Injury. 2026 Apr 15;57(6):113280. doi: 10.1016/j.injury.2026.113280. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate fixation failure following femoral neck system fixation (FNS) for intracapsular femoral neck fractures (FNF) and to determine whether fracture characteristics, particularly fracture orientation, were associated with fixation failure.

METHODS: A retrospective cohort study was performed at a Level I trauma center. 82 patients with intracapsular femoral neck fractures treated with FNS fixation were included. Fixation failure was defined as implant cut-out, loss of fixation, nonunion, or revision surgery. Associations between fracture characteristics and fixation failure were evaluated.

RESULTS: The mean age was 70.1 ± 12.7 years, with a mean follow-up of 22.2 ± 10.2 months. Eight fixation failures occurred (9.8%). Pauwels classification was significantly associated with fixation failure (p < 0.001), with higher-angle fractures demonstrating increased risk of failure. No failures occurred in Pauwels type I fractures, whereas failures occurred in Pauwels type II and III fractures. Fracture morphology (subcapital, including valgus impacted vs transcervical) and Garden classification were not associated with fixation failure (p = 1.000 and p = 1.000, respectively). One case of distal locking screw breakage was observed; however, most fixation failures were associated with fracture orientation rather than implant-related mechanical failure.

CONCLUSION: Fixation failure following femoral neck system fixation appears to be primarily associated with fracture orientation rather than implant-related mechanical failure. The low rate of implant-related mechanical complications suggests that the FNS provides adequate biomechanical stability for intracapsular femoral neck fracture fixation, whereas vertical fracture patterns remain a major determinant of fixation failure.

PMID:41997098 | DOI:10.1016/j.injury.2026.113280

Injury. 2026 Apr 11;57(6):113288. doi: 10.1016/j.injury.2026.113288. Online ahead of print.

ABSTRACT

BACKGROUND: Blunt cerebrovascular injury (BCVI) poses significant risk of devastating neurologic injury following blunt trauma. Selective screening criteria miss numerous clinically relevant injuries. Early diagnosis and treatment reduce these negative sequelae. Emerging data have prompted expanded interest in universal screening; however, no consensus screening strategy exists. This review evaluates the current state of BCVI screening.

METHODS: A narrative literature review was performed evaluating universal and liberalized BCVI screening criteria. A structured PubMed search was supplemented by manual review of references, trauma society abstracts, and other grey literature. Eligible studies included peer reviewed literature examining universal or liberalized BCVI screening among adult blunt trauma patients. Given the paucity of available data and relative heterogeneity in study design, findings were synthesized qualitatively.

RESULTS: Eight studies were included for evaluation. Across contemporary cohorts, various screening criteria including extended Denver, Memphis, and Western Trauma Association, miss 16-79% of BCVI identified under universal or liberalized screening protocols. Universal screening studies report BCVI incidence ranging from 2.7% to 7.6%. Reported rates of contrast-associated acute kidney injury and major bleeding were low, though rarely examined. Cost-modeling suggests universal screening may be economically favorable, particularly if BCVI incidence is greater than 6%.

CONCLUSIONS: Selective screening guidelines lack sufficient sensitivity to detect all clinically significant BCVI, including those of high grade. Universal or liberalized CTA screening increases detection and facilitates treatment in a timely manner, potentially reducing BCVI-associated stroke rates. Although current literature is limited and prospective studies are needed, current evidence supports strong consideration of universal or liberalized BCVI screening protocols for blunt trauma patients.

PMID:41997097 | DOI:10.1016/j.injury.2026.113288

Injury. 2026 Apr 15;57(6):113290. doi: 10.1016/j.injury.2026.113290. Online ahead of print.

ABSTRACT

BACKGROUND: Induced membrane technique (IMT), a novel approach for reconstructing critical-size bone defect, encounters the challenge of lengthy mineralization time after bone grafting. This study is to explore the effect of Naringin on M2 macrophage polarization-mediated osteogenesis in the induced membrane's bone graft area.

METHODS: The IMT model was established in SD rats. After 8 weeks of treatment with Naringin and interleukin-4 (IL-4), the repair effect of femoral bone defects was evaluated. Meanwhile, RNA sequencing (RNA-seq) was performed on the bone tissue from rats treated with Naringin to detect changes in gene transcription levels. In vitro, Macrophages were divided into four groups: Control group, si-JAK1 + Naringin group, Naringin group and IL-4 group. At corresponding stages, cell proliferation, cell phenotype (M1 or M2), factors related to the JAK/STAT6 pathway, and osteogenic factors secreted by macrophages were assessed. Additionally, a macrophage-osteoblast coculture system was established to analyze the effects of osteogenic factors derived from M2 macrophages on osteoblasts' viability and mineralization.

RESULTS: The result of RNA-seq on the bone tissue in the bone graft area revealed that genes upregulated by Naringin were significantly enriched in biological processes related to immune regulation and the JAK/STAT pathway. The in vivo study indicated that there is an increase in markers of M1 macrophages and a decrease in markers of M2 macrophages in the bone grafting area of IMT. Treatment with Naringin and IL-4 could stimulate the polarization of M0 macrophages towards M2, accelerate the healing of bone defects, and increase expression of osteogenic factors and JAK1/STAT6 pathway factors. The in vitro experiments showed that treatment of primitive macrophages (M0) with Naringin and IL-4 led to an increase in the number of M2 macrophages, enhanced secretion of osteogenic factors, upregulation of the JAK1/STAT6 pathway. Conversely, the number of M1 macrophages decreased. Additionally, si-JAK1 was able to reverse the positive effect of Naringin on M2 macrophage polarization. Furthermore, after co-culturing macrophages and osteoblasts, it was found that osteogenic factors derived from polarization of M2 macrophages could stimulate the activity and mineralization of osteoblasts. Finally, Molecular docking, molecular dynamics simulation (MDS) and CETSA results indicated that Naringin can directly bind to JAK1 protein in macrophages and maintain its thermal stability.

CONCLUSIONS: JAK1-mediated polarization of M0 macrophages towards M2 has a positive regulatory function in osteoblasts' mineralization. Naringin targets JAK1 in macrophages within the IMT's bone graft area, maintaining its stability, promoting the activation and phosphorylation of the JAK1/STAT6 pathway, stimulating M2 polarization of macrophages, and thereby facilitating bone graft growth and accelerating the repair of large bone defects.

PMID:41997096 | DOI:10.1016/j.injury.2026.113290

Injury. 2026 Apr 15;57(6):113268. doi: 10.1016/j.injury.2026.113268. Online ahead of print.

ABSTRACT

INTRODUCTION: Venous thromboembolism (VTE) is a major complication in pelvic ring and acetabular fractures (PAF). Evidence on incidence and optimal prophylaxis strategies remains limited. This study aimed to investigate the incidence of VTE in PAF patients under a standardized prophylaxis regimen.

METHODS: A prospective cohort study was conducted at a German Level I trauma center between January and December 2024. 81 patients with PAF (Pelvic ring fracture (PF) n = 47, Acetabular fracture (AF) n = 28, Combined fracture (CF) n = 6) were included. All patients received enoxaparin 4000 IU twice daily, initiated within 12 h of admission. Primary outcome was radiologically confirmed VTE during index hospitalization. Secondary outcomes included VTE timing, association with fracture type and treatment, and bleeding complications.

RESULTS: The overall incidence of VTE was 7.4% (6/81), including deep vein thrombosis (DVT) 6.2% (5/81), pulmonary embolism (PE) 2.5% (2/81), and one combined event. VTE occurred more often in AF (10.7% (3/28)) and CF (33.3% (2/6)) compared with PF (2.1% (1/47); p = 0.016). Three of five DVTs (60%) were asymptomatic. No associations were found with age, sex, ASA, trauma mechanism, or associated injuries. In the operatively treated group, one patient (1.9%; 1/53) required revision for postoperative hematoma; no further bleeding complications occurred.

CONCLUSION: A prophylactic regimen with enoxaparin 4000 IU twice daily was associated with a low incidence of VTE in PAF patients without an increased risk of bleeding. Routine duplex ultrasound screening enabled early VTE detection, including asymptomatic cases, and may improve outcomes in this high-risk population.

PMID:41997095 | DOI:10.1016/j.injury.2026.113268

Injury. 2026 Apr 9;57(6):113262. doi: 10.1016/j.injury.2026.113262. Online ahead of print.

ABSTRACT

INTRODUCTION: Respiratory complications following cervical spinal cord injury (CSCI) are a major cause of morbidity and mortality. Although several risk factors have been identified, quantitative predictors for respiratory deterioration are limited. The respiratory rate-oxygenation (ROX) index, defined as the ratio of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) to respiratory rate, has been validated for predicting outcomes in respiratory failure. Because the ROX index is a quantitative indicator that sensitively reflects temporal changes in respiratory status, we hypothesized that variations in the ROX index (delta ROX) could serve as a predictor of respiratory exacerbation (RE) in patients with CSCI. This study aimed to evaluate the association between delta ROX and RE in patients with CSCI.

PATIENTS AND METHODS: A single-center, retrospective observational study was conducted at a major trauma center in Japan between 2012 and 2023. Adult patients (aged ≥18 years) admitted to the intensive care unit (ICU) with traumatic CSCI were eligible. The primary outcome was RE requiring intubation within 7 days. The ROX index was calculated at each time point (2, 6, 12, 18, and 24 h after admission). The delta ROX index was defined as the ratio of the ROX index at each time point to the ROX index at ICU admission.

RESULTS: Among 54 eligible patients, 7 (13%) developed RE. The delta ROX index showed significant differences between the RE and control groups at 12 (0.69 vs. 1.27, p = 0.016), 18 (0.81 vs. 1.29, p = 0.005), and 24 h (0.73 vs. 1.33, p = 0.004). Receiver operating characteristic analysis demonstrated the highest predictive value at 24 h (area under the curve 0.94, 95% CI 0.87-1.00).

CONCLUSION: The delta ROX index may serve as a valuable predictor of RE in patients with CSCI. A decreasing trend in the ROX index during the first 24 h of ICU admission was associated with an increased risk of respiratory deterioration, potentially enabling earlier respiratory intervention. These findings suggest that the delta ROX index provides a dynamic, quantitative measure that may help identify patients at increased risk.

PMID:41997094 | DOI:10.1016/j.injury.2026.113262

J Bone Joint Surg Am. 2026 Apr 17. doi: 10.2106/JBJS.26.00211. Online ahead of print.

NO ABSTRACT

PMID:41996527 | DOI:10.2106/JBJS.26.00211

J Bone Joint Surg Am. 2026 Apr 17. doi: 10.2106/JBJS.25.01697. Online ahead of print.

NO ABSTRACT

PMID:41996521 | DOI:10.2106/JBJS.25.01697

J Bone Joint Surg Am. 2026 Apr 17. doi: 10.2106/JBJS.26.00098. Online ahead of print.

NO ABSTRACT

PMID:41996485 | DOI:10.2106/JBJS.26.00098

J Bone Joint Surg Am. 2026 Apr 17. doi: 10.2106/JBJS.26.00189. Online ahead of print.

NO ABSTRACT

PMID:41996477 | DOI:10.2106/JBJS.26.00189

J Bone Joint Surg Am. 2026 Apr 17. doi: 10.2106/JBJS.25.01633. Online ahead of print.

NO ABSTRACT

PMID:41996468 | DOI:10.2106/JBJS.25.01633

SICOT J. 2026;12:16. doi: 10.1051/sicotj/2026013. Epub 2026 Apr 16.

NO ABSTRACT

PMID:41988652 | PMC:PMC13082743 | DOI:10.1051/sicotj/2026013

SICOT J. 2026;12:15. doi: 10.1051/sicotj/2025065. Epub 2026 Apr 15.

ABSTRACT

BACKGROUND: ITF are extracapsular proximal femoral fractures that occur in both younger and older populations, with a higher prevalence among females. They account for most hip fractures, reaching 44.1%. The Elderly are at risk with an increased first-year mortality risk reaching up to 30%. This research aimed to compare the functional outcomes, effectiveness, and safety profile of long as opposed to short cephalomedullary nails (CMNs) in the management of unstable ITF in elderly individuals aged >60 years.

METHODS: This single-blinded randomized controlled research was carried out on 30 participants aged >60 years old, both sexes, with unstable ITF. Participants were categorized into two groups (GPs): GP A: had a long cephalomedullary nail (LCMN), and GP B: had short cephalomedullary nail.

RESULTS: Mean hospital stay length, period of surgery, operative blood loss, and the incidence of transfusion requirements were higher in GP A, yet no significant difference was observed. Functional outcomes, union and complication rates were comparable between the two GPs.

CONCLUSIONS: Irrespective of the length, CMNs are suitable for the treatment of unstable ITF, aiming to achieve early mobility and satisfactory functional outcome. Further large-sampled RCTs need to be conducted comparing both GPs based on more recent CT-based classification systems with osteoporosis considered.

PMID:41988651 | PMC:PMC13082745 | DOI:10.1051/sicotj/2025065

SICOT J. 2026;12:14. doi: 10.1051/sicotj/2026010. Epub 2026 Apr 15.

ABSTRACT

INTRODUCTION: Medial patellofemoral ligament (MPFL) reconstruction is a well-established treatment for recurrent lateral patellar dislocations, yielding satisfactory clinical outcomes. Although synthetic materials are not widely used due to limited long-term data, they offer the potential to eliminate donor-site complications and may provide promising results. This study evaluated the five-year clinical and functional outcomes of MPFL reconstruction using suture tape, hypothesising that it is a safe alternative to traditional grafts.

METHODS: Thirty patients aged 20 - 45 years with recurrent lateral patellar dislocations were treated between 2017 and 2020. Exclusion criteria included patellofemoral joint pathology, high-grade trochlear dysplasia, patella alta, neuromuscular disorders, or significant lower limb malalignment requiring correction. All patients underwent MPFL reconstruction using suture tape, placed in the superomedial half of the patella and fixed to the femoral footprint using a knotless anchor. The vastus medialis obliquus insertion was advanced laterally and distally. Preoperative assessments included clinical examinations, knee radiographs, alignment views, TT-TG measurements via CT scans, and MRIs. Patients were evaluated using the Kujala scale, International Knee Documentation Committee (IKDC) score, Crosby and Insall grading system, and Lysholm score.

RESULTS: At the 5-year follow-up, all patients had resumed their daily activities without recurrence of dislocation. The mean Kujala score improved from 65.23 to 93.60 (P < 0.001), with significant increases also observed in IKDC and Lysholm scores (P < 0.001). According to the Crosby/Insall grading system, 24 patients were rated as "excellent", and six patients were rated as 'good'. The mean knee extension was -5°, and flexion was 140° at the final follow-up.

CONCLUSION: MPFL reconstruction using suture tape with knotless anchors, combined with careful patient selection, appears to be a safe and effective option, demonstrating satisfactory five-year clinical outcomes and no recurrence of instability. However, this study was limited by its relatively small sample size and retrospective design.

PMID:41988650 | PMC:PMC13082744 | DOI:10.1051/sicotj/2026010

Injury. 2026 Apr 14:113275. doi: 10.1016/j.injury.2026.113275. Online ahead of print.

NO ABSTRACT

PMID:41991380 | DOI:10.1016/j.injury.2026.113275

Injury. 2026 Apr 10;57(6):113269. doi: 10.1016/j.injury.2026.113269. Online ahead of print.

ABSTRACT

INTRODUCTION: Choosing which patients should undergo computed tomography (CT) and what specific studies they should undergo remains an important decision point in caring for traumatically injured patients. Patients with physical exam findings isolated to the thoracic and/ or lumbar (T/L) spine may undergo CT T/L spine or CT of the chest, abdomen, and/ or pelvis (C/A/P), with clinicians alternately choosing between approaches based on perceived risks and benefits related to radiation, cost, and diagnostic value. No prior study has evaluated the outcomes of patients who underwent CT T/L spine to assess the risks and benefits of this more limited approach.

METHODS: We performed a retrospective cohort study of patients admitted to a large urban level 1 trauma center from January 1, 2021 to December 31, 2024 who underwent CT T/L spine. We collated data using information collected through our trauma registry as well as data gathered through manual chart review. We generated descriptive data related to patient, intervention, and imaging-related characteristics.

RESULTS: During the study period, 127 patients were admitted following a traumatic injury and underwent CT T/L spine. The imaging studies obtained and their chronologies differed among included patients. Of 58 patients who underwent initial CT T/L spine, 13 (22%) had evolving circumstances prompting additional CT C/A/P. Of these, two had new injuries identified on CT C/A/P. Those patients who first underwent CT T/L spine and then underwent CT C/A/P were administered an additional median of 547 milliGray x centimeters in the second set of images. Patients from all imaging chronology groups had discrepancies between documented physical exam and imaging findings.

DISCUSSION: A substantial number of patients who underwent CT T/L spine developed additional circumstances prompting a repeat set of images with CT C/A/P, with a small number of patients having additional clinically relevant injuries identified at that time. Upfront imaging with CT C/A/P might reduce the need for multiple trips to the CT scanner with an associated impact on labor needs, cost, and administered radiation.

PMID:41990427 | DOI:10.1016/j.injury.2026.113269

J Bone Joint Surg Am. 2026 Apr 16. doi: 10.2106/JBJS.26.00267. Online ahead of print.

ABSTRACT

Knee pain resulting from acute trauma and overuse injury is common among athletes and represents a major cause of reduced performance, time loss from sport, and long-term sequelae including osteoarthritis. Injectable therapies are frequently used as a nonoperative treatment modality to alleviate symptoms and facilitate early return to sport. This review evaluates the current evidence on commonly used knee injectables in the younger athletic population with pre-arthritic knee pain, including corticosteroids, hyaluronic acid, platelet-rich plasma (PRP), and other biologics. Relevant literature was identified without restriction on study design and with a focus on athlete-specific outcomes and clinical applicability. Overall, the available evidence on knee injectables for athletes remains limited, heterogeneous, and largely extrapolated from older, nonathletic cohorts. In the absence of available athlete-specific guidelines, most injectables carry weak and/or conditional recommendations, highlighting the need for individualized treatment and shared decision-making. High-quality, sport-specific clinical trials are required to establish clear guidelines and optimize outcomes in this population.

PMID:41990135 | DOI:10.2106/JBJS.26.00267

J Bone Joint Surg Am. 2026 Apr 16. doi: 10.2106/JBJS.26.00264. Online ahead of print.

NO ABSTRACT

PMID:41990129 | DOI:10.2106/JBJS.26.00264

J Bone Joint Surg Am. 2026 Apr 16. doi: 10.2106/JBJS.26.00442. Online ahead of print.

NO ABSTRACT

PMID:41990127 | DOI:10.2106/JBJS.26.00442

Injury. 2026 Apr 9;57(6):113277. doi: 10.1016/j.injury.2026.113277. Online ahead of print.

ABSTRACT

Road traffic crashes are sudden and traumatic events that extend beyond physical injuries, exerting profound adverse effects on individuals' cognitive, emotional, and social functioning. The literature demonstrates that survivors of road traffic crashes may develop a wide range of psychological responses, including Posttraumatic Stress Disorder (PTSD), Acute Stress Disorder, depression, anxiety, traumatic grief, dissociative disorders, sleep disturbances, and avoidance behaviors. The severity and course of these reactions vary depending on multiple factors, such as the nature and intensity of the crash, prior trauma history, personality traits, level of social support, and demographic characteristics. This narrative review examines the psychological and behavioral responses observed in traffic crash survivors, highlighting how these responses differ across developmental stages, the risk factors that contribute to their emergence, and the ways in which psychological intervention needs are shaped. Findings indicate that children and adolescents are particularly vulnerable to the psychological consequences of traffic crashes due to their developmental characteristics. Among psychosocial intervention methods, trauma-focused cognitive-behavioral therapy, Eye Movement Desensitization and Reprocessing (EMDR), group therapy, virtual reality-based exposure techniques, and psychoeducation programs have been found to be effective. Early psychological assessment, timely referral to appropriate intervention programs, and strengthening social support networks are crucial for preventing chronicity and promoting well-being. In conclusion, this review underscores that traffic crashes generate not only physical but also significant psychological and societal consequences. The assessment of multidimensional post-traumatic responses, the identification of risk and protective factors, and the implementation of evidence-based interventions address critical gaps in the literature and make substantial contributions to reducing the psychosocial burden associated with traffic accidents.

PMID:41985390 | DOI:10.1016/j.injury.2026.113277

Injury. 2026 Apr 10;57(6):113283. doi: 10.1016/j.injury.2026.113283. Online ahead of print.

ABSTRACT

BACKGROUND: Acute spinal cord injuries (SCIs) remain a devastating consequence of trauma. Treatment may involve administration of neuroprotective agents, surgery, and hemodynamic management. Hemodynamic management entails setting specific mean arterial pressure (MAP) goals to optimize perfusion of the spinal cord. Maintenance of MAP typically requires monitoring in the intensive care unit (ICU) and may necessitate vasopressor medications. This treatment utilizes significant resources. The objective of this study was to determine whether vasopressor requirements during the initial days of ICU admission are predictive of future need for these medications to maintain MAP goals in patients with SCI.

METHODS: A retrospective review of a prospective database was performed to identify all adult patients who presented to a Level 1 academic medical center with SCI between 2016 and 2024. Patients were included if they were between the ages of 18 and 89, had a cervical or thoracic spinal cord injury, and were managed with a MAP goal of at least 85 mmHg for five days. Patients with injury to the conus medullaris or cauda equina were excluded. Data collected included baseline demographics, mechanism of injury, ICU admission details, MAP measurements, and vasopressor use. Fisher's exact test was used to calculate predicted probabilities for subsequent vasopressor administration.

RESULTS: A total of 98 patients (median age 62.5 years, range: 18-89 years) were identified. Most patients (90.1%, n = 82) had an SCI involving the cervical spine. The median ICU length of stay was 6 days (range: 1-92 days). Among patients who did not require vasopressors within the first two days of ICU admission (n = 27), 88.9% (n = 24) did not require them subsequently. Furthermore, all patients (n = 24, 24.5%) who did not require vasopressors within the first three days of ICU admission did not need them thereafter.

CONCLUSION: Patients with SCI who did not require vasopressors to maintain a MAP of at least 85 mmHg during the initial two days of ICU stay were unlikely to subsequently need them. This finding can assist providers in improving resource allocation and bed assignment for patients with SCI in the ICU.

LEVEL OF EVIDENCE: III.

PMID:41985389 | DOI:10.1016/j.injury.2026.113283