EFORT Open Rev. 2026 Jan 9;11(1):34-45. doi: 10.1530/EOR-2025-0046.

ABSTRACT

Valgus accounts for 18.5% of patients undergoing a total knee arthroplasty (TKA). Following a mechanical alignment (MA) surgical technique, these patients have historically been more challenging than their varus counterparts. In valgus knees, conventional MA-TKA frequently distalizes and posteriorizes the lateral femoral condyle, increasing lateral patellar retinaculum tension and flexion space imbalance and instability. Personalized arthroplasty is gaining popularity for varus knees, but its value remains debated for valgus knees. This reluctance stems from outdated misconceptions about valgus knee anatomy and biomechanics and limited awareness of advancements in implant survivorship and outcomes. Patients with valgus HKA may present with various knee laxities. While medial collateral ligament (MCL) pseudo-laxity and generalized hyperlaxity are easy to manage, true MCL elongation requires careful evaluation and may necessitate surgical modifications. A surgical approach favoring patellar tracking and avoiding increasing medial compartment gaps is of paramount importance. Joint laxity assessment should guide surgical decisions, from tibial undercutting for mild laxity to soft tissue releases or constrained implants for severe instability. In the presence of a pathological patellofemoral joint, the surgical technique should be adapted with trochlear position/orientation modifications, patellar resurfacing medializing the implant, lateral retinacular release, or a tibial tuberosity osteotomy. Long-term studies show high patient satisfaction with restricted kinematic alignment, TKA in valgus knees, with outcomes comparable to varus knees.

PMID:41511890 | DOI:10.1530/EOR-2025-0046

EFORT Open Rev. 2026 Jan 9;11(1):1-2. doi: 10.1530/EOR-2025-0276.

NO ABSTRACT

PMID:41511886 | DOI:10.1530/EOR-2025-0276

J Bone Joint Surg Am. 2026 Jan 9. doi: 10.2106/JBJS.25.01276. Online ahead of print.

ABSTRACT

Orthopaedic surgeons are the custodians of the musculoskeletal system in Singapore, with >350 orthopaedic surgeons looking after the whole continuum of musculoskeletal disease in a population of 6 million. Orthopaedic research in Singapore currently has 4 focus areas: tissue engineering, biomechanics, clinical registries and cohorts, and population health and health services research. We have identified 4 key enablers of the continued development of orthopaedic research: talent development and academic clinical programs; shared data infrastructure, national cohorts, and artificial intelligence; innovation; and interdisciplinary, industry, and international collaboration. This is an exciting time for orthopaedic research in Singapore, where we find ourselves at the cusp of a new wave of talent, ideas, and resources. We stand ready and excited to partner with the world to advance musculoskeletal care globally.

PMID:41512087 | DOI:10.2106/JBJS.25.01276

SICOT J. 2025;11:60. doi: 10.1051/sicotj/2025062. Epub 2026 Jan 6.

ABSTRACT

INTRODUCTION: There is a paucity of data regarding the surgical treatment of distal femoral metastatic lesions. In this retrospective study, we aim to describe the outcome of surgery in this location and further analyze the findings based on the type of surgical reconstruction.

METHODS: 47 patients (48 fractures) who underwent surgery due to pathological fractures of the distal third of the femur, between 2000 and 2024, were included in the analysis. There were 29 prostheses and 19 osteosyntheses (10 plates, 9 nails). Local complications, implant revision rate, functional outcome regarding pain and ambulatory capacity, and overall survival were analyzed depending on the type of surgical treatment.

RESULTS: The complication pattern was different among implants used, with severe infections seen in prostheses (3/29 implants) and tumor recurrence in osteosynthesis (2/19 implants). In cases of osteosynthesis, failures resulting in revision surgery were documented only in cases of plate reconstruction (none when nails were used), resulting in a marginally higher revision rate (p = 0.14). Surgical treatment resulted in the restoration of the ambulatory capacity in 85% of patients, and pain levels were minor or moderate in 93%, without any significant difference between the surgical methods. Prostheses were used in patients with better overall survival (p = 0.015).

DISCUSSION: The patterns of local complications and their management differed between the different reconstruction techniques. Plate osteosynthesis had the highest risk for re-operation. The overall postoperative result was satisfactory, and functional outcomes were generally comparable. Patients with a good prognosis should be considered for reconstruction with a prosthesis when the bone quality does not allow nail osteosynthesis.

LEVEL OF EVIDENCE: IV, retrospective study.

PMID:41499667 | PMC:PMC12779260 | DOI:10.1051/sicotj/2025062

SICOT J. 2025;11:59. doi: 10.1051/sicotj/2025058. Epub 2026 Jan 6.

ABSTRACT

INTRODUCTION: Combined C1-C2 fractures are common upper cervical injuries with high morbidity and mortality. Controversy exists regarding which patients benefit from surgery because this is an understudied population with only class III evidence available. We examined surgical intervention and its impact on outcomes in patients with C1-C2 fractures.

METHODS: This retrospective cohort study of the National Trauma Data Bank included patients admitted between 1/2017 and 1/2023 for combined C1-C2 fractures (ICD-10 diagnosis codes S12.0 and S12.1). Exclusions were admission to a level III-V or non-trauma center, not admitted (died or discharged from the ED), and non-index/readmission. The first aim was to identify predictors of surgical intervention (vertebral fusion or internal fixation); multivariate backward regression included the following covariates: Patient demographics, injury severity, concomitant injuries, and specific C1 and C2 fractures. The second aim was to compare hospital outcomes between operative and nonoperative groups utilizing a propensity-matched (1:1) analysis: Mortality, ICU admission, complications, and hospital and ICU LOS.

RESULTS: There were 19,264 patients, and 3,759 (19.5%) were surgically managed. The adjusted odds of surgical intervention were greater with unstable injuries (displaced C1 fracture, displaced C2 fracture, spinal cord injury, vertebral ligament dislocation), specific C1 and C2 fractures (odontoid fracture, Jefferson burst fracture, posterior arch fracture), whereas surgical intervention odds decreased for frailty (mFI ≥2), ED hemodynamic instability, ED Glasgow coma score ≤8, and increasing age quintile. Propensity matching resulted in 6,710 well-matched patients. After matching, surgical intervention was associated with lower mortality (4.8% vs. 11.3%, p < 0.001) but higher ICU rates, longer LOS, and greater complication rates compared to the nonoperative group.

CONCLUSION: This study of nearly 20,000 patients with combined C1-C2 fractures provides class II evidence for surgical intervention, highlighting the balance between injury characteristics and patient resilience. Surgical intervention was associated with a significant survival benefit, emphasizing its role in select patients.

PMID:41499666 | PMC:PMC12779261 | DOI:10.1051/sicotj/2025058

Injury. 2025 Dec 12;57(2):112964. doi: 10.1016/j.injury.2025.112964. Online ahead of print.

ABSTRACT

INTRODUCTION: The ideal fixation construct for treatment of stress-positive lateral compression type 1 (LC1) pelvic ring injuries is controversial. The purpose of this study was determine if anterior and posterior fixation (AF+PF) versus posterior fixation only (PF) of patients with LC1 pelvic ring injuries is associated with home discharge.

PATIENTS AND METHODS: A multicenter retrospective review was performed at eight level one trauma centers of adult patients with stress-positive minimally displaced LC1 pelvic ring injuries (OTA/AO 61B) treated with AF+PF versus PF. Outcomes included length of stay, maximum feet ambulated with physical therapy (PT) while hospitalized, discharge disposition, independent ambulation at last follow-up, and mortality. AF+PF versus PF patients were compared in terms of age, sex, Charleston Comorbidity Index (CCI), injury mechanism, and Beckman score. Propensity-matching was used to control for group differences.

RESULTS: There were 434 patients included; 64.5% (n = 280) treated with AF+PF and 35.5% (n = 154) with PF. Patients treated with AF+PF, versus PF, were older (47.0 vs. 38.0 years; p = 0.01), had a higher CCI (0 vs 0; p = 0.02), a higher Beckman score (8.0 vs. 7.0; p = 0.04), more low-energy falls (18.6% vs. 8.4%; p = 0.004), less independent ambulators (92.1% vs 97.4%; p = 0.03), and more rami fractures with 100% displacement (26.8% vs. 12.3%; p = 0.0004). The groups did not differ in gender, complete sacral fractures, days to surgery, or follow-up duration (p > 0.05). Propensity-matching resulted in two groups of 141 patients, similar in age, CCI, Beckman score, low-energy falls, 100% rami fracture displacement, and follow-up duration (p > 0.05). On matched analysis, patients treated with AF+PF, versus PF, spent fewer days in the hospital (7.0 vs. 8.0; p = 0.03) and were more likely to discharge home (76.6% vs. 63.1%; p = 0.0005). There was no observed difference between groups in terms of feet ambulated with PT, independent ambulation at last follow-up, or mortality (p > 0.05).

CONCLUSION: Matched patients with stress-positive minimally displaced LC1 injuries treated with AF+PF compared to PF spent fewer days in the hospital and were more likely to discharge home.

LEVEL OF EVIDENCE: Therapeutic Level III.

PMID:41500149 | DOI:10.1016/j.injury.2025.112964

J Bone Joint Surg Am. 2026 Jan 7;108(1):60-67. doi: 10.2106/JBJS.25.00597. Epub 2025 Dec 2.

ABSTRACT

BACKGROUND: Patients who have undergone corrective surgery for adolescent idiopathic scoliosis (AIS), especially those with a major lumbar curve, may have persistent postoperative coronal imbalance (PCI) due to an insufficient ability to compensate for lumbar curve overcorrection. However, the optimal amount of curve correction required to prevent PCI remains uncertain. Therefore, this study aimed to evaluate the use of the intraoperative crossbar coronal-balancing technique as a strategy to minimize the risk of PCI in patients with AIS with a major lumbar curve (Lenke type-5 and 6 curves), and to confirm that the tilt angle of the lowest instrumented vertebra (LIV), intraoperatively and at the final follow-up, could be predicted from the preoperative supine right-side-bending (RSB) radiograph that was used to guide the correction.

METHODS: This study involved 39 patients with Lenke 5 or 6 AIS who underwent posterior spinal fusion and had a minimum 2-year follow-up. The median age was 14 years, 15% were male, and all were of Malaysian ethnicity: 84.6% Chinese, 12.8% Malay, and 2.6% Indian. The LIV tilt angle measured on the preoperative supine RSB radiograph, adjusted according to the pelvic obliquity (PO) measured on the erect radiograph (α angle), was used as a guide for the intraoperative LIV tilt angle (β angle). Following curve correction, the crossbar was centered over the sacrum intraoperatively. The position of the C7 vertebra was then assessed relative to the crossbar, and the amount of correction was adjusted to ensure that the proximal portion of the crossbar bisected the C7 vertebra under fluoroscopy. Outcomes included the coronal balance distance (CBD) and the LIV tilt angle at the final follow-up (δ angle).

RESULTS: Only 2 (5.1%) of the patients in the cohort had PCI at the final follow-up. At that time, the mean CBD was -6.6 ± 9.2 mm and the mean δ angle was -12.4° ± 4.8°. There were no significant differences between the α and β angles (p = 0.799) or between the α and δ angles (p = 0.705). The α angle correlated strongly with the β angle (ρ = 0.707) and the δ angle (ρ = 0.730, p < 0.001).

CONCLUSIONS: The intraoperative crossbar coronal-balancing technique was shown to be an effective method to minimize the risk of PCI in patients with AIS with a major lumbar curve. Guided by the α angle measured preoperatively, this approach may help facilitate the determination of the optimal intraoperative LIV tilt angle (β), which corresponds to the LIV tilt angle at the final folow-up (δ).

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

PMID:41498772 | DOI:10.2106/JBJS.25.00597

J Bone Joint Surg Am. 2026 Jan 7;108(1):51-59. doi: 10.2106/JBJS.24.00563. Epub 2025 Dec 2.

ABSTRACT

BACKGROUND: The aims of this study were to evaluate the timing and trend of venous thromboembolism (VTE) prophylaxis initiation following surgical intervention, and the impact of VTE prophylaxis timing on the occurrence of VTE complications, across North American trauma centers in patients with complete traumatic cervical spinal cord injury (SCI).

METHODS: This retrospective, observational cohort study utilized data from the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) from 2013 to 2020. We identified surgically treated patients with complete traumatic cervical SCI. Patient variables included age, sex, race, insurance coverage, and comorbidity status. Outcomes of interest included time to VTE prophylaxis following surgery and the occurrence of VTE complications. Mixed-effect regression models were constructed to evaluate the adjusted estimate for each outcome accounting for patient-, injury-, and hospital-level covariates.

RESULTS: The study included 5,325 patients treated across 463 trauma centers. The mean age in the cohort was 46.7 ± 18.9 years, with male predominance (81.1%). Race was predominantly White (62.3%) and Black (23.0%). The mean time to VTE prophylaxis initiation was 90 ± 112 hours, and the median time was 65 hours (interquartile range, 39 to 105 hours). The annual trend of VTE prophylaxis initiation after surgery was a decrease by 5.2 hours per year over the 8-year study interval. This was associated with an annual reduction of 6.2% in the odds of VTE complication occurrence. Multivariable mixed-effect regression models demonstrated a significant reduction in time to VTE prophylaxis (mean difference, -3.7 hours per year [95% confidence interval [CI], -5.3 to -2.1 hours per year]; p < 0.001) and VTE complications (odds ratio, 0.93 per year [95% CI, 0.88 to 0.98 per year]; p = 0.01) over the study period, after adjustment.

CONCLUSIONS: This analysis provides insight into VTE prophylaxis practice patterns following surgery for complete cervical SCI across North American trauma centers from 2013 to 2020. The timing of VTE prophylaxis initiation consistently decreased, which appeared to be associated with a significant reduction found in VTE complications.

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

PMID:41498771 | DOI:10.2106/JBJS.24.00563

J Bone Joint Surg Am. 2026 Jan 7;108(1):45-50. doi: 10.2106/JBJS.25.00406. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Robot-assisted spine surgery (RASS) enables precise pedicle screw insertion via pre-planned trajectories, and yet complications remain a notable concern. Prior work suggests that osseous pedicle wall breaches from instrumentation and ensuing complications related to robotic surgery may be from shifting of the reference frame or improper methodology. In this study, we hypothesized that the introduction of standardized institutional guidelines for RASS would reduce complications associated with robotic screw placement.

METHODS: This retrospective cohort study included patients who underwent RASS using 2 robotic systems at a single institution. We analyzed the cases of 264 patients in a historical cohort before, and 290 patients after, the implementation of a standardized institutional protocol developed to ensure safety with robotic placement of pedicle screws. The protocol provided surgeons with detailed guidelines for reference-frame placement, intraoperative screw trajectory and alignment checks, depth of drill insertion, verification of screw positioning, neuromonitoring for thoracic instrumentation, and postoperative imaging. Patient demographics, preoperative diagnoses, surgical characteristics, and complications were collected for all patients.

RESULTS: There was no difference between the pre-protocol and post-protocol groups with respect to patient demographics. In the pre-protocol cohort, 6 (2.3%) of the patients experienced robot-related complications, including nerve injury, durotomy, and malpositioned screws, with half of these complications attributed to reference-frame errors. Following the implementation of the protocol, no patient (0%) experienced a robot-related complication among 290 cases involving 2,030 screws placed with robotic assistance, representing a significant reduction (p = 0.01). The number of patients with open surgery (versus minimally invasive surgery) did not differ significantly between the pre-protocol (132 patients, 50%) and post-protocol (143 patients, 49.3%) groups. The mean number of instrumented levels per patient post-protocol was 3.3 ± 2.1. Non-robot-related complication rates were similar post-protocol (19.7%) versus pre-protocol (26.1%) (p > 0.05). Notably, post-protocol, there were no instances of a pedicle breach with neurostimulation or on postoperative imaging.

CONCLUSIONS: Following the implementation of standardized robotic surgery guidelines, no robot-related screw complications occurred in a post-protocol cohort of 290 patients. This study underscores the importance of protocol standardization, alongside technological advancements, in optimizing patient safety and improving outcomes in RASS. Well-designed institutional protocols may notably reduce robotic surgery complications and can be a valuable model for other institutions.

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

PMID:41498770 | DOI:10.2106/JBJS.25.00406

J Bone Joint Surg Am. 2026 Jan 7;108(1):25-34. doi: 10.2106/JBJS.24.01583. Epub 2025 Dec 1.

ABSTRACT

➢ Humeral head anatomy affects the tension and mechanics of the glenohumeral joint. Thus, aiming for anatomic reconstruction can help to avoid negative consequences of component malpositioning (such as "overstuffing") on soft-tissue tension and impingement-free range of motion.➢ The most common method to assess humeral head reconstruction is comparing the prosthetic humeral articular surface with the "perfect circle" incorporating the lateral cortex of the greater tuberosity, the medial greater tuberosity, and the medial calcar at the anatomic neck. Although this method is quick and helpful in assessing multiple parameters, it is important to also compare the radius of curvature, assess traditional measurements of humeral head anatomy or glenohumeral thickness, and consider that non-anatomic sizing may be used to achieve tension goals.➢ There is no consistent evidence of superior humeral head reconstruction quality with stemless, short-stem, or standard-length humeral components, suggesting that surgical technique and familiarity with an implant system remain most important.➢ Although stemless and short-stem components offer versatility in recreating pre-arthritic anatomy, their use places emphasis on having a reproducible technique for humeral neck osteotomy depth and inclination. Some techniques include careful osteophyte resection to visualize the true anatomic neck, the use of an intramedullary guide, and intraoperative assessment with fluoroscopy.➢ Although small deviations from pre-arthritic anatomy do not appear to affect clinical outcome, center-of-rotation deviations of exceeding 3 to 4 mm from the perfect circle have been associated with an inferior clinical outcome.

PMID:41498769 | DOI:10.2106/JBJS.24.01583

J Bone Joint Surg Am. 2026 Jan 7;108(1):12-14. doi: 10.2106/JBJS.25.00285. Epub 2025 Nov 20.

NO ABSTRACT

PMID:41498768 | DOI:10.2106/JBJS.25.00285

J Bone Joint Surg Am. 2026 Jan 7;108(1):10-11. doi: 10.2106/JBJS.25.00313. Epub 2025 Nov 18.

NO ABSTRACT

PMID:41498767 | DOI:10.2106/JBJS.25.00313

J Bone Joint Surg Am. 2026 Jan 7;108(1):8-9. doi: 10.2106/JBJS.25.00195. Epub 2025 Nov 20.

NO ABSTRACT

PMID:41498766 | DOI:10.2106/JBJS.25.00195

J Bone Joint Surg Am. 2026 Jan 7;108(1):4-5. doi: 10.2106/JBJS.25.01201. Epub 2026 Jan 7.

NO ABSTRACT

PMID:41498765 | DOI:10.2106/JBJS.25.01201

J Bone Joint Surg Am. 2026 Jan 7;108(1):3. doi: 10.2106/JBJS.25.01076. Epub 2026 Jan 7.

NO ABSTRACT

PMID:41498764 | DOI:10.2106/JBJS.25.01076

J Bone Joint Surg Am. 2026 Jan 7;108(1):1-2. doi: 10.2106/JBJS.25.01041. Epub 2026 Jan 7.

NO ABSTRACT

PMID:41498763 | DOI:10.2106/JBJS.25.01041

Int Orthop. 2026 Jan 7. doi: 10.1007/s00264-025-06732-9. Online ahead of print.

ABSTRACT

BACKGROUND: Giant cell tumour of the distal radius (GCTDR) is a locally aggressive benign tumour that often results in local recurrence and functional impairment. While curettage preserves joint function, it has high recurrence rates, particularly for grade III lesions. Wide resection reduces recurrence but compromises wrist function. This study evaluates the outcomes of non-vascularized fibular head-shaft autografting combined with distal radioulnar ligament (DRUL) reconstruction for GCTDR management.

METHODS: A retrospective study was conducted from 2010 to 2020, involving 50 patients with histologically confirmed GCTDR (Campanacci grade III). Surgical treatment included wide tumour excision, non-vascularized ipsilateral fibular head-shaft autograft reconstruction, and DRUL reconstruction using the palmaris longus tendon.

RESULTS: The recurrence rate was 4%, with no malignant transformation or metastasis. The average time to graft union was 7.2 ± 1.2 months, and functional outcomes were favourable, with an MSTS score of 26.2 ± 3.7 and a DASH score of 9.7 ± 13.1. No DRUJ instability was observed, and graft fractures occurred in 14% of patients, all of which healed.

CONCLUSION: Non-vascularized fibular head-shaft autografting, combined with DRUL reconstruction, is an effective approach for GCTDR, reducing recurrence, preserving wrist function, and maintaining long-term stability.

PMID:41498921 | DOI:10.1007/s00264-025-06732-9

Injury. 2025 Dec 11;57(2):112958. doi: 10.1016/j.injury.2025.112958. Online ahead of print.

ABSTRACT

BACKGROUND: Isolated anterior wall acetabulum fracture (AWF) represents a rare injury. There is a paucity of information available about this fracture and no classification has been proposed so far. The aim of this study was to analyse the various possible fracture patterns, related treatment approaches and to develop a new classification system.

METHODS: Common search engines were systematically searched, according to the PRISMA guidelines. Data relating to the studies that reported surgical approaches and results about isolated AW fractures were included. Data quality was also assessed. We topographically subdivided the fractures, according to the percentage of the anterior wall involved, location of the fracture, and the degree of comminution. The mean follow-up was 38.8 months (6-240).

RESULTS: 17 papers were eligible for this study. The ilio-inguinal (ILI) approach was the most used one (58.2 %). Different reconstruction techniques were deployed. Anatomical reduction was obtained in 46.6 % of the cases. 3 patients required hip prosthesis within 18 months. Based on the evidence gathered the anterior wall was divided into 3 segments (proximal, (P) middle (M) and distal (D)1/3 segment. Based on the area of involvement in each zone was also divided into Type I < 25 %; Type II 25-50 % and Type III >50 %. Comminution (C) was also assigned if present in any of the 3 zones.

CONCLUSION: Isolated anterior wall acetabulum fracture is an uncommon injury. The IIL approach was the most used for fixation. A new classification system was developed to guide surgical approach and fixation techniques.

PMID:41494481 | DOI:10.1016/j.injury.2025.112958

Injury. 2025 Dec 24;57(2):113010. doi: 10.1016/j.injury.2025.113010. Online ahead of print.

ABSTRACT

INTRODUCTION: Effective trauma triage relies on accurate trauma team activation (TTA) criteria to balance resource allocation and patient outcomes. Current guidelines prioritize high-risk of severe injury (HRSI) criteria, while moderate-risk of severe injury (MRSI) criteria are associated with high over-triage rates. Using data from the TraumaRegister DGU® (TR-DGU), this study evaluates the impact of different TTA criteria on patient outcomes and trauma system efficiency.

METHODS: A retrospective cohort study was conducted using TR-DGU data from 2018 to 2023, including patients aged ≥16 years with trauma team activation, emergency room treatment, and intensive or intermediate care admission. Patients were categorized based on TTA criteria: HRSI, MRSI, or provider decision ("None"). Injury severity, mortality, emergency interventions, intensive care unit (ICU) stay, and hospital length of stay were analyzed. Statistical comparisons utilized chi-square and Mann-Whitney-U tests, with significance set at p < 0.05.

RESULTS: The final cohort included 97,295 patients: 42 % met HRSI criteria, 38 % MRSI, and 20 % were assigned due to provider decision. Patients in the HRSI group had the highest injury severity (ISS=23.5), mortality (19.3 %), and need for emergency interventions (31 %). In contrast, the MRSI group had significantly lower severity (ISS=12.5), mortality (1.6 %), and intervention rates (13 %). The "None" group, comprising mostly elderly patients with ground-level falls, had a higher mortality rate (8.5 %) despite a comparable ISS (13.5).

CONCLUSION: Findings highlight the limitations of MRSI-based TTA criteria, which contribute to resource overutilization without improving patient outcomes. A tiered activation strategy prioritizing HRSI while refining MRSI criteria may enhance triage efficiency. The high mortality rate in the "None" group suggests the need for additional triage parameters, particularly for geriatric patients. These insights support recent guideline revisions and are the basis for further evaluations.

PMID:41494480 | DOI:10.1016/j.injury.2025.113010

Injury. 2025 Dec 11;57(2):112959. doi: 10.1016/j.injury.2025.112959. Online ahead of print.

ABSTRACT

BACKGROUND: Psychiatric disorders are common after traumatic brain injury, impeding recovery and increasing health and social costs internationally. clinicians caring for patients with TBI need an evidence base to support assessment of risk of and intervention to reduce psychiatric morbidity.

METHOD: We systematically searched for original studies published in English reporting development of multivariate models predicting anxiety, depression, PTSD and psychotic disorders in civilian adults at least six months after injury. The electronic search was conducted on 12 August 2024. Authors independently screened records, assessed study quality, and extracted data for descriptive analysis and narrative synthesis.

RESULTS: We included 34 studies presenting 47 multivariable models predicting psychiatric disorder six to 120 months after TBI of varying severity. Study samples, ranging from 43 to 207,354, were predominantly male and Caucasian/White and aged 30-45 years. Models inconsistently included demographic, psychosocial and injury-related variables with mixed results. Female sex, psychiatric history, race/ethnicity, physical health and assault/violent mechanism of injury were statistically significant two-thirds of models in which they were included. Infrequently included variables including coping style and intoxication at injury were strongly associated with disorder.

DISCUSSION: Faced with inconsistency in evidence we recommend that clinicians assess risk of suboptimal outcome broadly, asking not whether a given patient is at risk of a specific psychiatric condition but of any psychiatric disturbance following TBI. Patients with a psychiatric history and/or injured violently should be monitored but assessment must encompass biopsychosocial circumstances. Employment of a conceptual model of psychiatric disorder would support development of a cohesive evidence base.

PMID:41494479 | DOI:10.1016/j.injury.2025.112959