Injury. 2025 Dec 17;57(2):112978. doi: 10.1016/j.injury.2025.112978. Online ahead of print.

ABSTRACT

AIM: The aim of this investigation is to study the effect of intramedullary reaming on the repair of a rabbit tibial osteotomy stabilised by a specially designed locking nail.

MATERIALS AND METHODS: A tibial osteotomy was carried out in two similar groups of ten New Zealand White rabbits. In one group, reaming was carried out prior to nailing, while in the second group, the nail was inserted without reaming. At four weeks postoperatively, CT scans of operated and non-operated contralateral tibiae enabled the percentage increase in bone volume of the whole tibial shaft to be measured in both reamed and unreamed groups.

RESULTS: Although there was larger increase in callus volume in the tibial shaft of the reamed group (40.21 % ± 25.87) than the unreamed group (37.94 % ±15.12), this was not statistically significant (p = 0.81).

DISCUSSION: Intramedullary reaming of the intact rabbit tibia results in the production of vascular external callus formation. Although the medullary circulation is initially damaged, this is subsequently restored. Intramedullary reaming produces reaming debris that enters the osteotomy gap and acts as an autologous bone graft. In this study, all the rabbit tibial osteotomies stabilised by intramedullary nails progressed to bony union. Intramedullary reaming did not produce more callus than that following the insertion of an unreamed intramedullary nail.

CONCLUSION: All of the rabbit tibial osteotomies stabilised by intramedullary nails progressed to bone union and additional intramedullary reaming did not produce additional callus. The potential of the rabbit tibia to produce callus appears to be limited to the amount of callus required to achieve bone union.

PMID:41442904 | DOI:10.1016/j.injury.2025.112978

Injury. 2025 Dec 17;57(2):112979. doi: 10.1016/j.injury.2025.112979. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic brain injury (TBI) is a major cause of mortality worldwide. The goals of TBI management include prevention of secondary brain injury by reducing pathological increase in intracranial pressure. Craniotomy is an effective intervention for relieving refractory increased intracranial pressure. Therefore, we aimed to clarify the association between time from hospital arrival to craniotomy and outcomes in patients with severe TBI using data from a nationwide trauma registry.

METHODS: We identified patients who underwent craniotomy owing to severe blunt TBI (Glasgow Coma Scale score ≤ 8 and Abbreviated Injury Scale score 4 or 5 for the head region) between 2019 and 2023 from the Japan Trauma Data Bank. Exclusion criteria were transfer from another hospital, extracranial surgery, time from arrival to craniotomy > 8 h, or missing data regarding time to surgery or in-hospital mortality. Patients were categorized into the early (≤ 4 h) or delayed (> 4 h) surgery groups based on the time to craniotomy. The primary outcome was in-hospital mortality. Secondary outcomes included probability of favorable neurological outcomes (Glasgow Outcome Scale score 4 or 5), discharge to home rate, length of hospital stay, length of intensive care unit (ICU) stay, and duration of mechanical ventilation. Multivariable logistic regression analysis was performed to adjust for potential confounders.

RESULTS: Among the 1058 eligible patients, 960 (90.7%) and 98 (9.3%) underwent early and delayed craniotomy, respectively. In-hospital mortality was not significantly different between the groups even after adjusting for confounders. Furthermore, probability of favorable neurological outcomes, discharge to home rate, length of hospital stay, length of ICU stay, and duration of mechanical ventilation were not significantly different between the groups. A generalized additive model revealed no significant non-linear association between time to craniotomy and in-hospital mortality.

CONCLUSIONS: Short-term outcomes in patients with severe TBI were not significantly associated with time from hospital arrival to craniotomy. This finding highlights the importance of flexible, individualized clinical decision-making in patients with TBI. Further studies are warranted to identify specific patient subgroups that may benefit from early craniotomies.

PMID:41442903 | DOI:10.1016/j.injury.2025.112979

Injury. 2025 Dec 4;57(2):112941. doi: 10.1016/j.injury.2025.112941. Online ahead of print.

ABSTRACT

INTRODUCTION: Revised Trauma Quality of Life (RT-QOL) measurement among violence survivors is challenging because of loss to follow-up. This study evaluated RT-QOL instrument completion during follow-up phone calls after hospital discharge and assessed if time to follow-up call was associated with instrument completion.

MATERIALS AND METHODS: This was an observational cohort study of intentional interpersonal violence survivors treated at a Level 1 urban trauma center from March 2018-April 2024. Depression (Beck's Depression Inventory II), Post-Traumatic Stress Disorder (Breslau Post Traumatic Stress Disorder Scale 7-item), and Revised Trauma-specific Quality of Life (RT-QOL) instruments were phone administered after discharge in English or Spanish. Multivariable regression tested if time to follow-up call was associated with instrument completion while controlling for survivors' demographic, injury, hospital course and follow-up characteristics.

RESULTS: A total of 566 intentional interpersonal violence survivors were eligible. Survivors were mostly male (82.0 %), 25-64 years old (77.9 %), Black (65.2 %), and injured by firearm (44.7 %). Among the 566 eligible survivors, 115 survivors (20.3 %) had an inaccurate phone number in the medical record, and 32 (5.7 %) died after hospital discharge. Two survivors (0.4 %) partially completed and 51 (9 %) completed instruments. Survivors who completed instruments were called fewer times, 2 calls (IQR: 1-2.5) versus 3 calls (IQR: 1-3). Approximately 43 % of survivors who completed instruments, completed them on the first call. Time to follow-up call was not associated with instrument completion. Females had 2.45 higher adjusted odds of instrument completion after controlling for time to follow-up call, age, race, ethnicity and injury mechanism (p = 0.008). Among survivors who completed instruments, 21(41.1 %) screened positive on Beck's Depression Inventory II, 31 (60.8 %) screened positive on Breslau Post Traumatic Stress Disorder Scale 7-item, and 39 (76.5 %) reported RT-QOL symptoms impairing work.

CONCLUSIONS: Only female sex, not time to follow-up call, was associated with increased instrument completion among violence survivors.

PMID:41442902 | DOI:10.1016/j.injury.2025.112941

Injury. 2025 Dec 10;57(2):112952. doi: 10.1016/j.injury.2025.112952. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the diagnostic performance of single-energy CT (SECT) scan for detecting contralateral posterior pelvic ring injuries in patients with an operative pelvis fracture.

METHODS: Retrospective cohort study.

SETTING: Level I Trauma Center PATIENT SELECTION CRITERIA: Consecutive adults with operatively-treated pelvic ring injuries and preoperative and postoperative pelvis CT scans. Exclusion criteria were incomplete or unreadable imaging, pelvis CT obtained on a spine board or with a pelvic binder in place, prior pelvic instrumentation, or sacroiliac joint fusion.

OUTCOME: Measures and Comparisons: An "occult" contralateral sacroiliac joint injury was defined as either (A) a positive change of ≥2.0 mm between preoperative and postoperative CT measurements at this level on the "uninjured" side or (B) an intraoperatively fluoroscopic finding of ≥2.0 mm of sacroiliac joint widening on either static or dynamic stress fluoroscopic imaging on the "uninjured" side not present on the initial, preoperative CT RESULTS: One hundred forty-six adults, 62 % male sex, with a mean age of 42.5 years were included. A unilateral posterior pelvic ring injury was identified on the initial pelvis CT in ninety patients. An occult contralateral sacroiliac joint injury was identified in 11 patients (12.2 %), 5 by intraoperative fluoroscopic examination, none during instrumentation, and 6 by postoperative pelvis CT. One U-type sacral fracture was identified on postoperative CT. The diagnostic performance of pelvis SECT in the initial trauma evaluation for correctly classifying bilateral pelvic ring injuries was 84 % sensitivity with a 16 % false negative rate, 100 % specificity, 88 % negative predictive value, and 92 % accuracy.

CONCLUSIONS: In this cohort, 16 % of bilateral posterior ring injuries were incorrectly classified as unilateral from the initial pelvis CT. A complete unilateral posterior ring injury should raise suspicion for an occult contralateral injury and may warrant additional radiographic or fluoroscopic stress examination if clinically appropriate.

PMID:41442901 | DOI:10.1016/j.injury.2025.112952

Injury. 2025 Dec 16:112975. doi: 10.1016/j.injury.2025.112975. Online ahead of print.

NO ABSTRACT

PMID:41436346 | DOI:10.1016/j.injury.2025.112975

Injury. 2025 Dec 13:112973. doi: 10.1016/j.injury.2025.112973. Online ahead of print.

ABSTRACT

BACKGROUND: Needle thoracostomy (NT) is a frontline intervention for suspected tension pneumothorax in prehospital trauma care. The necessity for intervention in patients with relative indications is unclear, and locoregional protocols guiding NT placement by prehospital personnel vary. This study aims to identify factors associated with a positive response to NT and how often objective measures are utilized to prompt intervention, which may help better define indications for the procedure.

METHODS: A retrospective review of adult trauma patient who received prehospital needle decompression was performed utilizing the trauma registry database from a level 1ACS accredited trauma center in Omaha, Nebraska. A positive response was defined as increased oxygen saturation by 10 %, increased systolic blood pressure by 10 mmHg, improved ventilation or breath sounds, or return of spontaneous circulation.

RESULTS: A total of 214 patients were included, with an overall mortality rate of 52 % of which 144 (68 %) sustained blunt trauma and 67 (32 %) penetrating trauma. Mortality was 49 % for blunt trauma and 60 % for penetrating trauma (p = 0.182). Only 63 patients (30 %) responded to NT with an improvement in clinical parameters. The most common indication(s) for NT was documented as absent/reduced breath sounds (n = 118, 55 %), CPR (n = 79, 37 %), and hypoxia (n = 40, 19 %). After excluding patients with CPR en route (n = 135/214, 63 %), positive NT response increased to 48 % and overall mortality rate decreased to 26 %. There was no significant change in systolic blood pressure (mean difference: 0.3 mm Hg, 95 % CI:4.8-5.3, p = 0.910) or heart rate (-1.1 bpm, 95 % CI:5.8-3.6, p = 0.650) post-decompression. The incidence of hypoxia decreased from 68 % to 48 % (p < 0.001). Complications were identified in 14 % of patients and one patient did have a needle inserted into the heart, required a cardiac operation, and had subsequent anoxic brain injury.

CONCLUSIONS: This study highlights the low success rates of prehospital NT, with the majority of procedures being performed based on subjective indicators. Prehospital protocols should be refined by incorporating objective criteria, such as confirmed hypoxia, to better identify patients who may benefit from NT.

PMID:41436345 | DOI:10.1016/j.injury.2025.112973

Injury. 2025 Dec 10;57(2):112936. doi: 10.1016/j.injury.2025.112936. Online ahead of print.

ABSTRACT

PURPOSE: This study assessed whether ultrasonographic (U/S) detection of bridging callus can serve as an early sign of tibial fracture healing. By comparing U/S with serial radiographs, the goal was to identify the best predictors of fracture union. Previous studies indicate that early radiographic bridging callus may signal eventual healing, and U/S could detect this sooner than X-rays. Thus, U/S may provide earlier predictions of bone union or impaired healing.

METHODS: A prospective evaluation was conducted on a consecutive cohort of patients with tibial fractures managed by intramedullary nailing. Patients were followed until complete bone healing or determination of nonunion at twelve months. Demographic and clinical data were collected contemporaneously. Radiographic and ultrasound images were obtained monthly and independently assessed by two experienced orthopaedic surgeons.

RESULTS: Of the 42 initially enrolled patients 6 were lost to follow-up, resulting in the 36 included in the final cohort. There were 29 males and 7 females, aged between 22 and 64 years (mean, 39; median, 36.5). Fourteen fractures were open, with 20 classified as AO/OTA A, seven B, and nine C patterns. Of the 36 patients who completed the study, 31 healed uneventfully, while 5 did not achieve healing. An ultrasonographic bridging callus was observed between the first and third month following surgery. A "V"-shaped ultrasound corkscrew sign appeared in areas where no callus developed, and may serve as a prognostic factor for eventual nonunion. Bridging callus detected by ultrasound during the initial three months was identified as a positive prognostic indicator of bone healing.

CONCLUSION: Ultrasonography is rarely used to assess fracture healing, but it may help predict outcomes. Portable point-of-care ultrasound (POCUS) can reduce radiation in follow-ups. Detecting bridging callus on ultrasound within three months reliably indicates bone healing, often appearing a month before seen on X-ray and suggesting eventual union.

PMID:41435710 | DOI:10.1016/j.injury.2025.112936

J Bone Joint Surg Am. 2025 Dec 23. doi: 10.2106/JBJS.25.01244. Online ahead of print.

NO ABSTRACT

PMID:41433445 | DOI:10.2106/JBJS.25.01244

J Bone Joint Surg Am. 2025 Dec 22. doi: 10.2106/JBJS.25.00233. Online ahead of print.

ABSTRACT

BACKGROUND: Pilon fractures result in substantial morbidity and are associated with a high rate of ankle arthritis. However, literature is scarce regarding the prevalence of posttraumatic subtalar arthritis. Tibiotalocalcaneal (TTC) arthrodesis, or hindfoot nailing, is increasingly used for comminuted pilon fractures, which often involve the subtalar joint. This study aimed to determine the prevalence and severity of posttraumatic subtalar arthritis, to better understand the implications of this surgical technique in these cases.

METHODS: Patients who sustained a pilon fracture and underwent open reduction and internal fixation were retrospectively identified. The patients were categorized into 4 groups on the basis of the time interval between the date of injury and the latest available radiographs: <12, 12 to 24, 25 to 48, and >forty-eight months. The Kellgren-Lawrence (K-L) and NSS (None, Some, Severe) grading systems were used to evaluate the radiographs. Postoperative computed tomography (CT) scans, when available, were similarly graded using the CT Ankle Osteoarthritis (CTAO) system. Pearson correlation, chi-square, Mann-Whitney U, and Welch t tests were used. P < 0.05 was considered significant.

RESULTS: The study included 473 patients (mean age, 46.15 ± 7.50 years, 293 male and 180 female). The cohort was composed of 80.3% White and 15.8% non-White, with 3.9% missing data.(Patient age at the time of injury (p < 0.001) and at the time of imaging (p < 0.001), smoking status (p = 0.01), steroid use (p = 0.04), Charlson Comorbidity Index (CCI) (p = 0.003), AO/OTA classification (p = 0.03), and time from injury to final imaging (p = 0.004) were significantly correlated with the K-L grade. Group 3 was found to have a higher mean K-L grade than Group 1 (by 0.34, 95% confidence interval [CI]: 0.03 to 0.66; p = 0.04) and Group 2 (by 0.39, 95% CI: 0.05 to 0.73; p = 0.02). Group 4 had a higher K-L grade than Group 1 (by 0.37, 95% CI: 0.08 to 0.66; p = 0.01) and Group 2 (by 0.42, 95% CI: 0.11 to 0.73; p = 0.01). The CTAO score demonstrated meaningful correlation between subtalar arthritis and age at both the time of injury (p = 0.004) and the time of final CT (p = 0.01).

CONCLUSIONS: Multiple patient-based factors including age, smoking status, steroid use, CCI, AO/OTA classification, and the time interval since injury were significantly associated with the development of subtalar arthritis, as assessed using the K-L grade, after pilon fracture. This suggests that acute hindfoot nailing as an index treatment option for pilon fractures may have fewer clinical ramifications than has been anticipated on the basis of its violation of the subtalar joint.

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

PMID:41428802 | DOI:10.2106/JBJS.25.00233

Int Orthop. 2025 Dec 23. doi: 10.1007/s00264-025-06728-5. Online ahead of print.

NO ABSTRACT

PMID:41430401 | DOI:10.1007/s00264-025-06728-5

Injury. 2025 Dec 11;57(2):112968. doi: 10.1016/j.injury.2025.112968. Online ahead of print.

ABSTRACT

BACKGROUND: The epidemiology of traumatic spinal injuries (TSI) differs across various regions and is influenced by national income, infrastructure, and culture. TSIs are a source of high morbidity and mortality, requiring considerable resource allocation. Saudi Arabia's 2018 decision allowing women to drive introduced a new demographic element, potentially shifting TSI epidemiology. In this paper, we aimed to study patterns and outcomes of TSIs, including sex-based analyses, and to identify demographic, injury-related, and in-hospital factors associated with length of hospital stay, neurological severity, and spinal surgery requirement.

METHODS: This is a retrospective observational study conducted in a tertiary center between 2018 and May 2025. A total of 5380 computed tomography scans were screened. All patients with a diagnosis of spinal injury caused by a traumatic mechanism were included. Patients' demographics, mechanism of injury, injury level, associated injuries, AIS grade, hospital course, and disposition were collected and analyzed.

RESULTS: 623 TSI patients were included. Most of them were males (78.5 %) and Saudi nationals (74.2 %), with a male-to-female ratio of 3.7. The average age was 32.5 (±15.9) years. Substance use was documented in 7.4 % of cases. Four-wheel motorized-vehicle accidents (Four W-MVA) predominated (57.6 %) and were more common among Saudis (68.4 %), whereas falls from height (36.0 %), pedestrian injuries (21.1 %) were more common among non-Saudis. The most common injury was at the lumbar region (53.9 %), and most patients were neurologically intact (AIS E 93.7 %). Female sex and older age were associated with longer length of stay (LOS). Longer LOS was independently associated with prior psychiatric illness (RR=3.77), higher AIS severity (RR=1.22), pulmonary infection (RR=3.11), and ICU admission (RR=2.01). Higher AIS severity was linked to cervical involvement (per injured level RR=1.10) and vertebral subluxation/dislocation (RR=1.24).

CONCLUSION: The epidemiology of TSIs has demonstrated notable shifts in demographics, patterns of injury, and outcomes. This study highlights the need for targeted interventions, including intensified efforts to enforce traffic regulations, addressing health disparities experienced by non-Saudi residents, and an expansion of mental health services.

PMID:41422673 | DOI:10.1016/j.injury.2025.112968

Injury. 2025 Dec 11;57(2):112969. doi: 10.1016/j.injury.2025.112969. Online ahead of print.

ABSTRACT

Orthopedic injuries during pregnancy pose unique risks to maternal and fetal health. This review identifies different epidemiological data, maternal physiological changes, imaging considerations, pain management strategies, and operative considerations. Motor vehicle accidents, falls, and domestic violence contribute to fractures, emphasizing the need for tailored management. Special attention is given to imaging modalities, with a focus on fetal safety. Pain management strategies balance effective analgesia with fetal well-being, emphasizing the cautious use of opioids. Perioperative fetal monitoring and anticoagulation considerations address the intricacies of managing orthopedic injuries during pregnancy. Prevention strategies, such as promoting seat belt use and intimate partner violence screening, are crucial for minimizing risks. This concise review serves as a comprehensive guide for healthcare professionals managing orthopedic injuries in pregnant patients.

PMID:41421319 | DOI:10.1016/j.injury.2025.112969

Injury. 2025 Dec 13;57(2):112956. doi: 10.1016/j.injury.2025.112956. Online ahead of print.

ABSTRACT

BACKGROUND: Acute total hip arthroplasty (THA) plays an increasing role in the management of acetabular fractures in elderly patients. However, there is no consensus on the need for column fixation during primary THA, especially for the anterior column. This study aimed to assess the biomechanical impact of column stabilization during acute THA using a Burch-Schneider anti-protrusion cage (BSC) for a typical geriatric acetabular fracture.

METHODS: A finite element model of a hemipelvis with an anterior column posterior hemi-transverse fracture was developed to compare four treatment strategies during acute THA with BSC: anterior and posterior column plating (CAP), posterior column plating (CnP), anterior column plating (CAn), and BSC alone (Cnn). During peak load walking, we analyzed the pelvis displacement, fracture relative motion, bone strain around screws, and metal stress.

RESULTS: Pelvis displacement was lowest for CAP and highest for Cnn, while CnP and CAn showed intermediate values slightly higher than CAP. Fracture relative motion, bone strain, and metal stress followed similar patterns. Fracture relative displacement was around 1 mm on average, and below 5 mm, except for Cnn, where it exceeded this value on 22 % of the fracture surface. Peak strain far exceeded 1 % for Cnn, predominantly concentrated at screw tips and screw-plate junctions, as did peak metal stress.

CONCLUSION: This biomechanical analysis indicates that CnP alone provides mechanical stability comparable to isolated or additional anterior column plating. These findings support the single posterior approach concept for acute THA in the management of acetabular fractures in elderly patients.

PMID:41421318 | DOI:10.1016/j.injury.2025.112956

Injury. 2025 Dec 11;57(2):112962. doi: 10.1016/j.injury.2025.112962. Online ahead of print.

ABSTRACT

INTRODUCTION: A notable anatomic feature of the facet joint is the lateral mass, which is comprised of the superior and inferior articular processes of the vertebral body. A unique fracture pattern involves a lamina fracture and ipsilateral pedicle fracture resulting in a separation of the lateral mass from the vertebral body, called a floating lateral mass fracture (FLM). FLMs commonly co-occur with vertebral artery or neurologic injury and is usually managed surgically. Few studies have focused on FLMs alone; thus, the objective of the current study is to provide a systematic review regarding the epidemiology and management of FLM.

METHODS: A retrospective protocol was used to search Medline (via PubMed) and Embase to identify all studies focused on floating lateral mass fractures. "floating lateral mass fracture" and "cervical" or "spine" were used in conjunction with boolean terms to find related articles. Single-case studies, unpublished articles, non-English articles, and other systematic reviews were excluded. Studies focusing on C1 lateral mass fractures were also excluded. Data regarding patient characteristics, injury characteristics, diagnostic imaging, and treatment were gathered.

RESULT: A total of 332 patients were identified with floating lateral mass fractures (FLM) of the subaxial cervical spine. There were 217 men (63.4 %) and 68 women (20.5 %) and 47 participants with gender not reported. The mean age was 41.8 ± 7.98 years. The most common levels of injury C6 and C5. Motor vehicle accidents (MVAs) were the most reported index event. Cervical collars were the most used non-operative treatment modality, with most studies specifying the use of hard cervical collar or a halo vest. Vertebral subluxation was later identified in 22 (31 %) patients treated nonoperatively. Anterior cervical discectomy and fusion (ACDF) was the most performed procedure including a one level, with 67 patients (28.2 %) and two-level fusions with 55 patients (23.2 %), totaling to 122 patients (51.4 %). Minimal reports of subluxation post-operatively were reported.

CONCLUSION: Floating lateral mass fractures are an uncommon, but severe, subtype of cervical facet fractures. FLM inherently results in spinal instability, and as a result surgical management is preferred versus non-surgical.

PMID:41418386 | DOI:10.1016/j.injury.2025.112962

Injury. 2025 Dec 11;57(2):112970. doi: 10.1016/j.injury.2025.112970. Online ahead of print.

ABSTRACT

OBJECTIVE: Pelvic fractures are associated with substantial morbidity and mortality, yet the prognostic value of initial fibrinogen levels remains underexplored.

METHODS: We conducted a global retrospective cohort study using data from the TriNetX Global Collaborative Network (2005-2025), with ≥30 days of follow-up. Patients with pelvic fractures and fibrinogen data were included. Propensity score matching adjusted for age, sex, race, ethnicity, comorbidities, and labs. Primary outcomes were mortality and complications in patients with fibrinogen ≤200 mg/dL compared to >200.01 mg/dL. Relative risks (RR) and number needed to harm (NNH) were calculated at 1, 3, 7, 14, and 30 days. Subgroup and sensitivity analyses tested robustness.

RESULTS: 10,552 patients were included after matching, with 5276 patients in each cohort. The low fibrinogen group exhibited significantly higher risks of adverse outcomes at 30 days, including acute kidney injury (RR, 1.30; 95 % CI, 1.21-1.41; NNH: 18), shock (RR, 1.51; 95 % CI, 1.40-1.85; NNH: 12), respiratory failure (RR, 1.29; 95 % CI, 1.24-1.34; NNH: 9), acute respiratory distress syndrome (RR, 1.28; 95 % CI, 1.08-1.52; NNH: 84), disseminated intravascular coagulation (RR, 2.06; 95 % CI, 1.70-2.47; NNH: 32), and all-cause mortality (RR, 1.90; 95 % CI, 1.70-2.14; NNH: 15). These associations were consistent across subgroups stratified by age and sex, and held steady in sensitivity analyses using lower fibrinogen thresholds.

CONCLUSION: A fibrinogen level of ≤ 200 mg/dL is associated with increased mortality and acute organ dysfunction in patients with pelvic fractures.

PMID:41418385 | DOI:10.1016/j.injury.2025.112970

Injury. 2025 Dec 12;57(2):112963. doi: 10.1016/j.injury.2025.112963. Online ahead of print.

ABSTRACT

BACKGROUND: High-energy pelvic ring injuries (PRIs) are increasingly observed in the elderly, a population with unique physiological vulnerabilities. However, outcome data in patients aged ≥75 years remain scarce.

METHODS: In this retrospective cohort study, 331 patients with high-energy PRIs over 11 years at a Level 1 trauma centre were analysed. Using 1:1 propensity score matching, outcomes in patients aged ≥75 years were compared with younger patients (<75), adjusting for injury severity and baseline characteristics.

RESULTS: Twenty-eight patients aged ≥75 were matched to 28 younger counterparts. Mortality was significantly higher in the elderly group (32 % vs. 7 %, p = 0.006), despite comparable injury severity scores. Elderly patients were less likely to be admitted to the intensive care unit (ICU) (29 % vs. 64 %, p = 0.007), with shorter ICU stays, though total hospital length of stay did not differ. Fracture morphology and mechanisms of injury also varied by age, with older adults showing simpler patterns but higher mortality.

CONCLUSION: Elderly patients with high-energy PRIs exhibit distinct injury mechanisms and patterns, experience a five-fold higher mortality despite less frequent ICU admission and matched injury severity. These findings highlight the urgent need for age-adapted trauma protocols and proactive perioperative strategies in managing pelvic trauma in the elderly.

PMID:41418384 | DOI:10.1016/j.injury.2025.112963

J Bone Joint Surg Am. 2025 Dec 19. doi: 10.2106/JBJS.25.00971. Online ahead of print.

ABSTRACT

BACKGROUND: Large language models are increasingly being used in scientific writing, but their use in orthopaedic literature remains unclear.

METHODS: We analyzed 196 articles published in March 2025 in 10 leading orthopaedic journals. GPTZero quantified artificial intelligence (AI)-generated text by article section. Composite AI scores were calculated and tested for associations with the h5-index, study design, level of evidence, authorship characteristics, and geographic region with use of nonparametric and both Pearson and Spearman correlation analyses.

RESULTS: AI-generated content was detected in 89.8% of articles. The mean AI score was 18.1% (median, 14.9%). Scores differed by section (p < 0.001) and were the highest in the Results. AI use correlated with the proportion of non-MD authors (ρ = 0.22) and with the total author count (ρ = 0.19), but not with the h5-index. No association with study design or level of evidence was found. Differences by geographic region were modest and not significant after correction.

CONCLUSIONS: AI-generated content appears to be widespread, particularly in Results sections. Its use varies by authorship characteristics and geography but not by study design or journal prestige. Clear disclosure standards are essential to guide responsible AI use in scientific writing.

CLINICAL RELEVANCE: This study is clinically relevant because transparency in scientific writing supports accurate interpretation of the evidence used in patient care. Identifying the prevalence of AI-generated text helps to protect the integrity of the orthopaedic literature.

PMID:41417927 | DOI:10.2106/JBJS.25.00971

J Bone Joint Surg Am. 2025 Dec 19. doi: 10.2106/JBJS.25.00392. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative delirium (POD) is a clinically important complication in elderly patients undergoing total knee arthroplasty (TKA) that is associated with prolonged hospitalization, increased morbidity, and higher health-care costs. Although cognitive impairment is a known risk factor for POD, the role of comprehensive cognitive and psychological evaluation remains underexplored in patients undergoing TKA. This study aimed to evaluate the correlation of preoperative cognitive and psychological factors with POD after TKA.

METHODS: This prospective cohort study included 574 patients who were ≥60 years of age and underwent primary TKA at 1 of 2 major tertiary care hospitals. We assessed preoperative cognitive function using the Mini-Mental State Examination (MMSE), the full Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery, the Subjective Memory Complaints Questionnaire (SMCQ), and the Seoul Informant Report Questionnaire for Dementia (SIRQD). Psychological assessments were conducted with the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-15 (PHQ-15), and the Hospital Anxiety and Depression Scale (HADS). POD was evaluated daily from postoperative days 1 to 5 using the 4 A's Test (4AT) and the Confusion Assessment Method (CAM). A multivariable logistic regression analysis was performed to identify independent risk factors for POD.

RESULTS: POD occurred in 24 (4.2%) of 574 patients. Univariate analysis revealed that POD was significantly correlated with lower MMSE (p < 0.001), higher PHQ-15 (p = 0.014), higher PSQI (p = 0.014), and higher Charlson Comorbidity Index (p = 0.010) scores; preoperative use of sedatives (p = 0.044) and antidepressants (p = 0.027); and lower mean noise levels in the patient's hospital room (p = 0.002). In the receiver operating characteristic curve analysis, the optimal cutoff value for predicting POD was an MMSE score of ≤25, with a sensitivity of 74.5% and a specificity of 78.3% (area under the curve, 0.834; p = 0.001). Multivariable logistic regression analysis identified lower MMSE scores (odds ratio [OR], 0.771; p = 0.002) and higher PHQ-15 scores (OR, 1.187; p = 0.028) as significant independent predictors of POD.

CONCLUSIONS: This study comprehensively evaluated preoperative cognitive function and psychological symptoms in patients undergoing TKA. Even subclinical cognitive and somatic symptoms were linked to POD, emphasizing the need for preoperative identification of high-risk patients.

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

PMID:41417917 | DOI:10.2106/JBJS.25.00392

J Bone Joint Surg Am. 2025 Dec 19. doi: 10.2106/JBJS.25.01387. Online ahead of print.

ABSTRACT

Good judgment remains fundamental to clinical decision-making, and yet it is increasingly augmented by data and artificial intelligence (AI). Although AI holds promise for real-time clinical-decision support, its impact on patient care has been modest. The principal limitation is not algorithmic capability but the quality, structure, and completeness of the data available for training and deployment. Most AI systems rely on electronic medical records (EMRs), which were designed primarily for billing rather than clinical insight. Consequently, important clinical information is fragmented, inconsistently documented, or absent altogether. Natural language processing and large language models (LLMs) improve data extraction, and yet they remain constrained by the underlying data quality and important privacy concerns. A critical gap persists in the acquisition of quantitative physiological data, particularly for the musculoskeletal system, where current practice relies on qualitative or semiquantitative assessments collected at single time points. In contrast, other industries-such as the autonomous vehicle industry-have advanced further by integrating continuous, multimodal sensor data to inform real-time decisions. Emerging multimodal wearable technologies offer a pathway toward similarly rich physiological data sets in medicine. Meaningful progress in AI-enabled health care will require such a transformation in data acquisition, enabling more accurate, continuous, and clinically relevant decision support.

PMID:41417882 | DOI:10.2106/JBJS.25.01387

J Bone Joint Surg Am. 2025 Dec 19. doi: 10.2106/JBJS.25.00793. Online ahead of print.

ABSTRACT

BACKGROUND: Articular depression, especially in central tibial plateau segments, is surgically challenging. According to the 10-segment classification, the anterolateral approach visualizes only 36.6% of the tibial plateau. The aim of this study was to compare biomechanical performance between fluoroscopy-guided fixation techniques with and without needle arthroscopy.

METHODS: This cadaveric study used 16 knee specimens with standardized lateral tibial plateau fractures. Specimens were randomized to fluoroscopy-guided (FG) or fluoroscopy plus needle arthroscopy-guided (FNG) reduction performed via an anterolateral approach. Kirschner wires and proximal tibial plates were used for fixation. The primary outcome was load to failure. Secondary outcomes included stress, strain, stiffness, reduction quality, radiation exposure, and operative time.

RESULTS: Sixteen cadaveric specimens (9 right knees; 12 males) were studied. The FG group had greater mean articular depression (1.77 versus 1.69 mm) and step-off (2.44 versus 2.26 mm) than the FNG group. The FNG group had a higher mean load to failure (1,784 versus 1,063 N), whereas the FG group had greater mean stiffness (170.34 versus 130.82 N/mm) and a longer mean operative time (1,662 versus 1,524 seconds). The FG group also demonstrated higher mean fluoroscopic doses and larger differences in condylar width and the medial tibial plateau angle than the FNG group.

CONCLUSIONS: FNG reduction improved articular congruity and load to failure in lateral tibial plateau fractures without increasing operative time, supporting needle arthroscopy as a valuable adjunct for managing complex articular fractures with less invasive exposure.

CLINICAL RELEVANCE: This study is clinically relevant because it shows that incorporating needle arthroscopy during fixation of lateral tibial plateau fractures can improve reduction quality and stability without prolonging operative time.

PMID:41417880 | DOI:10.2106/JBJS.25.00793