Injury. 2025 Nov 13;56(12):112888. doi: 10.1016/j.injury.2025.112888. Online ahead of print.

ABSTRACT

INTRODUCTION: Malnutrition has emerged as a significant risk factor for postoperative complications in orthopaedic surgery. Despite this, the impact of malnutrition in orthopaedic trauma remains underexplored. This study aims to investigate 90 day and 1 year postoperative outcomes of ankle and pilon fracture open reduction and internal fixation (ORIF) in malnourished patients.

METHODS: Using a national database, adult patients who underwent surgery for ankle or pilon fractures with a minimum of one-year follow-up were identified. Patients were stratified into two cohorts based on the presence of serum markers for malnutrition within the year preceding surgery. Malnutrition was identified by any of the following values: serum or plasma transferrin ≤204 mg/dL, blood leukocytes ≤1.5 × 10³/µL, or albumin ≤3.5 g/dL. A 1:1 propensity score matching was performed with matched controls for relevant risk factors, demographics and comorbidities.

RESULTS: Before matching, 80,761 ankle fracture patients (7,455 malnourished; 73,306 controls) and 14,258 pilon fracture patients (1,648 malnourished; 12,610 controls) were identified. After matching, 14,676 ankle fracture (mean age 58.4 ± 16.9 years) and 3,214 pilon fracture (mean age 50.1 ± 17.2 years) patients were included. In the ankle fracture analysis, malnourished patients had higher rates of wound complications, post-operative infection, anemia, blood transfusions, incision and drainage and implant removal at 90 days post-operatively (p<0.0001). Within one year, malnutrition was significantly associated with increased malunion, non-union, amputation and implant related complications such infections, implant removal and irritation and debridement (p<0.05). Comparisons for pilon fracture patients were the same in addition to higher rates of wound complications (p<0.001) in malnourished patients.

CONCLUSION: Patients with malnutrition undergoing surgical fixation for ankle and pilon fractures experienced significantly higher rates of systemic complications and adverse surgical outcomes including infections, nonunion and all-cause return to the OR for staged removal of hardware, debridements, arthrodesis, and amputation. These findings should direct postoperative risk management and motivate study into interventions aimed at promoting nutrition and preventing complications in this at-risk population.

PMID:41265293 | DOI:10.1016/j.injury.2025.112888

J Bone Joint Surg Am. 2025 Nov 20. doi: 10.2106/JBJS.25.00963. Online ahead of print.

ABSTRACT

Human trafficking is a public health crisis with profound physical and psychological consequences. Orthopaedic surgeons, who are often the earliest providers to assess traumatic musculoskeletal injuries, have a unique opportunity to identify victims of trafficking. This article highlights 4 cases of patients with orthopaedic injuries sustained in the context of trafficking or through the subsequent psychological effects of such encounters. Despite the high percentage of human trafficking victims who interact with the health-care system, the recognition and identification of such victims remain low. We advocate for increased awareness of the possibility of patients with orthopaedic injuries having been trafficked and the consideration of human trafficking in trauma-informed care training.

PMID:41265470 | DOI:10.2106/JBJS.25.00963

J Bone Joint Surg Am. 2025 Nov 20. doi: 10.2106/JBJS.25.00506. Online ahead of print.

NO ABSTRACT

PMID:41264683 | DOI:10.2106/JBJS.25.00506

J Bone Joint Surg Am. 2025 Nov 20. doi: 10.2106/JBJS.25.00740. Online ahead of print.

NO ABSTRACT

PMID:41264674 | DOI:10.2106/JBJS.25.00740

Injury. 2025 Nov 13;56(12):112884. doi: 10.1016/j.injury.2025.112884. Online ahead of print.

ABSTRACT

BACKGROUND: The rise of homelessness in the United States has resulted in an alarming burden of unmet medical need. Homeless patients are at higher risk for orthopedic trauma yet there is limited literature investigating it. This study aims to investigate open reduction and internal fixation outcomes of lower extremity fractures in homeless patients.

METHODS: This retrospective database analysis evaluated homeless patients who underwent open reduction and internal fixation of the lower extremities. Patients were categorized based on the housing status preoperatively, resulting in 3596 homeless and 436,540 housed patients. A 1:1 propensity score matching analysis was performed, adjusting for age, sex, race, ethnicity, body mass index and comorbid conditions (diabetes, hypertension, chronic kidney disease, tobacco use, obesity, heart failure, liver diseases, substance abuse and opioid dependence). Postoperative complications were assessed at 90 days, and both surgical and medical related complications were evaluated at 1 year.

RESULTS: At 90 days, homeless patients had significantly higher rates of emergency department (ED) visits (RR 2.47, p < 0.0001), readmissions (RR 2.49, p < 0.0001), opioid dependence (RR 2.48, p = 0.001), substance abuse (RR 2.96, p < 0.0001), surgical site infections (RR 2.54, p < 0.0001), postoperative infections (RR 1.49, p < 0.0001), and blood transfusions (RR 2.12, p < 0.0001) compared to controls. At 1 year, homeless patients continued to demonstrate higher rates of ED visits (RR 2.62, p < 0.0001), admissions (RR 2.35, p < 0.0001), opioid dependence (RR 1.62, p = 0.011), and substance abuse (RR 4.00, p < 0.0001). Implant removal (RR 0.75, p = 0.001) and malunion/nonunion repair (RR 0.63, p = 0.018) were less frequent in homeless patients, while amputation was more common (RR 1.87, p = 0.018).

CONCLUSION: Homeless patients experience significantly higher rates of medical complications, fracture-related complications and increased opioid dependence following surgical fixation of lower extremity fractures. Further investigation into these findings and potential for perioperative medical optimization is indicated.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort.

PMID:41260189 | DOI:10.1016/j.injury.2025.112884

Injury. 2025 Oct 31;56(12):112871. doi: 10.1016/j.injury.2025.112871. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-reported outcomes following treatment of open lower limb fractures in the elderly are poorly reported. This study aimed to report clinical outcomes from the South Wales orthoplastic service using the Lower Extremity Functional Scale (LEFS).

MATERIALS AND METHODS: A retrospective observational cohort study was performed using LEFS scores for patients aged 65 years and over with open lower limb fractures undergoing either local or free flap reconstruction from June 2020 - June 2023. LEFS scores were collected from paper questionnaires of patients returning to the orthoplastic clinic for follow up. Deep infection, secondary amputation and time to union were recorded. Patients undergoing primary closure alone or reconstruction due to infection were excluded.

RESULT: Fifty-one patients were included, 15 (29 %) male and 36 (71 %) female. The median age was 72. There were 26 (51 %) ankle, 24 (47 %) tibial and 1 (2 %) mid-foot open fractures. Of the 24 open tibial fractures, 17 (71 %) were fixed with nails, 5 (21 %) with plates and screws or a combination of both (2, 8 %). Sixteen (67 %) received local flaps and 9 (38 %) required free flaps. Ankle fractures were fixed with screws, plates or fibula nails. Seven (27 %) required free flaps and 19 (73 %) pedicled flaps. The mid foot fracture received a bridging plate, screws and a free flap. Of these 51, 3 (6 %) died during admission, 3 (6 %) were lost to follow and 1 (2 %) died before the first follow up appointment. Of the remaining 44 patients, the median LEFS score was 35 at a median follow up of 51 weeks indicating moderate functional limitation. The median time to union was 26 weeks. One (2 %) patient developed a deep infection requiring metalwork removal and there were 6 (14 %) non-unions. There were no secondary amputations.

CONCLUSIONS: Open lower limb fractures in the elderly population can present challenges for orthoplastic reconstruction. We have shown successful fix and flap procedures are possible in a cohort traditionally considered to be high risk for surgery. Patients had reasonable functional outcomes at 12 months post-operatively. LEFS scores can provide objective data to evaluate recovery following orthoplastic reconstruction in this cohort.

PMID:41253070 | DOI:10.1016/j.injury.2025.112871

Injury. 2025 Nov 13;56(12):112890. doi: 10.1016/j.injury.2025.112890. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite advancements in surgical technique, patellar fractures remain challenging to manage. Internal fixation of simple transverse patellar fractures is commonly performed using tension band wiring techniques, such as cannulated screw anterior tension band wiring (CATB). However, CATB is associated with high rates of symptomatic hardware, fixation failure, and reoperation. The wagon wheel (WW) construct is a novel transtendinous/transligamentous technique that involves circumferential mini-fragment plating with radially directed screws. A previously published case series demonstrated that the WW construct was associated with decreased rates of reoperation, symptomatic hardware, time to union, and gait aid dependences compared with CATB. However, no biomechanical study has compared these fixation strategies. The goal of this study was to evaluate the biomechanical performance of the WW construct compared to CATB for fixation of simple patella fractures.

MATERIALS AND METHODS: Seven paired fresh-frozen human cadaveric lower extremities (n=14 knees) were utilized. All patellae were fractured using an oscillating saw to simulate two-part simple transverse AO/OTA 34-C1 patella fractures. Matched pairs of knees underwent randomization to the WW and CATB constructs. All surgically fixed specimens underwent cyclic loading testing through 1000 cycles, as well as subsequent load-to-failure testing. Failure was defined as fracture displacement ≥ 2 mm. High-resolution optical motion tracking system recorded fracture displacement in three dimensions throughout testing.

RESULTS: The WW construct demonstrated less mean fracture displacement on the first flexion cycle (WW: 0.09 vs. CATB: 0.32 mm; p=0.11) and after 1000 cycles of flexion (WW: 0.31 vs. CATB: 1.0 mm; p=0.017), equating to 69% less mean fracture displacement than CATB. The mean force required to cause construct failure was more than double for knees fixed with the WW construct compared with CATB (900 vs. 434 N; p=0.025) DISCUSSION: In the first human cadaveric biomechanical study to compare the novel WW construct to CATB, the WW construct demonstrated superior fixation stability and 69% less fracture displacement after 1000 cycles of flexion. The findings of this study provide biomechanical validation for previously reported clinical advantages of the peripheral plate-based WW construct, compared to CATB, demonstrating that the WW may offer superior fracture fixation stability through cyclic loading.

PMID:41253069 | DOI:10.1016/j.injury.2025.112890

J Bone Joint Surg Am. 2025 Nov 17. doi: 10.2106/JBJS.25.00260. Online ahead of print.

NO ABSTRACT

PMID:41252650 | DOI:10.2106/JBJS.25.00260

J Bone Joint Surg Am. 2025 Nov 18. doi: 10.2106/JBJS.25.00212. Online ahead of print.

ABSTRACT

BACKGROUND: Capitellar osteochondritis dissecans (OCD) is common in adolescent throwing athletes. Surgical treatment yields favorable clinical outcomes. However, the relationship between bone density and clinical outcomes following OCD treatment is not well understood. We hypothesized that surgery normalizes subchondral bone density distribution and that clinical outcome improvements correlate with the bone density changes. This study quantitatively analyzed these changes and compared different surgical techniques.

METHODS: Fifty-one male ethnic Japanese patients with capitellar OCD treated surgically (mean age at surgery: 14.0 ± 1.6 years) were enrolled, with a mean follow-up of 6.7 ± 3.1 years (mean age at final evaluation: 20.7 ± 3.5 years). Subchondral bone density was measured in Hounsfield units using computed tomography preoperatively and postoperatively, as well as in the contralateral elbow. Relative bone densities, expressed as proportions, in the distal humerus, radial head, and proximal ulna were compared among the preoperative, postoperative, and contralateral elbows within their respective anatomical subregions. Subgroups with reconstruction procedures and with preservation procedures were also analyzed separately. Functional outcome changes using Timmerman-Andrews scores were correlated with bone density changes.

RESULTS: In the distal humerus, subchondral bone density at the OCD lesion was significantly lower preoperatively (0.99 ± 0.17) than postoperatively (1.19 ± 0.17, p < 0.001) and in the contralateral elbow (1.17 ± 0.13, p < 0.001), whereas the density of the surrounding sclerotic bone was higher preoperatively (1.24 ± 0.10) than postoperatively (1.14 ± 0.10, p < 0.001) and in the contralateral elbow (1.07 ± 0.08, p < 0.001). The regions within and outside the site of the OCD lesion exhibited similar density distribution patterns postoperatively and in the contralateral elbow. In the radial head, the highest density was in the radial-volar quadrant preoperatively (1.14 ± 0.14) but shifted to the ulnar-volar quadrant postoperatively (1.06 ± 0.12, p = 0.020) and matched the contralateral value (1.02 ± 0.10, p < 0.001). Patterns in subchondral bone density in the regions were comparable between the reconstruction and preservation groups across all conditions. Improvements in Timmerman-Andrews scores correlated moderately with bone density normalization at the lesion site (R = 0.49, p = 0.003) and surrounding sclerotic bone (R = 0.43, p = 0.010).

CONCLUSIONS: Surgical treatment of capitellar OCD effectively restored the subchondral bone density distribution to normal patterns, regardless of the surgical technique. These bone density changes moderately correlated with improvements in functional outcome, providing quantitative evidence supporting the efficacy of surgical intervention for advanced lesions.

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

PMID:41252482 | DOI:10.2106/JBJS.25.00212

Int Orthop. 2025 Nov 18. doi: 10.1007/s00264-025-06694-y. Online ahead of print.

NO ABSTRACT

PMID:41251767 | DOI:10.1007/s00264-025-06694-y

J Bone Joint Surg Am. 2025 Nov 17. doi: 10.2106/JBJS.25.00127. Online ahead of print.

NO ABSTRACT

PMID:41248226 | DOI:10.2106/JBJS.25.00127

J Bone Joint Surg Am. 2025 Nov 17. doi: 10.2106/JBJS.25.00659. Online ahead of print.

NO ABSTRACT

PMID:41248225 | DOI:10.2106/JBJS.25.00659

Int Orthop. 2025 Nov 17. doi: 10.1007/s00264-025-06674-2. Online ahead of print.

ABSTRACT

BACKGROUND: Dynamic anterior shoulder stabilization (DAS) combined with Bankart repair (BR) has gained attention for treating anterior shoulder instability (ASI) with subcritical anterior glenoid bone loss (GBL). This study aims to evaluate the clinical and biomechanical outcomes of DAS combined with BR for ASI.

METHODS: A comprehensive search of PubMed, Embase, and Scopus through August 2024 identified biomechanical and clinical studies assessing DAS in ASI. Reviews, surgical techniques, case reports, and abstracts were excluded. A meta-analysis was performed using a random-effects model, with using weighted mean differences (WMD) for continuous variables to compare pre-to-post treatment effects. MINORS and QuADS tools were used to assess the quality of the included studies.

RESULTS: Five biomechanical studies (60 cadaveric shoulders, GBL 10%-20%) demonstrated that DAS significantly improved anterior glenohumeral stability and load-to-dislocation compared to isolated BR, particularly in models with < 20% GBL and on-track Hill-Sachs lesions (HSL). Three clinical studies (100 shoulders, mean age ranged from 23.4 to 21, GBL 8.2%-10.5%) revealed significant improvements in Rowe scores (mean difference [WMD] = 58.7; p < 0.001) and forward elevation (WMD = 4.8; p = 0.02), with no significant changes in external or internal rotation. Return-to-sport rates were high (90% at any level, 71% at the same level), with 8% experiencing recurrent instability and 2% requiring reoperation.

CONCLUSION: Available evidence suggests that DAS combined with BR offered significant biomechanical improvements, substantial patient-reported outcome improvements, better forward elevation, high return-to-sport rates, and a low complication profile for ASI with subcritical GBL. However, caution is advised in cases with off-track HSL and GBL of approximately 20%, where DAS offers less stability when compared to Remplissage and Latarjet and increased reoperations rates.

PMID:41247526 | DOI:10.1007/s00264-025-06674-2

Injury. 2025 Nov 10;56(12):112881. doi: 10.1016/j.injury.2025.112881. Online ahead of print.

ABSTRACT

The study aims to define a management protocol to outline a variety of clinical presentations associated with residuum pain after osseointegration. This is expected to assist clinicians in diagnosing and treating adverse events. In the present cohort study, a total of 406 patients with 429 (262 transfemoral and 167 transtibial) osseointegration cases were evaluated over the period spanning from November 2010 to November 2023 at Macquarie University and Norwest Private Hospital. International patients were excluded from the study due to the lack of detailed imaging and regular follow-up care. The average follow-up since surgery was found to be 6.1 ± 2.49 years. The stump pain management protocol was developed by retrospective analysis. Residuum pain is driven by mechanical, neuropathic, and infectious processes. Stump infections were categorized according to the OGAAP classification. Mechanical pain caused by aseptic or septic loosening was classified into grading systems to segregate the management. After clinical and radiological localization of neuroma, 94/262 ( 35.8%) transfemoral cases underwent 129 nerve-related procedures (117 TMR +12 RPNI). Out of 167 transtibial cases, 65 nerve interface procedures (61 TMR+4 RPNI) were performed in 42 (28.1%) cases on single or multiple nerves. Stump refashioning procedures were carried out in 115 cases (85/262 (32.4%) transfemoral; 30/167 (17.9%) in transtibial) who had pain due to recurrent soft tissue infections and overhanging soft tissues. The analysis of the average time between refashioning surgery and index surgery revealed a mean interval of 2.86 ±1.98 years. The use of bone-anchored prostheses, whilst safe and highly successful, necessitates a long-term commitment, with a potential need for ongoing management of adverse events. Based on radiographic and clinical data, the resultant categorization corresponds with related soft-tissue or bony pathology, which allows the surgeon to decide on the best course of management.

PMID:41242204 | DOI:10.1016/j.injury.2025.112881

Injury. 2025 Oct 20;56(12):112830. doi: 10.1016/j.injury.2025.112830. Online ahead of print.

ABSTRACT

IMPORTANCE: Methoxyflurane, an inhalational analgesic, has proven safety and efficacy in clinical trials and clinical practice. This double-blind, well-controlled study aimed to establish the benefit-risk of methoxyflurane in a paediatric population.

OBJECTIVE: To evaluate the safety and efficacy of methoxyflurane in children with minor trauma and acute pain presenting to emergency departments (ED).

DESIGN: Randomised, double-blind, multicentre, placebo-controlled study (MAGPIE).

SETTING: Conducted at 11 EDs in the UK and Ireland.

PARTICIPANTS: Participants aged from 6-<18 years of age with minor trauma and pain scores of 60-80 mm on a visual analogue scale (VAS), or 6-8 on a Wong Baker Pain Scale, were recruited.

INTERVENTIONS: Methoxyflurane 3 mL or placebo (normal saline, 5 mL) via a Penthrox® inhaler device, with a second inhaler upon request.

MAIN OUTCOME(S) AND MEASURE(S): Primary: change in VAS pain intensity from baseline to 15-minutes in participants aged 9-<18 years (secondary: included the total Intent-To-Treat (ITT) population, aged 6-<18 years).

RESULTS: 4513 patients screened, 249 participants randomised (127 methoxyflurane, 122 placebo), 192 treated (92 methoxyflurane, 100 placebo). Mean (standard deviation (SD)) age 11.1 (2.45) years; 108/192 (56 %) were male. At 15-minutes, the mean change from baseline in VAS was -20.0 mm (methoxyflurane) and -13.2 mm (placebo); least squares (LS) mean difference in 9-<18-year old's -6.8 mm [95 % CI -12.5 to -1.2 mm], p = 0.018, which was similar to the total ITT population. Fewer methoxyflurane participants required rescue medication (9.8 % vs 30.0 %). There were statistically significant odds of better global medication performance assessments for the methoxyflurane group compared to the placebo group, based on physician (OR 5.29, 95 % CI 3.02 to 9.45, p < 0.001) and research nurse assessments (OR 5.78, 95 % CI 3.32 to 10.27, p < 0.001). Adverse events were more common with methoxyflurane (64 %) vs. placebo (55 %). Common treatment emergent adverse events (TEAEs) included dizziness (methoxyflurane 41 %, placebo 12 %) and euphoric mood (methoxyflurane 12 %, placebo 0 %). Discontinuations due to TEAEs occurred in 8 methoxyflurane and 1 placebo participant. There were no serious adverse events related to methoxyflurane.

CONCLUSIONS AND RELEVANCE: In this pivotal placebo-controlled trial, methoxyflurane was efficacious for treatment of acute trauma-related pain in paediatrics, with a safety profile consistent with adults.

TRIAL REGISTRATION: NCT03215056.

PMID:41242203 | DOI:10.1016/j.injury.2025.112830

Injury. 2025 Nov 8;56(12):112883. doi: 10.1016/j.injury.2025.112883. Online ahead of print.

ABSTRACT

BACKGROUND: Post-traumatic hypothermia is a prevalent complication in trauma care, affecting up to 66 % of multiple trauma patients upon emergency admission and doubling trauma-related mortality. While risk prediction models for post-traumatic hypothermia have been developed, guidelines and evidence specific to their clinical utility-especially in pre-hospital and low- to middle-income country (LMIC) settings-remain scarce. This systematic review evaluates existing post-traumatic hypothermia risk prediction models, their performance characteristics, and applicability in diverse clinical contexts.

METHODS: Databases including China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, China Biomedical Literature Database, PubMed, Web of Science, and Cochrane Library were searched from the time of database establishment to July 2025. Two researchers independently screened the literature, extracted relevant data, and conducted quality assessments. The included studies were analyzed to comprehensively evaluate the predictive models for post-traumatic hypothermia risk.

RESULTS: A total of 9 studies were included, comprising 9 predictive models for the risk of post-traumatic hypothermia, with a total sample size of 91 to 732 cases and 24 to 117 outcome events. The area under the receiver operating characteristic curve (AUC) for the predictive models ranged from 0.704 to 0.990, with specificity ranging from 50.6 % to 95.2 %. and sensitivity ranging from 70.9 % to 92.8 %. The most frequently identified predictive factors in the models were trauma severity, wet clothing, lack of warming measures, fluid resuscitation, and environmental temperature at the time of injury. The included risk prediction models demonstrated overall good applicability, but they had a high risk of bias, which was associated with limitations in sample selection, indicator selection and measurement, study design flaws, and inadequate model validation.

CONCLUSION: Although the predictive model for post-traumatic hypothermia risk demonstrates certain advantages in overall applicability and can provide reference for clinical prediction of post-traumatic hypothermia risk, it has a high risk of bias. Future studies should be conducted in a multicenter, large-sample setting to strengthen external validation of the model and test its performance in different clinical environments to ensure its stability and accuracy.

PMID:41240776 | DOI:10.1016/j.injury.2025.112883

Injury. 2025 Nov 8;56(12):112886. doi: 10.1016/j.injury.2025.112886. Online ahead of print.

ABSTRACT

INTRODUCTION: Tibial plateau fractures are some of the most commonly treated injuries around the knee and loss of range of motion has a significant effect on post-operative outcomes, very few studies have demonstrated the impact of flexion contractures. The purpose of this study was to determine the effect that development of a knee flexion contracture has on outcomes following operative repair of tibial plateau fractures.

METHODS: Patients operatively treated for tibial plateau fractures (Schatzker II, IV, V, and VI) between 2005-2024 at a multi-center academic urban hospital system were included in this retrospective comparative study. Patients were grouped into 3 cohorts: 1. Full extension (FE), 2. 5-10 degrees of flexion contracture (Mild, ME) and 3. Greater than 10 degrees of flexion (Severe, SE) contracture at 6 months post-operatively. Patients with contracture were matched to patients who regained full extension based on age and Schatzker classification. Statistical analysis was used to evaluate outcomes including patient reported pain levels, Short Musculoskeletal Function Assessment (SMFA) scores, complication rates and reoperation rates.

RESULTS: The cohort consisted of 3 groups of 30 patients (14 Schatzker II, 5 Schatzker IV, 3 Schatzker V, and 8 Schatzker VI). The average knee flexion contracture for the mild cohort was 5 degrees and the average knee flexion contracture for the severe cohort was 12.7 degrees. Patients who experienced flexion contracture had poorer SMFA scores at 6 months, and those in the severe cohort had the poorest SMFA scores (112.6) when compared to those with full extension at 6 months (77.7) (p<0.001). Flexion contractures were associated with higher rates of fracture related infection (FRI) (p =0.002). Patients with flexion contracture also had a higher rate of subsequent re-operation, with 36.7% of the ME undergoing re-operation and 40% of SE undergoing re-operation.

CONCLUSIONS: Patients who developed a flexion contracture following repair of a tibial plateau fracture experienced worse outcomes, higher rates of complications, increased pain, and poorer function at long term follow up compared to those who achieved full knee extension.

PMID:41240775 | DOI:10.1016/j.injury.2025.112886

Injury. 2025 Oct 31:112865. doi: 10.1016/j.injury.2025.112865. Online ahead of print.

NO ABSTRACT

PMID:41238443 | DOI:10.1016/j.injury.2025.112865

Injury. 2025 Nov 1;56(12):112855. doi: 10.1016/j.injury.2025.112855. Online ahead of print.

ABSTRACT

BACKGROUND: Neurovascular complications after tibial plateau fractures are rarely reported, despite their clinical relevance. While Schatzker type IV fractures have traditionally been considered the most at risk, supporting evidence is limited. This is the first large-scale study systematically evaluating neurovascular injuries in tibial plateau fractures. The aim was to determine the incidence of arterial and neurological injuries and to identify fracture patterns most frequently associated with these complications.

METHODS: We conducted a retrospective review of patients who underwent open reduction and internal fixation for tibial plateau fractures at a level I trauma center between January 2015 and December 2023. Eligible patients had complete records, radiographs, CT angiography, and ≥12 months follow-up. Fractures were classified using both Schatzker and AO/OTA systems. Arterial injury was defined as a CT angiography confirmed lesion requiring surgical repair, and neurological injury as a motor or sensory deficit documented clinically or by electromyography within 1 month.

RESULTS: A total of 320 patients were included (mean age 44.3 years; 71.3 % male). Vascular injury occurred in 2 cases (0.62 %), both high-energy open fractures classified as Schatzker VI and AO/OTA C3. Five additional patients (1.56 %) had arterial occlusions without rupture or clinical ischemia, all of which resolved without surgery. Neurological injury was observed in 13 patients (4.06 %), 84.6 % related to high-energy trauma. Ten cases corresponded to Schatzker VI, predominantly AO/OTA C3 (n = 8). No neurovascular complications occurred in Schatzker IV fractures. Proximal fibular fracture was present in 61.5 % of neurological cases with a OR of 4.46 (CI 1.41-14.03, p = 0.010).

CONCLUSIONS: Neurovascular complications in tibial plateau fractures are uncommon (<5 %) but are associated with high-energy, open, and complex patterns, particularly Schatzker VI and AO/OTA C3. Contrary to traditional belief, Schatzker IV fractures were not associated with neurovascular compromise. Proximal fibular fracture may serve as a clinical marker for neurological risk. CT angiography should not be performed routinely, but is especially recommended in open and high-energy fractures. Further prospective studies are needed to validate these associations and optimize imaging strategies.

PMID:41237662 | DOI:10.1016/j.injury.2025.112855

Injury. 2025 Nov 13;56(12):112831. doi: 10.1016/j.injury.2025.112831. Online ahead of print.

ABSTRACT

This study aimed to analyse the load-deformation behaviour of pelves treated with external fixation following AO61C1.3a pelvic injury. Designing a biomechanical setup , the load-bearing capacity of pelves was assessed across varying pin configurations (two, three, or four external fixator pins). Mechanical parameters such as stiffness, peak-to-peak, valley-to-valley, fracture line, total displacement, deformation, and maximum load were derived to quantify pelvis stability. The 3-pin configuration demonstrated superior stability with significantly smaller pubis and sacral fracture displacements under all loading conditions (p<0.001), and was the only configuration below the clinical failure threshold. Notably, this configuration minimised fracture movement despite global outcome parameters showing no significant differences between the groups. These findings highlight the importance of fracture-specific stability over global stiffness in ensuring effective fixation. The results indicate that optimal biomechanical resistance to C1.3a pelvic instability is achieved through a combination of two pins on the injured side and a single pin on the stable hemipelvis using contemporary pin devices. This study offers the biomechanical basis required to facilitate the design and execution of clinical trials addressing pelvic ring injuries.

PMID:41237661 | DOI:10.1016/j.injury.2025.112831