J Bone Joint Surg Am. 2026 Jan 21;108(2):83-91. doi: 10.2106/JBJS.25.01212. Epub 2025 Dec 1.

NO ABSTRACT

PMID:41563332 | DOI:10.2106/JBJS.25.01212

J Bone Joint Surg Am. 2026 Jan 21;108(2):81-82. doi: 10.2106/JBJS.25.01312. Epub 2026 Jan 21.

NO ABSTRACT

PMID:41563331 | DOI:10.2106/JBJS.25.01312

J Bone Joint Surg Am. 2026 Jan 21;108(2):79-80. doi: 10.2106/JBJS.25.01096. Epub 2026 Jan 21.

NO ABSTRACT

PMID:41563330 | DOI:10.2106/JBJS.25.01096

J Bone Joint Surg Am. 2026 Jan 21;108(2):77-78. doi: 10.2106/JBJS.25.01083. Epub 2026 Jan 21.

NO ABSTRACT

PMID:41563329 | DOI:10.2106/JBJS.25.01083

J Bone Joint Surg Am. 2026 Jan 21;108(2):75-76. doi: 10.2106/JBJS.25.01361. Epub 2026 Jan 21.

NO ABSTRACT

PMID:41563328 | DOI:10.2106/JBJS.25.01361

Int Orthop. 2026 Jan 21. doi: 10.1007/s00264-026-06741-2. Online ahead of print.

NO ABSTRACT

PMID:41563467 | DOI:10.1007/s00264-026-06741-2

Injury. 2026 Jan 11;57(3):113051. doi: 10.1016/j.injury.2026.113051. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Unstable pelvic ring fractures are severe injuries with substantial mortality and a high burden of associated injuries. Advances in trauma care have improved outcomes. However, recent data from high-volume centers remain scarce. We aimed to evaluate mortality, associated injuries, and predictors of mortality in surgically treated unstable pelvic ring fractures.

METHODS: We retrospectively analyzed 451 consecutive patients with surgically treated Tile B or C pelvic ring fractures admitted to a Level 1 trauma center between 2008 and 2021. Patient demographics, injury characteristics, and associated injuries were recorded. Kaplan-Meier methods were used to estimate survival, and Cox regression for identifying independent predictors of mortality.

RESULTS: Overall mortality at 3-month was 4.2% (95% CI 2.3-6.0) and at 1-year at 6.0% (95% CI 3.8-8.2). Tile C fractures had a higher early mortality than Tile B (3-month: 6.5% vs. 2.1%; 1-year: 7.4% vs. 4.7%). Associated injuries were common: 78% of patients had at least one and 66% had two or more injured regions. Patients with injuries in ≥2 regions had markedly higher intensive care unit (ICU) admission, transfusion requirements, and early mortality. In multivariable Cox regression, age (HR 1.06 per year), Glascow Coma Scale (GCS) ≤8 (HR 4.9), and Tile C (HR 3.6) were independently associated with 90-day mortality.

CONCLUSION: Mortality after surgically treated unstable pelvic ring fractures at 3- month and 1 year was 4.2% and 6.0%, respectively. Age, low GCS, and Tile C fracture pattern were independent predictors of early death. Associated injuries and overall trauma burden were strongly associated with ICU admission, transfusion, and early mortality.

PMID:41558223 | DOI:10.1016/j.injury.2026.113051

Injury. 2026 Jan 10;57(3):113035. doi: 10.1016/j.injury.2026.113035. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic acromio-clavicular dislocation is a challenging injury to treat. Many surgical procedures are available for its management which may be anatomical or non-anatomical. The aim of this study was to assess the clinical and radiological outcome in the patients with chronic acromio-clavicular dislocation treated by hybrid biological semitendinosus autograft and synthetic non-absorbable sutures.

METHODS: From July 2021 to January 2025, 21 patients with chronic acromio-clavicular dislocation were treated by hybrid biological semitendinosus autograft and synthetic non-absorbable sutures. Grade III to VI chronic acromio-clavicular injuries were included. Post-operatively, the patients were clinically assessed using Constant shoulder and Acromio-clavicular joint instability scores. Acromio-clavicular arthritis, coraco-clavicular ossification, distal clavicle osteolysis, coraco-clavicular and acromio-clavicular distances were radiologically evaluated.

RESULTS: The mean age at time of surgery was 28.52 ± 8.0 (range: 19-45) years. The acromio-clavicular dislocation was type III in 7 patients (33.4 %), type IV in 12 patients ( %57.1) and type V in 2 patients (9.5 %). The mean follow-up period was 24.29 ± 3.51 (range: 18-30) months. The mean post-operative Acromio-clavicular joint instability and Constant shoulder scores were 93.14 ± 8.16 (range: 78-100) and 90.14 ± 8.16 (range: 80-100) points respectively. None of the patients showed recurrent dislocation, arthritis and distal clavicle osteolysis.

CONCLUSION: Bi-modal stabilization using hybrid biological semitendinosus autograft and synthetic non-absorbable sutures is an effective and reliable surgical option to treat chronic acromio-clavicular dislocation. Most of the reported complications associated with this procedure didn't affect the functional outcome.

PMID:41558222 | DOI:10.1016/j.injury.2026.113035

Injury. 2026 Jan 10:113050. doi: 10.1016/j.injury.2026.113050. Online ahead of print.

ABSTRACT

BACKGROUND: Vascular compromise is a serious complication in free-flap surgery for traumatic reconstruction or fracture-related infections, often leading to partial or total flap loss if not detected promptly. We evaluated transcutaneous partial pressure of carbon dioxide (TcPCO₂) real-time monitoring as an objective, non-invasive method for ultra-early detection of vascular compromise in free flap reconstruction.

METHODS: This sequential cohort study consisted of a retrospective development phase and a prospective validation phase. An abnormality was defined as a rise of >10 mmHg from the baseline TcPCO₂ value, with re-exploration performed if the elevation persisted after recalibration. High-resolution (1-s interval) TcPCO₂ data were analyzed to assess diagnostic accuracy and concordance with arterial partial pressure of carbon dioxide (PaCO₂).

RESULTS: In pilot studies, TcPCO₂ increased within 20-100 s of induced ischemia and correlated strongly with PaCO₂ (r = 0.708, p < 0.001). Among 81 clinical free flap cases (50 retrospective, 31 prospective), TcPCO₂ monitoring detected all seven episodes of vascular compromise with 100% sensitivity and specificity, and no false positives. All the compromised flaps were successfully salvaged. Compared with conventional clinical assessment, TcPCO₂ monitoring provided earlier recognition of perfusion disturbances.

CONCLUSION: TcPCO₂ monitoring is a non-invasive, objective, and reproducible tool for ultra-early detection of vascular compromise in free flap surgery. Its implementation enables timely re-exploration, reduces reliance on subjective bedside assessments, and may significantly improve flap salvage outcomes.

PMID:41549011 | DOI:10.1016/j.injury.2026.113050

Injury. 2026 Jan 10:113026. doi: 10.1016/j.injury.2026.113026. Online ahead of print.

ABSTRACT

BACKGROUND: The 2023-2025 war on Gaza has severely impacted healthcare infrastructure, necessitating the establishment of makeshift facilities to manage war-related injuries. This study evaluates the outcomes and resource accessibility for emergency laparotomy or thoracotomy injuries in a makeshift trauma surgery unit in Gaza during the war.

METHODS: A prospective cohort study was conducted from July 16 to August 31, 2024, including consecutive patients with war-related injuries who underwent emergency laparotomy or thoracotomy, with 30-day follow-up. Obstetrics and gynecology facilities were repurposed as a trauma surgery unit. Outcomes included mortality, complications, unplanned reoperations, and resource accessibility.

FINDINGS: Among 79 patients, 84% (66/79) sustained injuries due to blast mechanism, of which 53% (35/66) were prehospital reported as caused by airstrikes. 94% (74/79) underwent emergency laparotomy, 9% (7/79) underwent emergency thoracotomy, and 3% (2/79) underwent both surgeries. In-hospital mortality was 32% (25/79). Postoperative complications occurred in 69% (51/74), with surgical site infections being the most common (58%, 43/79). Additionally, 15% (11/74) required an unplanned return to the operating theater. Only 5% (4/79) had access to preoperative CT imaging. 62% (49/74) of patients were treated postoperatively in corridors or outdoors. 56% (24/43) of patients were lost to follow-up by day 30.

CONCLUSION: This study describes severe truncal trauma managed in a makeshift civilian facility with limited medical resources, where non-surgical hospital spaces were repurposed for trauma care. High rates of mortality and postoperative complications were observed, and basic surgical resources were unavailable for the majority of patients. A trauma database was able to be maintained despite the constraints of a humanitarian crisis.

PMID:41549010 | DOI:10.1016/j.injury.2026.113026

Injury. 2026 Jan 10;57(3):113027. doi: 10.1016/j.injury.2026.113027. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma results in approximately 1.19 million deaths and 20-50 million disabilities globally each year. With increasing industrialization, road traffic injuries have become a leading cause of Disability Adjusted Life Years and traumatic amputations. These sudden amputations often lead to significant psychological distress. This study aims to assess the effectiveness of psychosocial interventions in enhancing the Quality of Life of post-traumatic amputees.

MATERIAL AND METHODS: This randomized controlled trial enrolled 74 post-traumatic extremity amputees aged over 18 years, who were cognitively coherent, had adequate social support, and no prior psychological illness. Following baseline psychosocial assessment, participants were randomly assigned to two groups: Group A (n = 39) received conventional care, while Group B (n = 35) received both psychosocial intervention and conventional care for seven weeks. Psychosocial outcomes were reassessed in both groups at the eighth week post-intervention.

RESULTS: Quality of life showed significant improvement in both the groups. However, there was no significant difference between the groups. Level of depression, anxiety and stress significantly decreased in both the groups at 8 weeks, but the difference was not significant between the groups. However, body image showed a significant improvement in Group B as compared to Group A (p = 0.023).

CONCLUSION: Our study did not show any observable positive effects of psychosocial intervention over conventional care on quality of life, depression, stress, or anxiety except on body image. We hypothesize that positive results might be seen in quality of life of amputees if a larger study with longer duration of psychosocial intervention is conducted.

PMID:41548408 | DOI:10.1016/j.injury.2026.113027

Injury. 2026 Jan 9;57(3):113019. doi: 10.1016/j.injury.2026.113019. Online ahead of print.

ABSTRACT

BACKGROUND: Percutaneous sacroiliac (SI) screw fixation is a widely used technique for stabilizing sacral fractures but is considered technically demanding due to complex pelvic anatomy and proximity to neurovascular structures. Conventional fluoroscopy-guided methods are associated with a relatively high risk of screw misplacement and considerable radiation exposure to patients and staff. Robotic-assisted navigation systems have been introduced to enhance screw accuracy and reduce radiation exposure. The aim of this study was to assess the efficiency, safety, and accuracy of sacroiliac screw fixation using a robot-assisted method compared with a conventional freehand technique.

METHODS: Medical records of patients treated with sacroiliac screw fixation for sacral fractures at a single Level 1 trauma center between December 2014 and August 2025 were retrospectively analyzed. Patients were divided into robotic-assisted and freehand fluoroscopy-guided groups for comparative analysis. Primary outcomes were intraoperative radiation exposure and operative time; secondary outcomes included screw position accuracy and complications. Statistical analysis was performed with significance set at p < 0.05.

RESULTS: Twenty-five patients (mean age: 57.7 ± 22.4 years) were included; 15 in the robotic-assisted and 10 in the conventional fluoroscopy-guided groups. A total of 47 SI-screws were inserted: 29 in the robotic group and 18 in the conventional group. Operative times were comparable between groups (47.1 ± 16.3 min and. 45.1 ± 30.0 min, respectively; p = 0.85). Compared to conventional fluoroscopy, robotic assistance was associated with reduced fluoroscopy time (55.1 ± 23.1 vs. 181.1 ± 104.4 s, p=0.053) and higher screw placement accuracy (94 % vs. 62 %, p = 0.06), although these did not reach statistical significance. No major intraoperative complications occurred.

CONCLUSION: Robotic-assisted navigation in sacroiliac screw insertion can potentially lower radiation exposure and improve screw placement accuracy compared to conventional techniques, without prolonging surgical time. These findings support robotic guidance as a safe and potentially more precise alternative for sacral fracture fixation. Further prospective studies should be performed to evaluate the possible benefits of robotic assisted sacroiliac screw fixation.

PMID:41548407 | DOI:10.1016/j.injury.2026.113019

Injury. 2026 Jan 9;57(3):113018. doi: 10.1016/j.injury.2026.113018. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: To compare the effectiveness of platelet-rich plasma (PRP) injection, corticosteroid injection, and wrist splinting in patients with bilateral moderate carpal tunnel syndrome (CTS) using clinical, electrophysiological, and radiological parameters.

MATERIAL AND METHODS: This randomized controlled study included 45 patients with bilateral moderate carpal tunnel syndrome, divided equally into three groups: PRP + splint, steroid + splint, and splint-only (control). Assessments were conducted pre-treatment and at 1 and 6 months post-treatment using VAS scores (pain and numbness), pinch and grip strength, QuickDASH questionnaire, EMG, and MRI.

RESULTS: VAS scores significantly improved in all groups at both follow-ups, with greater reductions in night pain and numbness in the PRP and steroid groups versus control. All groups showed improved strength at month 1; by month 6, grip strength improved only in the PRP group, while pinch strength improved in both PRP and steroid groups. While A significant reduction in the Quick DASH symptom score was observed in the PRP and steroid groups, EMG findings improved significantly in all groups. MRI showed a significant decrease in palmar bowing in the PRP and steroid groups.

CONCLUSION: While both PRP and steroid injections were more effective than splinting alone in improving symptoms and function, PRP demonstrated some indications of more sustained benefits, particularly at the 6-month follow-up.

PMID:41548406 | DOI:10.1016/j.injury.2026.113018

Injury. 2026 Jan 10;57(3):113043. doi: 10.1016/j.injury.2026.113043. Online ahead of print.

ABSTRACT

Skin flaps are widely used in plastic and reconstructive surgery. However, inadequate blood perfusion during flap mobilization can trigger an ischemic process that may lead to tissue necrosis in the absence of effective management of the inflammatory process. In this context, the search for new biocompatible strategies to ensure the viability of ischemic skin flaps (ISFs) remains necessary. Therefore, this study evaluated novel alginate-ZIF-8 (ALG-ZIF-8) hydrogel systems with Rhizophora mangle (R. mangle) extract and tannic acid (TA) to assess their potential in preventing necrosis in ISF. Twenty-two male Wistar rats underwent the surgical creation of ISF and were divided into four groups: 0.9% saline (negative control - NegC), placebo alginate hydrogel (pALGgel), ALG-ZIF-8 hydrogel system with 5% TA (ALGzTA), and finally, ALG-ZIF-8 hydrogel system with 5% R. mangle (ALGzRm). Flap outcomes were evaluated through macroscopic observation, followed by morphometric analysis of viable and necrotic areas, and histomorphometric analysis of fibroblasts, blood vessels, and leukocytes, using ImageJ and PrimeCam 5.1 software. Statistical analysis was performed using IBM SPSS software (version 27). The results suggest that the formulations produced divergent outcomes by differentially modulating inflammatory and angiogenic responses. The ALGzRm formulation tended to show a protective profile, associated with a significant reduction in leukocyte infiltration (p < 0.001), while the ALGzTA formulation was linked to a detrimental response, including exacerbated inflammation and a pathologically high blood vessel count (p = 0.015). In conclusion, findings suggest that the ALGzRm-gel has a potential for tissue repair, mediated by the modulation of inflammatory and angiogenic responses.

PMID:41548405 | DOI:10.1016/j.injury.2026.113043

Injury. 2026 Jan 11;57(3):113039. doi: 10.1016/j.injury.2026.113039. Online ahead of print.

ABSTRACT

BACKGROUND: Acute Compartment Syndrome (ACS) is a severe condition that can threaten limb viability, particularly in patients who experience prolonged immobility, such as in the found-down phenomenon. Inadequate removal of nonviable muscle after fasciotomy increases the risk of infection. While non-invasive imaging modalities have been explored for early ACS diagnosis, no tools currently exist to guide precise debridement intraoperatively. Existing technologies are limited by susceptibility to interference, lack of standardized thresholds and insufficient real-time surgical utility. This study aimed to evaluate the association between muscle perfusion, quantified by indocyanine green (ICG)-based dynamic contrast-enhanced fluorescence imaging (DCE-FI), and the degree of muscle necrosis in ACS, assessed via histopathological analysis, to explore the potential of DCE-FI to guide intraoperative muscle debridement.

METHODS: A total of 15 adults (aged 18 years or older) undergoing ACS surgical treatment were included in this study between 2023 and 2024. DCE-FI imaging was performed and eight muscle specimens spanning the entire length of the incision were obtained for each patient. Necrosis percentage was assigned to each sample based on histopathological evaluation by a pathologist. Patients were then classified into high necrosis (HN) and low necrosis (LN) groups based on their average necrosis scores from these eight samples, using 50 % necrosis as a cutoff. Perfusion-related kinetic parameters derived from DCE-FI, including maximum fluorescence intensity (Imax) and blood flow (BF), were evaluated and compared between the two groups.

RESULTS: The HN group exhibited significantly lower Imax (p < 0.001) and BF (p < 0.001), compared to those in the LN group, indicating substantially reduced muscle perfusion. The HN group had significantly lower median values (Imax 23.0 RFUs, BF 1.9 mL/min/100g) compared to the LN group (Imax 32.4 RFUs, BF 3.1 mL/min/100g).

CONCLUSIONS: ICG-based DCE-FI demonstrated strong potential for intraoperative identification of muscle damage resulting from ACS. This technique may serve as a valuable adjunct for guiding surgical debridement which may minimize complications and reduce the number of debridement procedures required, particularly in challenging cases of delayed or missed diagnosis of compartment syndrome.

PMID:41548404 | DOI:10.1016/j.injury.2026.113039

Injury. 2026 Jan 10:113034. doi: 10.1016/j.injury.2026.113034. Online ahead of print.

ABSTRACT

BACKGROUND: Post-burn elbow flexion contractures significantly impair upper-limb function by restricting the essential functional arc of motion required for activities such as self-care, feeding, hygiene, and vocational tasks. Standard management using contracture release and skin grafting is limited by high rates of recontracture due to secondary graft contraction. Locoregional perforator flaps based on the radial recurrent or ulnar recurrent vessels are often missed, even though they offer thin, pliable, and durable tissue. This study evaluates the flap surface area required to resurface the elbow flexure crease and analyzes postoperative functional outcomes using the Mayo Elbow Performance Score (MEPS).

METHODS: A prospective observational study was conducted over a three-year period in a tertiary care plastic surgery department. Patients aged 12 years and older presenting with post-burn elbow flexion contractures and with either the radial or ulnar border of the arm unaffected were included. Flap area was estimated from the contralateral limb or an age- and sex-matched individual in bilateral cases. Radial recurrent artery perforator (RRAP) or ulnar recurrent artery perforator (URAP) flaps were harvested based on perforator availability. MEPS was recorded preoperatively and at 6 weeks postoperatively. Early mobilization was initiated within 48 h, and donor sites were grafted as needed.

RESULTS: Twelve patients out of 38 (31%) (eight males, four females; mean age, 34 years) met the inclusion criteria. Flame burns accounted for 9 cases, and scald injuries for 3. The mean flap area required to reconstruct the flexure crease was 39 cm². Preoperatively, elbow function was markedly limited, with a mean MEPS of 60 (range 45-70). Following contracture release and flap resurfacing, early mobilization was achieved in all patients without the need for postoperative splinting. At 6 weeks, the mean MEPS improved significantly to 98 (range 95-100), confirmed by Wilcoxon rank-sum testing (p< 0.05). No flap failures, wound complications, or early recontractures were noted.

CONCLUSION: Radial and ulnar recurrent artery perforator flaps provide reliable, thin, and contour-appropriate tissue for resurfacing the elbow flexure crease after burn contracture release. Their ability to permit early mobilization and prevent recontractures makes them an effective primary reconstructive option in about 31% of cases.

PMID:41547588 | DOI:10.1016/j.injury.2026.113034

Injury. 2025 Dec 17;57(3):112960. doi: 10.1016/j.injury.2025.112960. Online ahead of print.

ABSTRACT

INTRODUCTION: The treatment paradigm of pelvic ring injuries has undulated over recent decades. Open reduction and internal fixation (ORIF) became more common in the 1990s and early 2000s followed by a decline in the late 2000s and 2010s, in favor of nonoperative management. Recently, minimally invasive pelvic stabilization using percutaneous pelvic fixation (PFF) has gained popularity. The trends of ORIF, PPF, and nonoperative management of pelvic ring injuries over the last decade is not well described. This study aims to characterize such trends among early-career orthopaedic trauma surgeons from 2003 to 2023.

METHODS: Data was collected from the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List database for Candidates who indicated that their subspecialty was trauma over a time period involving 20 years of Case List submissions (2003-2023). Pelvic ring fixation was identified using CPT codes for ORIF (27,217, 27,218) and PPF (27,216). Total case volumes and trends in fixation type were analyzed, including an age-based subgroup analysis of younger (age 18-50) and older (age ≥65) adults, RESULTS: Of 15,164 total ABOS Part II Candidates, 795 indicated a trauma subspecialty and performed at least one pelvic ring fixation, with a total of 7311 pelvic fixation cases (3317 ORIF; 3994 PPF). Annual pelvic ring injury fixations increased five-fold during the study period, from 110 in 2003 to 592 in 2023. The proportion of ORIF decreased from 70 % to 40 %, while PPF increased from 30 % to 60 %. The share of early-career surgeons' practice dedicated to percutaneous fixation tripled. Operative fixation (both PPF and ORIF) of pelvic ring injuries in older adult patients became more common over this period.

CONCLUSION: Percutaneous stabilization of pelvic ring injuries is increasing over time, reflecting evolving practice patterns among early-career trauma surgeons. Future studies should evaluate the clinical implications of this trend, including the impact on fellow and resident training.

PMID:41547086 | DOI:10.1016/j.injury.2025.112960

Injury. 2026 Jan 9;57(3):113024. doi: 10.1016/j.injury.2026.113024. Online ahead of print.

ABSTRACT

BACKGROUND: Prehospital management of suspected spinal injury has long relied on routine full immobilization. In recent years, several studies have questioned its benefit and highlighted possible adverse effects. The aim of this scoping review is to describe the evidence on the management of patients with suspected spinal injury, focusing on models based on full immobilization with rigid devices and a cervical collar, and on strategies of selective spinal motion restriction (SMR).

METHODS: A scoping review was conducted according to JBI methodology and PRISMA-ScR guidance, with a protocol registered on the Open Science Framework. The literature search was carried out in the PubMed, Scopus and Web of Science databases. Studies on adults or children with suspected traumatic spinal injury managed in the out-of-hospital setting were included when strategies of full immobilization, selective SMR or no immobilization were described or compared.

RESULTS: Twenty-seven studies met the inclusion criteria, including observational cohorts, experimental studies on volunteers, simulation studies and qualitative research. Overall, no clear advantage of routine full immobilization over more selective strategies emerges. Selective SMR based on clinical assessment and decision rules appears to reduce the use of rigid devices without evidence of increased missed unstable injuries. Prolonged immobilization is instead associated with pain, discomfort, alterations in tissue perfusion and greater use of imaging examinations. The overall body of evidence is heterogeneous and largely based on observational studies, in which the influence of confounding factors cannot be fully ruled out.

CONCLUSIONS: The available evidence supports moving away from routine full immobilization towards selective SMR in the prehospital setting. Emergency medical services should update protocols and training accordingly and promote prospective studies focused on clinical outcomes and patient experience.

PMID:41547085 | DOI:10.1016/j.injury.2026.113024

Injury. 2026 Jan 13;57(3):113029. doi: 10.1016/j.injury.2026.113029. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to hierarchically analyse the fixation effects of single and multiple screws on quadrilateral fractures in the acetabular region using finite element technology.

METHODS: A three-dimensional finite element model of the normal pelvis was constructed based on normal adult CT data using Mimics, Geomagic, SolidWorks, ANSYS. Six transverse equidistant fracture lines were designed for the hierarchical analysis, and five simulated human body positions were considered.

RESULTS: We compared the mechanical properties of single and multiple screws used for fixation under various operating conditions. The results indicated a layer-by-layer decrease in the relative displacement of the fracture lines from top to bottom under different strength conditions in the standing position and the lumbar spine. In the lateral decubitus position, fracture lines 1-5 decreased layer by layer, whereas fracture line 6 increased. Moreover, in the multiple-screw model, posterior column corridor screw experienced lower stress than in the single-screw model, while blocking screws bore significantly higher stress than posterior column corridor screw. Additionally, pronounced displacement occurred along the anterior and posterior columns sides of the quadrilateral region, while the central segment showed only minor shifting under different loading states in the standing and lumbar postures; in contrast, such behavior was not observed in the lateral decubitus position.

CONCLUSION: Multiple-screw fixation suggests better stability with smaller relative displacement than single-screw fixation under different loading conditions in the finite element analysis.

PMID:41547084 | DOI:10.1016/j.injury.2026.113029