EFORT Open Rev. 2026 Apr 7;11(4):259-267. doi: 10.1530/EOR-2025-0008.

ABSTRACT

Periprosthetic joint infections (PJIs) are a serious complication in both primary arthroplasty and revision arthroplasty, posing a major challenge in orthopaedic surgery and creating a substantial financial burden. This literature review examines the current knowledge on PJI prediction, diagnosis and prognosis, with a focus on scoring systems and machine learning (ML) tools developed to improve their management. We conducted a narrative literature review by searching Medline, CENTRAL and Embase up to October 1, 2024, with independent dual-reviewer screening. Nine non-randomized studies were included, covering 297,981 prostheses and 7,190 PJIs. Two studies assessed prediction based on patient history but highlighted the need for refinement and multi-centre prospective validation. Five studies evaluated ML in diagnosis, showing promising accuracy, yet requiring broader validation in larger, more diverse clinical contexts. Two studies addressed prognosis, but models remain limited in providing individualized, treatment-specific insights. The development of ML models represents an interesting approach, given the rising prevalence of PJIs and the need for better management. However, available studies face important limitations, including small sample sizes, lack of external validation and limited transparency regarding parameters and models. To make ML tools clinically relevant, future research should prioritize external validation, larger multi-centre prospective studies and transparent reporting. Ultimately, robust ML models have the potential to enhance PJI management, improve patient outcomes and reduce healthcare costs.

PMID:41945564 | DOI:10.1530/EOR-2025-0008

EFORT Open Rev. 2026 Apr 7;11(4):307-316. doi: 10.1530/EOR-2025-0224.

ABSTRACT

Paediatric spondylodiscitis (SD) is an infection involving the vertebral bodies and adjacent intervertebral discs in populations below 16 years old. It is rarely confined to a single compartment; more often, it spreads to other areas in the spinal column and may cause other infections, such as epidural abscesses, subdural abscesses, septic arthritis of the facet joints, paravertebral abscesses and even meningitis. SD predominantly affects children from 6 to 48 months old, and the lumbar spine seems to be most at risk; no specific markers are currently available for a biological diagnosis of SD. Blood cultures are often negative, and even disc or bone biopsies show limited yields. However, recent advances in nucleic acid amplification tests have laid the foundations for developing and implementing more efficient methods of identifying pathogens in samples. Microbiologically, Kingella kingae dominates in children from 6 to 48 months old, while Staphylococcus aureus is more common in infants under 6 months and in older children. High-throughput sequencing performed on plasma samples (recognised as liquid biopsy) is a promising multi-purpose tool that can detect not only pathogens circulating in the bloodstream but also those emanating from focal infections, something particularly interesting in cases of paediatric SD, where disc sampling is strongly discouraged. Paediatric SD treatments are mainly medical; surgery is rarely indicated, except for abscess drainage, emergency neurological decompression or spinal stabilisation.

PMID:41945563 | DOI:10.1530/EOR-2025-0224

EFORT Open Rev. 2026 Apr 7;11(4):349-358. doi: 10.1530/EOR-2025-0005.

ABSTRACT

PURPOSE: This systematic review aimed to evaluate the effectiveness of surgical versus conservative management in terms of union rates, functional outcomes and complications.

METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomised controlled trials published between January 2017 and November 2023 were sourced from MEDLINE, Embase, PubMed and Cochrane databases. Outcomes assessed included union rates, functional scores and complications.

RESULTS: Six trials, involving 579 patients with midshaft clavicle fractures, met the inclusion criteria. The union rate was higher in the surgical group (93.3-100%) compared to the conservative group (82-94%). Time to union was significantly shorter for surgical management in two out of three studies reporting this outcome. Shoulder scores revealed short-term improvements in surgical groups but no significant differences at 12 months or longer. Complication rates were comparable: hardware irritation was more frequent in surgical groups, while non-union was more prevalent in conservative management. Only two studies found a statistically significant difference in union rates favouring surgery.

CONCLUSION: Surgical management offers higher union rates and faster recovery but does not demonstrate significant long-term advantages in functional outcomes compared to conservative treatment. Complication rates are similar, with distinct profiles. Clinicians should prioritise patient-centred decision-making, considering individual preferences and clinical contexts, as operative intervention may not significantly enhance long-term outcomes. Further research should perform subgroup analyses to refine management strategies.

PMID:41945562 | DOI:10.1530/EOR-2025-0005

EFORT Open Rev. 2026 Apr 7;11(4):268-276. doi: 10.1530/EOR-2025-0170.

ABSTRACT

BACKGROUND: Preoperative hypoalbuminemia is common in patients undergoing total hip or knee arthroplasty (THA/TKA). While it has been linked with poorer postoperative outcomes, there remains a paucity of systematic reviews or meta-analyses dedicated to conducting a comprehensive evaluation of this issue.

METHODS: A comprehensive search was conducted across the PubMed, Embase, and Web of Science databases. Studies were selected and analyzed in adherence to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, and the quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Data were extracted and subjected to meta-analysis or qualitative synthesis for outcomes. This meta-analysis was registered in the PROSPERO database (NO. CRD42024581376).

RESULTS: Fourteen studies involving 1,194,088 patients were included. Meta-analyses showed that preoperative hypoalbuminemia was associated with a greater risk of all-cause complications (OR: 2.89, 95% CI: 1.94-4.31), sepsis (OR: 2.54, 95% CI: 1.88-3.45), septic shock (OR: 3.44, 95% CI: 1.15-10.25), pneumonia (OR: 3.83, 95% CI: 3.14-4.67), urinary tract infection (OR: 1.59, 95% CI: 1.13-2.23), myocardial infarction (OR: 2.10, 95% CI: 1.47-2.98), superficial incisional infection (OR: 2.16, 95% CI: 1.56-3.00), periprosthetic joint infection (OR: 4.03, 95% CI: 2.15-7.53), wound dehiscence (OR: 1.68, 95% CI: 1.06-2.69), transfusion (OR: 1.84, 95% CI: 1.72-1.98), unplanned reoperation (OR: 1.60, 95% CI: 1.38-1.87), and mortality (OR: 7.14, 95% CI: 5.44-9.37).

CONCLUSION: Preoperative hypoalbuminemia is associated with an increased risk of numerous types of complications, transfusion, unplanned reoperation, and mortality after THA or TKA. Therefore, presurgical protocols formulated to deal with these unfavorable clinical outcomes may pay particular attention to this specific patient group.

PMID:41945558 | DOI:10.1530/EOR-2025-0170

EFORT Open Rev. 2026 Apr 7;11(4):299-306. doi: 10.1530/EOR-2025-0122.

ABSTRACT

Fractures of the lower limbs represent a common cause of hospital admission. Surgical intervention is increasingly indicated in paediatric patients. The gold standard for treating long bone fractures in the immature skeleton is intramedullary fixation with titanium elastic nails. Minimally invasive plating is considered a suitable option when elastic nailing is not feasible. The use of a plate provides adequate mechanical stability for weight-bearing and limb mobility while preserving biological bone integrity and resulting in limited scarring, generally well accepted by patients and families, although it requires a more extensive incision than intramedullary fixation. Potential drawbacks of this technique include a more extensive surgical approach, possible delay in weight-bearing, and the potential need for implant removal.

PMID:41945553 | DOI:10.1530/EOR-2025-0122

EFORT Open Rev. 2026 Apr 7;11(4):290-298. doi: 10.1530/EOR-2024-0165.

ABSTRACT

PURPOSE: With the increased challenges in diagnosing DDH using traditional ultrasound imaging methods, accurate diagnosis is essential. This study assesses the effectiveness of AI in the imaging-based diagnosis of DDH through a systematic review.

METHODS: This review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered in Prospero (registration ID: CRD42024563606). A comprehensive search was conducted across Ovid MEDLINE, PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Studies were screened using selection criteria, and quality was assessed using standardised tools. Thematic content analysis was also performed. Of the 32 studies identified, 19 were included, with 15 undergoing quantitative analysis. The main outcome measures were sensitivity, specificity, accuracy, AUROC, PPV, and NPV. Median, median absolute deviation, Bonett-Price 95% confidence intervals, maximum, minimum, and interquartile ranges were calculated and presented in a box-and-whisker diagram.

RESULTS: In the 19 included studies, the median sensitivity was 90.0% and specificity was 93.2% across 36,907 patients. Fifteen studies reported diagnostic accuracy, with a median of 92.6%. Accuracy rates ranged from 79.2 to 99%. The most common model architecture was mask R-CNN. Four studies (21%) were judged to have a high risk of bias using the QUADAS-2 tool.

CONCLUSIONS: AI technologies hold significant potential for enhancing the diagnostic accuracy of DDH. However, existing variability and bias across studies highlight the need for further standardisation and validation.

PMID:41945551 | DOI:10.1530/EOR-2024-0165

J Bone Joint Surg Am. 2026 Apr 7. doi: 10.2106/JBJS.26.00161. Online ahead of print.

NO ABSTRACT

PMID:41945662 | DOI:10.2106/JBJS.26.00161

Injury. 2026 Mar 30:113168. doi: 10.1016/j.injury.2026.113168. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic brain injury (TBI) in children and adolescents is a leading cause of disability and mortality, with long-term health-related consequences. There is little evidence describing the children and adolescents most at risk of TBI.

OBJECTIVE: To identify the demographic and clinical predictors of TBI in secondary school-aged children in England.

PARTICIPANTS AND SETTING: Linked Clinical Practice Research Datalink and Hospital Episode Statistics Admitted Patient Care data were used to identify patients aged 11-18 years registered with a GP surgery in England between 2013 and 2021.

METHODS: Multivariable Cox regression was used to assess the association between demographic and clinical risk factors and time to medically attended TBI.

RESULTS: The analytical sample included 402,249 children, 2.3% of which had a TBI presenting to primary or hospital care when aged 11-18 years. In the fully adjusted model, increased risk of TBI was associated with being male; less socioeconomically deprived; having a history of fracture, abuse, depression, or previous TBI; having two or more previous GP visits, having more previous Emergency Department visits; and having fewer hospital admissions.

CONCLUSION: Using a nationally representative dataset we were able to identify which children were most at risk of TBI in their secondary school years. TBI is often preventable and targeted interventions could be aimed at these children and their families.

PMID:41936468 | DOI:10.1016/j.injury.2026.113168

Injury. 2026 Mar 25;57(6):113171. doi: 10.1016/j.injury.2026.113171. Online ahead of print.

ABSTRACT

Open fractures are at risk for fracture-related infection (FRI) due to environmental contamination, with 40-80% of bacteria existing in biofilms. Standard treatment includes prophylactic antibiotics, surgical debridement, and irrigation; however, bacteria can persist in a biofilm/sessile form on bones and orthopedic implants. While some infections show clear clinical symptoms, others may remain subclinical for long periods. These biofilm-associated infections are difficult to treat due to their reduced susceptibility to antibiotics. This study aims to develop a clinically relevant rat model for FRI, overcoming limitations of existing models that use non-clinical materials like Polyetheretherketone (PEEK) and planktonic bacteria. By inoculating the fracture site with bacteria isolated from biofilms and utilizing stainless steel surgical implants, which are standard in clinical practice, we aim to create a more accurate representation of FRI. This improved model will provide a valuable tool for preclinical research for improving the management of FRIs, enabling the evaluation of therapeutic interventions on biofilm infections in the presence of clinically relevant implants. The experimental procedure involved creating a femur fracture in an anesthetized rat and inoculating it with 104-105 CFUs/ml Staphylococcus aureus bacteria derived from biofilms grown in vitro on glass slides for three days. The fracture was stabilized with a stainless-steel plate and screws, and the wound was closed. After one week, the anesthetized rats underwent surgical debridement and irrigation and received one dose of systemic antibiotic cefazolin. Three weeks after fracture, rats were euthanized, and the hardware and bone were harvested, washed of planktonic bacteria, and separately analyzed for CFUs. The results showed the rats demonstrated S. aureus biofilm growth in the bone and hardware with > 106 CFUs/ml. There were no differences between CFUs/ml in bone and on hardware. Our FRI model is uniquely valuable as a model for evaluating novel therapeutics against implant-associated infections.

PMID:41936238 | DOI:10.1016/j.injury.2026.113171

Injury. 2026 Apr 1;57(6):113201. doi: 10.1016/j.injury.2026.113201. Online ahead of print.

NO ABSTRACT

PMID:41936237 | DOI:10.1016/j.injury.2026.113201

Injury. 2026 Apr 1:113198. doi: 10.1016/j.injury.2026.113198. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of trauma follow-up care after hospital discharge is to support patients with serious injuries recover to their fullest extent. Whilst the physical health of patients is a central focus of follow-up care, psychosocial support is described as challenging and inadequate, with few trauma follow-up services able to provide integrated psychosocial support inclusive of routine access to psychosocial experts. As trauma follow-up care within Australia and New Zealand (Australia and New Zealand) is predominantly provided by nursing and medical trauma clinicians, exploring how psychosocial care and support is provided by these clinicians is warranted. The broad aim of this qualitative study was to explore trauma clinicians' experiences in providing trauma follow-up care with this paper focusing on the provision of psychosocial care and support.

METHODS: Semi-structured interviews were used to explore the experiences of trauma clinicians in providing follow-up care after hospital discharge to patients who have experienced serious injury. Twenty participants were purposively selected from public hospitals throughout Australia and New Zealand who provided trauma follow-up care after hospital discharge. Qualitative data were transcribed verbatim and analysed using inductive content analysis.

RESULTS: Psychosocial care and support provided by trauma service clinicians during follow-up appointments to patients who have experienced serious injuries can be separated into three categories: (i) recognising the importance of psychosocial health after injury; (ii) components of psychosocial care which has three sub-categories of (a) comprehensive psychosocial care and support; (b) variability in assessment; (c) health care practitioner preparedness to provide psychosocial support; and (iii) access to psychological services.

CONCLUSION: Trauma clinicians recognise the importance of providing psychosocial care and support to patients who experience serious injury. In the absence of routine access to expert psychosocial/psychological practitioners, trauma clinicians provided psychosocial support using a variety of approaches which results in disparities in how psychosocial care is provided to patients in Australia and New Zealand. Implementation of a standardised assessment to psychosocial health, in conjunction with an anticipatory framework to assist trauma clinicians in providing psychosocial care and support, may provide a partial solution, and reduce the incidence of psychosocial issues and improve an individual's quality of life following serious injury.

PMID:41934055 | DOI:10.1016/j.injury.2026.113198

Injury. 2026 Mar 25;57(6):113194. doi: 10.1016/j.injury.2026.113194. Online ahead of print.

ABSTRACT

BACKGROUND: While the short-term risks of severe injury among older adults (age≥65) are well studied, little is known about long-term functional outcomes in this population. This knowledge gap impacts clinicians' ability to counsel patients and provide care aligned with their values. Our objective was to evaluate the association between severe injury and the likelihood of an older adult remaining alive and living in their own home five years later.

METHODS: This was a retrospective, matched, population-based cohort study using administrative health data in a large regional trauma system (2006-2019). Community-dwelling older adults presenting with severe injury were matched with uninjured controls from the general population on age, sex, rurality, social determinants of health, comorbidity, and frailty. Time from injury to nursing home admission or death was compared between injured patients and matched controls using Kaplan-Meier analysis and extended Cox models.

RESULTS: A total of 20,217 older adults admitted with severe injury were identified and matched with controls. Median ISS was 16 (IQR 16-21), and in-hospital mortality was 22.8% (n = 4615). After five years, the probability of remaining alive and home was 40% for all included cases and 64% for controls. Median time spent alive and home for cases was 2.7 years and exceeded the 5-year follow-up period for controls. While the risk of nursing home admission or death decreased over time, cases remained at elevated risk compared to controls for at least 5 years (years 2-5, HR 1.18, 95% CI 1.13-1.24).

CONCLUSION: Most severely injured older adults survive to live in their own home for several years following injury. Nonetheless, patients who survive their injury have an increased risk of nursing home admission or death for at least five years. Long-term supports are necessary to ensure that patients remain alive and independent for years following their injury.

PMID:41932165 | DOI:10.1016/j.injury.2026.113194

Injury. 2026 Mar 31;57(6):113165. doi: 10.1016/j.injury.2026.113165. Online ahead of print.

ABSTRACT

BACKGROUND: Spinopelvic dissociation (SPD) is an infrequent high-energy injury, which is often associated with lumbosacral plexus and cauda equina deficits Sexual dysfunction (SD) is a common comorbidity of the SPD, caused by direct or indirect trauma to the neurovascular structures within the pelvic cavity. The objective of this retrospective study was to to compare the sexual functions of patients with SPD underwent triangular osteosynthesis (TOS) with the normal population.

METHODS: The study was approved by the medical school's institutional review board (IRB). Between 2012 and 2023, 23 consecutive patients (9 women and 14 men) with SPD (16H-type and 7 U-type) were treated using TOS with a minimum follow- up of 36 months. The sexual functions of the patients were evaluated and compared with the Female Sexual Functional Index (FSFI) questionnaires for women and the International Index of Erectile Function (IIEF) questionnaires for men. A control group was formed from the normal population of the same age and gender group as these patients.

RESULTS: The average age of patients was 31.9 years (range, 18-65 years). Mean follow-up was 37.8 months (range 36-51 months). No significant difference was found in the male gender group compared to the normal population in terms of erectile function (P > 0.05), but a significant difference was found in orgasmic function, sexual desire, sexual satisfaction, and general satisfaction (P < 0.05). In the female gender group, no significant difference was found in sexual desire, lubrication, and pain during intercourse compared to the normal population (P > 0.05), but a significant difference was found in sexual arousal, orgasmic function, satisfaction, and total score (P < 0.05).

CONCLUSION: Compared to the normal population, sexual functions can be preserved partially in patients with SPD underwent TOS. The results of our preliminary data did not demonstrate a significant association between neurogenic etiology and sexual dysfunction following SPD.

PMID:41932164 | DOI:10.1016/j.injury.2026.113165

Injury. 2026 Mar 20;57(6):113166. doi: 10.1016/j.injury.2026.113166. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to model the cost-effectiveness of continuous pressure monitoring (CPM) in a hypothetical cohort of patients with a fracture of the tibial diaphysis.

METHODS: Decision-tree model structure was utilised to capture 60-day costs and health related quality of life (HRQoL) following a fracture of the tibial diaphysis. Depending on the effectiveness of the diagnostic method, patients were allocated to one of six validated outcome grades for acute compartment syndrome (ACS). Mean costs, utilities, and hospital length of stay were applied to each of these grades. Parameter inputs and costs were obtained from UK-specific published literature where possible. Analysis was performed from the UK National Health Service (NHS) perspective to determine the estimated impact in a hypothetical cohort of 1000 patients with a tibial diaphyseal fracture using CPM versus current standard diagnostic methods for ACS.

RESULTS: Base case results indicated that the utilisation of CPM was associated with significant cost savings of £ 452/patient when compared with the standard care of clinical assessment and/or single point pressure measurement (SPPM). An associated additional 2733 NHS bed days were saved. Incremental quality-adjusted life year (QALY) gain of 0.02 was found, resulting in a dominant incremental cost effectiveness ratio (ICER). When analyses were performed considering different diagnostic outcome grade distributions and for a varying time horizon, CPM was found to have both increased cost savings and cost-efficacy.

CONCLUSIONS: This early economic model suggests that CPM of patients with a tibial diaphyseal fracture could be a cost-effective diagnostic option, although more data is required in order to validate the model assumptions. However, given the established evidence demonstrating the superior diagnostic performance characteristics of CPM when compared to clinical symptoms and/or SPPM, this economic data adds further support to the use of CPM as an essential diagnostic adjunct in patients at risk of ACS.

PMID:41932163 | DOI:10.1016/j.injury.2026.113166

Injury. 2026 Mar 25;57(6):113191. doi: 10.1016/j.injury.2026.113191. Online ahead of print.

ABSTRACT

BACKGROUND: Healthcare is an energy and resource intensive sector, imparting significant environmental burden on a global scale. Minimizing avoidable resource utilization within hospitals can help achieve environmental sustainability amongst healthcare systems. Reducing surgical complications, such as tibial fracture-related infections (FRIs), which require resource-rich healthcare activities can be an impactful approach to achieve environmental sustainability, while maintaining or advancing patient health outcomes. The objective of this study was to leverage healthcare resource utilization data to evaluate the environmental impact of tibial FRIs amongst patients undergoing surgical treatment.

METHODS: An environmental model was developed using inputs informed from a systematic literature review and synthesized in a meta-analysis. Healthcare resource utilization data were used to compare the environmental impact for patients with and without a tibial FRI in relation to key healthcare activities such as hospital length of stay, reoperations, antibiotic therapy, and emergency room visits. A subgroup analysis was conducted to understand the environmental implications of more severe open fractures complicated by FRI, to supplement the mixed (open/closed) fracture population presented in the base case. Sustainability data was obtained from the Sustainable Healthcare Coalition's Care Pathways Guidance document and other published sources. Outcomes assessed were greenhouse gas (GHG) emissions, water use, and waste generated.

RESULTS: The results of this environmental impact assessment demonstrated that effectively preventing tibial FRIs can lead to a substantial reduction in carbon footprint. Preventing one FRI may result in an average reduction of 1025.3 kg CO2, water savings of 1778.6 m3, and waste savings of 79.4 kg. Results of the subgroup analysis, which included patients with open tibial fractures, further substantiated the environmental impact associated with tibial FRIs.

CONCLUSION: Preventing tibial FRIs may have a substantial environmental impact leading to a reduction in GHG emissions, water use, and waste generation. Interventions that reduce the incidence of tibial FRIs may contribute to the global goal of environmental sustainability. The results of this study are intended to empower healthcare providers and decision makers within the healthcare sector to make informed decisions that contribute to improved environmental sustainability, while maintaining or advancing patient health outcomes.

PMID:41932162 | DOI:10.1016/j.injury.2026.113191

Injury. 2026 Mar 22:113157. doi: 10.1016/j.injury.2026.113157. Online ahead of print.

ABSTRACT

BACKGROUND: Hyponatremia is common in traumatic brain injury (TBI) population, and is associated with poor outcomes. The main mechanisms are the syndrome of inappropriate antidiuresis (SIAD) and cerebral salt wasting syndrome (CSW). This study aimed to assess hyponatremia prevalence and time of onset in patients with TBI and assess differences between SIAD and CSW.

METHOD: This retrospective cohort study was conducted between 2015 and 2018 in our level 1 trauma center. Patients admitted to the intensive care unit with TBI were included. Three subgroups were determined using urinary clinical and biological criteria: SIAD, CSW, and Undetermined. Predictive factors were assessed for each subgroup, especially the influence of free water, sodium, or fluid intake.

RESULTS: Among 351 trauma patients with TBI, 57 (16 % [95 %CI 12 %20 %]) developed hyponatremia within 30 days. 30 (9 % [95 %CI 6 %12 %]) developed a SIAD, 13 (4 % [95 %CI 2 %6 %]) a CSW, 14 (4 % [95 %CI 2 %6 %]) an undetermined form. CSW subgroup had higher Simplified Acute Physiology Score II (SAPS II), Injury severity score ISS, more cerebral injuries, intracranial pressure monitoring, mechanical ventilation than the SIAD subgroup. Fluid, sodium and free water intake in the 48 h preceding hyponatremia did not influence CSW or Undetermined hyponatremia development, whereas excessive free water intake in the 48 h preceding hyponatremia was associated with SIAD development.

CONCLUSION: Hyponatremia prevalence was 16 %, half were SIAD and one quarter were CSW. Patients with CSW were more severely injured than those who developed SIAD. Excessive free water intake could induce more SIAD-related hyponatremia due to impaired urine dilution.

LEVEL OF EVIDENCE: III, prognostic/epidemiological.

PMID:41927419 | DOI:10.1016/j.injury.2026.113157

Injury. 2026 Feb 17:113110. doi: 10.1016/j.injury.2026.113110. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe a CT finding which indicates Posterior Ligamentous Complex (PLC) injury in acute thoracolumbar spinal fractures and to determine if this has been described previously.

METHODS: The anomaly was first described by the senior author. We reviewed 1235 trauma CTs looking for this sign. We identified all thoracolumbar fractures and classified these as thoracic or lumbar fractures depending on the spinal level of the injured vertebra. We sought to determine if the 'dirty fat pad' sign was present on the mid-sagittal CT images of the spine. If present we looked to see if there was MRI confirmation of disruption of the posterior ligamentous complex. A literature review was performed of the MEDLINE, Embase Classic and EMBASE databases for descriptions of the appearance of the posterior ligamentous complex on CT following spinal trauma, from their respective inceptions in 1946 and 1974, to 21.11.25.

RESULTS: We found 356 thoracolumbar fractures in the 1235 trauma CTs. Twenty scans showed the 'dirty fat pad' sign (5.6%). MRI in these cases confirmed the disruption of the posterior ligamentous complex. The literature review provided titles and abstracts describing CTs with spinal trauma. These papers were screened for relevance, and thirty-two texts then reviewed in full. No paper retrieved described the radiological appearance of the fat pads on CT or MRI, in health or injury.

CONCLUSION: In our study we found that the 'dirty fat pad sign' was relatively uncommon. However, when seen, it did indicate disruption of the posterior ligamentous complex of the spine. We recommend the use of this sign and suggest it should be sought when reviewing acute trauma CTs. If present it would suggest ligamentous disruption thus guiding clinicians to provide more caution in protecting the patient during transfers and treatments.

PMID:41927418 | DOI:10.1016/j.injury.2026.113110

Injury. 2026 Mar 26:113196. doi: 10.1016/j.injury.2026.113196. Online ahead of print.

NO ABSTRACT

PMID:41925414 | DOI:10.1016/j.injury.2026.113196

J Bone Joint Surg Am. 2026 Apr 2. doi: 10.2106/JBJS.26.00091. Online ahead of print.

NO ABSTRACT

PMID:41926566 | DOI:10.2106/JBJS.26.00091

J Bone Joint Surg Am. 2026 Apr 2. doi: 10.2106/JBJS.25.01558. Online ahead of print.

NO ABSTRACT

PMID:41926565 | DOI:10.2106/JBJS.25.01558