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Ocular trauma from pressure cooker explosions: A retrospective analysis from South India

Injury -

Injury. 2025 Nov 20;57(2):112900. doi: 10.1016/j.injury.2025.112900. Online ahead of print.

ABSTRACT

AIM: To analyze the spectrum of ocular injuries caused by pressure cooker explosions, evaluate visual outcomes, and highlight the need for increased safety awareness.

METHODS: This retrospective study reviewed medical records of 40 patients presenting with ocular trauma due to pressure cooker explosions between January 2010 and December 2022 across four tertiary eye care centers in South India. Data collected included demographics, injury type, clinical findings, imaging results, surgical interventions, and visual outcomes. Injuries were classified based on the Birmingham Eye Trauma Terminology (BETT) system and graded according to the presenting and final best-corrected visual acuity (BCVA).

RESULTS: The mean age at presentation was 40 ± 13.4 years, with a female predominance (65 %). Urban residents (62.5 %) were more frequently affected than rural individuals (37.5 %). Closed globe injuries comprised 80 % of cases, while open globe injuries accounted for 20 %. Blast injuries were the most common mechanism (57.5 %), followed by thermal injuries (40 %). Common ocular findings included hyphema (10 %), iridodialysis (7.5 %), traumatic cataract (12.5 %), and vitreous hemorrhage (7.5 %). Surgical intervention was required in 37.5 % of cases, with procedures ranging from conjunctival tear repair to evisceration. Poor visual prognosis was associated with open globe injuries and severe blast trauma.

CONCLUSION: Pressure cooker-related ocular trauma predominantly affects women in domestic settings and can lead to severe vision loss. Increased public awareness, manufacturer adherence to safety standards, and user education on proper handling may help reduce the incidence of such injuries.

PMID:41317659 | DOI:10.1016/j.injury.2025.112900

Chemical Disinfection of an Accidentally Contaminated and Irreplaceable Inorganic Element During Orthopaedic Surgery Is a Safe Option

JBJS -

J Bone Joint Surg Am. 2025 Nov 19;107(22):2582-2587. doi: 10.2106/JBJS.24.01163. Epub 2025 Nov 19.

ABSTRACT

BACKGROUND: During surgical procedures, the accidental contamination of a critical instrument or implant can jeopardize the entire operation. Resterilizing the item is not always feasible and can be time-consuming. Since extending the duration of the surgery heightens the risk of postoperative complications, it is essential to balance this risk with the risk of infection from contamination. Currently, there is no simple, safe, and quickly available method to address this issue. This study explored the efficacy of using chemical disinfection to deal with this problem.

METHODS: In part 1 of the study, 3 types of discs (cobalt-chromium, titanium, and polyethylene) were contaminated with Staphylococcus epidermidis, disinfected with use of 3 different procedures (2% chlorhexidine in 70% isopropanol alcohol, 0.9% povidone-iodine in 46% isopropanol alcohol, or 70% ethanol), and analyzed for remaining bacteria. A control group without disinfection was included. In part 2, the discs were dropped on the floor of an operating room, left on the floor for 30 seconds, and then collected before undergoing the same procedure as in part 1.

RESULTS: In part 1, all 3 alcohol-based disinfection procedures showed a high efficacy, as there was no growth found on any of the discs. These results were highly significant compared with those found for the control group (p < 0.01 for all). In the control group, polyethylene had the highest mean level of contamination (157.3 colony-forming units [CFUs]) and titanium had the lowest (58.4 CFUs). Part 2 confirmed the effectiveness of alcohol-based disinfection, with no growth observed in the test cultures. In the control group, polyethylene seemed to be the most prone to contamination. However, the level of contamination was low for all materials (0 to 8 CFUs per disc).

CONCLUSIONS: In the event of accidental contamination of an essential element or implant during a surgical procedure with no possibility of replacing the element, 2 minutes of disinfection in an alcohol-based solution seems to be a safe, simple, and quick option.

CLINICAL RELEVANCE: In the event of accidental contamination of an irreplaceable inorganic element during orthopaedic surgery, we recommend soaking the element in an alcohol-based disinfectant for 2 minutes and rinsing it with saline solution.

PMID:41315044 | PMC:PMC12614374 | DOI:10.2106/JBJS.24.01163

Diagnostic Utility of a Rapid Myeloperoxidase Test in Synovial Fluid for Chronic Periprosthetic Joint Infection

JBJS -

J Bone Joint Surg Am. 2025 Nov 19;107(22):2574-2581. doi: 10.2106/JBJS.24.01514. Epub 2025 Nov 19.

ABSTRACT

BACKGROUND: Numerous biomarkers have been identified for the diagnosis of periprosthetic joint infection (PJI), but no single biomarker has been proven to have definitive accuracy. Alpha-defensin is an excellent biomarker that is included as a minor criterion in the 2nd International Consensus Meeting (ICM) PJI diagnostic criteria; however, its high cost limits its accessibility at many general medical facilities. Consequently, alternative biomarkers for PJI diagnosis are under investigation. Myeloperoxidase (MPO), an enzyme with microbicidal properties through the catalysis of hypochlorous acid production, has emerged as a promising alternative. MPO has previously been reported as an effective biomarker for PJI. In the present study, we conducted a rapid MPO test as a point-of-care test (POCT) and evaluated its diagnostic utility.

METHODS: Patients with a suspected infection after total joint arthroplasty were categorized into the PJI or aseptic failure groups according to the 2nd ICM PJI diagnostic criteria. MPO and alpha-defensin levels in synovial fluid that was collected during surgery were quantified using an enzyme-linked immunosorbent assay (ELISA), and their diagnostic accuracy was compared. Additionally, an MPO POCT was conducted, and its diagnostic accuracy was assessed.

RESULTS: The investigation included 23 patients with PJI and 23 with aseptic failure. All were Japanese. MPO and alpha-defensin ELISAs exhibited a strong correlation, and, at the optimal cutoff, both tests demonstrated a sensitivity of 0.957 and a specificity of 0.957. The MPO POCT produced results in just 10 minutes and achieved a sensitivity of 1.00 and a specificity of 0.913.

CONCLUSIONS: The MPO ELISA demonstrated high diagnostic accuracy for PJI, equivalent to that of the alpha-defensin test. Furthermore, the MPO POCT showed similarly high diagnostic accuracy. The MPO POCT is a promising and rapid tool for diagnosing PJI and could serve as an alternative to the alpha-defensin test.

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

PMID:41315043 | DOI:10.2106/JBJS.24.01514

Synovial Fluid MicroRNA Biomarkers Enable Accurate Diagnosis of Hip and Knee Periprosthetic Joint Infections

JBJS -

J Bone Joint Surg Am. 2025 Nov 19;107(22):2561-2573. doi: 10.2106/JBJS.24.01559. Epub 2025 Nov 19.

ABSTRACT

BACKGROUND: Diagnosing hip and knee periprosthetic joint infections (PJIs) is challenging, necessitating sensitive and specific biomarkers for accurate diagnosis. Cell-free microRNAs (miRNAs) are emerging as noninvasive biomarkers. We hypothesized that hip and knee PJIs are associated with unique cell-free miRNA profiles in synovial fluid, which can be used for the diagnosis of infection.

METHODS: Synovial fluid samples from 173 Caucasian patients undergoing septic or aseptic revision total joint replacement (TJR) of the hip or knee, as well as samples from 6 osteoarthritic knees, were analyzed. The samples were divided into a discovery group (40 samples; 50% septic) and a validation cohort (133 samples; 35% septic). Small RNA next-generation sequencing (NGS) was used to screen miRNAs in the discovery samples, with reverse transcription-quantitative polymerase chain reaction (RT-qPCR) used to confirm the NGS findings and to validate results in the independent, larger cohort. Logistic regression and cross-validation were applied to assess the diagnostic power of individual and combined miRNAs.

RESULTS: NGS identified 132 miRNAs with significant differences (false discovery rate < 0.05) between the septic and aseptic synovial fluid samples. Of these, 18 miRNAs were further analyzed with use of RT-qPCR in the independent cohort, with miR-223-3p and miR-338-5p showing the highest increases in septic synovial fluid (log2 fold change >4) and miR-151a-3p and miR-214-3p showing the most substantial reductions. To investigate the performance of the multivariable models, logistic regression was performed by dividing the cohort into a training set (60%) and a test set (40%), which showed improved performance relative to that of the univariate models (median area under the curve [AUC] for the multivariable models, 0.96). A subgroup analysis by joint type, gender, and synovial fluid sample preparation confirmed robust miRNA biomarker performance for PJI.

CONCLUSIONS: Cell-free miRNA levels in the synovial fluid of patients undergoing septic hip or knee TJR were altered in response to infection, indicating immune cell activity in the joint. These miRNAs offer sensitive and specific pathogen-independent biomarkers with potential clinical applications in the diagnosis of hip and knee PJI.

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

PMID:41315042 | PMC:PMC12614378 | DOI:10.2106/JBJS.24.01559

Timing of Debridement, Antibiotics, and Implant Retention for Early Periprosthetic Joint Infection: Data from the Finnish Arthroplasty Register

JBJS -

J Bone Joint Surg Am. 2025 Nov 19;107(22):2554-2560. doi: 10.2106/JBJS.25.00946. Epub 2025 Nov 19.

ABSTRACT

BACKGROUND: Debridement, antibiotics, and implant retention (DAIR) is the method of choice in the treatment of acute periprosthetic joint infection (PJI). However, the optimal timing of DAIR is somewhat unclear. We assessed the success of DAIR performed during different time intervals after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using data from the Finnish Arthroplasty Register (FAR).

METHODS: There were 178,498 primary operations (78,888 THAs and 99,610 TKAs) from May 2014 to April 2022 recorded in the FAR. Male patients represented 53.4% of the THA group and 55.5% of the TKA group. The most common age group was ≤62 years in the THA group and ≥76 years in the TKA group. All patients were of Finnish ethnicity. A total of 1,014 DAIR procedures were performed within 6 months after the primary arthroplasty. Cases of reoperation after DAIR were followed for 1 year after the DAIR; re-revision due to PJI within 1 year was regarded as a failure of the DAIR treatment. We compared the failure rate of DAIR among 3 time intervals: 0 to 42, 43 to 84, and 85 to 180 days after the primary operation. A Cox regression model was used to assess risk factors for re-revision.

RESULTS: In the THA group, the failure rate was 15.1% when DAIR was performed within 42 days, 10.0% when performed at 43 to 84 days, and 31.4% when performed at 85 to 180 days after the primary THA. In the TKA group, the failure rate was 8.9% when DAIR was performed within 42 days, 16.7% when performed at 43 to 84 days, and 9.8% when performed at 85 to 180 days after the primary TKA. Later DAIR was not associated with an increased re-revision risk, compared with the reference of 0 to 42 days, in the THA group (43 to 84 days: hazard ratio [HR], 1.2 [95% confidence interval (CI), 0.6 to 2.2; p = 0.63]; 85 to 180 days: HR, 1.4 [95% CI, 0.6 to 3.0; p = 0.41]). The same was true in the TKA group (43 to 84 days: HR, 1.0 [95% CI, 0.4 to 2.4; p = 0.98]; 85 to 180 days: HR, 1.9 [95% CI, 1.0 to 3.8; p = 0.065]).

CONCLUSIONS: The failure rate of DAIR may not increase as much as previously thought if performed >6 weeks after primary total joint arthroplasty. Thus, DAIR can also be worth considering as a treatment method for PJI beyond the first 6 weeks postoperatively, depending on the severity of the case.

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

PMID:41315041 | PMC:PMC12614382 | DOI:10.2106/JBJS.25.00946

Addressing methodological gaps in finite element analysis of novel hook plates for patellar fracture fixation

Injury -

Injury. 2025 Nov 1:112859. doi: 10.1016/j.injury.2025.112859. Online ahead of print.

ABSTRACT

This letter evaluates the methodological shortcomings in the FEA research conducted by Ma et al. (2025) that contrasts hook plates with tension-band wiring for patellar fractures. Unresolved concerns consist of: uniform bone material characteristics simplifying biomechanics; static loads neglecting dynamic physiological forces; idealized fracture spaces missing clinical variation; and unverified interfaces exaggerating stability. These gaps may exaggerate the effectiveness of the implant. We suggest personalized modeling, simulations of dynamic loading, and studies on mesh convergence to enhance clinical significance. Tackling these issues would enhance forthcoming evaluations of orthopedic devices based on FEA.

PMID:41314893 | DOI:10.1016/j.injury.2025.112859

Infection and Nonunion Rates in Open Fractures: Description of 6,042 Fractures from the FLOW and PREP-IT Trials

JBJS -

J Bone Joint Surg Am. 2025 Nov 19;107(22):2541-2553. doi: 10.2106/JBJS.24.01055. Epub 2025 Nov 19.

ABSTRACT

BACKGROUND: Infection and nonunion are common sequelae of open fractures. Studies have shown infection and nonunion rates ranging from 2% to 52% and 12% to 17%, respectively. The present article describes the rates of surgical site infection (SSI) and delayed union/nonunion following open fractures in a large contemporary series of patients from prospective clinical trials with adjudicated outcomes.

METHODS: A descriptive analysis was performed with use of patient data from the FLOW, Aqueous-PREP, and PREPARE-Open studies. These studies, published within the past 10 years, included multiple international trauma centers and shared definitions for SSI and delayed union/nonunion. SSI and delayed union/nonunion rates were stratified by the OTA/AO fracture and Gustilo-Anderson open fracture classification systems. Kaplan-Meier estimators were utilized to obtain point estimates, and the log-log transformation approach was utilized to calculate 95% confidence intervals (CIs) for outcome rates.

RESULTS: A total of 6,042 open fractures were included. The cumulative SSI rates at 12 months for Gustilo-Anderson Types 1, 2, 3A, 3B, and 3C were 5.1%, 9.7%, 13.8%, 28.9%, and 26.2%, respectively. The cumulative rates of delayed union/nonunion at 12 months for Gustilo-Anderson Types 1, 2, 3A, 3B, and 3C were 3.0%, 5.2%, 8.0%, 14.0%, and 17.0%, respectively. Utilizing the OTA/AO fracture classification to increase the point estimate granularity, the estimated 12-month SSI and delayed union/nonunion rates in 156 Gustilo-Anderson type 3B open tibial shaft fractures (OTA/AO 42) were 34.7% (95% CI, 26.7% to 41.9%) and 18.4% (95% CI, 12.0% to 24.4%), respectively. A companion website with SSI and delayed union/nonunion rates was developed to supplement this article.

CONCLUSIONS: Open fractures are a substantial problem with complications that include infection and nonunion. The present data are useful for prognosis, research study design, and informing public awareness and policy. These results show that, despite current treatment approaches, the rates of SSI and delayed union/nonunion following treatment of open fractures remain high at 1 year and are not substantially improved from historical rates spanning several decades. Although open fracture sequelae remain a burden for patients, orthopaedic surgeons, and health-care systems, there may be opportunities for improvement in outcomes.

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

PMID:41315040 | PMC:PMC12614385 | DOI:10.2106/JBJS.24.01055

Critical considerations in shock index application for normotensive trauma patients: Limitations and future directions

Injury -

Injury. 2025 Oct 31:112874. doi: 10.1016/j.injury.2025.112874. Online ahead of print.

ABSTRACT

This letter addresses the research conducted by Lin et al. regarding the shock index (SI) as an indicator of compensated shock in normotensive trauma cases. We acknowledge the authors' efforts while highlighting significant limitations: overlooked confounding due to cardioactive drugs, survival bias from omitting early fatalities, influences of prehospital fluid resuscitation, and insufficient age-specific SI thresholds. We additionally challenge transfusion as a surrogate for shock and emphasize the variation in injury mechanisms. Suggestions consist of modifications in pharmacovigilance, incorporation of early mortality statistics, and multi-center confirmations with microcirculatory outcomes.

PMID:41314892 | DOI:10.1016/j.injury.2025.112874

Global Perspectives on the Management of Periprosthetic Joint Infection

JBJS -

J Bone Joint Surg Am. 2025 Nov 19;107(22):2521-2528. doi: 10.2106/JBJS.25.00775. Epub 2025 Nov 19.

ABSTRACT

➢ The rate of periprosthetic joint infection (PJI) is rising globally, with substantial regional variability, and PJI has 5-year mortality rates of 15% to 25%, which exceed those of early-stage breast and prostate cancer and rival those of colorectal and hematologic malignancies.➢ Diagnostic criteria, including synovial fluid analysis, novel culture techniques, and molecular techniques, have improved in accuracy. However, infections caused by fastidious, biofilm-forming microorganisms continue to pose a major diagnostic challenge worldwide.➢ While patient selection remains critical for successful outcomes, the use of DAIR (debridement, antibiotics, and implant retention), 1-stage, 2-stage, and 1.5-stage procedures varies across regions and is often influenced by logistical constraints, resource availability, and clinical expertise. In parallel, discordant definitions of treatment success in the literature hinder comparative research and outcome benchmarking. A tiered framework-encompassing infection eradication, surgical burden, joint function, and patient-reported outcomes-offers a path toward standardized and clinically meaningful reporting.➢ Advances in immunogenetics, artificial intelligence-driven risk modeling, and precision medicine, alongside the emergence of research consortia and global collaborations, are opening new frontiers in treatment strategies and creating opportunities for innovative, individualized approaches to PJI management.

PMID:41315038 | DOI:10.2106/JBJS.25.00775

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