomic background during adolescence on subsequent TBI in a large cohort of Finnish adolescents with an average 25-year follow-up.

MATERIALS AND METHODS: Baseline Finnish Adolescent Health and Lifestyle survey data gathered biennially (1981-1997) was linked with the diagnosis of subsequent TBI from the Finnish Care Register for Health Care. A structural equation modeling (SEM) was used to analyze the associations between health behavior, poor perceived health, poor school success, and low family socioeconomic background during adolescence on subsequent TBI.

RESULTS: Total of 41 336 persons were included in the analyses. During the follow-up, 1 459 (3.5 %) TBIs occurred. Men were more likely to suffer a TBI. The mean follow-up time was 25.3 years (SD 4.0) and the mean age at the time of TBI was 32.1 years (SD 7.7). Health compromising behavior and not living with both parents in adolescence were associated with the increased risk of TBI. Also, poor perceived health and stress symptoms increased the risk of TBI. Low family socioeconomic status (SES) was only indirectly associated with TBI trough health compromising behavior.

CONCLUSION: The main finding was that health compromising behavior was associated with TBI, and low family SES was associated with TBI through health compromising behavior in later life. Poor perceived health, stress symptoms, and not living with both parents in adolescence increased the risk of TBI, too. Our findings suggest that adolescents who are at risk of drifting into health compromising behavior and report stress symptoms have an increased risk of TBI in later life.

PMID:40168891 | DOI:10.1016/j.injury.2025.112293

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