Injury. 2025 Aug 10;56(10):112679. doi: 10.1016/j.injury.2025.112679. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the rate of unplanned reoperation to address fracture-related complications between extraarticular floating knee fracture patterns and those involving the articular surface of the knee, and to assess the impact of concomitant patella fracture on outcomes.

METHODS: Design: Retrospective study of patients with a floating knee injury treated at a single level 1 trauma center from 2012-2022.

SETTING: Single, urban, level 1 trauma center. Patient selection criteria: Patients ≥18 years old with a floating knee injury treated at a single urban level 1 trauma center from 2012-2022, with at least 3 months of followup. Outcome measures and comparisons: The primary outcome measure was the rate of unplanned reoperation to treat infection, obtain union, or surgically address knee stiffness.

RESULTS: Reoperation to address fracture-related complications was high in both extra and intraarticular floating knee patterns, with a trend toward more surgery to address knee stiffness in those with articular involvement (p = 0.078). Concomitant patella fracture and open fracture were present in 12 and 46 of the 64 patients, respectively; the presence of open fracture was significantly associated with reoperation to address either nonunion or infection (p < 0.001). An associated patella fracture was significantly associated with requiring surgery to address knee stiffness (p = 0.009).

CONCLUSIONS: Floating knee injuries with at least one articular fracture, especially when the patella is involved, had higher rates of surgery for knee stiffness. Intraarticular floating knee injuries are challenging, often requiring reoperation for infection, nonunion, or stiffness. Surgeons should be proactive with early motion protocols, supervised therapy, and tools like continuous passive motion to reduce knee stiffness risk.

LEVEL OF EVIDENCE: III.

PMID:40816063 | DOI:10.1016/j.injury.2025.112679

Injury. 2025 Aug 5;56(10):112649. doi: 10.1016/j.injury.2025.112649. Online ahead of print.

ABSTRACT

INTRODUCTION: Occult hip fractures are femoral neck fractures diagnosed by MRI or CT scan following negative plain radiographs. Incomplete intertrochanteric occult hip fractures (IIOHFs) do not involve the medial cortex. These fractures can be isolated but can also occur in the presence of greater trochanter (GT) fractures. Many authors recommend further imaging to exclude IIOHFs in cases where a GT fracture is present on plain radiograph, in order to evaluate the intertrochanteric region fracture extension. There is no consensus on the optimal treatment for IIOHFs, with approaches ranging from surgical fixation to full weight bearing. At our institution a protocol of immediate full weight bearing for patients diagnosed with IIOHFs was implemented. This study retrospectively evaluates the outcomes of this treatment protocol.

METHODS: The medical records of patients who underwent MRI for suspected occult hip fractures were retrospectively analyzed. Inclusion criteria included: (1) patients with no findings on plain radiographs who were diagnosed by MRI with intertrochanteric fractures not involving the medial cortex, and (2) patients with isolated GT fractures diagnosed by plain radiographs and fracture extension greater than one-third of the intertrochanteric width seen on MRI. Data regarding initial hospitalization, diagnostic timing and findings, and follow-up outcomes were collected.

RESULTS: Of 196 MRI scans performed during the study period, 45 patients met the inclusion criteria. None of these patients experienced secondary displacement of the fracture despite immediate full weight bearing. The average age was 81.1 years, and 21(10.7%) patients were male. The mean time from admission to MRI was 30 h, and the average length of hospitalization was 6.3 days. The 45 intertrochanteric fractures that were included in this study include nine isolated incomplete intertrochanteric fractures and 36 GT fractures with extension greater than one third of the intertrochanteric width. None of the GT fractures had involvement of the medial cortex.

CONCLUSION: Our findings suggest that immediate full weight bearing is a safe treatment approach for IIOHFs. Operative fixation or immobilization may be unnecessary for these fractures. Our findings also challenge the clinical necessity of routine MRI scans in patients with GT fractures to assess for fracture progression.

PMID:40816062 | DOI:10.1016/j.injury.2025.112649

Int Orthop. 2025 Aug 15. doi: 10.1007/s00264-025-06640-y. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the clinical and radiological outcomes between posterior laminectomy and laminoplasty hybrid decompression and laminectomy with lateral mass screw fixation in multilevel degenerative cervical myelopathy.

METHODS: A total of 158 patients for multilevel degenerative cervical myelopathy (DCM) undergoing surgical treatment were enrolled in this study from May 2018 to December 2023, including 97 patients who underwent posterior laminectomy and laminoplasty hybrid decompression (PLLDH) and 61 patients treated with posterior lateral mass screw fixation (PLMSF). To minimize potential confounding factors, propensity score matching was employed for inter-group comparison. Neurological function scores and radiographic parameters were systematically compared between the two surgical groups.

RESULTS: Following propensity score matching (PSM), baseline characteristics showed no statistically significant differences between the two surgical groups. The matched cohorts demonstrated that operative duration, intraoperative blood loss, VAS scores, Cobb angle, dural sac cross-sectional area at the narrowest level, and posterior dural displacement had no statistically significant differences(P > 0.05). However, significant inter-group differences were observed in JOA scores (P<0.05), NDI scores (P<0.05), and cervical range of motion (P<0.05) postoperatively.

CONCLUSION: Both PLLDH and PLMSF are effective surgical approaches for treating multilevel DCM, demonstrating satisfactory clinical outcomes. However, PLMSF resulted in greater postoperative loss of cervical mobility compared to PLLDH.

PMID:40815488 | DOI:10.1007/s00264-025-06640-y

J Bone Joint Surg Am. 2025 Aug 14. doi: 10.2106/JBJS.24.01472. Online ahead of print.

ABSTRACT

BACKGROUND: The precise pathological mechanisms through which obesity increases the risk of slipped capital femoral epiphysis (SCFE) remain unclear. We aimed to investigate the impact of childhood obesity on the morphology of the capital femoral epiphysis in children and adolescents without hip disorders.

METHODS: We performed a retrospective cross-sectional study that included 4,888 children and adolescents 7 to 19 years of age who underwent a hip or pelvic computed tomography (CT) scan, most for abdominal pain, between 2004 and 2022. Automated 3D-CT analysis assessed epiphyseal tubercle height, superior and anterior peripheral cupping, and epiphyseal tilt. Generalized additive models (GAMs) were used to examine the associations between epiphyseal morphology and age, stratified by obesity status, while adjusting for sex.

RESULTS: We observed distinct age-related trajectories of femoral-head morphology related to obesity. Subjects with obesity demonstrated a larger femoral-head diameter from ages 7 to 15 years (obese versus normal-weight differences: 0.3 to 2.3 mm), smaller epiphyseal tubercle height after 9 years of age (normal-weight versus obese differences: 0.4% to 1.3%), and a more posteriorly tilted epiphysis, as assessed by a smaller axial tilt angle (normal-weight versus obese differences: 4° to 1°) from ages 7 to 15 years. In subjects with obesity, the superior epiphyseal cupping was larger before 11 years of age (obese versus normal-weight differences: 1.6% to 0.4%), but after 13 years of age, the superior epiphyseal cupping was smaller (normal-weight versus obese differences: 0.2% to 2%).

CONCLUSIONS: Children with obesity demonstrated a smaller epiphyseal tubercle height, greater posterior epiphyseal tilt, and reduced superior cupping compared with children of normal weight. These anatomical differences may contribute to the increased risk of SCFE in patients with obesity and offer potential imaging markers for earlier identification and risk-stratification.

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

PMID:40811524 | DOI:10.2106/JBJS.24.01472

J Bone Joint Surg Am. 2025 Aug 14. doi: 10.2106/JBJS.25.00149. Online ahead of print.

ABSTRACT

BACKGROUND: There are limited long-term data on the results of conversion of a surgically or spontaneously fused knee to a total knee arthroplasty (TKA) in the literature. The purpose of this study was to determine the long-term (minimum, 21-year) results of TKA in a fused knee.

METHODS: We reviewed the results of 95 TKAs in the fused knees of 93 patients (mean age, 41.9 ± 9.4 years; range, 23 to 62 years) using a TKA system. The mean follow-up was 25.1 years (range, 21 to 31 years).

RESULTS: The mean Knee Society score was 88 points (range, 56 to 96 points) at the final follow-up. The mean range of motion was 76.4° (range, 0° to 105°). Nine knees (9%) required revision for aseptic loosening of TKA components. One knee (1%) was revised for pyogenic infection, and another knee was revised for recurrent tuberculous infection. Approximately 80% of patients were satisfied with the TKA. Approximately 67% of patients reported that their quality of life improved greatly after TKA. Kaplan-Meier survivorship, with revision for failure as the end point, was 88.4% (95% confidence interval, 83% to 97%) at 25.1 years postoperatively.

CONCLUSIONS: Conversion of a fused knee to TKA resulted in good long-term fixation and high satisfaction.

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

PMID:40811520 | DOI:10.2106/JBJS.25.00149

J Bone Joint Surg Am. 2025 Aug 14. doi: 10.2106/JBJS.25.00164. Online ahead of print.

NO ABSTRACT

PMID:40811512 | DOI:10.2106/JBJS.25.00164

J Bone Joint Surg Am. 2025 Aug 14. doi: 10.2106/JBJS.24.01611. Online ahead of print.

ABSTRACT

BACKGROUND: Extra-articular subtalar arthrodesis generally has been recommended for treating severe valgus deformities of the hindfoot in patients with cerebral palsy (CP). However, it is unknown whether restricted subtalar joint motion affects the shape of the foot during continued growth in children. The purpose of the present study was to evaluate the effectiveness and longevity of extra-articular subtalar arthrodesis in ambulatory patients with spastic CP, with a specific focus on its impact on the final foot shape and plantar pressure distribution.

METHODS: The present retrospective study included 99 feet in 60 children with a mean age (and standard deviation) of 7.6 ± 2.1 years at the time of surgery and 16.6 ± 4.7 years at the latest follow-up. Radiographic changes were analyzed both during the early postoperative period and at extended follow-up. At the latest follow-up, the feet were classified into 3 categories (hindfoot valgus, neutral, or varus) on the basis of the valgus/varus index obtained from dynamic pedobarographs.

RESULTS: All radiographic parameters improved at 6 months after surgery. However, at the latest follow-up, all measurements except for the lateral talocalcaneal angle indicated overcorrection of the hindfoot valgus deformity. The overall valgus/varus index decreased from 0.54 ± 0.25 before surgery to -0.29 ± 0.35 at the latest follow-up. Five feet (5.1%) were classified as hindfoot valgus, 41 feet (41.4%) as neutral, and 53 feet (53.5%) as varus. Patients with hindfoot varus were younger at the time of surgery, and a lower anteroposterior talus-first metatarsal angle at 6 months after surgery was found to be the only significant radiographic predictor of the development of hindfoot varus. Revision procedures were performed on 22 feet (41.5%) in the varus group.

CONCLUSIONS: Extra-articular subtalar arthrodesis is associated with a high risk of progressive hindfoot varus deformity in patients with CP. Our findings highlight the need to reevaluate traditional surgical indications for correcting hindfoot valgus deformity, which have largely been based on the severity of the deformity observed on radiographs. Decision-making also should account for growth-related changes associated with restricted subtalar motion and the intraoperative position of the hindfoot and forefoot.

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

PMID:40811496 | DOI:10.2106/JBJS.24.01611

Injury. 2025 Aug 7;56(10):112653. doi: 10.1016/j.injury.2025.112653. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to compare demographics, treatments, and outcomes of interprosthetic (IPFFs) and periprosthetic femur fractures (PPFFs). IPFFs were hypothesized to occur in older patients and have higher rates of reoperation, implant failure, and mortality.

METHODS: This was a retrospective cohort at a Level 1 trauma center analyzing adults with PPFFs/IPFFs from 2012-2024. Patients with < 30 days follow-up were excluded. Patient characteristics, treatments, and complications were compared between IPFFs and PPFFs.

RESULTS: 276 patients with 30 IPFFs and 246 PPFFs were included. IPFFs were older (74y v 69y p=.035), more commonly osteoporotic (33% v 11% p<.001), and more commonly current (17% v 14%) or former smokers (7% v 0% p<.001). IPFFs presented with 29 total hip (THA) and knee (TKA) arthroplasties and one THA and unicompartmental knee arthroplasty. PPFFs presented with 130 fractures around THAs and 116 fractures around TKAs. IPFFs more commonly presented with unstable prostheses (40% v 21% p=.017). Of the seven IPFFs treated with nail-plate hybrid constructs (NPCs), six (86%) were immediately weightbearing as tolerated (WBAT). Of the 23 IPFFs not treated with NPCs, 9 (39%) were immediately WBAT (p=.031). IPFFs had more blood loss (811mL v 513mL p=.016). The mortality rate was 15% in IPFFs and 4% in PPFFs (p=.02). IPFFs had higher rates of implant failure (23% v 7% p=.004) and superficial infection (15% v 4% p=.013). Of the seven IPFFs treated with NPCs, there were no implant failures, while 7/23 (30%) IPFFs treated with other techniques failed (p=.09).

CONCLUSIONS: IPFFs were older, more commonly osteoporotic, more likely to be smokers, and more often had unstable prostheses at presentation than PPFFs. While treatments were similar, the rate of mortality, implant failure and superficial infection was higher in IPFFs. NPCs may allow for earlier weightbearing but their long-term effects regarding outcomes and stability require further investigation in prospective studies.

LEVEL OF EVIDENCE: III.

PMID:40812247 | DOI:10.1016/j.injury.2025.112653

Injury. 2025 Aug 8;56(10):112672. doi: 10.1016/j.injury.2025.112672. Online ahead of print.

ABSTRACT

Mountain accidents have increased over the last decade all around the globe mostly due to a raise of mountain activity practitioners. Outcomes of accidents usually imply evacuation, traumatic injuries or even cardiovascular events. Sex, age, activity, altitude, experience, and equipment adequacy relate to accidents as direct causes or moderators of accident severity. This study focuses on the mountain accidents in Catalonia with descriptive and ordinal regression analysis aiming to characterize a victim vulnerability profile, which remains largely unexplored. The current sample includes 3257 mountain rescue operations from the Catalan Fire Department records between 2011 and 2021. Descriptive analysis showed that the most common profile was being hiker (63 %), climber (11.6 %), mountain biker (10.2 %), man (60.3 %), going in group (84.3 %), occurring in weekends (53.7 %), and suffering traumatic events (61.4 %) or needing technical support (20.4 %). Moreover, the main causes of fatality were falls and cardiovascular issues with the latter showing the higher fatality rate (55.5 %). Ordinal regression analysis explained a modest amount of variance (Nagelkerke R2 = 0.12), suggesting that predictors of higher severity were Group, Altitude, Male, Gathering, Mountain Biking and other practices such as Hunting. Recommendation to rescue teams comprise standardizing and potentiate data collection, conducting awareness campaigns targeted mainly to hikers, mountain bikers and elderly men, and to reinforce awareness campaigns and rescue teams during weekends.

PMID:40812246 | DOI:10.1016/j.injury.2025.112672

Injury. 2025 Aug 8;56(10):112668. doi: 10.1016/j.injury.2025.112668. Online ahead of print.

ABSTRACT

This study explores the effects of some of the key factors, including emergency response measures, roadway and environment, traffic-related attributes, and crash-specific factors, on the Injury Severity Score (ISS) of Road Traffic Crashes' (RTCs) victims, both directly and through pre-hospital time (PHT), using rigorous path analysis. Data for 298,654 crashes, compiled by the Road Traffic Injury Research and Prevention Center (RTIRPC) in Karachi (Pakistan), were used for analyses. Owing to the corner-solution distribution of the response variables (PHT and ISS), two Tobit regression models are estimated after accounting for missing values through synthetic data generation. Marginal effects from these models are used in the path analysis. The findings suggest that ISS increases by 0.01 units with a unit increase in PHT, highlighting the critical need for rapid evacuation of crash victims to medical facilities. The mode of evacuation emerged as a crucial factor, with ambulances resulting in increased PHT and ISS compared to private or public transport, underscoring the improvement needed in the dedicated ambulance-based emergency response. PHT and ISS were found to be higher in nighttime crashes, necessitating better emergency medical services (EMS) response during the night. Intersection crashes were associated with lower PHT and ISS; whereas, crashes on undivided roads and those involving multiple or large vehicles increased PHT and ISS. The path analysis revealed that the overall effects of some of the key variables on ISS were higher than their direct effects - something that could not be explored without the path analysis. These insights can help policymakers develop strategies to improve emergency response and road safety, ultimately reducing the number of RTC-related injuries and fatalities.

PMID:40812245 | DOI:10.1016/j.injury.2025.112668

Injury. 2025 Aug 6;56(10):112673. doi: 10.1016/j.injury.2025.112673. Online ahead of print.

ABSTRACT

BACKGROUND: Resuscitative thoracotomies (RTs) are controversial interventions that heavily consume resources and can pose risks for the surgical team. Increasingly limited resources and risk to healthcare teams have encouraged the continued refinement of RT guidelines. We evaluated RT futility indicators amid institutional RT practice guideline changes.

METHODS: Thoracotomies conducted at our Level 1 Trauma Center from January 2017 to July 2023 were reviewed and classified as either RT or non-resuscitative (non-RT). Injury characteristics, patient demographics, procedure details, and mortality outcomes were collected through chart review.

RESULTS: Of 78 thoracotomies, 56 (71.8 %) were RTs, predominantly on patients with penetrating injuries (55.4 %), specifically gunshot wounds (46.4 %). Most RTs (87.5 %) complied with Eastern Association for the Surgery of Trauma guidelines. The procedure mortality rate was 4.6 % for non-RT and 67.9 % for RT, and hospital mortality was 13.6 % for non-RT and 89.3 % for RT. Thus, 10.7 % of RT patients survived to discharge, including 5 (16.2 %) with penetrating injuries and 1 (4.0 %) with blunt injuries. Ten (17.8 %) RT patients arrived with fixed and dilated pupils, 11 (19.6 %) arrived with no signs of life, and 4 (10.7 %) received pre-hospital CPR, all of whom did not survive to discharge. Changes in institutional practice guidelines decreased the frequency of total thoracotomies, but not RT numbers.

DISCUSSION: RT utilization and mortality rates remained consistent after implementing stricter institutional guideline policies. Improving odds of survival may require further refinement to RT practice guidelines regarding patient selection criteria. We recommend adding witnessed cardiac arrest and prioritizing pupillary response to RT futility guidelines regardless of injury pattern.

PMID:40812244 | DOI:10.1016/j.injury.2025.112673

J Bone Joint Surg Am. 2025 Jul 18. doi: 10.2106/JBJS.24.01575. Online ahead of print.

ABSTRACT

BACKGROUND: Clinician equipoise-indifference between treatment arms-provides an ethical foundation for clinician participation in randomized controlled trials (RCTs). In preparation for an RCT comparing arthroscopic partial meniscectomy versus enhanced nonoperative therapy for patients with a meniscal tear and knee osteoarthritis (OA) who remain symptomatic after a course of physical therapy, we conducted a mixed-methods study to assess equipoise among potential enrolling clinicians.

METHODS: Fifteen clinicians with experience managing meniscal tears assessed 29 vignettes of hypothetical patients who met trial eligibility criteria. We randomly varied 13 vignette features (e.g., age, sex, radiographic severity, tear morphology). Clinicians expressed their willingness to enroll each hypothetical patient. After polling, we recorded and transcribed a moderated discussion to document clinician thought processes. We performed a quantitative analysis to identify clinical features associated with the likelihood of enrollment and an exploratory thematic analysis of the transcribed discussion to explicate the quantitative findings.

RESULTS: The 15 orthopaedic surgeons and physician assistants assessed 29 vignettes describing hypothetical patients. Eight votes were missing, leaving 427 vignettes, of which the clinicians were willing to enroll 302 (71%) (range, 24% to 100%) in the trial. Three clinicians were willing to enroll <50% of vignettes. Clinicians were willing to enroll just 39% of vignettes with bucket-handle tears. In logistic regression analyses, a bucket-handle tear (adjusted odds ratio [aOR], 0.12; 95% confidence interval [CI], 0.04 to 0.37) and Kellgren-Lawrence 3 radiographs (aOR, 0.54; 95% CI, 0.36 to 0.82) were independently associated with clinician unwillingness to randomize. The qualitative analysis confirmed that clinicians believed that bucket-handle tears should be managed operatively, whereas combinations of greater age, severe OA, inability to walk 200 yards, and higher body mass index (BMI) pushed clinicians toward nonoperative therapy.

CONCLUSIONS: This methodology can be used to identify clinicians who should be engaged in discussions and interventions to support equipoise. It can also inform development of exclusion criteria (e.g., exclude bucket-handle tears) to increase the proportion of eligible subjects referred for enrollment.

CLINICAL RELEVANCE: Orthopedic surgeons play crucial roles in randomized controlled trials, the foundation of clinical practice guidelines, by enrolling patients from their practices. This article examines clinician equipoise, a key determinant of the willingness of clinicians to enroll eligible patients in trials.

PMID:40802780 | DOI:10.2106/JBJS.24.01575

Injury. 2025 Aug 5:112627. doi: 10.1016/j.injury.2025.112627. Online ahead of print.

ABSTRACT

BACKGROUND: The role for routine follow-up imaging in nonoperative management (NOM) of blunt splenic injury (BSI) remains controversial. Delayed complications, specifically vascular abnormalities such as pseudoaneurysms are associated with failure of NOM (FNOM). This study examined a ten-year experience with NOM of BSI and the influence of repeat imaging. Our centers have no guidelines for follow-up imaging.

METHODS: A retrospective cohort study was conducted including all trauma patients with BSI admitted within a regional trauma system (two Level III and one Level I ACS-verified trauma centers) between 2013 and 2022. Patient demographics, injury features, imaging and outcomes were obtained from trauma registry data and chart review. Patients undergoing splenectomy 6 hours or more after presentation were categorized as FNOM.

RESULTS: A total of 1815 patients presented with BSI during the study period. Urgent splenectomy was performed in 15.6 % (N=283). The rate of FNOM was 3.4 % (N=62). Among the 1532 patients initially managed nonoperatively, 139 (9.1 %) underwent a follow-up CT scan. Most scans were obtained in response to clinical changes, while 13.7 % (N= 19) were obtained for splenic surveillance. Follow-up scans were followed by 8 splenectomies and 9 embolizations. Among the 19 scans performed for surveillance, two revealed a pseudoaneurysm; one of which underwent embolization. Results are limited by a low rate of screening imaging and a lack of long-term outcome information.

CONCLUSION: A low rate of FNOM was achieved despite less than 2 % (19/1532) of patients undergoing screening follow-up imaging. These findings suggest that there is limited opportunity for routine surveillance imaging to improve outcomes in BSI. Reimaging in response to clinical changes is a cost-effective alternative.

PMID:40803925 | DOI:10.1016/j.injury.2025.112627

Injury. 2025 Aug 7;56(10):112664. doi: 10.1016/j.injury.2025.112664. Online ahead of print.

ABSTRACT

OBJECTIVES: We conducted a sex-stratified analysis to assess the prevalence and predictors of violence and non-fatal injury among adolescents attending school in Thailand.

METHODS: The data for this study were obtained from the Thailand Global School-based Student Health Survey (GSHS), a nationally representative survey conducted in 2021 with a sample size of 5661 students aged 13-17 years. Multiple logistic regression analyses were used to examine the protective factors and risk factors that influence non-fatal injury and violence. The regression analysis was reported using adjusted odds ratios (AORs) and 95 % confidence intervals (CIs), with a p-value < 0.05.

RESULTS: The national prevalence of violence and non-fatal injury among school-going adolescents was 11.6 % and 52.6 %, respectively. Boys had a substantially higher prevalence of violence (7.6 %) and non-fatal injury (26.4 %) compared to girls (3.6 % and 24.1 %, respectively). Stratifying by sex, school truancy, and bullying were associated with violence and non-fatal injuries in girls, as well as suicidal ideation, anxiety, hunger, and various health risk behaviors, like tobacco, alcohol, and cigarette use, were found to be associated with violence and non-fatal injuries in boys. In contrast, parental supervision, peer support, and sedentary behavior were found to be protective factors for Thai adolescents.

CONCLUSIONS: Future policies should consider individual risk factors and parent-child-teacher bonding to mitigate the burden of violence and injury among in-school adolescents in Thailand.

PMID:40803265 | DOI:10.1016/j.injury.2025.112664

Injury. 2025 Aug 6;56(10):112674. doi: 10.1016/j.injury.2025.112674. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric extremity fractures represent a frequent cause of emergency department visits, with inequity in care linked to socioeconomic status, race, and insurance type. Despite standardized treatment algorithms, currently available evidence indicates that socially disadvantaged children experience delays in surgical fixation and pain management. This scoping review aims to evaluate the impact of socioeconomic factors on multiple elements of pediatric extremity fracture management.

METHODS: This scoping review followed PRISMA standards. Eligible studies included pediatric patients (<18 years) with extremity fractures, incorporated measures of social or economic status, and evaluated pre-defined management outcomes. Studies conducted before 2010 or outside of the United States were excluded. Abstracts and full texts were screened independently by multiple reviewers using Covidence software.

RESULTS: After duplicate removal, 9,671 articles were screened, with 78 undergoing full-text review; 33 articles met all inclusion criteria. The 33 eligible studies predominantly consisted of retrospective cohort analyses, with sample sizes ranging from fewer than 500 to over 9 million patients. Major outcomes evaluated included type of treatment offered (n=10), pain management (n=10), time to care (n=8), post-discharge care (n=4), imaging (n=3), and pre-hospital care (n=1). Inequities were identified across multiple domains, commonly associated with insurance status, race, family income, and primary language. Children with public insurance consistently experienced higher rates of nonoperative management and longer delays to definitive treatment. Racial/ethnic minority children had lower odds of receiving opioid analgesics despite equivalent pain levels.

DISCUSSION AND CONCLUSION: Socioeconomic disadvantage, measured at both the individual and regional level, is strongly associated with differences in pediatric extremity fracture management, including inequitable access to timely imaging, operative care, and adequate pain control. These findings underscore the critical need for targeted policy interventions, standardized clinical protocols, and improved care coordination to reduce disparities and ensure equitable pediatric fracture care for all children.

PMID:40803264 | DOI:10.1016/j.injury.2025.112674

Injury. 2025 Aug 9;56(10):112656. doi: 10.1016/j.injury.2025.112656. Online ahead of print.

ABSTRACT

BACKGROUND: Portugal's favourable conditions for water-based recreational activities (WRA) often lead to incidents requiring intervention by the National Maritime Authority (AMN). Despite being documented in the SEGMAR database, participant profiles and severity factors, particularly for water-board-related incidents (BRIs), remain underexplored. This study aims to profile individuals involved in BRIs, identify determinants of severe incidents, and examine key clusters within the AMN's jurisdiction from 2020 to 2023.

METHODS: A cross-sectional observational study analysed 14,456 WRA incidents from the SEGMAR database. BRIs included activities involving water-boards (e.g., surfing, bodyboarding, kitesurfing) and collisions with water-boards. Severe BRIs were defined as incidents causing injuries, fatalities, or disappearances. Sociodemographic, temporal, and spatial factors were analysed using descriptive analysis and Quasi-Poisson regression to estimate frequency ratios (FR). Cluster analysis identified at-risk groups, and the severe to non-severe BRIs ratio was mapped by captaincy and municipality. Statistical significance was set at p<0.05.

RESULTS: BRIs made up 11.9% of all incidents, occurring more often among men, individuals aged 15-55, and foreigners, especially outside the bathing season and in unsupervised areas (p<0.001). Severe BRIs were linked to winter (FR 1.92; 95% CI 1.15-3.19), nighttime (FR 2.0; 95% CI 1.6-2.6), dawn (FR 1.6; 95% CI 1.3-2.0), and the bathing season (FR 1.9; 95% CI 1.3-2.7). Clusters revealed at-risk groups: children under 14 at patrolled beaches in summer evenings, men over 55 at unpatrolled areas in autumn, and young females at unpatrolled beaches in winter. Seven captaincies and 20 municipalities had a severe to non-severe BRIs ratio above 1.

CONCLUSION: BRIs predominantly affect men, young adults, and foreigners. Key risk factors include extreme ages, non-summer seasons, unsupervised areas, and low-light conditions. Targeted interventions, such as adjusting lifeguard schedules to cover high-risk times, promoting safety campaigns for children and older adults, and reinforcing safety infrastructure at unpatrolled beaches, might be important to mitigate risks and reduce incident severity.

PMID:40803263 | DOI:10.1016/j.injury.2025.112656

Int Orthop. 2025 Aug 13. doi: 10.1007/s00264-025-06616-y. Online ahead of print.

ABSTRACT

PURPOSE: The Aden Trauma Centre in Yemen, supported by Médecins Sans Frontières (MSF), introduced internal fixation (IF) procedures to address the high burden of fractures as a result of road traffic accidents and conflict-related injuries. This study aimed to describe the clinical characteristics of patients undergoing IF, evaluate their complication and healing outcomes, and explore factors influencing postoperative results.

METHODS: A retrospective cohort design was employed, including all patients who underwent internal fixation-using SIGN nails or plates/screws-between January and December 2022. Demographic information, fracture characteristics, surgical techniques, and postoperative outcomes were analyzed. Cox proportional hazards models were used to identify key predictors of complications and bone healing.

RESULTS: A total of 177 patients (208 fractures) were included. The overall complication rate was 14.4%. Open fractures and comorbidities were significant predictors of complications, while type of implant (SIGN nail vs. plate/screws) did not affect complication risk. Around three-quarters of fractures achieved radiographic healing at a median of five to six months. Infection and other complications emerged as major risk factors for delayed or impaired union. About a quarter of patients defaulted from care, potentially underestimating late complications and nonunion rates.

CONCLUSION: Findings indicate that IF is feasible and effective in this high-need, low-resource context, demonstrating complication rates in line with global estimates. Open fractures, comorbidities, and limited follow-up infrastructure remain the main challenges to optimizing outcomes in such contexts.

PMID:40801987 | DOI:10.1007/s00264-025-06616-y

Int Orthop. 2025 Aug 13. doi: 10.1007/s00264-025-06635-9. Online ahead of print.

NO ABSTRACT

PMID:40801986 | DOI:10.1007/s00264-025-06635-9

Int Orthop. 2025 Aug 13. doi: 10.1007/s00264-025-06637-7. Online ahead of print.

ABSTRACT

PURPOSE: Lumbosacral transitional vertebra (LSTV) is a common anomaly linked to the degeneration of the lumbar spine. The aim of this work was to study lumbar spine mobility in subjects with and without LSTV using flexion-extension radiographs.

METHODS: In this retrospective single-center study, we identified subjects with flexion-extension radiographs and abdominopelvic CTs performed between years 2005-2023. LSTVs were graded according to Castellvi classification, and lumbar mobility evaluated through total lumbar lordosis, disc wedging angles, segmental lordosis angles, and range-of-motion (RoM) from the flexion-extension radiographs. Independent samples t-test and Mann-Whitney U-test were used for statistical analyses.

RESULTS: The study group comprised Castellvi types II-IV (n = 29, mean age 59.1 years, 62% males) and control group 20 subjects without LSTV (mean age 65.1 years, 35% males). The study group presented a smaller overall RoM of lumbar spine than controls (33.5°±14.2° vs. 38.3°±12.1°, p = 0.23). Distribution of total lumbar mobility differed in transitional L5/S1-level being 10.7% with study group and 22.2% with controls (p = 0.002); similarly, assessing disc wedging angles, extension and RoM were lower with study group than controls being 8.7 ± 4.8° vs. 12.9 ± 4.7° (p = 0.002) and 3.3 ± 3.8° vs. 7.3 ± 3.8° (p < 0.001), respectively. Same results were seen with segmental lordosis measurements: 15.7 ± 5.6° vs. 23.1 ± 4.5° (p < 0.001) and 3.3 ± 5.5° vs. 8.3 ± 3.8° (p < 0.001), respectively. There were no statistically significant differences of relative distribution of lumbar motion at the upper lumbar levels between the groups.

CONCLUSIONS: LSTV decreases mobility of the lumbar spine in the L5/S1-level but does not increase relative motion at the upper lumbar levels. The overall compensation of mobility seems to distribute equally throughout the superior lumbar segments and not excessively to the superior adjacent level.

PMID:40801985 | DOI:10.1007/s00264-025-06637-7

Injury. 2025 Aug 6:112652. doi: 10.1016/j.injury.2025.112652. Online ahead of print.

NO ABSTRACT

PMID:40796423 | DOI:10.1016/j.injury.2025.112652