Int Orthop. 2026 Apr 13. doi: 10.1007/s00264-026-06807-1. Online ahead of print.

ABSTRACT

PURPOSE: Autologous osteoperiosteal transplantation (AOPT) from the iliac crest has been proposed as a potential treatment for large osteochondral lesions of the talus (OLTs). This single-arm study aims to prospectively evaluate the clinical, radiological, and arthroscopic outcomes of AOPT from the iliac crest in patients with large cystic OLTs.

METHODS: This is a prospective single-arm study. We evaluated 42 patients who underwent AOPT from the iliac crest for OLTs. The mean follow-up was 32.5 months. Clinical outcomes were assessed using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) scores, and Tegner activity scores. Radiologic outcomes were evaluated via X-ray, CT, and MRI. Arthroscopy was performed on a subset of patients for second-look evaluation.

RESULTS: Significant clinical improvements were observed, with VAS scores decreasing from 4.36 ± 1.76 to 0.45 ± 0.63, AOFAS scores increasing from 75.38 ± 13.52 to 95.33 ± 4.81, and Tegner scores increasing from 2.00 ± 0.99 to 4.10 ± 1.10. Postoperative imaging revealed the resolution of subchondral radiolucency, improvement of articular surface protrusion or collapse, graft integration with surrounding bone, and a reduction in marrow oedema. Follow-up arthroscopy demonstrated significant lesion repair, with cartilage-like tissue integrated into the talus. No complications, including infections or donor-site morbidity, were observed.

CONCLUSION: AOPT from the iliac crest is associated with favourable short- to mid-term clinical, radiological, and arthroscopic outcomes, with no complications observed in this series. These findings provide prospective evidence supporting the potential of AOPT from the iliac crest as a treatment option for large talar osteochondral defects.

PMID:41973114 | DOI:10.1007/s00264-026-06807-1

Injury. 2026 Apr 2:113212. doi: 10.1016/j.injury.2026.113212. Online ahead of print.

NO ABSTRACT

PMID:41968020 | DOI:10.1016/j.injury.2026.113212

Injury. 2026 Apr 10:113256. doi: 10.1016/j.injury.2026.113256. Online ahead of print.

NO ABSTRACT

PMID:41968019 | DOI:10.1016/j.injury.2026.113256

Injury. 2026 Apr 10:113248. doi: 10.1016/j.injury.2026.113248. Online ahead of print.

NO ABSTRACT

PMID:41968018 | DOI:10.1016/j.injury.2026.113248

Injury. 2026 Apr 3;57(6):113231. doi: 10.1016/j.injury.2026.113231. Online ahead of print.

ABSTRACT

BACKGROUND: Skiing and snowboarding are popular winter sports in the United States that attract millions of participants annually. Despite advancements in protective equipment and adoption, contemporary national data on trends, injury patterns, and resource utilization associated with ski and snowboard-related hospitalizations remains limited.

METHODS: Nonelective hospitalizations for ski and snowboard-related injuries were identified using the 2016-2022 National Inpatient Sample. Trends in hospitalization incidence and costs were assessed, alongside patient demographics, hospital characteristics, and injury patterns.

RESULTS: Of 13,105 cases, 79.5% comprised the Ski cohort, while 20.5% comprised the Snowboard cohort. From 2016 to 2022, the incidence of ski-related hospitalizations increased from 1235 to 1905 cases (p = 0.37; p = 0.03 excluding Covid-19 years), while the incidence of snowboard-related hospitalizations increased from 245 to 455 cases (p = 0.13; p = 0.09 excluding Covid-19 years). Annual costs rose from $29.4 million to $52.5 million for ski-related hospitalizations (p = 0.04), and $3.61 million to $9.20 million for snowboard-related hospitalizations (p = 0.07). Compared to snowboarders, skiers were older and were more commonly treated at hospitals in rural regions. Across both cohorts, the census divisions with the highest total inpatient costs were the Mountain division ($176 million) followed by the Pacific division ($63.8 million) and the New England division ($26.2 million). Following risk-adjustment, snowboarders were more likely to sustain a traumatic brain injury (Adjusted Odds Ratio [AOR] 1.36, 95% Confidence Interval [CI] 1.04-1.78) as well as fractures to the humerus (AOR 2.32, 95%Cl 1.48-3.63) and radius/ulna (AOR 2.52, 95%CI 1.56-4.07) in reference to skiers. However, snowboarders were less likely to experience femur (AOR 0.37, 95%CI 0.25-0.54) and tibia/fibula fractures (AOR 0.22, 95%CI 0.16-0.32). Moreover, snowboarders faced shorter length of stay (-0.54 days, 95%CI -0.81-(-0.27)) and reduced hospitalization costs (-$3500, 95%CI -5,500-(-1500)) compared to skiers.

CONCLUSIONS: Ski and snowboard-related hospitalizations and associated costs rose from 2016 to 2022. Understanding contemporary trends and injury patterns can help inform targeted prevention. Potential strategies include promoting helmet use, equipment maintenance, and enhanced care in rural regions, all of which may help reduce injury risk and healthcare costs.

PMID:41967156 | DOI:10.1016/j.injury.2026.113231

Injury. 2026 Apr 9;57(6):113265. doi: 10.1016/j.injury.2026.113265. Online ahead of print.

ABSTRACT

BACKGROUND: Optimal management of acetabular fractures remains controversial. Open reduction and internal fixation (ORIF) may be followed by post-traumatic degeneration and late conversion arthroplasty, whereas acute total hip arthroplasty (THA) may introduce implant-related risks. We compared short- and long-term outcomes after ORIF versus acute THA in a large, multicenter electronic health record cohort.

METHODS: We performed a retrospective cohort study using the TriNetX Network. Adults with isolated, closed, acute acetabular fractures treated with either ORIF or acute primary THA were identified. Patients were propensity score-matched (PSM) 1:1 on demographics and comorbidities. Outcomes were assessed at 90 days and at 1, 2, 5, and 10 years, including mortality, complications, health care utilization, and procedure-specific failures (for ORIF: nonunion, post-traumatic osteoarthritis, and conversion to THA; for THA: periprosthetic fracture, prosthetic joint infection [PJI], instability/dislocation, and mechanical complications).

RESULTS: After PSM, 3700 matched pairs comprised the early follow-up cohorts. At 90 days, ORIF was associated with higher mortality (5.2% vs 3.5%; OR 1.5; p < 0.0001) and higher rates of stroke, respiratory failure, venous thromboembolism, and ICU admission, whereas acute THA had higher emergency department visits (9.1% vs 5.3%; p < 0.0001) and hip pain (23.2% vs 13.2%; p < 0.0001). Over long-term follow-up, acute THA demonstrated higher implant-related complications at 2 years, including periprosthetic/implant fracture (3.0% vs 0.8%), PJI (6.8% vs 3.8%), instability (7.7% vs 3.0%), and mechanical complications (6.3% vs 3.5%) (all p < 0.0001), while overall reoperation rates were similar at 2 years (11.8% vs 11.2%; p = 0.53) and remained comparable through 10 years. In the ORIF cohort, nonunion reached 11.3%; conversion to THA increased from 4.3% at 2 years to 5.8% at 10 years; and post-traumatic osteoarthritis (PTOA) increased from 21.2% at 2 years to 27.2% at 10 years. Pre-index hip disease was markedly more common among acute THA patients (OA 51% vs 10%; AVN 14% vs 1%).

CONCLUSIONS: In this study, ORIF was associated with higher early mortality and systemic complications, whereas acute THA was associated with higher implant-related complications. Despite these differing complication profiles, cumulative reoperation rates were similar through long-term follow-up. Progressive PTOA and conversion to THA remain important sequelae after ORIF.

PMID:41967155 | DOI:10.1016/j.injury.2026.113265

Injury. 2026 Apr 10;57(6):113281. doi: 10.1016/j.injury.2026.113281. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical calculators are used to determine which trauma patients require computed tomography (CT) scans of the spine. However, mild traumatic spinal cord injury (TSCI) may be present despite a negative CT scan. Therefore, the present study sought to internally validate the use of two calculators (whole spine and cervical-only) to identify such patients.

METHODS: The Spinal Cord Injury Model System Program was used to conduct this retrospective cohort study. Patients at least 15 years old with an American Spinal Injury Association (ASIA) grade D injury due to blunt trauma were included. Patients with and without concurrent vertebral injury were considered CT-evident and CT-occult, respectively. A Firth's regression was used to establish β coefficients, which were converted into points to predict CT-occult TSCI. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated at the optimal point threshold.

RESULTS: This study included 589 patients (mean age = 54.1 ± 16.7), of whom 182 (31%) were CT-occult. In the all-injury level calculator, ages 30-70 added three points; ages 70+ added one point; fall injuries added one point; cervical level injury added seven points; clinical suspicion of central cord syndrome (CCS) added one point, whereas the presence of associated injuries deducted three points. At the seven-point cutoff, sensitivity was 97.3%, specificity was 21.9%, PPV was 35.8%, and NPV was 94.7%. The cervical calculator assigned one point for ages 45-60, fall injuries, and CCS, but deducted two points if there were associated injuries. At the zero-point threshold, sensitivity was 96.6%, specificity was 8.5%, PPV was 36.4%, and NPV was 82.4%.

CONCLUSIONS: The calculators demonstrated high sensitivity and may be invaluable adjuncts for assessing suspected CT-negative TSCI. External validation is necessary to determine their generalizability.

PMID:41967154 | DOI:10.1016/j.injury.2026.113281

Injury. 2026 Apr 9;57(6):113282. doi: 10.1016/j.injury.2026.113282. Online ahead of print.

ABSTRACT

PURPOSE: To report a single-center experience evaluating procedural performance and early imaging-based safety of CBCT-guided cement-augmented percutaneous pelvic fixation for fragility fractures.

MATERIALS AND METHODS: This retrospective cohort included 51 consecutive patients with pelvic fragility fractures who underwent CBCT-guided percutaneous screw fixation with cement augmentation between November 2023 and September 2025. Endpoints were technical success, operative time, radiation exposure, and adverse events. Exploratory analyses assessed associations between operative parameters and fracture classification, body mass index, number of entry sites, and number of screws.

RESULTS: A total of 76 screws were placed in 51 patients. Technical success was 100% (successful completion of planned screw placement). Mean operative time was 51.3 ± 14.1 min and increased with the number of screws (ρ = .368; adjusted P = .018) and the number of entry sites (ρ = .390; adjusted P = .015). Median DAP was 64.45 Gy·cm² (Q1-Q3, 50.35-103.85) and increased with operative time (ρ = .448; adjusted P = .004) and BMI (ρ = .480; adjusted P = .003). Two postoperative hardware-related adverse events required reintervention (modified CIRSE grade 3).

CONCLUSION: This retrospective single-center experience confirms reproducibility of CBCT-guided cement-augmented percutaneous pelvic fixation with 100% technical success. However, without patient-centered outcomes, comparative data, and systematic longer-term follow-up, clinical benefit cannot be assessed.

LEVELS OF EVIDENCE: This paper is Level IV / Level 4 of evidence.

PMID:41967153 | DOI:10.1016/j.injury.2026.113282

Injury. 2026 Apr 9;57(6):113276. doi: 10.1016/j.injury.2026.113276. Online ahead of print.

ABSTRACT

INTRODUCTION: Functional bracing is a common non-operative treatment for humeral shaft fractures. The effects of patient-specific soft tissue characteristics on fracture site biomechanics during bracing are poorly understood and may alter healing. This study leveraged finite element analysis (FEA) to characterize the impact of arm diameter and muscle-adipose composition on fracture site strain during bracing. In conjunction with other factors, researchers and clinicians may apply these findings toward optimizing outcomes in patients with humeral shaft fractures.

METHODS: Nine humerus FEA models were constructed with concentric cylindrical tubes representing fractured diaphyseal bone, muscle, adipose, and a plastic brace. Models had varying arm diameters (small, medium, and large, based on institutional data) and muscle-to-adipose tissue ratios (25%/75%, 50%/50%, 75%/25%). To simulate bracing and physiological bending movements, a uniform radial pressure (5.33 kPa) was applied to the brace, and a lateral force (40 N) was applied to the distal humerus with the proximal end fixed. Fracture site strain values were computed for each arm configuration. FEA findings were validated with biomechanical testing of a cadaveric arm that was braced and subjected to the same bending forces.

RESULTS: For a specific arm size, an increase in adiposity, as indicated by a lower muscle-to-adipose ratio, resulted in increased Perren strain values at the simulated fracture site. Furthermore, at a given ratio of muscle-to-adipose, an increase in arm size corresponded to a decreased level of strain experienced at the fracture site. Cadaveric biomechanical testing yielded comparable strain values to FEA models of similar arm composition.

DISCUSSION: These findings suggest that smaller diameter arms and increased adipose levels may increase fracture instability during functional brace treatment of humeral shaft fractures. Further, these findings may inform patient selection for functional bracing versus surgery for humeral shaft fractures or guide modifications to functional brace design.

PMID:41967152 | DOI:10.1016/j.injury.2026.113276

Injury. 2026 Apr 3:113213. doi: 10.1016/j.injury.2026.113213. Online ahead of print.

NO ABSTRACT

PMID:41966891 | DOI:10.1016/j.injury.2026.113213

Injury. 2026 Apr 2:113211. doi: 10.1016/j.injury.2026.113211. Online ahead of print.

NO ABSTRACT

PMID:41966890 | DOI:10.1016/j.injury.2026.113211

Injury. 2026 Apr 3:113240. doi: 10.1016/j.injury.2026.113240. Online ahead of print.

ABSTRACT

This correspondence addresses the recent study by Yeo et al., which identified polytrauma and night-time presentation as independent risk factors for missed injuries (MIs) in trauma patients. While acknowledging the study's contribution to trauma system evaluation, we highlight three critical methodological limitations that affect the interpretation of these findings. First, the significantly longer hospital stay in the MI group (41.3 days vs. 21.5 days) suggests a substantial detection bias, where prolonged hospitalization increases the likelihood of incidentally diagnosing Type II injuries. Second, a "history bias" exists due to the absence of orthopaedic trauma surgeons during the majority of the study period (2019-2023), which likely accounts for the prevalence of musculoskeletal MIs rather than night-time risk alone. Third, the broad definition of "night-time" (8:00 PM - 8:00 AM) conflates shift handover errors with circadian fatigue, obscuring the underlying mechanism of failure. We suggest that future research must control for length of stay and utilize granular time-series analysis to guide precise system-level interventions.

PMID:41966889 | DOI:10.1016/j.injury.2026.113240

Injury. 2026 Apr 6:113220. doi: 10.1016/j.injury.2026.113220. Online ahead of print.

NO ABSTRACT

PMID:41966888 | DOI:10.1016/j.injury.2026.113220

Injury. 2026 Apr 6:113228. doi: 10.1016/j.injury.2026.113228. Online ahead of print.

NO ABSTRACT

PMID:41966887 | DOI:10.1016/j.injury.2026.113228

Injury. 2026 Apr 7;57(6):113254. doi: 10.1016/j.injury.2026.113254. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic spinal injury (TSI) is a devastating condition with a disproportionately high burden in low-resource settings. Data on its management and outcomes in semi-urban Cameroon is limited.

OBJECTIVE: To describe and analyse the management and outcomes of TSI patients at the Buea Regional Hospital in Southwest Cameroon.

METHODS: A retrospective review was conducted for all TSI patients admitted between 2017 and 2022. Data on patient management, complications, mortality, and functional neurological improvement were collected and analysed using inferential statistics and modelling to identify associated factors.

RESULTS: 51 TSI patients aged 38.3±15.7 years were included. CT scan was the initial imaging in 63.7% of patients. Surgery was performed in 31.4% of cases, with a median time from injury to surgery of 31.0 (IQR: 13.0-41.1) days. In-hospital complication rate was 52.9% (95% CI: 38.6%, 66.8%), predominantly pressure ulcers and paralytic ileus (27.5% each). A multivariable model (Hosmer-Lemeshow P = 0.95; AUC=0.87) identified age >40 years (aOR=6.64) and delayed spine surgery (≥ 6 days post injury, aOR=84.8) as significant predictors of complications. Functional neurological improvement occurred in 27.9% (95% CI: 15.8%, 43.9%) of patients and was associated with non-cervical injuries (p = 0.03), specific initial Frankel grades A and C (p = 0.04), and administration of multi-vitamin/mineral medications (p = 0.007). The overall in-hospital mortality rate was 20.4% (95% CI: 10.7%, 34.8%), with higher mortality observed in patients over 40 (p = 0.03), those with cervical spine injuries (p = 0.004), and those presenting with urinary dysfunction (p = 0.04).

CONCLUSION: TSI care in our setting is associated with high complication and mortality rates, especially among older patients and those with delayed spine surgery. These critical challenges in TSI care suggest a possible need for targeted interventions to improve timeliness of care and complication prevention to enhance overall patient outcomes in this resource-limited setting.

PMID:41966794 | DOI:10.1016/j.injury.2026.113254

Injury. 2026 Apr 7;57(6):113255. doi: 10.1016/j.injury.2026.113255. Online ahead of print.

ABSTRACT

Achieving accurate reduction of a displaced hemipelvis in vertically unstable posterior pelvic ring injuries remains technically challenging. We describe a reproducible posterior reduction technique, termed the Anchored-Free Inter-Screw with Cobb Leverage (AFIS-CL) technique, which utilizes an anchored reference screw, a plate-independent free screw, controlled compression with a Jungbluth clamp, and adjunctive leverage using a Cobb's elevator. Reduction is performed through a posterior approach without skeletal traction, allowing direct intraoperative control of hemipelvic alignment. Sequential correction of vertical, anteroposterior, and rotational displacement is achieved under fluoroscopic guidance, followed by definitive posterior fixation while maintaining the achieved reduction. The technique was applied in five patients with vertically unstable posterior pelvic ring injuries. Satisfactory radiographic reduction was achieved and maintained in all cases without neurovascular complications, and no secondary displacement was observed at final follow-up. The AFIS-CL technique provides a practical and reproducible posterior reduction strategy that may facilitate three-dimensional correction and stable maintenance of reduction in vertically unstable pelvic ring injuries.

PMID:41966793 | DOI:10.1016/j.injury.2026.113255

Injury. 2026 Apr 8;57(6):113261. doi: 10.1016/j.injury.2026.113261. Online ahead of print.

ABSTRACT

INTRODUCTION: Hand fragility fractures are often excluded from routine osteoporosis screening, yet they may represent a sentinel event for future morbidity. This study aimed to assess the fracture risk profile of older adults presenting with hand fragility fractures, quantify the 'treatment gap' in current practice, and evaluate the utility of the Second Metacarpal Cortical Index (2MCI) as a pragmatic triage tool.

METHODS: A retrospective cohort study was conducted across three seasonal timepoints at a UK Major Trauma Centre. Patients aged ≥50 presenting with low-energy hand fractures were included. Fracture risk was stratified using the Fracture Risk Assessment Tool (FRAX) calculated retrospectively from primary care records. Care pathways were audited for DEXA referral and treatment initiation. 2MCI was measured on standard radiographs and correlated with FRAX and hip T-scores.

RESULTS: 134 patients were included (median age 71; 56% female). FRAX scoring classified 88% as intermediate, high or very high risk. Despite this, only 8% (11/134) of the total cohort underwent a DEXA scan. Of those scanned, 64% had osteopenia or osteoporosis. Eleven patients (8%) sustained subsequent fractures. 2MCI demonstrated excellent inter-rater reliability (ICC=0.81) and strong correlation with hip T-scores (r = 0.64). A 2MCI threshold of <45% yielded 100% specificity for detecting low bone mass, though sensitivity was limited.

CONCLUSION: Patients with hand fragility fractures represent a high-risk cohort that is currently underserved by osteoporosis screening pathways. While 2MCI shows promise as an adjunctive triage tool, the primary finding is a significant missed opportunity for secondary prevention. Hand surgeons should routinely consider fracture risk assessment in this population.

PMID:41966792 | DOI:10.1016/j.injury.2026.113261

Injury. 2026 Mar 30;57(6):113163. doi: 10.1016/j.injury.2026.113163. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric tennis participation has grown steadily, yet limited research exists on sex- and age-based injury differences in this population. Understanding these patterns can inform tailored injury prevention efforts.

MATERIALS AND METHODS: We queried the National Electronic Injury Surveillance System (NEISS) for tennis-related emergency department (ED) visits in patients under 18 years old from 2014 to 2023. Injuries were analyzed by sex, age group, injury type, and body region. National estimates (NEs) were calculated using NEISS sample weights. Statistical comparisons were performed to assess gender differences in injury patterns.

RESULTS: A total of 1679 pediatric tennis-related injuries were reported, corresponding to a national estimate of 48,368 cases based on the database's sample weighting system. Males accounted for 53.1% of injuries, with a peak incidence at age 14; females made up 46.9%, peaking at age 16. Significant sex-based differences emerged across multiple domains. Males were more likely to experience fractures (p < 0.001), lacerations (p < 0.001), and upper extremity injuries, particularly to the elbow, eyeball, and face. In contrast, females sustained more ankle injuries (p < 0.001) and had a higher prevalence of strains and sprains (p < 0.001). By age, males sustained significantly more injuries in elementary school years (p < 0.001), while females had more injuries during high school (p < 0.001).

DISCUSSION AND CONCLUSION: Distinct injury patterns exist between sexes in pediatric tennis injuries. Males more frequently experienced high-impact trauma, likely reflecting play style and biomechanics, while females showed a higher rate of lower extremity overuse injuries, especially at the ankle. These findings align with known neuromuscular and biomechanical differences in movement and landing strategies between sexes. The high rate of head and ocular trauma in males further supports the need for facial and eye protection in youth tennis. These findings support the need for sport and sex-specific injury prevention strategies which include neuromuscular training and protective equipment to promote safety among young tennis players.

PMID:41966791 | DOI:10.1016/j.injury.2026.113163

Injury. 2026 Apr 6:113229. doi: 10.1016/j.injury.2026.113229. Online ahead of print.

NO ABSTRACT

PMID:41963186 | DOI:10.1016/j.injury.2026.113229

Injury. 2026 Apr 9;57(6):113253. doi: 10.1016/j.injury.2026.113253. Online ahead of print.

ABSTRACT

BACKGROUND: Pelvic fractures, including pelvic ring fractures and acetabular fractures, are relatively rare but often severe and associated with a significant physical and societal burden. Outcome data on long-term health related quality of life (HRQoL) following pelvic fractures remains scarce. This study aimed to evaluate long-term HRQoL outcomes in a patient cohort with pelvic fractures up to 8 years post injury.

MATERIALS AND METHODS: A long-term prospective follow-up study of the Brabant Injury Outcome Surveillance (BIOS) pelvic fractures cohort was performed. HRQoL was assessed at 1, 2, and 8 years post injury using the EQ-5D-3L among adult patients (≥ 18 years) with pelvic fractures. Longitudinal trajectories of HRQoL and subgroup differences by sex, age, and trauma mechanism over time were assessed using linear mixed models.

RESULTS: Of the 184 included patients, the response rate was 86% (n = 159) at 1 year follow-up, 63% (n = 115) at 2 years follow-up, and 34% (n = 63) at 8 years follow-up. The mean EQ-5D-3L VAS score at 1 year follow-up was 74.8 (SD 16.2) and improved over time to a mean score of 78.0 (SD 16.6) at 2 years follow-up. At 8 years follow-up the mean EQ-5D-3L VAS has decreased to 72.7 (SD 20.4). The mean EQ-5D-3L index score was 0.80 (SD 0.24) at 1 year follow up. At 2 years follow-up, the mean EQ-5D-3L index score increased to 0.81 (SD 0.21) and plateaued thereafter with a mean score of 0.81 (SD 0.24) at 8 years follow-up. Pain/discomfort remained the most affected domain with almost half of patients reporting problems at 8 years follow-up. Female sex, higher ISS, and pre-injury health complaints were identified as significant risk factors for long-term limitations across multiple domains.

CONCLUSION: Although improvements in HRQoL were observed over time, persistent complaints and decreased HRQoL were reported at 8 years follow-up. These findings underscore the importance of monitoring HRQoL and tailored interventions to manage the ongoing impact of pelvic fractures on HRQoL.

PMID:41962197 | DOI:10.1016/j.injury.2026.113253