Injury. 2025 Apr 4;56(6):112314. doi: 10.1016/j.injury.2025.112314. Online ahead of print.

ABSTRACT

BACKGROUND: Wound healing is a complex and regulated process that involves the coordinated action of key signaling pathways. Activating transcription factor 3 (ATF3) is a stress-inducible protein that has recently emerged as a critical modulator of cellular responses to injury, including those involved in wound healing.

AIM: The aim of this study was to explore the repurposing of existing pharmacological agents to activate ATF3 and evaluate their potential to enhance wound healing factors.

METHODS: We selected three compounds: retin-A, furosemide, and acrivastine based on their ability to modulate ATF3 expression and assessed their effects on wound healing processes in primary cell cultures. We evaluated wound healing-related genes such as LL-37, HBD-2, HBD-3, and VEGFA by qPCR, and a wound healing scratch assay using keratinocytes was conducted to evaluate cell migration.

RESULTS: Interestingly, retin-A induced the expression of key wound healing-related genes, including HBD-2, HBD-3, LL-37, and VEGF. Also, retin-A was the only compound showing wound healing effects, while furosemide and acrivastine did not exhibit any noticeable activity.

CONCLUSION: Our research highlights the potential of retin-A as therapeutic agents to improve wound healing, particularly in chronic wound models.

PMID:40220516 | DOI:10.1016/j.injury.2025.112314

Injury. 2025 Apr 3;56(6):112318. doi: 10.1016/j.injury.2025.112318. Online ahead of print.

ABSTRACT

INTRODUCTION: Transpubic screw fixation is a valuable option for stabilization of superior pubic ramus fractures. However, insertion of a transpubic screw can be challenging or sometimes even impossible due to a narrow or curved transpubic screw corridor, which is present in 38 % of cases. To overcome this problem, a modified technique for insertion of a transpubic screw by advancing a pre-bent guidewire in an ESIN-like fashion is described.

MATERIALS AND METHODS: A retrospective, non-inferiority pilot study with patients, who received a transpubic screw, was performed to investigate potential procedure-associated complications as well as short-term radiological and clinical outcomes of the modified technique in comparison to the classical technique for insertion.

RESULTS: From 01/2021 to 04/2024, 24 transpubic screws were inserted at two major trauma centers, of which nine screws were inserted using the modified technique. Ten patients with a total of eleven transpubic screws (modified technique: 5; classical technique: 6) were available for this pilot study. One patient from the modified technique subgroup experienced a screw migration without affecting fracture healing and without necessitating hardware removal. The complication rate of the modified technique was not significantly inferior to the classical technique (p = 0.50). Residual displacement of the pubic ramus fracture was not significantly inferior using the modified technique compared to the classical technique (modified: 5.0 ± 2.2 mm; classical 4.4 ± 3.3 mm; p = 0.38). The clinical outcome was not significantly inferior using the modified technique compared to the classical technique regarding VAS pain (modified: 2.4 ± 4.3; classical 2.6 ± 2.5; p = 0.47), VAS satisfaction (modified: 8.8 ± 1.8; classical 9.0 ± 1.0; p = 0.42) and Majeed score (modified: 82.0 ± 12.6; classical 90.0 ± 12.5; p = 0.17).

CONCLUSION: The modified technique for insertion of a transpubic screw using a pre-bent guidewire is feasible in narrow and particularly curved transpubic corridors. It was not inferior compared to the classical technique regarding complications as well as short-term radiological and clinical outcomes.

PMID:40215699 | DOI:10.1016/j.injury.2025.112318

Int Orthop. 2025 Apr 11. doi: 10.1007/s00264-025-06508-1. Online ahead of print.

NO ABSTRACT

PMID:40214746 | DOI:10.1007/s00264-025-06508-1

Int Orthop. 2025 Apr 11. doi: 10.1007/s00264-025-06526-z. Online ahead of print.

ABSTRACT

PURPOSE: Revision total hip arthroplasty (rTHA) is an increasingly common procedure due to the growing number of primary total hip arthroplasties (THAs) performed worldwide. This study evaluates the long-term implant survival, functional outcomes, and radiographic performance of cemented femoral stem (Beznoska s.r.o., Kladno, Czechia) in rTHA.

METHODS: A retrospective analysis was conducted on 183 patients who underwent rTHA with cemented stem between March 2012 and December 2023. The mean follow-up duration was 71.26(± 39.31) months. Implant survival was analyzed using Kaplan-Meier survival estimates, and failure modes were assessed. Radiographic changes were classified using the Gruen Zones system. Functional outcomes were evaluated using the Harris Hip Score (HHS). Cox proportional hazard models were applied to identify prognostic factors influencing implant survival.

RESULTS: The five-year implant survival rate was 98.1%, declining to 83.9% at twelve years. The overall failure rate was 3.83%, with periprosthetic infection (4 cases) being the most common cause, followed by aseptic loosening (2 cases). Radiographic changes were observed in 24.03% of cases, predominantly in Gruen Zones 2, 6, and 1. Functional outcomes were favorable, with a mean HHS of 81.28(± 5.74), comparable to outcomes reported for uncemented revision stems. Age, stem diameter, and stem length did not significantly impact implant survival.

CONCLUSION: The cemented stem demonstrated favourable long-term survival, with high implant retention rates. Functional outcomes indicated overall satisfactory performance. Radiographic evaluation revealed localized changes around the implant, predominantly in Gruen Zones 2, 6, and 1. Implant failure was relatively rare, with periprosthetic infection being the most common cause.

PMID:40214745 | DOI:10.1007/s00264-025-06526-z

Injury. 2025 Mar 27;56(6):112301. doi: 10.1016/j.injury.2025.112301. Online ahead of print.

ABSTRACT

BACKGROUND: In some multi-fragment tibial plateau fracture patterns, it may be more technically demanding to provide the appropriate support when using anatomic pre-contoured proximal tibial plates or other small fragment plates, especially when buttressing smaller apex-directed fracture fragments. The purpose of this study is to describe our surgical technique and highlight the potential role of low profile, mini fragment (2.0_2.7 mm) plates in the surgical management of different types of tibial plateau fractures.

METHODS: This is a retrospective study of 45 cases (45 patients, 31 males, mean age of 43.5 years) who had unicondylar or multicondylar tibial plateau fractures and were surgically managed using mini fragment plates, either as supplementary or standalone implants. The clinical notes and radiographs were reviewed to determine performance and complications, with particular focus on bony union, loss of reduction, implant failure, and soft tissue complications.

RESULTS: No intraoperative complications were recorded, and after a mean of 50.7 months, all the fractures have united. Two cases had knee stiffness and required manipulation under anesthesia, while only one case of secondary mild joint space depression was noted in the follow-up radiographs. No cases of nonunion, implant failure, or other cases of loss of reduction were recorded at the last radiolographic follow-up. Two patients required plate removal, at 4 months (a skeletally immature patient) and 18 months (another patient presented with secondary wound infection) postoperatively after fracture union. At the last radiographic follow-up, the average postoperative knee flexion was 121 degrees (range, 100-140), and the average postoperative Kellgren-Lawrence OA grade was 1 (range, 0-4).

CONCLUSIONS: The low-profile mini fragment plates are effective implants that may be safely used, either in association with other proximal tibial anatomic plates or as standalone implants, depending on the fracture configuration, with overall good outcomes.

PMID:40209613 | DOI:10.1016/j.injury.2025.112301

Injury. 2025 Apr 2;56(6):112316. doi: 10.1016/j.injury.2025.112316. Online ahead of print.

ABSTRACT

PURPOSE: This study investigates Japanese trends in Open Reduction and Internal Fixation (ORIF) surgeries for acetabular and pelvic fractures, focusing on age, gender, regional disparities, and how orthopedic surgeon distribution affects surgical volumes, aiming to identify factors contributing to geographic variations.

METHODS: Surgical volumes for acetabular (K124-2) and pelvic (K125) fractures were categorized by age, gender, and prefecture in the National Database of Health Insurance Claims and Specific Health Checkups of Japan (2016-2022). Correlation analyses assessed relationships between surgical volumes, aging populations, and orthopedic surgeon availability.

RESULTS: Surgical volumes of the elderly increased among individuals over 65, with a notable rise in female pelvic fractures. Acetabular fractures were more prevalent in younger males. Urban areas with more orthopedic surgeons showed higher surgical volumes (p < 0.0001), while aging population rates correlated negatively (p < 0.0001).

CONCLUSION: ORIF for acetabular and pelvic fractures is increasing in Japan's aging population. Surgeon distribution influences surgical volumes, highlighting the need for treatment guidelines in primary care and telemedicine-based strategies.

PMID:40209612 | DOI:10.1016/j.injury.2025.112316

J Bone Joint Surg Am. 2025 Apr 10. doi: 10.2106/JBJS.24.01080. Online ahead of print.

ABSTRACT

BACKGROUND: Vitamin C shows strong anti-inflammatory and analgesic effects, so we explored whether it can replace glucocorticoids in reducing pain and inflammation after total hip arthroplasty (THA).

METHODS: In this prospective trial, a consecutive series of 107 patients (43.0% men, 56.8 ± 10.1 years of age, 100% Han Chinese) who underwent THA due to end-stage hip disease at our medical center between January 2023 and January 2024 were randomized to receive vitamin C, dexamethasone, or neither dexamethasone nor vitamin C after surgery. The 3 groups were compared in terms of the primary outcomes of pain reported on a visual analogue scale (VAS), perioperative morphine use, and blood indices of inflammation and fibrinolysis as well as in terms of secondary outcomes of efficacy and safety.

RESULTS: Compared with patients in the control group, those who received vitamin C or dexamethasone reported a significantly lower VAS pain score on postoperative day 1, had significantly lower perioperative morphine consumption, and demonstrated significantly lower blood levels of C-reactive protein on days 1 and 2. The 2 groups also showed a significantly lower rate of rescue analgesia on postoperative day 1 and significantly higher Harris hip scores of joint function at 2 and 12 weeks after surgery, as well as significantly smaller thigh circumference and a lower rate of swelling on the first 2 days after surgery. Either treatment was associated with a significantly lower rate of postoperative nausea and vomiting. Dexamethasone was associated with greater blood glucose levels after surgery.

CONCLUSIONS: Vitamin C may be an effective substitute for glucocorticoids for reducing morphine use and the risk of nausea or vomiting and for improving joint function after THA without side effects causing blood glucose fluctuations.

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

PMID:40208930 | DOI:10.2106/JBJS.24.01080

Int Orthop. 2025 Apr 10. doi: 10.1007/s00264-025-06528-x. Online ahead of print.

NO ABSTRACT

PMID:40208270 | DOI:10.1007/s00264-025-06528-x

Int Orthop. 2025 Apr 10. doi: 10.1007/s00264-025-06517-0. Online ahead of print.

ABSTRACT

PURPOSE: The "weekend effect" suggests that patients operated upon weekends may experience worse outcomes. This study evaluates whether the day of the week impacts outcomes and costs of open reduction and internal fixation (ORIF) surgery for distal radius fractures (DRF) in a large nationwide cohort.

METHODS: A retrospective cohort study was conducted using data from the PearlDiver Mariner M165Ortho dataset, which covers a U.S. population of over 165 million from 2010 to 2022. Patients who underwent ORIF surgery for DRF were categorized into weekday and weekend groups. Demographics, comorbidities, and adverse outcomes within six months and two years post-surgery were analyzed.

RESULTS: Of the 266,378 patients who underwent ORIF for DRF with at least two years of follow-up, 252,866 had surgery on weekdays, while 13,512 had surgery on weekends. The weekend group exhibited higher rates of surgical site infection (SSI) (OR: 2.29[95%CI = 1.51-3.48], P < 0.001), hardware failure (OR: 5.80[95%CI = 1.13-31.25], P = 0.042), and readmissions (OR: 2.48[95%CI = 2.12-2.91], P < 0.001) at six months post-operatively. At two years post-operatively, the weekend group continued to show higher rates of complications including SSI (OR: 1.66[95%CI = 1.16-2.36], P = 0.005), malunion (OR: 1.44[95% CI = 1.06-1.93], P = 0.017), and readmission (OR: 1.55[95%CI = 1.39-1.74], P < 0.001). Mean total surgical costs were 16.4% higher in the weekend group ($2,394.85 vs. $2,057.88, P < 0.001).

CONCLUSIONS: This nationwide analysis demonstrates a significant "weekend effect" in ORIF surgery for DRF, with weekend surgeries associated with substantially higher complication rates, readmissions, and costs. These findings highlight the need for systemic changes to ensure consistent quality of care throughout the week, including improved weekend staffing, standardized protocols, and resource allocation.

LEVEL OF EVIDENCE: III (Retrospective cohort).

PMID:40208269 | DOI:10.1007/s00264-025-06517-0

Injury. 2025 Apr 1;56(6):112324. doi: 10.1016/j.injury.2025.112324. Online ahead of print.

ABSTRACT

INTRODUCTION: Dual plating for distal femoral fractures, especially with a metaphyseal comminution, is biomechanically superior compared to single lateral plating, promotes fracture union and prevents complications. However, the optimal placement and length of the additional medial plate are still unknown. Thus, we aimed to biomechanically compare three different double plate constructs for distal femoral fractures.

MATERIALS AND METHODS: A distal femoral fracture with a metaphyseal comminution (AO/OTA 33-A3) was created in synthetic femora and stabilized according to the following groups of 6 specimens each: Single lateral plate (SP), double plate with anteromedial oblique locking plate (DPOB), double plate with parallel medial locking plate with 4 screws (DP4S) and double plate with parallel medial locking plate with 6 screws (DP6S). Afterwards, the femora were tested axially with a quasi-static load of 400 N as well as torsionally with 5 Nm of internal and external rotation. Interfragmentary motion and rotation were measured with an optical 3D motion analysis system.

RESULTS: Fracture gap motion and varus-valgus tilt under axial testing were significantly lower with DPOB, DP4S and DP6S than with SP (p = 0.02) without a significant difference between the double plate constructs. DP4S and DP6S showed a significant lower anteroposterior tilt under axial loading than SP (p = 0.02), whereas DPOB showed no significant difference compared to SP but had a significantly higher anteroposterior tilt than DP6S (p = 0.02). Under internal and external rotation testing, anteroposterior shift was significantly different, and axial rotation was significantly lower with DPOB, DP4S and DP6S compared to SP (p = 0.02) without a significant difference between the double plates.

CONCLUSION: Dual plating is biomechanically superior under axial and torsional loading compared to the traditional single lateral plating for distal femoral fractures with metaphyseal comminution. A parallel arrangement of double plates is biomechanically more effective in resisting anteroposterior tilt, whereas the length of parallel medial plates (with 4 or 6 screws) has no influence on the biomechanical performance.

PMID:40203770 | DOI:10.1016/j.injury.2025.112324

Injury. 2025 Apr 1;56(6):112319. doi: 10.1016/j.injury.2025.112319. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic spinal injuries are a significant public health issue due to their high frequency and severity, impacting the entire healthcare system, especially when neurological sequelae are involved. These injuries require comprehensive resuscitative management, prioritizing spinal injuries within the context of associated injuries. Understanding the epidemiology of spinal fractures in polytraumatized patients is essential for improving care planning, primary prevention methods, and hospital management.

METHODS: This retrospective, single-center, observational study used the TRAUMABASE database from 2018 to 2022 to provide an epidemiological overview of polytraumatized patients with spinal fractures treated in a level I trauma center. Patients admitted to the Post-Anesthesia Care Unit (PACU) with at least one spinal fracture were included, excluding those with isolated transverse process fractures or incomplete clinical files. Data collected included demographics, injury mechanism, Injury Severity Score (ISS), type of spinal lesion, Glasgow Coma Scale (GCS), surgical management, length of hospital stay, and mortality.

RESULTS: From 2018 to 2022, 561 patients with spinal fractures in the context of polytrauma were treated, with 386 patient records analyzed after exclusions. The mean age was 43 years, with a majority being male (75.1 %). The main injury mechanisms were falls from height (47.7 %) and traffic road accidents (46.4 %). Spinal surgery was performed on 53 % of patients, with a mean delay of 2.8 days from trauma to surgery. The overall mortality rate was 14.8 %, with neurological impairment, higher age, higher ISS score, lower GCS score, and absence of spinal surgery as unfavorable prognostic factors. The mean cost of hospitalization per patients was 76.854 ± 53.719 euros [3.502; 65.6623].

DISCUSSION: This study highlights the severity of polytraumatized patients with spinal lesions, with a mean ISS score of 24.4 and frequent associated severe traumatic brain injuries. The main injury mechanisms were falls from height and traffic road accidents, with a high representation of self-inflicted injuries. Overall, the study provides valuable insights into the management and outcomes of polytraumatized patients with spinal injuries.

PMID:40203769 | DOI:10.1016/j.injury.2025.112319

J Bone Joint Surg Am. 2025 Apr 9. doi: 10.2106/JBJS.24.01181. Online ahead of print.

ABSTRACT

BACKGROUND: The present study aimed to assess the long-term outcomes of lumbosacral hemivertebra (LSHV) resection and short segmental fusion in a pediatric population and to assess the evolution of deformity curves.

METHODS: Patients who sought medical attention at our institution between 2010 and 2018 were assessed for eligibility. A classification of R10 and U9 or higher for the distal radius and ulna, respectively, was used to indicate maturity. Imaging parameters and quality-of-life scores were recorded at postoperative follow-up visits. Analyses were performed for the entire group and for subgroups of patients with and without a curve progression.

RESULTS: A total of 15 male and 15 female patients were included, with a mean age of 6.9 ± 2.4 years at the time of surgery. The main curve averaged 26.6° ± 6.5° preoperatively, 7.5° ± 4.6° (p < 0.001) at 3 months postoperatively, and 8.6° ± 3.2° (p = 0.205) at the latest follow-up. In the coronal plane, the coronal balance averaged 21.3 ± 16.7 mm preoperatively, 11.4 ± 8.5 mm (p = 0.007) at 3 months postoperatively, and 11.2 ± 8.9 mm (p = 0.858) at the latest follow-up. A total of 7 complications were recorded in 6 patients (20.0%). The Scoliosis Research Society 22-Item Questionnaire (SRS-22) total score (p < 0.001), appearance score (p < 0.001), and satisfaction score (p < 0.001) were all significantly different from preoperatively to postoperatively. Compared with the compensatory curve progression group, the non-progression group had a higher SRS total score (p = 0.013) and satisfaction (p < 0.001).

CONCLUSIONS: For pediatric patients <10 years old, LSHV resection and short segmental fusion could provide correction and global spine balance improvement. However, the observed loss of correction in the compensatory curve in some patients during the follow-up may compromise the satisfaction.

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

PMID:40203129 | DOI:10.2106/JBJS.24.01181

J Bone Joint Surg Am. 2025 Apr 9. doi: 10.2106/JBJS.24.01119. Online ahead of print.

ABSTRACT

BACKGROUND: The sequelae of open reduction of developmental and/or syndromic hip dislocations include osteonecrosis/proximal femoral growth disturbance and residual dysplasia. There is limited information comparing the rates of these sequelae in patients with developmental dysplasia of the hip (DDH) and arthrogryposis multiplex congenita (AMC). We performed a dual-center retrospective cohort study to compare rates of proximal femoral growth disturbance and residual dysplasia between patients with DDH and AMC who had undergone open hip reduction for the treatment of non-traumatic hip dislocations.

METHODS: We identified patients <18 years of age who had undergone open reduction for the treatment of hip dislocation between 1981 and 2020 at 2 tertiary pediatric hospitals. Patients with AMC were matched by age against patients with DDH in a 1:2 ratio. Preoperative data included demographic characteristics, the severity of dislocation according to the International Hip Dysplasia Institute (IHDI) classification system, and the acetabular index. Outcomes included the acetabular index at 2 years postoperatively, the IHDI classification at the time of final follow-up, and the presence and grade of proximal femoral growth disturbance according to the Salter criteria at 2 years postoperatively and according to the Kalamchi and MacEwen (KM) classification system at the time of final follow-up.

RESULTS: Eighty-two patients (98 hips) with DDH were matched against 39 patients (49 hips) with AMC. The mean follow-up was 107 months (range, 24 to 443 months). There was no difference in the mean age at surgery (1.5 ± 0.7 versus 1.4 ± 1.3 years; p = 0.86), preoperative IHDI classification, acetabular index, or spica cast duration (p > 0.05 for all), but the DDH cohort had more females (83% versus 56%; p = 0.003). Postoperatively, the prevalence of proximal femoral growth disturbance was higher in the AMC group than in the DDH group according to the Salter criteria at 2 years (57% versus 21%; p < 0.001) and according to the KM criteria at the time of final follow-up (59% versus 16%; p < 0.001). At 2 years postoperatively, there was no difference between the DDH and AMC groups in terms of the acetabular index (31° ± 6.2° versus 29° ± 6.9°; p = 0.3) or reoperation rate (24% versus 20%; p = 0.68), but the AMC cohort had more IHDI grade II-IV hips than the DDH cohort (24% versus 9%; p = 0.02), reflecting re-subluxation/dislocation.

CONCLUSIONS: Open reduction for hip dislocation in patients with AMC was associated with a significantly higher rate of proximal femoral growth disturbance and re-subluxation/dislocation compared with that in patients with DDH, despite similar preoperative characteristics. This information may guide perioperative counseling for families of patients with AMC.

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

PMID:40203125 | DOI:10.2106/JBJS.24.01119

Int Orthop. 2025 Apr 9. doi: 10.1007/s00264-025-06516-1. Online ahead of print.

NO ABSTRACT

PMID:40202543 | DOI:10.1007/s00264-025-06516-1

SICOT J. 2025;11:23. doi: 10.1051/sicotj/2025022. Epub 2025 Apr 8.

ABSTRACT

Advances in technology, prosthetic components and rehabilitation techniques have improved the quality of life for amputees. Wearing a prosthesis enabled them to participate in sports at a high level. Participating in competitive sports puts them at risk of joint injury. This case describes a disabled professional paralympic athlete with a transtibial amputation who has torn his anterior cruciate ligament (ACL). This patient underwent anterior cruciate ligament reconstruction one year before the Paris 2024 Paralympic Games. Surgery had to be adapted in terms of the patient's operative position, choice of graft and incisions to limit conflict with the prosthesis. Anterior cruciate ligament reconstruction with an ipsilateral quadriceps tendon graft enabled the patient to return to competition and place 4th in his category at the Paris 2024 Paralympic Games. This is the first case of ACL reconstruction in a transtibial amputee reported in the literature. It highlights a rare and difficult surgical procedure that can yield good results.

PMID:40198809 | PMC:PMC11978240 | DOI:10.1051/sicotj/2025022

Injury. 2025 Mar 24;56(6):112294. doi: 10.1016/j.injury.2025.112294. Online ahead of print.

ABSTRACT

BACKGROUND: Spontaneously reduced hip dislocation or reduced hip dislocation with a missing reduction history are challenge to the treating surgeon as the signs are usually subtle in such cases. The purpose of this study is to investigate and report on the incidence of the signs of femoral head notching and the presence of intracapsular air bubble in the computed tomography (CT) scans of hip dislocation cases in our center.

METHODS: Cases of traumatic hip dislocation, either without associated acetabular fractures or with acetabular fractures that did not require surgery from 2002 to 2021 were included retrospectively. Their CT scan films were analyzed to look for the presence and direction of femoral head notching and appearance of intracapsular air-bubble.

RESULTS: 30 hips with traumatic hip dislocation and 28 hips with acetabular posterior wall fracture without dislocation were included in this study. We noted notching on the femoral head in the CT axial scans of 23 of 30 hips (76.7 %). 17 cases of notching were noted in association with posterior dislocation, and there were 6 cases associated with anterior dislocation (p = 0.543). We observed intracapsular air bubbles in the CT scans of 28 of the 30 hips in our series (93.3 %). The sensitivity and specificity of notching sign were 56.7 % (95 % CI 37.4∼74.5 %) and 100 % (95 % CI 87.7∼100 %), respectively. For the bubble sign, the sensitivity and specificity were 90 % (95 % CI 73.5∼97.9 %) and 100 % (87.7∼100 %), respectively.

CONCLUSION: We recommend an early CT scan in patients presented with a history of suspected hip dislocation without an obvious finding on plain radiography. The presence of femoral head notching or intracapsular air-bubble would strongly suggest a history of hip dislocation.

LEVEL OF EVIDENCE: Diagnostic Level III, Retrospective cohort study.

PMID:40198971 | DOI:10.1016/j.injury.2025.112294

Injury. 2025 Mar 25;56(6):112303. doi: 10.1016/j.injury.2025.112303. Online ahead of print.

ABSTRACT

BACKGROUND: Open fractures of the lower extremity have a higher risk of fracture-related infections (FRI) or nonunion. The purpose of this study was to identify risk factors for complications and evaluate outcomes.

METHODS: In this retrospective, single center study, we identified and included 187 patients with extraarticular and intraarticular fractures of the tibia or fibula between 2010 and 2018. Patient characteristics, treatment protocols, and complications were assessed, with a focus on soft tissue management and timing of wound closure versus fracture fixation. To analyze risk factors for FRI and nonunion, a univariate logistic regression model was used.

RESULTS: The open fractures included were 52 Gustilo-Anderson type-I (28 %), 99 type-II (53 %), and 36 type-III (19 %) fractures. The mean time from admission to first surgical intervention was 3.47 h (SD 1.4), with 122 (60 %) patients treated within 3 h and 182 (97 %) patients, within 6 h. During primary surgery, definitive fracture fixation was carried out in 112 (60 %) patients and wound closure in 122 (65 %) patients. FRI was reported in 27 (14 %) patients with the highest prevalence in type-III fractures (31 %). Secondary wound closure was associated with a significantly higher risk for FRI than primary wound closure (odds ratio [OR] = 3.3; p = 0.004). Nonunion was reported in 37 (20 %) patients. Significant risk factors for nonunion were FRI (OR=11.9, p < 0.001) and definitive fracture fixation before wound closure compared to fracture fixation and wound closure at the same time (OR = 8.2, p < 0.001). Gustilo-Anderson type-IIIb and -IIIc fractures had a significant lower FRI-free survival compared to other fractures. No patient underwent amputation during the follow-up.

CONCLUSION: Open fractures of the tibia and fibula are associated with a high risk of FRI and nonunion. FRI is the strongest predictor of nonunion in open fractures of the lower extremity. Primary wound closure and simultaneous definitive fracture fixation are protective even in higher Gustilo-Anderson fracture types and prevent complications. Early antibiotic therapy and surgical treatment are crucial, as evidenced by all cases receiving treatment within 6 h post trauma.

PMID:40198970 | DOI:10.1016/j.injury.2025.112303

Injury. 2025 Apr 2;56(6):112322. doi: 10.1016/j.injury.2025.112322. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to investigate incidence rates of acetabular, pelvic, and proximal femur fractures in The Netherlands over a 10-year period (2012-2022). With an aging population, understanding trends in these osteoporotic fractures is essential for improving patient outcomes and guiding healthcare strategies.

METHODS: A retrospective cohort study was conducted using data from two national databases, forming a 'hospitalised' and an 'all patients' cohort. The study population included patients diagnosed with acetabular, pelvic, and proximal femur fractures in The Netherlands during the study period. Incidence rates were calculated per 100,000 person-years and linear regression was used to assess temporal trends. Age-adjustments were performed using Dutch population data from the Central Bureau of Statistics (CBS). Comparative analyses between the two cohorts were conducted to identify discrepancies.

RESULTS: A total of 283,991 patients were identified (12,020 acetabular, 70,595 pelvic and 201,376 proximal femur fractures). Of these patients, 159,563 were hospitalised (7123 acetabular, 24,192 pelvic, and 128,252 proximal femur fractures). Incidence rates of acetabular fractures increased by 26 % (hospitalised) and 98 % (all patients), while pelvic fractures showed stagnation in hospitalised patients (-0.13 %) but a 44 % rise in all patients. Proximal femur fractures increased by 5 % (hospitalised) and 15 % (all patients). Significant differences between the databases were noted across all fracture types.

CONCLUSION: The incidence of acetabular, pelvic, and proximal femur fractures has significantly increased in the last decade, most notably in acetabular and pelvic fractures. Furthermore, a shift toward out-patient treatment of acetabular and pelvic fractures was found. These findings highlight the need for improved fracture prevention and out-patient management strategies, while also underscoring the need for a nationwide registration for these injuries.

PMID:40198969 | DOI:10.1016/j.injury.2025.112322

Injury. 2025 Apr 1;56(6):112320. doi: 10.1016/j.injury.2025.112320. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare outcomes of lateral compression LC2 and LC3 pelvic ring injuries when posterior ring fixation is applied and different anterior ring constructs are used.

METHODS: A retrospective analysis from two Academic Level I Trauma Centers of all operatively treated LC2 and LC3 (AO/OTA 61-B2/B3) pelvic ring injuries from January 2019-January 2024. A comparison of anterior ring constructs was made: no fixation vs. fixation; indirect fixation (external fixators and InFix)) vs. internal fixation; long vs. short percutaneous screws. Long percutaneous screws were defined as either bicortical bypassing all 3 Nakatani zones or bypassing the fracture by 2 Nakatani zones with intramedullary juxtacortical or bicortical finishing. A short screw was defined as all other screws, regardless of direction. Primary outcome measure was >1 cm of pelvic ring displacement from post-operative to final radiographs showing fracture healing with sufficient callus. Secondary outcomes were unplanned major reoperation, removal of implants or non-union repair, and other surgical complications.

RESULTS: 67 patients met inclusion criteria. Most were female (n = 35, 52 %), mean age was 48.3 (SD 21.7) and most injuries were LC3 (n = 39, 58 %). All cases had posterior ring fixation. Twelve (18 %) had no anterior ring fixation and there was a statistically higher rate of deformity compared with patients with anterior ring fixation (n = 55, 82 %) (58 % vs. 16 %, p = 0.005). Indirect fixation (n = 12, 18 %) had a statistically higher rate of deformity compared with internal fixation (n = 43, 64 %) (50 % vs. 7 %, p = 0.002). There was a statistically higher rate of deformity when a short percutaneous screw (n = 6, 9 %) rather than long screw was used (n = 26, 39 %) (50 % vs. 0 %, p = 0.004).

CONCLUSIONS: Routine anterior ring fixation in conjunction with posterior ring fixation is strongly encouraged for LC2 and LC3 injuries. A long percutaneously-applied anterior screw provides optimal stability to maintain reduction and prevent deformity.

LEVEL OF EVIDENCE: Therapeutic Level 3.

PMID:40198968 | DOI:10.1016/j.injury.2025.112320

Int Orthop. 2025 Apr 9. doi: 10.1007/s00264-025-06521-4. Online ahead of print.

ABSTRACT

PURPOSE: This research was designed to explore the incidence of anaemia before surgery and the rate of mortality one year after surgery for femoral neck fractures in older adults. It also investigated whether anaemia prior to surgery influences the likelihood of mortality within one year after the procedure.

METHODS: A retrospective cohort analysis was undertaken at Honghui Hospital, a tertiary academic medical institution affiliated with Xi'an Jiaotong University in China. This investigation included elderly individuals who underwent surgery for femoral neck fractures within the year spanning from January to December 2021. The research team gathered data encompassing demographic details, levels of haemoglobin prior to surgery, existing comorbid conditions, and mortality statistics after one year.

RESULTS: In this retrospective study, 994 patients were analyzed, with 84 reported fatalities. The incidence of anaemia in this group was 71.1%, affecting 707 individuals. Of these, 486 (48.8%) had mild anaemia, and 221 (22.2%) exhibited moderate to severe anaemia. Independent factors correlating with heightened one-year mortality risk included operative blood transfusions (odds ratio [OR] = 1.8, p = 0.0327), coronary artery disease presence (OR = 1.85, p = 0.0077), and moderate to severe anaemia (OR = 3.18, p = 0.0006). In contrast, higher body mass index (OR = 0.8, p < 0.0001) and red blood cell count (OR = 0.6, p = 0.0253) were linked to reduced one-year mortality risk. Multivariate logistic regression analyses underscored the independent association of moderate to severe anaemia with increased one-year mortality risk, with varying ORs across models: non-adjusted OR at 3.18 (p = 0.0006), Adjust I model OR at 3.08 (p = 0.0191), and Adjust II model OR at 2.96 (p = 0.0278).

CONCLUSION: At Honghui Hospital, affiliated with Xi'an Jiaotong University in China, anemia has been identified as a common condition among elderly patients undergoing surgery for femoral neck fractures, and it significantly contributes to an elevated risk of mortality within one year post-surgery. It is advisable to implement interventions aimed at managing anaemia before surgery, which should include setting haemoglobin thresholds that are not specific to any gender for its diagnosis.

PMID:40199757 | DOI:10.1007/s00264-025-06521-4