Injury. 2025 Oct 15:112821. doi: 10.1016/j.injury.2025.112821. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to assess the impact of the on-scene time interval on survival in traumatic out-of-hospital cardiac arrest (TOHCA) patients and to determine the threshold for the optimal on-scene time interval.

METHODS: We analyzed TOHCA patients aged >15 years in South Korea from January 2019 to December 2021. The on-scene time interval was defined as the duration spent at the scene, from emergency medical service (EMS) arrival at the scene to departure for the hospital. The primary outcome was survival to discharge. Mixed-effects logistic regression analysis was performed to assess the impact of the on-scene time interval on the outcome, adjusting for demographic variables and Utstein factors. We also performed a restricted cubic spline analysis to determine the optimal on-scene time interval associated with survival to discharge.

RESULTS: A total of 6106 TOHCA cases were included, with a survival to discharge rate of 3.7 %. Each 1 min increase in the on-scene time interval was associated with a 2 % decrease in the odds of survival to discharge (adjusted odds ratio [aOR]: 0.98, 95 % confidence interval [CI]: 0.96-0.99). The restricted cubic spline analysis showed a decrease in the odds of survival to discharge after 10 min of on-scene time interval. Additionally, TOHCA patients with on-scene time ≥20 min had a 51 % lower probability of survival to discharge compared to those with <10 min (aOR: 0.49, 95 % CI: 0.27-0.89).

CONCLUSION: A prolonged on-scene time interval has a negative impact on survival to discharge in TOHCA patients. Specifically, the probability of survival to discharge declined after 10 min on scene and was substantially lower when the interval exceeds 20 min.

PMID:41145320 | DOI:10.1016/j.injury.2025.112821

Injury. 2025 Oct 15;56(12):112810. doi: 10.1016/j.injury.2025.112810. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to retrospectively evaluate musculoskeletal injuries, clinical follow-ups and treatments of trauma patients admitted to our hospital after the 2023 Lattakia earthquakes and to analyze pelvic ring and acetabulum injuries.

PATIENTS AND METHODS: A total of 468 patients were admitted to our hospital. Of them, 235 who did not meet the inclusion criteria were excluded and a total of 233 trauma patients (113 males, 120 females; mean age: 32.2 ± 20.3 years; range, 6 to 94 years) affected by the earthquake were recruited. Age, sex, presence of orthopedic consultation, diagnosis of open/closed fracture, diagnosis of dislocation, presence of soft tissue injury, additional systemic injuries, neurovascular examination status, presence of compartment syndrome, conservative/surgical interventions.

RESULTS: The mean age of the patients was 32.2 ± 20.3 years. 120 were female, and 113 were male. In 13 patients, musculoskeletal injuries with additional system injuries were observed and evaluated as multiple injuries. In 15 patients, fractures were observed in more than one region and were evaluated as multi-trauma. 53 % had soft tissue injuries, 33.4 % had closed fractures, 6.4 % had other system injuries, 3.8 % had crush injuries, 2.1 % had nerve injuries, 0.8 % had compartment syndrome, 2.5 % had vascular injury, 2.1 % had dislocation, and 5.5 % had an open fracture.

CONCLUSIONS: The most common injuries due to high-energy trauma are isolated soft tissue injuries and fractures. The definition of the demographic characteristics and clinical outcomes of earthquake patients is critical to the development of preparedness, response, and recovery policies for future disasters.

PMID:41145024 | DOI:10.1016/j.injury.2025.112810

Injury. 2025 Oct 15;56(12):112813. doi: 10.1016/j.injury.2025.112813. Online ahead of print.

ABSTRACT

OBJECTIVE: Autograft application is the gold standard in the treatment of peripheral nerve damage, but alternative graft materials are needed. This study examines the effects of bacterial cellulose (BC) graft and vascular endothelial growth factor (VEGF) impregnated in bacterial cellulose graft on peripheral nerve repair.

METHODS: Bacterial cellulose derived from Gluconacetobacter xylinus cell culture was impregnated with 0.2 µm/ml VEGF and formed into conduits. Unilateral 8 mm sciatic nerve defect was created in Wistar rats (n = 18). Rats were divided into three groups as autograft (n = 6), BC/Cs (n = 6) and VEGF-BC/Cs (n = 6). Gait analysis and electromyography (EMG) measurements were performed at the end of the 8th week. Sciatic nerve tissues were taken for histological analysis. Myelinated axon numbers and vascular structures were examined in sections stained with toluidine blue under a light microscope.

RESULTS: According to the sciatic function index obtained from gait analysis and the EMG measurements, at the end of the 8th week, both graft groups obtained similar results to the autograft group. Analyses of myelinated axon counts, axon diameters, and myelin sheath thickness revealed similar results between the autograft and VEGF-BC/Cs groups. Examining the quantity of vessels and their diameters, the VEGF-BC/Cs group showed a significantly higher number of vessels than the other groups (p < 0.0001).

CONCLUSION: In the treatment of peripheral nerve injury, the application of VEGF-BC/Cs gave functional and histologically similar healing results to autograft. The positive effect of VEGF application on nerve regeneration was also observed by increasing the formation of new vessels.

PMID:41138332 | DOI:10.1016/j.injury.2025.112813

Int Orthop. 2025 Oct 25. doi: 10.1007/s00264-025-06680-4. Online ahead of print.

ABSTRACT

PURPOSE: Sleep disturbance is common in patients with rotator cuff tear arthropathy (RCTA). While reverse shoulder arthroplasty (RSA) is effective for improving pain and function, its effect on sleep quality (SQ) has not been well defined. This study aimed to evaluate the impact of RSA on SQ, recovery trajectory, and clinical outcomes.

METHODS: This retrospective study included patients with RCTA who underwent RSA between 2014 and 2021 with a minimum follow-up of 24 months. SQ and clinical outcomes were assessed using the Visual Analog Scale (VAS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Pittsburgh Sleep Quality Index (PSQI), and Jenkins Sleep Scale (JSS). Preoperative and postoperative values were compared to evaluate changes over time.

RESULTS: Forty-six patients (mean age, 68 years) with a mean follow-up of 5.7 years were included. Sleep disturbance was reported by 45.7% of patients preoperatively, decreasing to 26.1% at three months and 21.7% at the last follow-up (p < 0.001). Median PSQI scores improved from 6 preoperatively to 5 at three months and remained stable thereafter. The mean ASES score increased from 40.2 preoperatively to 62.2 postoperatively (p < 0.001), and the average VAS score decreased from 6.0 to 2.0 by six months (p < 0.001).

CONCLUSION: RSA leads to improvements in sleep and function in RCTA patients, though gains plateau with time. Future studies using objective sleep measures may further refine rehabilitation outcomes.

PMID:41137888 | DOI:10.1007/s00264-025-06680-4

Injury. 2025 Oct 20:112840. doi: 10.1016/j.injury.2025.112840. Online ahead of print.

ABSTRACT

BACKGROUND: Physiotherapists have a vital role in the assessment and management of patients with blunt mechanism chest wall injuries (CWI). Physiotherapy interventions focus on the prevention of both early and late complications and the promotion of functional rehabilitation. The aim of this study was to examine the experiences of physiotherapists, healthcare professional (HCP) stakeholders and patients/carers to develop deeper understanding of the role and capabilities required by physiotherapists when caring for patients with blunt mechanism CWI.

METHOD: Qualitative focus groups were run with physiotherapy, HCP stakeholders and patients/carers following a pre-designed topic guide. Focus groups explored participants' experience of physiotherapy care in relation to blunt mechanism chest wall injuries. Data analysis followed Braun and Clarke's Reflexive Thematic Analysis process, and the Dreyfus model of adult skill acquisition was applied as a theoretical model to support the analysis process.

RESULTS: Seven focus groups were run with 41 participants (26 physiotherapist participants, 8 HCP stakeholder participants, and 7 patient/carer participants), between November 2024 and January 2025. Four main themes were identified from the data, including (i) Recognising clinical patterns and complexity, (ii) Applying clinical decision making to patient care, (iii) The role of experiential learning in shaping expertise, and (iv) Modelling effective interprofessional working strategies. Using these data, a framework of practice domains was formed. The results of this study will form the foundation of a new competency assessment tool that can be used by physiotherapists caring for patients with blunt mechanism chest wall injuries.

CONCLUSIONS: These findings have provided deeper insights into the role of the physiotherapist in the management of patients with blunt mechanism chest wall injuries. The study also demonstrates the importance of clinical experience in safe clinical decision making, and the need for capabilities that are relevant for both novice and expert physiotherapy practice.

PMID:41136264 | DOI:10.1016/j.injury.2025.112840

Injury. 2025 Oct 20;56(12):112836. doi: 10.1016/j.injury.2025.112836. Online ahead of print.

ABSTRACT

BACKGROUND & OBJECTIVES: Personal values have undergone rapid transformations, resulting in a generational clash between traditionalist values and contemporary values. We hypothesized that understanding the personal values of younger physicians will help reduce conflicts and define new medical education strategies focused on their interests and lifestyle. The primary aim of this study was to examine the associations among those in training and junior orthopaedic surgeons' self-reported values using the Rokeach Value Survey. As a secondary aim, we sought to compare these findings with those of a cohort of orthopaedic surgeons from four generations.

METHODS: A cross-sectional survey study using the Rokeach Values Survey (RVS) was performed. The RVS was distributed electronically via email and through the social network Instagram to 270 orthopaedic surgeons and orthopaedic residents and fellows from Baby Boomers, Generation X, Generation Y, and Generation Z. The distribution was based on the number of previously identified members of each generation from the orthopaedic departments of five institutions taking part in this study. The exclusion criteria were no response from both value sets, no response from either value set, or graduate medical students. Descriptive analysis and multiple comparison tests were used to analyze the order of importance for the values between the generations.

RESULTS: Of the 270 potential participants invited, 236 (87.4 %) respondents, 207 (87.7 %) men and 29 (12.3 %) women, were included. There were 52 (22 %) generation Z respondents (response rate, 65 %), 74 (31.4 %) generation Y respondents (response rate, 92.5 %), 60 (25.4 %) generation X respondents (response rate, 100 %), and 50 (21.2 %) Baby Boomers respondents (response rate, 100 %). The mean age of Generation Z participants was 24.9 years, ranging from 23.2 to 26.0 years, the mean age of Generation Y participants was 36.6 years, ranging from 27.2 to 43.6 years, the mean age of Generation X participants was 50.8 years, ranging from 44.6 to 58.2 years, and the mean age of Baby Boomer participants was 65.5 years, ranging from 59.9 to 72.9 years. Overall, younger generations (Y and Z) presented significant differences in self-reported values compared with Baby Boomers and Generation X.

CONCLUSIONS: In our study, we found that the younger generations presented greater ambition, cheerfulness, courage, independence, and desire for a comfortable and exciting life; and lower imagination, politeness, honesty, forgiveness, and interest in wisdom and true friendship. Our findings may provide more insight for managing age-related conflicts, encouraging balance and respect, and developing skills and strategies to promote effective learning and teaching.

PMID:41135431 | DOI:10.1016/j.injury.2025.112836

Injury. 2025 Oct 15;56(12):112819. doi: 10.1016/j.injury.2025.112819. Online ahead of print.

ABSTRACT

Fertility preservation in males with spinal cord injuries (SCI), pelvic trauma, traumatic brain injury (TBI), and other trauma-related conditions that impact male fertility and sexual function represents a crucial yet underexplored aspect of trauma medicine. These injuries can severely impair sperm quality, hormonal balance, and reproductive potential due to direct physiological damage and secondary effects, such as erectile and ejaculatory dysfunction. This review outlines the mechanisms by which these injuries impact fertility, examines the timeline of potential sperm quality deterioration, and evaluates both acute and chronic management strategies, including sperm retrieval techniques. In this context, the importance of early fertility counseling and timely cryopreservation is emphasized as a means to mitigate long-term impacts on quality of life, while a multidisciplinary approach-encompassing surgical, hormonal, and psychological interventions-is essential to optimize reproductive outcome. We highlight two key opportunities for intervention that trauma teams should consider: an early-stage andrologist consultation to assess fertility preservation options, and a later-stage consultation to address the frequent risk of sexual dysfunction. These simple steps-early sperm cryopreservation and follow-up for erectile and ejaculatory function-can meaningfully improve reproductive and psychosocial outcomes. By synthesizing current evidence, this article underscores the need for targeted research and standardized protocols to support fertility preservation in male trauma patients-an aspect of care that deserves greater attention given the potential of simple, timely actions to improve quality of life.

PMID:41135430 | DOI:10.1016/j.injury.2025.112819

Injury. 2025 Oct 13;56(12):112801. doi: 10.1016/j.injury.2025.112801. Online ahead of print.

ABSTRACT

AIM: Comminuted radial head fractures pose technical challenges regarding visualisation and access for anatomical reduction and fixation. The traditional lateral 'window' approaches (Kocher, Kaplan and EDC split) can, at times, offer limited views and a more extensive exposure can be beneficial in comminuted patterns (Mason II/III). We present a lateral epicondyle osteotomy as an alternative for unobstructed views of the radial head to utilise for open reduction and internal fixation (ORIF).

METHODS: The patient is positioned supine with the operative arm on an arm board. A standard lateral skin incision centred over the radial head and lateral epicondyle is utilised. Both the Kaplan and Kochers interval are opened through deep dissection and the annular ligament is released. The lateral epicondyle is exposed using sharp dissection and a drill hole is made (for subsequent lag screw) either angled anteriorly to the coronoid fossa or posteriorly to the olecranon fossa. A chevron osteotomy is completed around the drill hole and the bone block along with attached common extensor origin and LUCL reflected distally to expose the radial head. The fracture stabilisation can then be performed and the osteotomy reduced and compressed through the pre drilled orientation. 2 cases are used to describe the use of a lateral epicondyle osteotomy for varied fracture patterns.

RESULTS AND CONCLUSIONS: In our experience the radial head is exposed with an unobscured exposure. All performed osteotomies have healed with good post operative DASH scores (average 31.65). No removal of metalwork has been required and patient satisfaction has been rated as high. Previously no literature has described the lateral epicondyle osteotomy in detail for accessing the radial head. Using our experience, through a lateral epicondyle osteotomy one can achieve a clear visualisation of the radial head and its articular surface without the need to strip fragments of its periosteum and blood supply, avoiding the need for removal and 'back table' reconstruction. It also prevents the need to detatch the LUCL complex and offers a more robust reconstruction with a reliable healing potential through an osteotomy.

PMID:41135429 | DOI:10.1016/j.injury.2025.112801

Injury. 2025 Oct 20:112835. doi: 10.1016/j.injury.2025.112835. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic brachial plexus injuries (TBPIs) are severe, life-altering injuries associated with significant functional impairment. While previous studies have highlighted mechanisms of injury, there is limited research on the geographical and socioeconomic factors influencing TBPI incidence. This study examines TBPI patterns across England and Wales, identifying demographic risk factors and geographic "hotspots".

METHODS: A retrospective cohort study was conducted using data from the Trauma Audit and Research Network (TARN) and the STATS-19 road traffic accident database from January 2010 to March 2022. Patients with confirmed TBPIs meeting TARN inclusion criteria were analysed. Cases were categorised into vehicular collisions (VCs) and non-vehicular injuries (NVIs). Key variables included age, sex, injury mechanism, Index of Multiple Deprivation (IMD) scores, and urban-rural classification. Geographic distribution was assessed to identify high-incidence regions.

RESULTS: A total of 1003 TBPI cases were identified: 601 (60 %) vehicular and 402 (40 %) non-vehicular related injuries. VC TBPIs were more frequent in young males (median age: 35 years), whereas NVIs occurred more in older females (median age: 63 years), mainly due to falls <2 m. Higher IMD scores were associated with penetrating injuries. Urban "hotspots" for penetrating injuries included cities in Greater London, Greater Manchester, and West Yorkshire.

DISCUSSION: This study describes geographic and socioeconomic patterns of TBPIs across England and Wales. Although less frequent than other trauma entities, TBPIs carry a high per-patient burden due to upper-limb paralysis and neuropathic pain, with substantial indirect costs. The identification of demographic profiles and regional clustering provides an epidemiological baseline to inform clinicians and major trauma services.

PMID:41130884 | DOI:10.1016/j.injury.2025.112835

Injury. 2025 Oct 11;56(12):112806. doi: 10.1016/j.injury.2025.112806. Online ahead of print.

ABSTRACT

INTRODUCTION: The mortality rate for tibial shaft fractures in the elderly is comparable to that of hip fractures, yet there is considerable variation in their management. Operative treatment allows for earlier weight-bearing and reduces potential complications of prolonged immobilization; however, it carries risks for this comorbid cohort. The main objective of this study was to assess the difference in 1-year mortality between operative and non-operative management.

METHODS: A multicentre study was conducted across six trusts in England, including eight acute hospitals: three major trauma centres and five district general hospitals (DGHs). Data were collected retrospectively, covering a 5-year period from January 2017 to December 2021. The study included all patients aged 65 and over with diaphyseal tibial fractures (AO42). Patients with non-acute (>3 weeks), periprosthetic, pathological, or multiple lower limb fractures were excluded.

RESULTS: A total of 171 patients were identified, comprising 38 % males and 62 % females. Of these, 59.6 % were managed operatively, while 40.4 % were managed non-operatively. The median length of stay was similar between groups (8 days non-operative vs. 8.5 days operative, p = 0.87). Non-union (21.7 % vs. 6.3 %, p < 0.001) and malunion rates (27.7 % vs. 4.6 %, p = 0.001) were significantly higher in the non-operative group. One-year mortality was also higher in the non-operative group (38.3 % vs. 12.1 %, p < 0.001). Univariate and multivariate analyses showed an odds ratio of 4.5 and 4.7 for one-year mortality with non-operative treatment, with p-values of <0.001 and 0.005, respectively.

CONCLUSION: This study demonstrated that non-operatively treated tibial shaft fractures in the elderly are associated with significantly higher rates of non-union, malunion, and 1-year mortality. Therefore, we recommend an expedited multi-disciplinary approach to managing these patients, including surgical treatment and unrestricted weight bearing where possible, to optimize outcomes.

LEVEL OF EVIDENCE: Level III.

PMID:41130139 | DOI:10.1016/j.injury.2025.112806

Injury. 2025 Oct 22;56(12):112804. doi: 10.1016/j.injury.2025.112804. Online ahead of print.

NO ABSTRACT

PMID:41130138 | DOI:10.1016/j.injury.2025.112804

Injury. 2025 Oct 17;56(12):112834. doi: 10.1016/j.injury.2025.112834. Online ahead of print.

ABSTRACT

BACKGROUND: Femoral neck fractures are significant injuries, often seen in the elderly and less commonly in patients younger than 65 years old. If internal fixation is preferable and feasible, many options for cannulated screw orientation exist. One of the standard approaches remains three screws in a parallel trajectory and inverted triangle formation. It is hypothesized that the diverging constructs are non-superior biomechanically to the parallel configuration when treating moderate Pauwels angle, transcervical femoral neck fractures.

METHODS: This study used 32 identical femur models (16 parallel trajectory, 16 diverging) representing healthy bone. A fracture with Pauwel's angle of 40 degrees was created for all femurs, and a 3D printed guide was utilized for screw placement for both parallel and divergent screw trajectories. Torsional stiffness, axial stiffness, and axial load to failure were tested for both screw trajectories. The models were examined immediately after testing for anatomical points of failure. Statistical analysis included two-tailed t-tests and Fisher exact testing.

RESULTS: Thirty femurs were included for final analysis. One model from each group exceeded the testing machine's limits and was excluded. Parallel screws demonstrated significantly greater axial stiffness compared to the diverging screws (431 N/mm ± 45 N/mm vs 367 N/mm ± 104 N/mm, respectively, p = 0.032). No significant difference was found between torsional stiffness and axial load to failure between the parallel and diverging screws (6.36 Nmm/deg ± 2.46 Nmm/deg vs 6.69 Nmm/deg ± 2.14 Nmm/deg, respectively, p = 0.691) (4461 N ± 402 N vs 4095 N ± 601 N, respectively, p = 0.063). No one failure mode occurred more often when comparing the two groups (p > 0.05).

CONCLUSION: Parallel trajectory of cannulated screws in moderate Pauwels angle femoral neck fractures is biomechanically superior to diverging trajectory of cannulated screws. With widely available guides for consistent placement and reproducibility of parallel screws, this clinically feasible and efficient screw trajectory can most likely be relied upon for robust femoral neck fracture fixation.

LEVEL OF EVIDENCE: Controlled laboratory study.

PMID:41130137 | DOI:10.1016/j.injury.2025.112834

Injury. 2025 Oct 17;56(12):112829. doi: 10.1016/j.injury.2025.112829. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical efficacy of the bone transport with locking plate (BTLP) technique, which combines an external fixator and a locking plate for the treatment of infected bone defects in the lower extremities, within the induced membrane.

METHODS: A retrospective analysis was conducted on patients with infected bone defects of the F4 type according to the new FRI classification in the lower extremities treated at our hospital between July 2018 and September 2022. The treatment protocol was divided into two stages. In the first stage, debridement was performed, the bone defect was fixed with plate and filled with antibiotic-loaded cement to induce membrane formation. In the second stage(8 weeks later), removal of the bone cement and BTLP technique was applied within the induced membrane for bone transport to repair the defect. Outcomes, including infection control rate, bone union rate, and complications, the clinical efficacy were assessed using the Paley scoring system.

RESULTS: A total of 90 patients were included in this study, with 41 cases involving the tibia and 49 cases involving the femur. After an average follow-up of 20.5 months, infection recurrence was observed in 13 cases (14.4 %). Among these, 76.9 % of the recurrent infections did not affect bone healing and were controlled after removal of the internal fixation. The final infection control rate was 96.7 %, two patients with severe infection could not achieve control, and one underwent amputation. The initial bone union rate was 93.3 %, with an average union time of 7.8 months after bone transport completion. The final bone union rate was 95.6 %. The average external fixation index (EFI) was 16.3 days/cm. The average Visual Analogue Scale (VAS) score for the femur was higher than that of the tibia. Complications include the pin-tract leakage and skin inflamed for the femur was higher than that of the tibia. Functional outcomes were significantly better in the tibia compared to the femur.

CONCLUSION: The BTLP technique within the induced membrane is an effective method for the treatment of infected bone defects. However, attention should be given to the relatively high incidence of complications and the adverse effects on joint function when applied to the femur.

PMID:41130136 | DOI:10.1016/j.injury.2025.112829

Injury. 2025 Oct 14;56(12):112811. doi: 10.1016/j.injury.2025.112811. Online ahead of print.

ABSTRACT

Minimally invasive reduction of lateral compression type 2 (LC-2) pelvic ring fractures is not well described [1]. While the gold standard remains open reduction and internal fixation with plates and screws, this technique is associated with notable risks, including significant blood loss, nerve injury, wound dehiscence, and postoperative infection [1-3]. A minimally invasive technique of fracture reduction and fixation for LC-2 fractures is presented, with emphasis on imaging to visualize realignment of the reduced ilium.

PMID:41130135 | DOI:10.1016/j.injury.2025.112811

Injury. 2025 Oct 17;56(12):112833. doi: 10.1016/j.injury.2025.112833. Online ahead of print.

ABSTRACT

BACKGROUND: Tranexamic acid (TXA) is an established method of reducing blood loss during total hip arthroplasty (THA). Despite many randomized controlled trials (RCTs) examining its use, the optimal dose and route of administration of TXA in THA remain up for debate. Therefore, this study aimed to determine the robustness of RCT findings in this field by applying statistical fragility methodology, including fragility index (FI) and fragility quotient (FQ) calculations.

METHODS: Embase, MEDLINE, and Pubmed were searched for RCTs examining the dose, administration, or the pairing of TXA with another drug in THA. All dichotomous outcomes were extracted, for which the FI and FQ were calculated. The FI was found by determining the number of event reversals required to flip an outcome's statistical significance, and was then divided by sample size to yield the FQ.

RESULTS: Literature review yielded 25 RCTs totaling 73 outcomes. Across all outcomes, the median FI was 4.0, with an associated median FQ (mFQ) of 0.047. There were 12 statistically significant outcomes reporting a mFQ of 0.020, while the remaining 61 outcomes were deemed insignificant (mFQ = 0.049). 22 outcomes pertained to blood/platelet transfusion (mFQ = 0.033), 10 outcomes involved thromboembolic events (mFQ = 0.062), 12 outcomes described cases in which additional drugs were required after TXA administration (mFQ = 0.020), and 29 outcomes described other adverse events (mFQ = 0.049).

CONCLUSION: The results of RCTs examining the administration of TXA in THA were statistically fragility, resulting in a median FQ of 0.047. Outcomes reporting significance and those studying the need for additional drugs after TXA administered were particularly fragile. Thus, this study recommends RCTs report fragility statistics in combination with P-values and demonstrates that TXA administration in THA may warrant further level I evidence research.

PMID:41130134 | DOI:10.1016/j.injury.2025.112833

Injury. 2025 Oct 17;56(12):112832. doi: 10.1016/j.injury.2025.112832. Online ahead of print.

ABSTRACT

OBJECTIVES: To analyze outcomes of posterior wall acetabular fracture fragments fixed with the Synthes non locking 5 hole hind/midfoot plates (H-plates) in comparison to previously described methods. The hypothesis is that H-plates provide comparable outcomes to other fixation methods.

METHODS: DESIGN: Retrospective review SETTING: Level 1 Trauma Center (2018-2023) PATIENT SELECTION CRITERIA: Adult patients with an acetabular fracture (AO/OTA 62) that underwent open reduction and internal fixation (ORIF) of a posterior wall component with free screws, spring plates or H plates. Patients with <3 months follow up were excluded.

OUTCOME MEASURES AND COMPARISON: Primary outcomes included conversion to total hip arthroplasty (THA), revision ORIF, all other reoperations, and dislocations. Secondary outcomes included surgical site infection (SSI) and mortality. Outcomes were compared between fixation with H plate, Spring plate and screws.

RESULTS: Of 343 patients, 102 (29.7 %) had fixation of posterior wall fracture components with H plates. The average age was of 38.7 (18-84), with 69.7 % being males and follow up of 250 days (90-972). When comparing H plates with all other fixation methods there were no significant differences with regards to rates of THA conversion (5.9 % vs 11.6 %, P = 0.104), revisions (0 vs 0.8 %, P = 0.356) or reoperations (3.9 % vs 4.1 %, P = 0.922). When comparing H plates, spring plates, and independent screws as separate groups for fixation, THA conversion rate was lower with H plates (5.3 % vs 16.7 % vs 10.4 %, P = 0.042). Revision fixation (0.0 % vs 0.0 % vs 1.9 %;p = 0.017) and reoperations (4.2 % vs 4.4 % vs 2.8 %, P = 0.810) were not significantly different. Age (OR1.105, p < 0.001), spring plate (OR 11.63, p < 0.001 and free screw use (OR 4.2, p = 0.028) increased risk for THA conversion.

CONCLUSION: H-plate use was associated with lower rate of conversion to total hip arthroplasty compared to other fixation options. Future prospective research should focus on evaluating the outcomes of different fixation choices for acetabular fractures with posterior wall components.

LEVEL OF EVIDENCE: III.

PMID:41130133 | DOI:10.1016/j.injury.2025.112832

Int Orthop. 2025 Oct 23. doi: 10.1007/s00264-025-06675-1. Online ahead of print.

ABSTRACT

PURPOSE: Displaced intra-articular calcaneal fracture treatment may involve surgical intervention to restore the anatomy of the calcaneus and promote proper healing. Numerous surgical techniques, such as open reduction internal fixation (ORIF) or percutaneous fixation, have been utilized with varying degrees of success in achieving anatomical reduction and functional outcomes. However, complication rates are still high, and there is ongoing debate regarding the optimal surgical approach. This study presents a delta-frame triplanar external fixation technique combining intra- and extra-calcaneal distraction, specifically designed for Sanders III/IV fractures with soft-tissue compromise.

METHODS: The technique combines intra-calcaneal and extra-calcaneal distraction principles to restore calcaneal morphology in three planes. 18 patients with Sanders type III and IV DIACFs were definitively surgically treated using a delta type triplanar fixator in a single stage between 2017 and 2020. Calcaneal restoration was achieved through the intra- and extra-articular distraction principle. Outcome measures included clinical, radiological and patient-reported outcomes including the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and the Foot and Ankle Disability Index (FADI).

RESULTS: Eighteen patients (mean age 38 years) representing 26 fractures were evaluated. Two patients required subtalar arthrodesis by one year post injury. The post-operative Bohler and Gissane angles averaged 29.1° and 112.4°, respectively. Calcaneal inclination angle, height, and Böhler angle were restored within appropriate limits in all cases. At a mean follow-up of 52 ± 8.6 months (range 42 to 84 months), mean AOFAS and FADI scores were 82.5 and 85.5, respectively.

CONCLUSION: The delta-framed triplanar external fixation technique appears safe, yielding favorable radiological outcomes and a low complication rate in the management of displaced intra-articular calcaneus fractures. These findings suggest effective restoration of calcaneal anatomy using triplanar external fixation.

PMID:41128844 | DOI:10.1007/s00264-025-06675-1

Injury. 2025 Oct 15;56(12):112809. doi: 10.1016/j.injury.2025.112809. Online ahead of print.

ABSTRACT

BACKGROUND: Foot fractures account for approximately 10 % of all fractures and 40 % of lower extremity fractures. They are associated with pain, mobility limitations, and prolonged recovery, contributing to considerable healthcare and societal costs. While the clinical and economic burden of foot fractures is recognised globally, data specific to the UK population are sparse, outdated, and often grouped under broader injury categories. Given rising demands on the UK's publicly funded NHS, an up-to-date, population-level understanding of foot fracture burden is essential for targeted prevention and planning.

METHODS: This retrospective cross-sectional study used publicly available model-based estimates from the Global Burden of Disease (GBD) 2021 study. Incidence and Years Lived with Disability (YLDs) for foot fractures (excluding ankle) were analysed across the UK from 1990 to 2021. Age-standardised incidence rates (ASIR) and age-standardised YLD rates (ASYR) were examined. Poisson regression and Pearson correlation were used to explore associations between geography, age, and incidence. Leading causes of injury were also described.

RESULTS: Between 1990 and 2021, the UK experienced an overall decline in ASIR for foot fractures, from 376.6 to 314.9 per 100,000. All four UK nations showed decreasing trends, with England demonstrating the steepest reduction (annual percentage change: -0.18 %). Regionally, London had the lowest incidence and highest rate of decline. Males had consistently higher incidence rates than females, with adolescent males (15-24) particularly affected. A strong negative correlation was observed between age and incidence (r = -0.850, p < .001), though incidence and YLDs in the elderly increased between 1990 and 2021. Falls were the leading cause of foot fractures, especially among older adults, and their incidence rose markedly over time.

CONCLUSION: Foot fractures remain a significant and evolving public health issue in the UK, particularly among young men and older women. The observed trends highlight successes in injury prevention but also reveal emerging needs-particularly in fall prevention and support for the ageing population. These findings support more targeted public health strategies and future economic evaluations of injury-related care in the NHS.

PMID:41124823 | DOI:10.1016/j.injury.2025.112809

Injury. 2025 Oct 15;56(12):112815. doi: 10.1016/j.injury.2025.112815. Online ahead of print.

ABSTRACT

INTRODUCTION: A regional anaesthesia list was introduced in an outpatient clinic for the manipulation of distal radius fractures. Outcomes in patients managed with regional anaesthesia were compared with those managed using a haematoma block.

METHODS: Data was collected prospectively on 66 patients with displaced distal radius fractures manipulated using a haematoma block. Following introduction of the regional anaesthesia list, data was collected on 55 patients prospectively. Radiological parameters were recorded pre and post manipulation. Patient's pain was measured following anaesthesia and following reduction. Surgical intervention rates were recorded for fractures that lost reduction in the weeks following manipulation. PROMs were measured at 18-month follow-up using the PRWE and EQ5D-3 L.

RESULTS: Post reduction volar tilt was superior in the regional group (2.4 degrees) compared to the haematoma group (0.5 degrees). Surgical intervention was required in 22 patients in the haematoma group due to loss of reduction, compared to six in the regional anaesthesia group. Pain levels were reported to be lower in patients managed using regional anaesthesia. At 18-month follow-up PROMs were comparable in both groups.

CONCLUSION: The paper supports the use of regional anaesthesia to manipulate distal radius fractures. Regional anaesthesia provides better pain relief, achieves better fracture reduction and reduces the need for surgical intervention.

LEVEL OF EVIDENCE: IV.

PMID:41124822 | DOI:10.1016/j.injury.2025.112815

Int Orthop. 2025 Oct 21. doi: 10.1007/s00264-025-06671-5. Online ahead of print.

ABSTRACT

PURPOSE: Femoral neck fractures in nongeriatric patients pose a significant clinical challenge due to the high clinical failure rate. To address this, Alpha fixation and the Femoral Neck System (FNS) were developed but seldom been compared head-to-head. The purpose of this study was to compare the clinical prognosis of these two methods with traditional parallel screws.

METHODS: This retrospective cohort study included 341 patients aged 18-65 years, treated between June 2020 and June 2023. Patients were grouped by fixation strategies: (1) parallel screws (n = 206), (2) Alpha fixation (n = 73), and (3) FNS (n = 62). Fixation failure (nonunion, severe femoral neck shortening, varus collapse) was compared as primary clinical outcome using univariate and multivariate analyses. Secondary outcomes included avascular necrosis and reoperation rates. Analyses were stratified by Pauwels classification.

RESULTS: Fixation failure rates were highest with parallel screws (21.4%), intermediate with FNS (12.9%), and lowest with Alpha fixation (9.6%). Multivariate analysis showed significantly lower fixation failure with Alpha fixation compared to parallel screws (adjusted OR = 0.29, 95% CI: 0.10-0.73, p = 0.014). Alpha fixation significantly reduced femoral neck shortening (p = 0.017), whereas FNS significantly reduced varus collapse (p = 0.013). In Pauwels type III fractures, Alpha fixation and FNS both significantly reduced fixation failure rates compared to parallel screws; no difference was found in Pauwels types I-II.

CONCLUSIONS: Alpha fixation and FNS significantly outperformed parallel screws in reducing fixation failure in vertical femoral neck fractures among nongeriatric patients. Alpha fixation showed advantages in limiting femoral neck shortening, whereas FNS more effectively prevented varus collapse. For stable fractures, conventional parallel screws remain a reasonable choice.

PMID:41117917 | DOI:10.1007/s00264-025-06671-5