Injury. 2026 Apr 11:113285. doi: 10.1016/j.injury.2026.113285. Online ahead of print.

ABSTRACT

INTRODUCTION: Venous thromboembolism (VTE) is a common complication in trauma patients; however, there have been limited studies on VTEs and the prevention thereof in patients with inferior vena cava (IVC) injuries. This study aimed to examine VTE incidence and the preventative efficacy of VTE prophylaxis regimens after operative IVC repair.

METHODS: A 12-year retrospective review was performed of all patients who presented with IVC injuries to an urban level 1 trauma center. A subgroup analysis of VTE incidence, prophylaxis regimen (i.e., prophylactic anticoagulation [PAC] and/or antiplatelet [AP]) efficacy, and other clinical variables was performed on patients who underwent a primary or patch IVC repair and survived > 72 h.

RESULTS: A total of 132 patients presented with IVC injuries requiring operative management, with 56% overall survival. Among the 66 patients who received primary or patch repair and survived > 72 h, 27% had a VTE during index hospitalization and/or readmission. VTEs occurred a median of 9 days post-injury, and the most common type of VTE was deep vein thrombosis, followed by IVC thrombosis and pulmonary embolism. There were no significant differences in any clinical variables compared between patients who developed VTEs during index hospitalization and those who did not, including VTE prophylaxis timing, hospital or ICU length-of-stay, and injury severity score. Index hospitalization VTE rates differed significantly based on prophylaxis strategy (p = 0.018), with a 100% (2/2) VTE rate among patients who received no prophylaxis, a 22% (11/50) rate among patients who received a single modality (AP or PAC), and a 7% (1/14) rate among patients who received dual strategies (AP+PAC). However, VTE rates did not differ between single- and dual-prophylaxis strategies when compared directly.

CONCLUSION: Patients undergoing primary or patch IVC repair experienced high rates of VTEs, but these rates differed by prophylaxis strategies. While we observed trends toward reduction in the incidence of VTE with dual (PAC + AP) modalities versus single modality therapy, this study was underpowered to observe an actual effect given the small sample size. Further research or prospective trials are warranted to determine optimal prophylaxis strategies, especially given the markedly elevated VTE risk in patients with IVC injuries.

PMID:42055836 | DOI:10.1016/j.injury.2026.113285

Injury. 2026 Apr 22;57(6):113299. doi: 10.1016/j.injury.2026.113299. Online ahead of print.

ABSTRACT

BACKGROUND: Hip fracture care requires timely diagnosis, expedited surgery, and high-risk inpatient management. Failures along this pathway can result in patient harm and malpractice exposure. This review synthesized cross-jurisdiction malpractice trends and inflation-adjusted liability payments associated with adult hip fracture care.

METHODS: A PRISMA-guided systematic review was conducted. PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched from January 2000 through January 2026. Eligible studies reported malpractice claims and outcomes specific to adult hip fracture care. Monetary values were converted to 2026 United States dollars (USD) using the Consumer Price Index. British pound values were converted using 1 GBP = 1.30 USD. Results were synthesized descriptively owing to heterogeneity in medicolegal frameworks.

RESULTS: Six studies met the inclusion criteria, representing 1192 hip fracture-related claims from the United States (U.S.), United Kingdom (U.K.), and Norway. Hip fractures accounted for 7%-17% of fracture-related claims in tort-based systems. Among 445 National Health Service Litigation Authority (NHSLA) claims, plaintiff success rates ranged from 56% to 69%, compared with 31% in 80 U.S. jury-based cases. Diagnostic delay or missed diagnosis was the most frequent allegation (28%-40%) and the only independent predictor of plaintiff success in U.S. data (odds ratio, 12.57). U.K. datasets reported total indemnities exceeding $25 million (2026 USD), with pressure injuries demonstrating the highest mean payouts. In Norway's no-fault system, 616 claims were filed following 90,601 hip fracture surgeries (0.7% claim rate), with 36% accepted, most commonly for hospital-acquired infection.

CONCLUSIONS: Medicolegal risk after hip fracture care clusters around process-driven failure points, particularly diagnostic delay and ward-based care breakdowns, rather than isolated technical errors. Missed diagnosis was the only independent predictor of plaintiff success in the U.S.

DATA: Findings suggest that pathway-level interventions targeting diagnostic accuracy, operative timeliness, and inpatient surveillance may reduce both patient harm and medicolegal exposure.

PMID:42054931 | DOI:10.1016/j.injury.2026.113299

Injury. 2026 Apr 22;57(6):113302. doi: 10.1016/j.injury.2026.113302. Online ahead of print.

ABSTRACT

INTRODUCTION: Various factors can influence the survival of patients with severe burns. One of these factors could be the day or time of the burn injury. There are studies describing worse outcomes and higher mortality, as well as longer hospital stays, for emergency presentations at night and weekends for certain conditions. This study evaluates data from multiple burn centers, to analyse whether the day of the week, time of day or season of the year when a severe burn injury occurs has an impact on patient survival in a single patient cohort.

METHODS: Only primary admitted adult patients with documented date and time of admission to hospital and existing Burn mortality prediction (BumP)-Score were eligible for this study. The BumP score is used to calculate mortality using the variables age, burn area, presence of full-thickness burns, presence of inhalation trauma, circumstances of the burn and presence of pre-existing conditions. In the analyzed period 6152 patients were included. For the following subgroups burn trauma frequencies and characteristics of patients were analysed: Time of day, weekdays versus weekends, month and season. For outcome analysis the standardised mortality ratio (SMR) was calculated.

RESULTS: The SMR calculation revealed no significant difference between daytime and nighttime (0.939 [95% CI 0.831 - 1.046] vs. 0.985 [95% CI 0.863 - 1.106], p = 0.556). There was also no difference in the SMR between weekdays and weekends (0.932 [95% CI 0.836-1.027] vs. 1.027 [95% CI 0.875-1.179], p = 0.375), nor between time of day (p = 0.873), or season (p = 0.197).

DISCUSSION: The timing of burn injury does not significantly affect overall patient survival in relation to the time of day and between weekends and weekdays, or season although temporal trends and variations in SMR suggest that structural or logistical factors may play a role. The quality of care is consistently high regardless of the time of the burn admission.

PMID:42054930 | DOI:10.1016/j.injury.2026.113302

Injury. 2026 Apr 21;57(6):113258. doi: 10.1016/j.injury.2026.113258. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic spine fractures often occur with multisystem injuries. Pelvic and transverse process (TP) fractures have been linked to visceral trauma, but whether the pelvis behaves as an "organ protective" structure in spine injury is unclear.

OBJECTIVE: To determine how concomitant pelvic fractures and TP fracture burden influence visceral injury patterns in patients with spinal fractures.

METHODS: This retrospective cohort included adult trauma patients with CT-confirmed spinal fractures at a single Level I trauma center (2015-2023). Patients were grouped into spine-only or spine-plus-pelvic fracture groups. Demographics, mechanism, TP characteristics, and visceral injuries (thoracic, abdominal, neurologic) were recorded. Liver, spleen, and kidney injuries were graded using the American Association for the Surgery of Trauma criteria, and a Visceral Injury Complexity Score (VICS) was calculated. Bivariate analyses and multivariable Poisson regression assessed associations between pelvic injury and TP fracture count with visceral injury burden and organ-specific severity.

RESULTS: Among 154 patients (86 spine only, 68 spine plus pelvic), overall visceral (92.5% vs 70.9%) and abdominal injuries (85.1% vs 50.9%) were more common in spine only trauma, which also showed higher VICS and spleen injury grades. Pelvic injury independently predicted fewer abdominal injuries and lower liver, spleen, and composite organ injury severity, whereas increasing TP fracture count predicted higher total visceral, thoracic, and neurologic injury counts and greater spleen, kidney, and composite organ injury severity.

CONCLUSIONS: In spine trauma, pelvic fractures were associated with reduced abdominal organ injury burden, while greater TP fracture burden identified patients with more extensive multisystem trauma, supporting a dual role of the pelvis as both an injury marker and a potential organ protective structure.

PMID:42054929 | DOI:10.1016/j.injury.2026.113258

Int Orthop. 2026 Apr 30. doi: 10.1007/s00264-026-06808-0. Online ahead of print.

ABSTRACT

PURPOSE: To define the 'patient acceptable symptom state' (PASS) and 'minimum important change' (MIC) for the Oxford Hip Score (OHS) following aseptic revision total hip arthroplasty (rTHA), and identify factors associated with their achievement.

METHODS: A prospective cohort of 135 patients (138 hips) undergoing aseptic rTHA at a single centre were followed up at one and two years postoperatively. Demographics, health-related quality of life (HRQoL; EQ-5D) and OHS were recorded at each timepoint. Anchor techniques were used to define the MIC and PASS. Regression models identified factors associated with PASS and MIC achievement.

RESULTS: The OHS PASS was 31.5 and 33.5 at one and two years postoperatively, respectively. The MIC was 8.5 at both timepoints. A greater preoperative EQ-5D was independently associated with PASS achievement at both timepoints. One-year MIC achievement was independently associated with lower BMI (p = 0.042) and lower preoperative OHS (p = 0.007), whilst lower preoperative OHS (p = 0.016) alone was independently associated with two year MIC achievement (p = 0.016). Lower preoperative EQ-5D and ASA grade 3 were associated with failure to achieve either PASS or MIC at one year (p = 0.030) and two years (p = 0.013) postoperatively, respectively.

CONCLUSION: The PASS and MIC thresholds for the OHS following aseptic rTHA contextualise the score and can inform study design. Greater preoperative HRQoL was independently associated with PASS achievement, whilst worse preoperative function was independently associated with MIC achievement. These thresholds should be considered in conjunction when assessing outcomes following aseptic rTHA.

PMID:42056500 | DOI:10.1007/s00264-026-06808-0

Int Orthop. 2026 Apr 29. doi: 10.1007/s00264-026-06815-1. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the association between preoperative extracellular water-to-total body water ratio (ECW/TBW) and time to walking independence among female patients undergoing total hip arthroplasty (THA).

METHODS: This retrospective cohort study included female patients who underwent primary THA between January and December 2022. Preoperative ECW/TBW was measured using bioelectrical impedance analysis and dichotomized at 0.400. The primary outcome was time to walking independence within 14 postoperative days. Cox proportional hazards models assessed the association between ECW/TBW and walking independence, adjusting for age, comorbidities, nutritional status, skeletal muscle mass index, non-operated knee extensor strength, walking pain, and maximum walking speed. Model performance was evaluated using likelihood ratio tests, Harrell's C-index, and time-dependent area under the curve (AUC).

RESULTS: Among 142 patients, 118 (83.1%) achieved walking independence within 14 days. Patients with ECW/TBW ≥ 0.400 achieved walking independence later than those with ECW/TBW < 0.400 (log-rank p < 0.001). In multivariable analysis, ECW/TBW ≥ 0.400 was associated with delayed walking independence (hazard ratio 0.29, 95% CI 0.16-0.52). Including ECW/TBW improved model fit and increased the time-dependent AUC at postoperative day 14.

CONCLUSION: Higher preoperative ECW/TBW is associated with delayed walking independence after THA and may complement preoperative assessment when predicting early postoperative functional recovery.

PMID:42056499 | DOI:10.1007/s00264-026-06815-1

Int Orthop. 2026 Apr 29. doi: 10.1007/s00264-026-06810-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Total hip arthroplasty (THA) for hip developmental dysplasia (DDH) carries a high perioperative complication rate, with dislocation representing the most frequent adverse event. Monoblock dual-mobility (DMM) cups have demonstrated promising results in reducing prosthetic instability while ensuring long-term implant survival. However, data specifically addressing DMM THA in low-grade DDH remain scarce. The aim of this study was to evaluate clinical outcomes and complication rates at a minimum ten-year follow-up in patients undergoing DMM THA for low-grade DDH.

MATERIALS AND METHODS: A single-centre retrospective study was conducted, including all patients who underwent DMM THA for Crowe grade I or II DDH between 2008 and 2018. Clinical outcomes including the Harris Hip Score (HHS), Postel-Merle d'Aubigné (PMA) score, Devane score, visual analog scale (VAS), and range of motion (ROM) were assessed preoperatively, at one year, and at final follow-up. Implant survival was estimated using Kaplan-Meier analysis.

RESULTS: Thirty-one THAs were performed in 25 patients (mean age 55.1 ± 13.4 years; mean follow-up 10.06 ± 1,98 years). All functional scores improved significantly at final follow-up (HHS 48 to 98, PMA 11 to 17, Devane 3 to 4, all p < 0.001). No dislocation, loosening, periprosthetic fracture, or septic complication was recorded. Implant survival was 100% at ten years.

CONCLUSION: The DMM THA for low-grade DDH provides excellent long-term functional outcomes with a remarkably low complication profile, supporting the routine use of DMM cups in this indication.

PMID:42056498 | DOI:10.1007/s00264-026-06810-6

Int Orthop. 2026 Apr 29. doi: 10.1007/s00264-026-06822-2. Online ahead of print.

NO ABSTRACT

PMID:42053624 | DOI:10.1007/s00264-026-06822-2

J Bone Joint Surg Am. 2026 Apr 28. doi: 10.2106/JBJS.26.00066. Online ahead of print.

NO ABSTRACT

PMID:42048440 | DOI:10.2106/JBJS.26.00066

J Bone Joint Surg Am. 2026 Apr 28. doi: 10.2106/JBJS.25.01595. Online ahead of print.

NO ABSTRACT

PMID:42048438 | DOI:10.2106/JBJS.25.01595

J Bone Joint Surg Am. 2026 Apr 28. doi: 10.2106/JBJS.26.00107. Online ahead of print.

NO ABSTRACT

PMID:42048435 | DOI:10.2106/JBJS.26.00107

J Bone Joint Surg Am. 2026 Apr 28. doi: 10.2106/JBJS.25.01685. Online ahead of print.

NO ABSTRACT

PMID:42048434 | DOI:10.2106/JBJS.25.01685

J Bone Joint Surg Am. 2026 Apr 28. doi: 10.2106/JBJS.25.01700. Online ahead of print.

NO ABSTRACT

PMID:42048430 | DOI:10.2106/JBJS.25.01700

J Bone Joint Surg Am. 2026 Apr 28. doi: 10.2106/JBJS.25.01678. Online ahead of print.

NO ABSTRACT

PMID:42048429 | DOI:10.2106/JBJS.25.01678

J Bone Joint Surg Am. 2026 Apr 28. doi: 10.2106/JBJS.26.00035. Online ahead of print.

NO ABSTRACT

PMID:42048428 | DOI:10.2106/JBJS.26.00035

J Bone Joint Surg Am. 2026 Apr 28. doi: 10.2106/JBJS.26.00121. Online ahead of print.

NO ABSTRACT

PMID:42048427 | DOI:10.2106/JBJS.26.00121

J Bone Joint Surg Am. 2026 Apr 28. doi: 10.2106/JBJS.25.01521. Online ahead of print.

NO ABSTRACT

PMID:42048425 | DOI:10.2106/JBJS.25.01521

Int Orthop. 2026 Apr 28. doi: 10.1007/s00264-026-06821-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Popliteal artery injury (PAI) associated with proximal tibial fracture (PTF) is rare but limb-threatening, and its morphological characteristics remain poorly defined. This study aimed to investigate the fracture patterns, associated vascular and soft tissue injuries, and clinical outcomes of PTF with PAI.

METHODS: We retrospectively reviewed cases of PTF with PAI treated at a single institution. Based on previous reports and our experience, fractures were classified into isolated medial tibial plateau fracture (IMTPF), hyperextension bicondylar tibial plateau fracture (HBTPF), metaphyseal shearing fracture (MSF), and others. Clinical characteristics, treatment strategies, and outcomes were analyzed.

RESULTS: Among 336 patients with PTF, nine (2.7%) had associated PAI. Fracture patterns included IMTPF (n = 2), HBTPF (n = 2), MSF (n = 4), and others (n = 1). IMTPF and HBTPF were typically closed injuries associated with traction-induced vascular injury and demonstrated favorable clinical outcomes following timely revascularization and stable fixation. In contrast, MSF was characterized by anterior open wounds and direct vascular injury caused by posterior displacement of the distal fragment. Two MSF cases required soft tissue reconstruction with pedicled gastrocnemius flap, and one case resulted in amputation.

CONCLUSION: PTF with PAI is associated with specific fracture patterns that reflect distinct injury mechanisms and clinical courses. Recognition of these patterns, particularly MSF, may facilitate early diagnosis, guide treatment strategies, and improve clinical outcomes.

PMID:42050057 | DOI:10.1007/s00264-026-06821-3

Int Orthop. 2026 Apr 28. doi: 10.1007/s00264-026-06791-6. Online ahead of print.

ABSTRACT

PURPOSE: Chronic acromioclavicular joint instability (ACJI) remains challenging, and the optimal surgical technique is debated. Weaver-Dunn reconstruction is widely used, but modifications have been made to improve horizontal and vertical stability. This study addressed the clinical outcomes of a modified Weaver-Dunn procedure reinforced with a double EndoButton construct.

METHODS: This retrospective single-center study included 23 patients undergoing modified Weaver-Dunn reconstruction for chronic ACJI between 2012 and 2024, with a minimum follow-up of 12 months. Indications included symptomatic Rockwood grade 3 or higher after failed conservative management. Surgery was performed arthroscopically in most cases; five cases used an open approach. Clinical assessment included Constant-Murley score, Subjective Shoulder Value (SSV), Visual Analog Scale (VAS) for pain, ROM, piano-key sign, and clavicular drawer test. Radiographic evaluation included coracoclavicular distance, alignment, and loss of reduction. Complications and revisions were documented.

RESULTS: At a mean follow-up of 79 months, pain improved significantly (VAS 2.9 to 0.4, p = 0.001). Constant score increased from 60 to 87 (p = 0.001), and SSV improved significantly. Forward flexion improved from 159° to 175° (p = 0.015), and abduction from 163° to 175° (p = 0.03). Clinical stability improved, with disappearance of the piano-key sign and drawer sign in 82% and 91% of cases. Four patients (17%) showed recurrent grade 3 or higher dislocation. Complications occurred in five patients (22%), including one coracoid fracture and one EndoButton migration.

CONCLUSION: Modified Weaver-Dunn reconstruction using two EndoButtons provided significant improvements in pain, function, ROM, and clinical stability with acceptable recurrence and complication rates.

PMID:42047728 | DOI:10.1007/s00264-026-06791-6

J Bone Joint Surg Am. 2026 Apr 27. doi: 10.2106/JBJS.25.01533. Online ahead of print.

NO ABSTRACT

PMID:42044206 | DOI:10.2106/JBJS.25.01533