Injury. 2025 Jul 22:112623. doi: 10.1016/j.injury.2025.112623. Online ahead of print.

ABSTRACT

PURPOSE: Inferior vena cava (IVC) filters are considered for preventing fatal pulmonary embolism (PE) in patients unable to undergo anticoagulant therapy. Trauma patients face a heightened risk of PE due to immobility and hypercoagulability. Although effective, IVC filters have long-term risks and should be removed when no longer indicated. A dedicated follow-up clinic can improve IVC filter retrieval rates and minimize complications. This study evaluates the impact of a dedicated clinic on retrieval rates, complications, and follow-up.

METHODS AND MATERIALS: A retrospective analysis was conducted on trauma patients with IVC filters inserted between October 2011 and October 2021. A dedicated trauma clinic, established in January 2018, followed discharged patients with inserted IVC filters. Inclusion criteria included prophylactic and therapeutic indications and emergent presentations. Patients who died during hospitalization or had filters retrieved at other hospitals were excluded.

RESULTS: During the pre-clinic period, 639 IVC filters were inserted, and 380 (59.5 %) were retrieved, with an average dwell time of 200 days. In the post-clinic period, 332 filters were inserted, and 278 (83.8 %) were retrieved, with a reduced average dwell time of 150 days. Complications decreased from 37 cases (average dwell time: 303 days) pre-clinic to 10 cases (average dwell time: 187 days) post-clinic.

CONCLUSION: The establishment of a dedicated follow-up clinic significantly improved IVC filter retrieval rates and reduced dwell times at this trauma center. This study highlights the value of follow-up clinics in ensuring timely IVC filter retrieval and minimizing complications when filters are no longer clinically required.

PMID:40738827 | DOI:10.1016/j.injury.2025.112623

Injury. 2025 Jul 24;56(10):112611. doi: 10.1016/j.injury.2025.112611. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize the mechanisms, distribution, and outcomes of traumatic limb amputations among military casualties during the Israel-Hamas War, and to evaluate the association between life-saving interventions and survival.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study analyzed data from the Israel Defense Forces Trauma Registry. The cohort included 3253 urgent battlefield casualties who sustained limb injuries and were treated by IDF medical forces between October 27th, 2023 and October 31st, 2024.

MAIN OUTCOMES AND MEASURES: The primary outcomes were anatomical distribution of amputations, mechanism of injury, application of life-saving interventions (tourniquet, whole blood, freeze-dried plasma), and survival on the way to hospital admission and during hospitalization.

RESULTS: Of 3253 casualties, 135 (4.2 %) were initially recorded as having amputations. After review, 112 cases were confirmed to involve at least one amputated limb. Explosive devices were the leading cause of injury among amputees (88.9 %). Among the 112 confirmed cases, 50 (44.6 %) survived until hospital admission, and 62 (55.4 %) were pronounced dead prior to hospital arrival; 4 of the survivors died during hospitalization. Tourniquets were applied in 90 % of survivors compared to 24.2 % of deceased (p < 0.001). Whole blood and FDP were administered more frequently in survivors (60 % and 40 %, respectively) than in deceased casualties (9.7 % and 4.8 %, respectively; p < 0.001 for both). Above-knee amputations were the most common anatomical level in both groups.

CONCLUSION AND RELEVANCE: Combat-related limb amputations during the Israel-Hamas War were primarily caused by explosions and were associated with high mortality. Prompt application of life-saving interventions, particularly tourniquets and early blood resuscitation, was strongly associated with survival. These findings emphasize the critical need for rapid hemorrhage control and trauma care readiness in modern military conflict settings.

PMID:40738012 | DOI:10.1016/j.injury.2025.112611

Injury. 2025 Jul 22:112622. doi: 10.1016/j.injury.2025.112622. Online ahead of print.

NO ABSTRACT

PMID:40731241 | DOI:10.1016/j.injury.2025.112622

Injury. 2025 Jul 10;56(10):112609. doi: 10.1016/j.injury.2025.112609. Online ahead of print.

ABSTRACT

INTRODUCTION: Intraarticular scapular fractures occur mostly in high-energy injuries in contrast to glenoid fractures, which occur mostly in humeral head dislocations. In addition to open repositioning and osteosynthesis, minivascular osteosynthesis under the control of fluoroscopy and arthroscopy has been also used. Arthroscopy allows debridement of the fracture line in the intraarticular area as well as its repositioning during repositioning maneuvers under direct visualization. Furthermore, arthroscopy allows full control over the placement of osteosynthetic material in the subchondral region.

MATERIAL AND METHODS: Between 2013 and 2020, we performed osteosyntheses of 15 intraarticular fractures of the scapula using arthroscopy in addition to perioperative fluoroscopy. Patients were followed up at regular intervals at a mean of 10 days, 4 weeks, 3, 6, 12 and 24 months and 5 years after surgery including radiographic follow-up. Clinical outcomes and signs of radiological fracture healing were assessed continuously. Additionally, at 2 and 5 years after surgery, we evaluated the results according to the Constant score system. In particular, we evaluated ventral flexion of the arm, which we consider the dominant indicator of shoulder joint function.

RESULTS: There were 11 males and 4 females, mean age 37.5 (24-52) years. Perioperatively, we achieved fracture reduction with dislocation in the intraarticular region up to a maximum of 2 mm, which was measured arthroscopically and on perioperative and postoperative radiographs. We did not observe any inflammatory complications in the postoperative period. The mean duration of fracture healing was 112 days. The mean Constant score at two years after surgery was 85 points, and at five years was 87 points.

DISCUSSION: There are relatively few papers on similar topics in the world literature, but those that exist present the benefits of arthroscopy in some types of osteosyntheses of intraarticular fractures of the scapula. The most reported are osteosyntheses of the anterior glenoid in bony Bankart lesions. The numbers of patients in each paper are comparable or smaller.

CONCLUSION: Minimally invasive osteosynthesis of intraarticular fractures of the scapula under arthroscopic control allows precise reduction of fragments. Our study demonstrated favourable outcomes of this method with minimal complications.

PMID:40729990 | DOI:10.1016/j.injury.2025.112609

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.00471. Online ahead of print.

ABSTRACT

BACKGROUND: We revaluated the radiographic results of a 2004 landmark, multicenter prospective study of patients with Legg-Calvé-Perthes disease (LCP). In the current study, we developed a new classification to evaluate the femoral head, acetabulum, and greater trochanter in the hips of patients with LCP, to address what we found to be deficiencies in the Stulberg rating system, which is based mainly on femoral head shape.

METHODS: We digitized and analyzed approximately 5,000 radiographs and related data sheets of 337 patients (345 hips) with LCP from the 2004 study. We found many unexpected abnormalities, including serious lesions of the femoral head, that had not been noted in that study. To record our findings in the femoral head, acetabulum, and greater trochanter, we developed a classification system that we termed the HAT (Head, Acetabulum, Trochanter) classification, which assigns the femoral head 1 to 5 points, the acetabulum 1 point if dysplastic, and the greater trochanter 1 point if elevated to or above the femoral head. The sum is the HAT score, which we compared with the Stulberg score, other predictive factors, and the Nonarthritic Hip Score (NAHS) from two 20-year follow-up studies of a number of patients from the 2004 study.

RESULTS: The intraclass correlation coefficient (ICC) of the HAT score was 0.93 (95% confidence interval [CI]: 0.90 to 0.95), and the total HAT score correlated strongly with the NAHS. Forty-nine percent of all hips had acetabular dysplasia, which correlated with a worse NAHS. A HAT of ≤3 was considered a good result. The odds of a patient developing acetabular dysplasia at skeletal maturity were lower after surgical treatment than after nonoperative treatment. In addition, surgically treated patients had better HAT scores than nonoperatively treated patients, especially if their skeletal age was ≥6 years at LCP onset. Better outcomes were also associated with a favorable lateral pillar classification, a younger skeletal at onset, and male sex.

CONCLUSIONS: The HAT classification is reproducible and allows a more comprehensive analysis of the radiographic outcomes of LCP. The system is flexible and would allow for different measures of its 3 components in future studies.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40729461 | DOI:10.2106/JBJS.24.00471

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.00835. Online ahead of print.

ABSTRACT

BACKGROUND: Aseptic loosening remains a main complication following total knee arthroplasty (TKA), requiring revision surgery. Radiostereometric analysis (RSA) can assess the risk of aseptic loosening. This study evaluated the migration and segmental motion of cemented and uncemented femoral and asymmetrical tibial Persona components (Zimmer Biomet) with model-based RSA.

METHODS: We conducted a randomized controlled trial with 63 patients (22 male patients and 41 female patients, with a mean age of 62 years) and compared patients who underwent TKA with cemented and uncemented Persona components. The primary outcome measure was the maximal total point motion (MTPM) after 2 years. The Mann-Whitney U test was used to compare groups. Migration was visualized by plotting the mean and 95% confidence interval (CI).

RESULTS: After 3 months, femoral components demonstrated an MTPM of 0.41 mm (95% CI, 0.35 to 0.48 mm) in the cemented group and 0.65 mm (95% CI, 0.50 to 0.80 mm) in the uncemented group. Subsequently, a stabilization occurred, and the MTPM after 24 months was 0.51 mm (95% CI, 0.41 to 0.61 mm) in the cemented group and 0.83 mm (95% CI, 0.65 to 1.02 mm) in the uncemented group. There was a significant difference between fixation types at 3 months (p = 0.04), 6 months (p = 0.03), 12 months (p = 0.02), and 24 months (p = 0.02). At 3 months postoperatively, the tibial component demonstrated an MTPM of 0.70 mm (95% CI, 0.53 to 0.88 mm) in the cemented group and 0.76 mm (95% CI, 0.61 to 0.91 mm) in the uncemented group. A stabilization was then observed, and migration after 24 months was 0.72 mm (95% CI, 0.55 to 0.89 mm) for cemented components and 0.78 mm (95% CI, 0.64 to 0.92) for uncemented components.

CONCLUSIONS: TKA with cemented and uncemented Persona components showed migration values within acceptable ranges, suggesting successful long-term fixation; however, significant differences in mean MTPM between cemented and uncemented femoral components were found.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40729455 | DOI:10.2106/JBJS.24.00835

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.01205. Online ahead of print.

ABSTRACT

BACKGROUND: Lumbar spinal fusion (LSF) is a common surgical procedure for treating lumbar degenerative conditions. The use of osteobiologics to enhance fusion has emerged as a promising alternative to address the limitations of autologous iliac crest bone graft (AICBG), but their comparative efficacy and safety remain unclear. This systematic review and network meta-analysis (NMA) aimed to assess the fusion rates, safety profiles, and clinical outcomes of the use of osteobiologics in LSF.

METHODS: PubMed/MEDLINE and Scopus databases were searched for randomized controlled trials (RCTs) comparing different osteobiologics to AICBG in LSF. Data on fusion rates, complications, pain, disability, blood loss, operative time, and length of stay (LOS) were extracted. The risk of bias was evaluated using the Cochrane Risk of Bias-2 tool, and the certainty of evidence was assessed using the GRADE framework. The NMA was performed using a frequentist random-effects model to compare the efficacy and safety of various osteobiologics, along with associated perioperative and clinical outcomes.

RESULTS: Forty-three RCTs including a total of 3,823 patients were identified. The use of rhBMP-2 (recombinant human bone morphogenetic protein-2) significantly improved fusion rates (odds ratio [OR]: 3.71; 95% confidence interval [CI]: 2.59 to 5.32; p < 0.0001) and reduced complications (OR: 0.30; 95% CI: 0.13 to 0.68; p < 0.0001) compared with AICBG, with moderate certainty of the evidence. Other osteobiologics, including ABM/P-15 (anorganic bone matrix/15-amino acid peptide fragment) and allograft, demonstrated reduced complication rates, although the quality of the evidence was low to very low. No significant differences were observed for pain, disability, or LOS. The use of rhBMP-2, autologous local bone, and silicate-substituted calcium phosphate was associated with decreased operative time, with rhBMP-2 additionally associated with lower intraoperative blood loss.

CONCLUSIONS: Use of rhBMP-2 was associated with significantly higher fusion and lower complication rates compared with AICBG, as well as decreased operative time and blood loss. Other osteobiologics may also offer benefits, but the supporting evidence is low-quality and limited by the notable underrepresentation of these materials in the published literature.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40729448 | DOI:10.2106/JBJS.24.01205

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.00792. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior cruciate ligament tears are a common injury that is often treated with arthroscopic anterior cruciate ligament reconstruction (ACLR). This meta-analysis investigates the impact of tourniquet use on ACLR and the outcomes of this procedure.

METHODS: Searches were conducted across 4 databases: Embase, PubMed, Scopus, and the Web of Science. The quality of the included studies was assessed using the Consolidated Standards Of Reporting Trials (CONSORT) 2010 checklist. A meta-analysis was performed to compare the outcomes between patients who underwent ACLR with versus without a tourniquet.

RESULTS: Eight studies were eligible for systematic review; of these, 6 were eligible for meta-analysis. The CONSORT scores for the studies ranged from 22 to 37. No significant differences were found between the groups in terms of intraoperative blood loss (standardized mean difference, with versus without a tourniquet [SMD], -2.15; 95% confidence interval [CI]: -5.87, 1.58; I2 = 99%), surgery time (SMD, -0.57; 95% CI: -1.32, 0.18; I2 = 94%), or Lysholm knee scores after 1 year (SMD, -0.06; 95% CI: -0.33, 0.21; I2 = 0%). The quality of the arthroscopic visual field varied across the studies. Postoperative pain levels were significantly higher in the tourniquet group (SMD6-hour follow-up, 1.77; 95% CI: 0.07, 3.47; I2 = 93%), although morphine consumption did not differ significantly between the groups (SMD, 0.25; 95% CI: -0.83, 1.33; I2 = 93%). The no-tourniquet group had significantly greater thigh (SMD, -0.46; 95% CI: -0.79, -0.14; I2 = 36%) and calf (SMD, -0.26; 95% CI: -0.49, -0.03; I2 = 70%) circumferences postoperatively.

CONCLUSIONS: Tourniquet use during ACLR did not significantly impact intraoperative blood loss, hemoglobin levels, or surgery time but was associated with increased postoperative pain. The use of epinephrine solution may be a viable alternative to the use of a tourniquet to improve visualization.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40729445 | DOI:10.2106/JBJS.24.00792

Int Orthop. 2025 Jul 29. doi: 10.1007/s00264-025-06626-w. Online ahead of print.

NO ABSTRACT

PMID:40728644 | DOI:10.1007/s00264-025-06626-w

Int Orthop. 2025 Jul 29. doi: 10.1007/s00264-025-06625-x. Online ahead of print.

NO ABSTRACT

PMID:40728643 | DOI:10.1007/s00264-025-06625-x

Int Orthop. 2025 Jul 29. doi: 10.1007/s00264-025-06627-9. Online ahead of print.

ABSTRACT

PURPOSE: Shepherd's crook deformity is a characteristic complication of fibrous dysplasia (FD) of the femur, leading to coxa vara and mechanical instability. Two-stage surgical approaches involve initial valgus osteotomy followed by delayed intramedullary femoral stabilization, prolonged treatment, and increasing morbidity. This study evaluates a one-stage surgical correction that employs fibular strut allograft augmentation for both the femoral neck and shaft.

METHODS: A retrospective review was performed on 17 patients with Shepherd's crook deformity who underwent one-stage hip lag screw and side plate fixation with fibular strut allograft augmentation of the femoral neck and shaft between 2002 and 2022. Radiographic and clinical outcomes were assessed, including neck-shaft angle (NSA) restoration, fixation stability, graft incorporation, and functional improvement. The median follow-up of the patients was 96 months.

RESULTS: The mean preoperative NSA was 93° (SD: 13.5°), improving significantly to 130° (SD: 5°) at the latest follow-up (p < 0.001). Stable fixation was achieved in 16 of 17 patients, with one case of fixation failure. Fibular graft resorption was noted in six patients but did not compromise fixation. Clinically, postoperative pain, limping, and activity limitations improved substantially, though seven patients experienced persistent restrictions in outdoor activities. The average limb shortening was 3.5 cm before the operation and 0.9 cm at the end of the follow-up.

CONCLUSION: One-stage correction of Shepherd's crook deformity using lag hip screw fixation and fibular strut allograft augmentation could be a viable alternative to staged procedures, though further studies are needed to confirm its efficacy and generalizability.

PMID:40728642 | DOI:10.1007/s00264-025-06627-9

J Bone Joint Surg Am. 2025 Jul 28. doi: 10.2106/JBJS.25.00532. Online ahead of print.

NO ABSTRACT

PMID:40720550 | DOI:10.2106/JBJS.25.00532

Int Orthop. 2025 Jul 28. doi: 10.1007/s00264-025-06613-1. Online ahead of print.

NO ABSTRACT

PMID:40719875 | DOI:10.1007/s00264-025-06613-1

Injury. 2025 Jul 21;56(10):112618. doi: 10.1016/j.injury.2025.112618. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFPs) in older adults are increasingly recognized as serious injuries with substantial morbidity. However, mortality after FFP has not been comprehensively quantified across timepoints or patient subgroups, limiting the ability to inform prognosis and guide clinical strategies. This systematic review and meta-analysis aimed to assess the 1-year mortality following FFP in patients aged ≥60 years. We also assessed the mortality at 30 days, 3 months, 6 months, 2 years, and 5 years after FFP, and the differences in mortality by geographic region, sex, fracture classification, or treatment modality.

METHODS: We conducted a systematic review and meta-analysis of studies published from inception to May 2024 in MEDLINE, Embase, and CENTRAL databases. Eligible studies reported mortality outcomes in patients aged ≥60 years with FFP. A random-effects model was used to estimate pooled mortality at prespecified time points. We assessed the risk of bias using the Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool. Subgroup analyses were conducted to assess differences by region, sex, fracture classification, and treatment modality. We conducted a sensitivity analysis including only the high-quality studies according to the JBI assessment. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS: The pooled 1-year mortality was 17 % (95 % confidence interval, 14 %-19 %). The certainty of this evidence was rated as low because of publication bias and heterogeneity. The mortality at 30 days, 3 months, 6 months, 2 years, and 5 years were 5 %, 10 %, 14 %, 26 %, and 46 %, respectively. Mortality was lower in studies from Asia than in those from Europe or North America. Male sex, lower-grade FFPs, and nonoperative management showed numerically higher mortality, though not statistically significant.

CONCLUSION: FFPs are associated with substantial short- and long-term mortality, warranting their recognition as high-risk injuries in older adults. Regional and treatment-related variation highlights the need for individualized management. Future research should clarify causal mechanisms and assess targeted interventions to reduce mortality risk.

PMID:40714375 | DOI:10.1016/j.injury.2025.112618

Int Orthop. 2025 Jul 26. doi: 10.1007/s00264-025-06618-w. Online ahead of print.

ABSTRACT

PURPOSE: Dislocation after total hip arthroplasty (THA) via the posterior approach remains a serious complication. This cadaveric study compared two soft tissue repair techniques-trans-osseous and direct suturing-regarding their effect on dislocation torque and angle.

METHODS: Ten hips from five fresh-frozen cadavers were used. A Posterior approach identified the short external rotators. Following standard THA, each limb was mounted on a motorized torque wrench. Hips were tested first with no posterior repair (NPR), then with either transosseous or direct repair techniques. Dislocation torque and angle were recorded, with each hip serving as its own control.

RESULTS: Posterior repair significantly increased the force required for dislocation compared to NPR (mean 9.12 Nm vs. 2.73 Nm; p = 0.004). Trans-osseous repair led to a 4.41-fold increase in torque (p = 0.04), and direct repair a 2.47-fold increase (p = 0.03), with a significant difference between the two (p = 0.016). The dislocation angle increased with repair (mean 54.6° vs. 45.1°; p = 0.09), though not significantly. Trans-osseous and direct repairs increased the angle by 1.70× and 1.18×, respectively.

CONCLUSION: Posterior soft tissue repair improves hip stability in THA performed via a posterior approach. Trans-osseous repair provides significantly greater resistance to dislocation torque than direct suturing and may be the preferred technique to reduce postoperative instability.

PMID:40715845 | DOI:10.1007/s00264-025-06618-w

Int Orthop. 2025 Jul 26. doi: 10.1007/s00264-025-06620-2. Online ahead of print.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is a highly effective procedure for end-stage knee osteoarthritis, but postoperative instability remains a major concern, impacting patient satisfaction and leading to potential revision surgeries. Understanding patient-related risk factors for instability is crucial for optimizing outcomes and minimizing complications.

METHODS: We conducted a retrospective cohort study of patients who underwent revision TKA at our clinic between 1996 and 2021, focusing on those who required revision specifically due to instability. We analyzed a dataset of 39,572 primary TKA patients without documented revisions and 859 revision patients. Data extraction included age, gender, body mass index (BMI), age-adjusted Charlson Comorbidity Index (CCI) score, and comorbidities. Statistical analyses, including binary logistic regression, were performed to identify independent risk factors for instability.

RESULTS: The instability group (n = 859) had a mean age of 65.7 years and a significantly lower proportion of males compared to the control group (mean age 67.5 years, p < 0.001; males 30.7% vs. 38.1%, p < 0.001). Notable risk factors included younger age, female gender, stroke, deep vein thrombosis (DVT), and scleroderma. Specifically, scleroderma was associated with a high risk of instability (P < 0.01 OR [odds ratio] 9.27, CI [confidence interval] 2.01 to 42.7), stroke (P = 0.01 OR 1.8, CI: 1.1 to 3.1), and DVT (p < 0.01 OR: 2.0, CI: 1.4 to 2.8).

CONCLUSION: Patient-related factors such as younger age, female gender, stroke, DVT, and scleroderma significantly influence the risk of instability following primary TKA. These findings highlight the multifactorial nature of TKA instability and underscore the importance of tailored preoperative assessment and postoperative care. Addressing these risk factors can improve patient outcomes and reduce the incidence of instability following TKA.

PMID:40715844 | DOI:10.1007/s00264-025-06620-2

Injury. 2025 Jul 19:112619. doi: 10.1016/j.injury.2025.112619. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite evidence of frequent adverse psychological reactions including PTSD in major trauma survivors, psychological support represents a frequent gap in UK major trauma care pathways. North Bristol Trust Major Trauma and Plastics Psychology Service has been newly developed in response at an NHS Major Trauma Centre (MTC). The service aims to address patients' psychological needs early on and throughout recovery from major trauma, alongside physical and functional recovery. Thus, a qualitative service evaluation was conducted. It aimed to explore major trauma clinicians' perspectives and experiences of the psychology service and to identify areas of strength and opportunity for development.

METHOD: Semi-structured interviews were conducted with a purposive sample of seven major trauma clinicians working at the MTC who make referrals to, and interact with, the psychology service. Data were thematically analysed using a codebook approach.

RESULTS: Thematic analysis of qualitative data revealed five themes: (1) Necessity of specialist psychology for major trauma patients; (2) Psychological involvement facilitates patients' recovery; (3) Psychologists have an important role in supporting clinicians; (4) Requirement for service expansion; (5) Importance of psychologists' integration within a multidisciplinary team. Overall, the importance of the psychology service in facilitating patients' holistic recovery was emphasised, as well as its role in emotionally and professionally supporting major trauma clinicians. Service expansion was suggested to better meet patients' needs by permitting increased provision of training and formalised support sessions for clinicians, greater involvement of psychologists in rehabilitation, and psychological support for patients' families.

CONCLUSIONS: Findings highlighted a perceived positive impact of integrated, specialist psychological support on the recovery of major trauma patients and the psychological wellbeing of major trauma clinicians. A need for future service expansion to overcome current capacity pressures and permit suggested developments was also emphasised. Replication of the psychology service in additional NHS MTCs to reach patients in other regions offers a potential solution to current inequities in post-major trauma psychological care in the UK.

PMID:40713353 | DOI:10.1016/j.injury.2025.112619

Injury. 2025 Jul 16:112612. doi: 10.1016/j.injury.2025.112612. Online ahead of print.

ABSTRACT

BACKGROUND: Shock index (SI) has been used to identify patients at risk for severe injury and predict those who require an emergent intervention. In adults, SI > 0.9 is considered elevated. Shock index pediatric age-adjusted (SIPA) modifies this threshold based on patients' age. This analysis leverages a large dataset to empirically identify threshold values of SI using a composite outcome capturing patients' need for emergent intervention.

METHODS: Pediatric patient data was abstracted from the Trauma Quality Improvement Program Participant Use Files from 2013 - 2020. 484,586 patients were included in the analysis. Area under the receiver-operator characteristic curve (AUROC) was used to empirically derive optimal cutoffs by age group. Need for emergent intervention included craniotomy, thoracotomy, laparotomy, chest tube, angioembolization, endotracheal intubation, and blood transfusion within 24 h of arrival or use of mechanical ventilation or admission to an intensive care unit.

RESULTS: Empirically derived SIPA-E cutoffs (1.23, 1.05, 0.95, and 0.85 for ages 1-3, 4-6, 7-12, and 13-17 years, respectively) were similar to established SIPA-L cutoffs (1.22, 1.22, 1.00, and 0.90). Overall accuracy was consistent between the two cutoffs with nearly equal trades of sensitivity for specificity but remain low overall (empirical cutoff sensitivity = 33.8 %, specificity = 79.5 %; established cutoff sensitivity = 26.5 %, specificity = 86.8 %).

CONCLUSIONS: Empirically derived cutoffs agreed with established cutoffs for SIPA, but overall accuracy is low. Rather than predicting broad outcomes, SIPA seems better suited to narrow cases where it has shown greater accuracy, such as the need for urgent blood transfusion.

LEVEL OF EVIDENCE: Prognostic/epidemiological; Level III.

PMID:40713352 | DOI:10.1016/j.injury.2025.112612

J Bone Joint Surg Am. 2025 Jul 25. doi: 10.2106/JBJS.25.00574. Online ahead of print.

NO ABSTRACT

PMID:40712043 | DOI:10.2106/JBJS.25.00574

J Bone Joint Surg Am. 2025 Jul 25. doi: 10.2106/JBJS.24.01520. Online ahead of print.

ABSTRACT

BACKGROUND: Achieving and maintaining global spinal balance is a crucial goal in posterior spinal fusion for adolescent idiopathic scoliosis (AIS). Despite its substantial impact on operative success, there is a noticeable gap in the literature regarding a systematic evaluation of the trajectory and durability of this critical parameter. With this study, we aimed to characterize the evolution of global balance after posterior spinal fusion for AIS.

METHODS: A prospective, multicenter spinal deformity database was retrospectively queried for patients with AIS undergoing posterior spinal fusion. Standing, 2-view radiographs (anteroposterior and lateral) were obtained at the first-erect visit, 6 months, 1 year, 2 years, and 5 years, with a subset of patients having radiographs at the 10-year mark. Coronal balance was defined as the difference, in centimeters, between the C7 plumb line and the central sacral vertical line (CSVL). The sagittal vertical axis (SVA) measured sagittal balance, calculated as the difference, in centimeters, between the C7 plumb line and the posterosuperior corner of the superior end plate of S1.

RESULTS: The study included 477 patients with 5 years of follow-up and 84 patients with a decade of follow-up. The mean patient age was 14.1 years, 67.9% of the patients were White, and 81.6% of the patients were female. Preoperative assessment revealed that 50.7% of the patients demonstrated optimal global balance. The initial postoperative evaluation showed essentially no improvement, with only 55.6% achieving optimal balance (Coronal and Sagittal Harmony [CASH] A0) at the first-erect visit. Subsequent follow-up demonstrated steady improvement, with 81.8% reaching optimal balance at 5 years and 87.7% at the 10-year mark.

CONCLUSIONS: This study offers a comprehensive analysis of global spinal alignment and traces the balance trajectory (in both the coronal and sagittal planes) after posterior spinal fusion in AIS. To our knowledge, it is the largest and longest follow-up study of its kind. The findings highlight a profound and steady postoperative improvement in global balance over time, advancing our understanding of postoperative spinal balance in AIS. The novel CASH classification introduced here serves as a possible tool for evaluating overall alignment and balance in patients with AIS.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40712001 | DOI:10.2106/JBJS.24.01520