Injury. 2026 Mar 13;57(4):113156. doi: 10.1016/j.injury.2026.113156. Online ahead of print.

ABSTRACT

BACKGROUND: Appropriate triage is essential to reducing preventable deaths and optimizing the allocation of limited medical resources in trauma care. Although the mechanism of injury (MOI) has been incorporated into prehospital triage protocols, its predictive accuracy remains controversial. This study aimed to investigate the association of MOI and anatomical injury sites with the need for emergency procedures and in-hospital outcomes using a nationwide trauma registry in Japan.

METHODS: This retrospective cohort study analyzed data from the Japan Trauma Data Bank (JTDB) between 2019 and 2021. Adult trauma patients (age ≥18 years) directly transported from the scene were included. The primary outcome was the implementation of emergency procedures upon hospital arrival, and the secondary outcome was in-hospital mortality. Multivariable logistic regression was performed to calculate odds ratios (OR) with 95% confidence intervals (CI). Discriminatory ability was evaluated using the area under the receiver operating characteristic curve (AUC).

RESULTS: Among 42,124 eligible patients, 16,580 (39.3%) underwent emergency procedures. Railway-related trauma (OR, 95% CI: 5.50, 3.73-8.11), crush injuries (2.03, 1.50-2.75), head injuries (4.35, 4.12-4.59), and abdominal injuries (20.06, 16.66-24.16) were significantly associated with emergency procedures. The AUCs for predicting emergency procedures were 0.57 for MOI and 0.72 for injury sites, and 0.53 and 0.77, respectively, for in-hospital mortality.

CONCLUSIONS: Anatomical injury sites demonstrated greater discriminative performance than MOI in predicting the need for emergency procedures and in-hospital mortality. These findings highlight the limitations of mechanism-based triage and suggest that incorporating anatomical assessment may improve triage accuracy and resource utilization.

PMID:41861500 | DOI:10.1016/j.injury.2026.113156

J Bone Joint Surg Am. 2026 Mar 20. doi: 10.2106/JBJS.26.00068. Online ahead of print.

NO ABSTRACT

PMID:41861031 | DOI:10.2106/JBJS.26.00068

Injury. 2026 Feb 16;57(4):113121. doi: 10.1016/j.injury.2026.113121. Online ahead of print.

ABSTRACT

PURPOSE: Tibial plateau fractures are often surgically treated to restore native joint congruity and articular alignment. While these injuries portend an increased risk for end stage knee osteoarthritis, it is unknown whether the fixation constructs contribute to the development of osteoarthritis by influencing articular stress distribution following instrumentation.

METHODS: We conducted a cadaver study measuring resultant intra-articular stresses of the native knee due to physiological levels of ex-vivo loading, after instrumentation with plate and screw fixation, and after implant removal. To account for variable subchondral bone density, we used 3D printed bone with osteoporotic and normal cancellous bone volume fraction, and SawBones where there is no appreciable cancellous bone.

RESULTS: There was no statistical difference in peak, average, or total contact pressures following implant fixation and removal from the preimplantation articular pressure states in all loads and all models (p > 0.05). There was also no difference between the pressure changes of the cadaveric and Sawbones models. There were statistically significant pressure changes between cadaveric and 3D printed models following fixation, however these changes were within previously described physiologic loads (<10 MPa).

CONCLUSIONS: Subchondral instrumentation of tibial plateau fractures did not materially alter articular pressures. These findings suggest that the development of end-stage knee osteoarthritis may not be a result of altered biomechancial stresses from the instrumentation. Further, elective removal of implants is not supported by biomechanical reasons alone to reduce future risk. Supplementing cadaveric studies with patient-specific models while tuning variables can enhance the fidelity of these investigations.

STATEMENT OF CLINICAL RELEVANCE: The findings may guide surgeons in their operative indications and clinical decision making as well as guide future biomechanical research on periarticular implant effects.

PMID:41855643 | DOI:10.1016/j.injury.2026.113121

Int Orthop. 2026 Mar 19. doi: 10.1007/s00264-026-06768-5. Online ahead of print.

ABSTRACT

BACKGROUND: Favourable long-term clinical and radiological outcomes with low revision and reoperation rates have been reported for unicondylar knee arthroplasty (UKA) in the treatment of end-stage unicompartmental knee osteoarthritis. However, no information on these data is available for the Turkish population. Our aim was to analyze the demographics, indications, outcomes, and revision rates of UKA in Türkiye using a nationwide database.

METHODS: The electronic medical records of 8,590 patients undergoing UKA for unicompartmental osteoarthritis between 2016 and 2022 were retrospectively analyzed. Demographic data of the study population including sex, age, body mass index (BMI), and institution were assessed. The primary outcome measures were complication and revision rates.

RESULTS: Of the 8,590 analyzed patients, 85.2% were women with an average age of 59 ± eight years. The primary indication was osteoarthritis in 7,205 (94.1%) cases. Most patients received cemented implants (78% vs. 22%) and the use of fixed insert designs increased from 18 to 74% between 2018 and 2022. The overall complication rate for the study population was 5.5% (475/8,590). The rate of complications did not differ according to fixation type. However, it was statistically significantly higher in patients who received mobile UKA than the fixed design (3.8% vs. 1.8% for mechanical complications and 1.7% vs. 0.6% for other complications, respectively; P < 0.001). The overall revision rate was 4.4% (234/5,377), with rates being similar for cemented and cementless designs (P = 0.832). However, the revision rate of mobile UKA was significantly higher than that of fixed designs (P < 0.001).

CONCLUSION: The majority of UKAs in Türkiye were cemented implants with an increased usage of fixed bearings over time. Mobile-bearing designs had significantly greater complication and revision rates compared to fixed-bearing implants.

PMID:41854873 | DOI:10.1007/s00264-026-06768-5

Int Orthop. 2026 Mar 19. doi: 10.1007/s00264-026-06750-1. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the Fast Anterior Medium Approach (FAMA) as an alternative to traditional anterior cervico-thoracic approaches, enhancing access to the C7-T1-T2 and T2-T4 junctions while minimizing postoperative morbidity. The cervico-thoracic junction is one of the most challenging regions to access surgically due to its deep location and proximity to critical neurovascular structures. Conventional approaches, including postero-lateral thoracotomy and transmanubrial techniques, are associated with high morbidity. The FAMA technique was designed to provide enhanced exposure while reducing surgical trauma.

METHODS: A cadaveric study was performed to understand how FAMA approach could find application in spine surgery in order to obtain wider access to the cervico-thoracic spine with lower post-operative morbidity compared to the surgical procedure with sternotomy. This approach involves controlled dislocation of the sterno-clavicular joint to extend anterior access without requiring sternotomy.

RESULTS: The approach allowed excellent exposure of the thoracic apex, enabling safe spinal stabilization procedures with minimal disruption to surrounding structures. No major neurovascular injuries occurred.

CONCLUSION: The FAMA approach represents a viable alternative to conventional cervico-thoracic surgical techniques, offering improved visualization and accessibility while preserving anatomical integrity. This technique has the potential to reduce morbidity and improve patient recovery. Larger-scale studies are required to validate these findings.

PMID:41854872 | DOI:10.1007/s00264-026-06750-1

Int Orthop. 2026 Mar 18. doi: 10.1007/s00264-026-06786-3. Online ahead of print.

ABSTRACT

BACKGROUND: Morton's neuroma is a painful forefoot condition commonly treated with corticosteroid injections. Although ultrasound guidance improves injection accuracy, various single-operator approaches exist with differing reproducibility and technical challenges. This study describes and evaluates a novel " three-handed " ultrasound-guided technique involving coordinated manipulation by both a radiologist and an injecting physician, hypothesized to enhance the therapeutic response while maintaining a low complication rate.

METHODS: We retrospectively reviewed the data of 56 evaluable patients (selected from a total of 110 treated patients) with symptomatic Morton's neuroma. The technique involved a radiologist applying dorsal compression to stabilize the neuroma while an orthopaedic surgeon performed a plantar, ultrasound-guided injection of 1 cc betamethasone. The primary outcome was patient-reported pain relief at ≥ one month follow-up, categorized as significant (> 50% relief), partial (30-50%), or minimal (< 30%).

RESULTS: The cohort (n = 56; 75.0% female; mean age 54.3 ± 11.4 years) had a mean follow-up of 9.5 months. Significant improvement (> 50% pain reduction) was reported by 75.0% (42/56) of the patients. The overall clinical response rate (pain reduction > 30%) was 80.4% (of 45/56). The outcomes were not significantly different (p = 0.746) between the one-site (n = 33) and two-site (n = 23) injection groups. No major complications occurred, and 8.9% (5/56) of the patients reported transient pain.

CONCLUSIONS: Ultrasound-guided three-handed technique is a safe and feasible method for Morton's neuroma injection. This cooperative approach enhances neuroma stabilization and needle visualization, yielding high rates of preliminary clinical improvement. These retrospective findings are limited by selection bias and lack of control. Prospective randomized trials are warranted to validate its efficacy against standard single-operator techniques.

PMID:41851449 | DOI:10.1007/s00264-026-06786-3

Injury. 2026 Mar 13:113151. doi: 10.1016/j.injury.2026.113151. Online ahead of print.

ABSTRACT

BACKGROUND: Severe hand injuries with extensive soft-tissue loss present a significant reconstructive challenge. Achieving stable coverage while preserving hand function often necessitates the combined use of regional and local flaps. The posterior interosseous artery (PIA) flap, in combination with regional flaps harvested from non-salvageable digits, may offer an effective solution.

METHODS: A retrospective analysis was performed on patients with severe hand injuries who underwent reconstruction using a PIA flap between 2022 and 2025. Patients were treated with either an isolated PIA flap or a PIA flap combined with local flaps, including fillet flaps harvested from non-salvageable digits or rotational flaps, depending on the extent and location of the defect. Demographic characteristics, injury mechanisms, defect locations, and surgical details were recorded. Postoperative complications and functional outcomes were assessed using fingertip-to-palm distance, Quick DASH score, and VAS for pain.

RESULTS: Fourteen patients with severe hand injuries were included in the study. The mean age was 39.4 years, and the mean follow-up period was 19.7 months. Five patients with complex, multi-site defects underwent combined reconstruction using a PIA flap with local flaps (four with fillet flaps, one with a rotational flap), while nine patients were treated with an isolated PIA flap. Successful soft-tissue coverage was achieved in all patients without total flap loss. Partial distal flap necrosis occurred in two patients due to venous congestion and was managed with wound care followed by split-thickness skin grafting. At final follow-up, the mean fingertip-to-palm distance was 2.07 cm, the mean Quick DASH score was 21.89, and the mean VAS pain score was 2.07. All patients achieved stable wound healing and were able to perform daily activities without the need for further reconstructive procedures.

CONCLUSION: The PIA flap, either alone or in combination with local flaps, provides reliable soft-tissue coverage and favorable functional outcomes in patients with severe hand injuries. Combined reconstruction strategies should be considered based on defect characteristics, with acceptable complication rates and good functional recovery. This technique represents a valuable option in complex hand trauma reconstruction.

LEVEL OF EVIDENCE: IV.

PMID:41850965 | DOI:10.1016/j.injury.2026.113151

Injury. 2026 Mar 12;57(4):113152. doi: 10.1016/j.injury.2026.113152. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency Spinal Stabilization (ESS) represents a cornerstone of contemporary polytrauma management, yet its independent impact on respiratory outcomes remains a subject of ongoing debate. This study investigates whether tracheostomy (TS) rates and duration of mechanical ventilation (DMV) are primarily driven by the surgical intervention itself, neurological impairment, or overall injury severity.

METHODS: We retrospectively analyzed 914 severely injured patients (ISS≥16) admitted to a Level I trauma center. Primary outcomes were TS rate and DMV. Multivariate logistic and linear regression models were employed to isolate the independent effects of ESS, injury severity (ISS, AIS), and neurological status. A dedicated subgroup analysis of operated patients (n = 85) evaluated surgical technique (e.g., ventral stabilization) and physiological severity scores (SAPS2, TISS-10).

RESULTS: ESS patients demonstrated a significantly elevated TS rate (39.5% vs. 20.6%, p < 0.001) despite being younger and exhibiting lower physiological severity at admission (SAPS2 28.0 vs. 33.5, p = 0.013). In the total cohort, thoracic injury (OR 1.99, p < 0.001) and ISS (OR 1.04, p = 0.002) independently predicted TS; ESS was not an independent predictor (p = 0.27). Within the ESS subgroup, spinal cord injury (SCI) emerged as the strongest predictor for TS (OR 3.33, p = 0.032), whereas surgical invasiveness (ventral stabilization) exerted no independent impact (p = 0.520). DMV was exclusively determined by ISS (p < 0.001); neither neurological status nor surgical technique independently influenced ventilation duration.

CONCLUSIONS: ESS serves as a reliable clinical marker for increased TS requirements but does not independently prolong mechanical ventilation. TS necessity is primarily dictated by SCI and overall injury burden rather than surgical invasiveness. Early TS in ESS patients with SCI appears to effectively compensate for physiological deficits, aligning ventilation durations with those of non-neurologically impaired patients. ESS should therefore be recognized as a clinical "red flag" prompting proactive multidisciplinary airway management to optimize respiratory weaning strategies.

PMID:41850132 | DOI:10.1016/j.injury.2026.113152

Injury. 2026 Mar 17;57(4):113162. doi: 10.1016/j.injury.2026.113162. Online ahead of print.

NO ABSTRACT

PMID:41850131 | DOI:10.1016/j.injury.2026.113162

Injury. 2026 Mar 13:113153. doi: 10.1016/j.injury.2026.113153. Online ahead of print.

ABSTRACT

BACKGROUND: The role of diagnostic laparoscopy in adults with blunt abdominal trauma and the effect of negative laparoscopy on mortality is not well delineated.

METHODS: We reviewed the National Trauma Data Bank (2007-2019) for adults sustaining blunt abdominal trauma who underwent operative intervention. We performed a doubly robust, augmented inverse propensity weighted multivariable logistic regression to estimate the effect of a negative diagnostic laparoscopy on mortality in adults with operative blunt abdominal trauma.

RESULTS: 87,864 patients met the inclusion criteria. Diagnostic laparoscopy occurred in 6.6% (n = 5816) of patients, with a 21.1% (n = 1226) conversion to laparotomy rate. The rate of negative diagnostic laparoscopy was 28.6% (n = 1665). Negative laparoscopy patients had a 49% reduction in odds of mortality (OR 0.51, 95%CI 0.47 - 0.56, p < 0.001) compared to negative laparotomy patients. Patient's that underwent laparoscopy, found to have intra-abdominal injury, had a similar reduction in odds of mortality compared to negative laparotomy patients (OR 0.54, 95% CI 0.51 - 0.57, p < 0.001).

CONCLUSION: Diagnostic laparoscopy may be safe for adults with blunt abdominal trauma and prevent significant morbidity and mortality from a negative laparotomy.

PMID:41846201 | DOI:10.1016/j.injury.2026.113153

J Bone Joint Surg Am. 2026 Mar 18. doi: 10.2106/JBJS.25.00964. Online ahead of print.

ABSTRACT

BACKGROUND: It is unclear whether postoperative pain differs by treatment type for patients with severe open tibial fractures.

METHODS: We performed a secondary analysis of data from the FIXIT study. Adults with severe open tibial fractures were randomized to undergo definitive modern external ring fixation (n = 122) or internal fixation (n = 132). Primary outcomes were pain intensity and interference at 6 and 12 months, measured by the Brief Pain Inventory. Secondary outcomes were Numeric Pain Rating Scale (NPRS) scores and the incidence of moderate to severe pain. Post hoc subanalysis compared pain in patients with and without pin-site infections and with and without external fixation removal.

RESULTS: At 6 months, median pain intensity did not differ significantly between the external fixation group (4.1 [interquartile range (IQR), 2.2 to 5.5]) and the internal fixation group (3.0 [IQR, 1.8 to 5.8]) (p = 0.11); however, patients who underwent external fixation had greater median pain interference (6.0 [IQR, 3.3 to 8.0]) than patients who underwent internal fixation (4.0 [IQR, 1.9 to 7.4]) (p = 0.01). At 12 months, pain intensity, pain interference, and NPRS scores did not differ by treatment type. The overall incidence of moderate to severe pain was 33% at 6 months and 35% at 12 months. At 6 months, pin-site infections were associated with greater pain intensity (p = 0.01) but not greater interference (p = 0.10). At 12 months, the presence of external fixation was associated with greater pain intensity (p = 0.01) and interference (p < 0.01).

CONCLUSIONS: At 6 months after a severe open tibial fracture, patients treated with modern external ring fixation had greater pain interference than patients treated with internal fixation, partly because of pin-site infections. No differences in pain interference or intensity were seen at 12 months. At 12 months, patients with external fixation in place had greater pain intensity and interference than those whose external fixation had been removed, but this was not the case at 6 months. Approximately one-third of all patients had moderate to severe pain at both time points, highlighting that persistent pain is common, regardless of treatment type. These findings can guide surgeons in choosing ring external fixation or internal fixation for these fractures.

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

PMID:41849563 | DOI:10.2106/JBJS.25.00964

J Bone Joint Surg Am. 2026 Mar 18;108(6):416. doi: 10.2106/JBJS.25.00902. Epub 2025 Nov 20.

NO ABSTRACT

PMID:41848566 | DOI:10.2106/JBJS.25.00902

J Bone Joint Surg Am. 2026 Mar 18;108(6):399-400. doi: 10.2106/JBJS.25.01392. Epub 2026 Mar 18.

NO ABSTRACT

PMID:41848565 | DOI:10.2106/JBJS.25.01392

J Bone Joint Surg Am. 2026 Mar 18;108(6):397-398. doi: 10.2106/JBJS.25.01287. Epub 2026 Mar 18.

NO ABSTRACT

PMID:41848564 | DOI:10.2106/JBJS.25.01287

J Bone Joint Surg Am. 2026 Mar 18;108(6):395-396. doi: 10.2106/JBJS.25.01291. Epub 2026 Mar 18.

NO ABSTRACT

PMID:41848563 | DOI:10.2106/JBJS.25.01291

J Bone Joint Surg Am. 2026 Mar 18;108(6):393-394. doi: 10.2106/JBJS.26.00094. Epub 2026 Mar 18.

NO ABSTRACT

PMID:41848562 | DOI:10.2106/JBJS.26.00094

Int Orthop. 2026 Mar 18. doi: 10.1007/s00264-026-06780-9. Online ahead of print.

NO ABSTRACT

PMID:41848887 | DOI:10.1007/s00264-026-06780-9

Injury. 2026 Mar 9;57(4):113148. doi: 10.1016/j.injury.2026.113148. Online ahead of print.

NO ABSTRACT

PMID:41843999 | DOI:10.1016/j.injury.2026.113148

Int Orthop. 2026 Mar 17. doi: 10.1007/s00264-026-06784-5. Online ahead of print.

ABSTRACT

PURPOSE: To identify thresholds of acetabular chondral burden (number of Ilizaliturri zones involved) associated with failure to achieve minimal clinically important difference (MCID) following hip arthroscopy for femoroacetabular impingement, and to determine whether cartilage extent provides prognostic information independent of lesion severity (Outerbridge grade).

METHODS: We analyzed 168 consecutive patients who underwent hip arthroscopy with two year follow-up. Acetabular cartilage was assessed intraoperatively for extent (Ilizaliturri 6-zone classification) and severity (Outerbridge grading). Patients were categorized by chondral burden: 0 zones (N = 70), 1-2 zones (N = 62), or ≥ 3 zones (N = 36). Primary outcome was MCID achievement (≥ 9-point improvement) in Hip Outcome Score-Activities of Daily Living. Multivariable regression adjusted for age, sex, BMI, baseline function, and Outerbridge grade (Table 3).

RESULTS: MCID achievement differed significantly by chondral burden: 70% (0 zones), 79% (1-2 zones), and 50% (≥ 3 zones) (p = 0.011), representing a 29 percentage-point difference between groups. In multivariable analysis adjusting for Outerbridge grade and other confounders, the ≥ 3 zone group showed a trend toward reduced odds of achieving MCID (OR = 0.43, 95% CI: 0.18-1.02, p = 0.056). Extent and severity showed low correlation (ρ = 0.20), suggesting they represent distinct aspects of cartilage pathology.

CONCLUSION: Acetabular chondral involvement of ≥ 3 Ilizaliturri zones was associated with a lower probability of achieving clinically meaningful improvement after hip arthroscopy. Cartilage extent may provide prognostic information beyond lesion severity and should be considered during preoperative counseling and surgical decision-making.

PMID:41843111 | DOI:10.1007/s00264-026-06784-5

Int Orthop. 2026 Mar 17. doi: 10.1007/s00264-026-06773-8. Online ahead of print.

ABSTRACT

AIMS: This study evaluated the accuracy of resection of bone tumours and the fit between host bone and massive bone allograft (MBA) in children with malignant bone tumours of lower limb who underwent surgery using in-house 3-dimensional (3D)-printed patient-specific instruments (PSIs) for tumour resection and graft-specific instruments (GSIs) for shaping the MBA.

METHODS: This retrospective study included seven children (3 males, 4 females; median age 13) with malignant bone tumours of the lower limb who underwent intercalary resection and reconstruction with MBA between September 2023 and March 2025 using in-house designed 3D-printed PSIs and GSIs. Tumours were located in the femur (5 children) and tibia (2 children). We analysed the accuracy of bone resection, complications of reconstruction, and function of patients.

RESULTS: All resections achieved R0 margins. The median planned resection length was 16.5 cm versus 16.8 cm actually resected (median difference 0.2 cm). Bone union was achieved in 13 of 14 (92.9%) osteotomy sites. Bone union was faster at metaphyseal junctions (median 5.9 months) than diaphyseal junctions (median 8.4 months) (p = 0.01). One of the osteotomy sites (7.1%) had a delayed union requiring secondary bone grafting. The median Musculoskeletal Tumour Society score was 30 at the last follow-up.

CONCLUSION: 3D-printed PSIs and GSIs appear to enhance the accuracy of bone tumour resection and host bone-MBA fit, thereby reducing the risks of inadequate margins and non-union, respectively.

PMID:41843110 | DOI:10.1007/s00264-026-06773-8