Injury. 2025 Nov;56 Suppl 1:112687. doi: 10.1016/j.injury.2025.112687.

ABSTRACT

Firearm-related vascular trauma is a significant public health issue in Cape Town, South Africa, where gunshot wounds (GSWs) are a leading cause of penetrating extremity injuries. This commentary reviews the experience of Groote Schuur Hospital's Trauma Centre in managing extremity arterial injuries due to GSWs. Groote Schuur Hospital is a tertiary academic institution situated in Cape Town, South Africa. As one of the country's foremost teaching hospitals, we serve a population of approximately 4 million people from the greater Cape Town metropolitan area and surrounding regions. On average, we manage approximately 1000 trauma patients per month, including both blunt and penetrating trauma. We are a designated Level 1 Trauma Centre, offering comprehensive emergency trauma care. Our facility is equipped with advanced imaging modalities, including Lodox full-body radiography, standard X-rays, CT scanning, MRI, and interventional radiology. We also have 24-h access to fully staffed and operational trauma theatres, ensuring timely surgical intervention when required. The institutional approach emphasizes life-saving interventions, restoration of perfusion, limb preservation, and function. Vascular trauma, though infrequent, is more common in penetrating than blunt injuries, with the brachial and femoral arteries most commonly affected. Patient management is dictated by hemodynamic status and limb viability, using ATLS® principles and tools like the ankle-brachial index (ABI), arterial pressure index (API), duplex ultrasound, and computed tomography angiography (CTA). While open surgery remains the cornerstone for definitive repair, endovascular techniques are increasingly utilized in selected cases. Fasciotomy plays a critical role in preventing compartment syndrome in high-risk patients. Outcomes are influenced by injury severity, time to intervention, and associated injuries, with delayed care contributing significantly to limb loss and mortality. Although patient and limb survival is achievable with timely management, long-term complications, including graft failure, chronic pain, and psychological impact, are common. Improving outcomes requires systemic investment in trauma care, from prehospital triage to post-operative rehabilitation and follow-up.

PMID:41173560 | DOI:10.1016/j.injury.2025.112687

Injury. 2025 Nov;56 Suppl 1:112782. doi: 10.1016/j.injury.2025.112782.

NO ABSTRACT

PMID:41173559 | DOI:10.1016/j.injury.2025.112782

Injury. 2025 Nov;56 Suppl 1:112773. doi: 10.1016/j.injury.2025.112773. Epub 2025 Sep 22.

ABSTRACT

Acute Compartment Syndrome (ACS) is a time-critical, limb-threatening condition best characterized by increased intracompartmental pressure that compromises tissue perfusion, leading to ischemia, hypoxia, and ultimately irreversible necrosis. Fractures to the extremities account for >80 % of all ACS cases, and those involving the tibia account for more than two-thirds of all ACS cases. Open fractures and those secondary to high-energy trauma and penetrating injuries like gunshots are at higher risk of ACS. Despite decades of research and technological advancement, early diagnosis has remained a significant clinical challenge due to the nonspecific symptoms and the absence of a definitive diagnostic gold standard. This review aims to provide a comprehensive overview of the pathophysiology, risk factors, diagnostic modalities, and current challenges associated with ACS. It emphasizes the importance of shifting the diagnostic paradigm from binary criteria toward objective outcome-based clinical decision-making. ACS should be redefined as a pathophysiological continuum rather than a binary diagnosis. Accurate, early recognition, and timely intervention are crucial for minimizing long-term morbidity. Future diagnostic approaches should prioritize objective markers of tissue health and clinical outcomes over static thresholds. Several learned bodies have recommended continuous pressure measurement, which is seen in the newer literature as highly accurate. Continued research is needed to develop standardized classification systems or treatment protocols.

PMID:41173558 | DOI:10.1016/j.injury.2025.112773

Injury. 2025 Nov;56 Suppl 1:112753. doi: 10.1016/j.injury.2025.112753.

ABSTRACT

BACKGROUND: The optimal treatment for intracapsular neck of femur fractures secondary to civilian gunshot injuries (GSI) remains a challenge. Surgical fixation is associated with a high failure rate due to avascular necrosis and non-union. This manuscript reports on the largest series of patients who underwent total hip arthroplasty (THA) for civilian GSI involving the hip joint. The objectives are to assess clinical outcomes and to report on complications as well as associated injuries.

METHODS: All patients who had undergone THA for a civilian GSI to the hip joint at a single Level 1 Trauma Centre from 2009 -2022 were included. Patients with incomplete clinical records were excluded.

RESULTS: A total of 14 patients were identified, and all were males with an average age of 32 years (range 18-49). The mean follow-up time was 20 months (range 2 - 108). Ten of these patients received acute primary THA, whilst 4 had delayed THA for failed open reduction and internal fixation. The average time to surgery for the acute group was 7,6 days (range 3 - 14) and for the delayed group it was 39 months (range 10 - 120). Visceral injuries, mostly bowel and bladder, and other pelvis ring fractures, were the most commonly encountered associated injuries. One patient (7%) developed prosthetic joint infection (PJI) within 2 weeks of acute primary THA, despite negative microbiological samples obtained at index THA. He had associated large bowel injury, caused by a different projectile with no direct communication with the hip joint. No patients presented with PJI in the delayed group. In the delayed THA cohort, the mean pre-operative Harris Hip Score (HHS) was 53.2 points, and the mean postoperative HHS at 6 months was 85.5 points.

CONCLUSION: Total hip arthroplasty is a safe and feasible option for these complex injuries that carry poor surgical fixation outcomes. THA can be performed both in the acute setting, or in a delayed manner following failed surgical fixation.

PMID:41173557 | DOI:10.1016/j.injury.2025.112753

Injury. 2025 Nov;56 Suppl 1:112750. doi: 10.1016/j.injury.2025.112750.

ABSTRACT

Pathophysiology and incidence for VTE: Deep vein thrombosis and pulmonary embolism, collectively referred to as venous thromboembolism (VTE), represent significant complication in trauma patients, particularly in combat settings where injuries often involve high-energy mechanisms such as blasts and ballistic trauma. Combat casualties face additional risks less prevalent in civilian settings, including early transfusion of blood products, the use of fresh frozen plasma outside of large volume blood transfusions, the use of tourniquets and multiple or above-knee amputations, contributing to the higher VTE incidence in military subgroups. The incidence of VTE in civilian patients who sustain firearm injuries is not available in the literature. Risk factors and scores for VTE: Trauma Embolic Scoring System (TESS) stands out as the most validated and effective clinical tool that assesses the risk of VTE for combat casualties due to its sensitivity in military trauma settings, addressing factors like shock and major leg injuries. Thromboprophylaxis strategies and guidelines: Guidelines for preventing VTE in patients suffering combat gunshot wounds emphasizes early prophylaxis, typically within 24 h of injury, using both mechanical and chemical methods.

PMID:41173556 | DOI:10.1016/j.injury.2025.112750

Injury. 2025 Nov;56 Suppl 1:112787. doi: 10.1016/j.injury.2025.112787.

ABSTRACT

Low energy gunshot wounds (GSW) sustained in the civilian setting are an increasing burden on the orthopaedic and trauma services. They differ significantly in presentation and therefore treatment when compared to high energy injuries. Initial assessment should focus on assessment of life-threatening blood loss, early antibiotics, soft tissue injury and possible associated injuries (vascular and neurological). Fracture patterns differ from blunt injuries, and this should be considered when planning surgical fixation where appropriate. There is controversy regarding surgical debridement of the bullet tract, but possible iatrogenic complications should be considered with simple entry and exit wounds. Bullets need only be removed when retained metal is exposed to synovial fluid or cerebrospinal fluid. Consensus and high-level multicentre trials are required in future to better guide our assessment and management of these unique, but increasingly more common injuries.

PMID:41173555 | DOI:10.1016/j.injury.2025.112787

Injury. 2025 Nov;56 Suppl 1:112665. doi: 10.1016/j.injury.2025.112665.

ABSTRACT

Civilian firearm violence is a significant healthcare burden and particularly fractures after gunshot injuries are at risk for fracture related infection (FRI). This risk has been reported between 3.6 and 22 % in different retrospective case series. A central question is how to prevent this complication after ballistic injuries. Antibiotic prophylaxis - or better preemptive antibiotic therapy - should be applied early and recent data do not show benefits for long duration. A recent paper demonstrated that prophylactic antibiotic administration for ≥48 h is unwarranted for patients with ballistic fractures to the extremities and may even be associated with a higher infection risk. Three days of preemptive antibiotic therapy or even 24 h was not inferior compared to longer-duration therapy in the development of infectious sequelae after gunshot fractures to the pelvis. The microbiological profile of FRIs following gunshot injuries is diverse, though Gram-positive pathogens dominate but also polymicrobial infections are of significance. Narrow-spectrum agents, such as cefazolin or clindamycin, showed comparable effectiveness compared to extended gram-negative coverage in uncomplicated case in the absence of visceral involvement or gross contamination. However, in cases with bowel injuries or other high-risk features, broader-spectrum therapy may still be justified. A further important question is whether or not retained bullied fragments should be removed. Recent data showed a statistically significant increased risk of FRI when retained bullied fragments are not removed at the time of internal fracture fixation. Treatment of FRI after gunshot injuries should be based on the recently developed diagnostic, classification and treatment principles of FRI in general. This includes a straight forward diagnostic approach using suggestive and confirmatory criteria. Treatment strategy should rely on a multidisciplinary approach, including all relevant disciplines, e.g. plastic surgery, microbiology, infectious disease etc. Treatment goal is the infection free consolidation of the fracture with good function of the limb with restoration of quality of life, including psycho-social health of the patient.

PMID:41173554 | DOI:10.1016/j.injury.2025.112665

Injury. 2025 Nov;56 Suppl 1:112604. doi: 10.1016/j.injury.2025.112604.

ABSTRACT

INTRODUCTION: In South Africa, the prevalence of violent crime, especially involving firearms, poses a significant public health challenge, particularly when it affects children. Previous studies showed a decrease in paediatric civilian gunshot injuries following the introduction of the 2004 Firearms Control Act This study aims to describe the epidemiology, injury patterns, management, and outcomes of paediatric gunshot wounds (GSWs) at a tertiary paediatric referral centre in Cape Town over 10 years (2011-2020).

METHODS: A retrospective cross-sectional analysis was performed on children aged 0-12 years presenting to the Red Cross War Memorial Children's Hospital (RXH) in Cape Town with gunshot injuries from 1 January 2011 to 31 December 2020. The data were drawn from the ChildSafe database and hospital. Detailed demographic, clinical, management, and outcome data were extracted from hospital records and ancillary databases. Descriptive statistics, linear regression, and Chi-square tests were used for analysis.

RESULTS: A total of 236 paediatric firearm injury cases were identified, representing 0.3 % of all trauma cases during the study period. The annual incidence of GSWs increased significantly (+2.69 cases/year, p < 0.01). Crossfire accounted for 56.4 % of injuries, with a significant upward trend over the decade (p = 0.04). Most injuries occurred in males (56.8 %) and children aged 5-9 years (44 %). Extremity injuries were most common (50.3 %), but head and chest injuries were significantly associated with ICU admission (p < 0.001), mortality (p < 0.001), and resultant morbidity (p < 0.01). Eleven deaths were recorded (4.7 %), predominantly from isolated head injuries. Surgery was performed in 114 cases during first admission; 35 patients experienced complications, and 29 sustained resultant long-term morbidities including paralysis, traumatic brain injury sequelae, and vision loss. Crossfire was significantly associated with increased weekend incidence (p < 0.001) but paradoxically associated with lower mortality (p < 0.01).

CONCLUSION: Paediatric firearm injuries in Cape Town have increased over the past decade, with crossfire in gang-affected communities being a contributing factor. Despite legislative controls, these injuries remain a growing public health crisis with high rates of complications, disability, and mortality-particularly in cases involving the head and chest. A multi-sectoral approach encompassing violence prevention, community intervention, trauma care optimization, and improved surveillance is recommended.

PMID:41173553 | DOI:10.1016/j.injury.2025.112604

Injury. 2025 Nov;56 Suppl 1:112534. doi: 10.1016/j.injury.2025.112534.

ABSTRACT

After years of preparatory work, the implementation of bone-anchored prosthesis (BAP) for individuals with lower limb amputation started in 2009 in The Netherlands. Since then, several developments took place in indications, surgical techniques, implants, rehabilitation programs, and aftercare. In this article, we describe our journey and the lessons learned with BAP in the last 16 years. Although numerous positive developments have taken place, there remains both room and necessity for further improvement.

PMID:41173552 | DOI:10.1016/j.injury.2025.112534

Injury. 2025 Nov;56 Suppl 1:112535. doi: 10.1016/j.injury.2025.112535.

ABSTRACT

The management of complex limb injuries has evolved from a survival-focused approach to one emphasizing functional preservation, patient autonomy and reintegration. Historically, high amputation rates were due to limited vascular repair techniques and prolonged ischemia, particularly during World War II. Pioneering vascular interventions during the Korean and Vietnam Wars, coupled with advances in evacuation and early stabilization, significantly improved limb salvage outcomes. The advent of microsurgery and the orthoplastic approach further revolutionized treatment, facilitating early soft tissue coverage and biologically robust reconstructions. Despite these advancements, modern conflicts - especially those involving improvised explosive devices - present challenges of scale, resource constraints and delayed evacuations, necessitating flexible, phase-based care strategies. Contemporary decision-making increasingly involves patient-centered shared consent processes and must balance surgical feasibility with psychosocial and rehabilitative factors. Studies such as METALS and LEAP highlight that elective amputation may yield comparable, if not superior, outcomes in some cases, especially when supported by advanced prosthetic technologies. This review advocates for a strategic orthoplastic framework where early biological reconstruction, rather than anatomical perfection, guides decision-making. Rehabilitation is reframed as a parallel and integral process rather than a post-surgical adjunct, beginning from the acute phase and continuing iteratively throughout recovery. Utilizing ICF-based tools and patient-reported outcome measures allows individualized goal-setting and dynamic evaluation. Moreover, holistic rehabilitation - especially in military settings - demands interdisciplinary collaboration, early planning, and recognition of personal and environmental factors. Rehabilitation-specific counselling is crucial for both upper and lower extremity injuries, particularly given the psychological, functional, and social consequences of amputation or salvage. Ultimately, successful outcomes hinge not solely on surgical excellence but on the integration of rehabilitation planning, shared decision-making, and patient empowerment throughout the continuum of care.

PMID:41173551 | DOI:10.1016/j.injury.2025.112535

Injury. 2025 Nov;56 Suppl 1:112533. doi: 10.1016/j.injury.2025.112533.

ABSTRACT

INTRODUCTION: The incidence of civilian gunshot injuries is on the rise worldwide. Unfortunately, there is a lack of high-level evidence guiding management. The treatment of orthopaedic injuries from gunshots is complex and requires consideration of multiple aspects, including energy transfer to the tissue, severity of the wound, possible contamination, presence of fractures and associated injuries. Our study aimed to describe the variations in the treatment of GSW fractures across orthopaedic units across South Africa, a country with a high burden of GSW injuries.

METHODS: The gunshot-related injuries in trauma (GRIT) study was a snapshot study by a multicentre research network in South Africa. During the study period, a survey was distributed to the participating units. The aim was to determine variations in practice in certain key aspects of the management of GSW fractures across South Africa.

RESULTS: Twenty-three units representing all nine provinces in South Africa responded to the survey. All responding units managed gunshot injuries. The results showed great variation in the management in the bullet tract. While all units administered prophylactic antibiotics, there was no consensus on the duration. In a simulated case of a lower limb long bone fracture caused by a low-velocity gunshot, most units (n-18) indicated that they would manage the fracture with an intramedullary nail.

CONCLUSION: In South Africa, a country with a high burden of GSW injuries, there is substantial variability in the management of GSW fractures, especially of the long bones of the lower limb. Across participating units, there were variations in the treatment of the GSW tract, duration of prophylactic antibiotics and choice of fixation.

PMID:41173550 | DOI:10.1016/j.injury.2025.112533

Injury. 2025 Oct 24;56(12):112839. doi: 10.1016/j.injury.2025.112839. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior pelvic ring injuries frequently involve obturator ring disruption. With advancements in surgical techniques and rising patient expectations, there is growing interest in repairing these injuries within anterior pelvic ring treatment strategies. While current approaches (e.g., transabdominal, ilioinguinal) are used, they present limitations. This study describes a Modified Lateral-Perineal Approach (MLPA) for treating obturator ring fractures.

METHODS: We retrospectively reviewed 22 pelvic fracture patients with obturator ring injuries that had been treated via the MLPA. All patients underwent open reduction and internal fixation (ORIF) between June 2019-June 2024. According to the Tile classification, there were 16 type B fractures and 6 case of type C fractures. All patients had a reduction and fixation to the fracture of the superior pubic ramus and inferior ramus of pubis-ischium ramus. Incision length, operative time, blood loss, time to sitting/weight-bearing, union time, adductor strength (MRC 0-5), satisfaction and complications were recorded. The quality of fracture reduction was evaluated according to Matta radiographic criteria. The pelvic function was evaluated according to Majeed Pelvic Score at the last follow-up.

RESULTS: Twenty-two patients (10 male, 12 female; mean age 49.7 ± 13.7 years) were included. Mean follow-up was 15 ± 3 months. Mean surgical parameters: incision length 8.5 ± 1.1 cm, operative time 106.4 ± 23.4 min, blood loss 89.1 ± 41.2 mL. All achieved "excellent" Matta scores. Functional recovery: sitting at 6.6 ± 3.4 days, partial weight-bearing at 15.7 ± 7.2 days, full weight-bearing at 8.9 ± 2.5 weeks. Radiographic union occurred at 9.5 ± 2.4 months. One-year Majeed score averaged 88.5 ± 4.5. Adductor strength was MRC grade IV in 3 patients and V in 19. All patients expressed satisfaction. There were no complications of nonunion, internal fixation failure, vascular injury, nerve palsy, or hernia. All of the patients were esthetically satisfied with the scar.

CONCLUSION: The MLPA provides a safe and effective simultaneous exposure of the obturator ring's key structures: the superior pubic ramus, inferior ramus of pubis-ischium ramus. The advantage of this approache to repair the obturator ring include safety, simplicity, early weight-bearing, aesthetics, and satisfactory clinical efficacy with a low incidence of complications.

PMID:41172618 | DOI:10.1016/j.injury.2025.112839

Int Orthop. 2025 Oct 31. doi: 10.1007/s00264-025-06685-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Two-stage revision of total hip arthroplasty (THA) remains the gold standard for periprosthetic joint infection (PJI). Trabecular Metal (TM) offers a valuable option for acetabular reconstruction, but evidence in septic revision THA (rTHA) is scarce. This study evaluated outcomes of TM implants in two-stage rTHA for infection, hypothesizing results comparable to existing literature, especially in cases with major bone loss.

MATERIALS AND METHOD: We retrospectively analyzed 32 two-stage rTHA (32 patients) performed between January 2010 and July 2021, with a minimum two years follow-up. All patients received TM acetabular implants. Bone loss was classified according to Paprosky: 3 IIA, 8 IIB, 3 IIC, 12 IIIA, and 6 IIIB, with pelvic discontinuity in 13 cases.

RESULTS: At mean follow-up of 30.2 ± 10.9 months (range, 24 to 69), infection eradication was achieved in 87,5%. Staphylococcus species accounted for 84,4% of cases. Seven complications occurred, including six reoperations: five revisions (two for recurrent infection, 3 for mechanical failure). The overall failure rate was 21,9%. At 24 months, the healing rate, including all causes of failure, was 78,1% and revision-free rate 84,4%.

CONCLUSION: TM implants in two-stage rTHA for septic failure achieved satisfactory mid-term results, even in advanced acetabular bone loss (44% Paprosky II, 56% Paprosky III). To our knowledge, this is the first study exclusively evaluating TM in this context, supporting its role in complex acetabular reconstruction during septic revisions.

LEVEL OF EVIDENCE: IV.

PMID:41168498 | DOI:10.1007/s00264-025-06685-z

Injury. 2025 Oct 17:112816. doi: 10.1016/j.injury.2025.112816. Online ahead of print.

ABSTRACT

BACKGROUND: Blunt splenic trauma in children is increasingly managed non-operatively (NOM), given the spleen's critical role in immune function and the high success rate of NOM. While the immunodeficiency following splenectomy is well-established, the long-term immune outcomes after NOM for high-grade splenic injuries remain underexplored in pediatric patients.

METHODS: A matched-pair case-control study was conducted, including children under 18 treated with NOM for AAST grade III-V blunt splenic injuries between 2013 and 2023, and age-, sex-, and year-matched controls with acute appendicitis. Data on demographics, medical history, infection-related outcomes, and healthcare utilization were collected from medical records, national health databases, and caregiver questionnaires.

RESULTS: Sixty children with high-grade splenic injuries were matched with 60 controls. Over a mean follow-up of 5.4 years, infection rates, including pneumonia and otitis media, were comparable between groups. No cases of overwhelming post-splenectomy sepsis or positive blood cultures were reported. Antibiotic use was similar (31% in the NOM group vs. 24% in controls, p=0.52).

CONCLUSIONS: Non-operative management of high-grade blunt splenic injuries in children is associated with infection rates comparable to healthy controls, suggesting that splenic immune function may not be significantly compromised. These findings suggest there is no need for vaccination and prophylactic antibiotic treatment in this population. Further research incorporating laboratory assessments is warranted to validate and refine long-term management strategies.

PMID:41162235 | DOI:10.1016/j.injury.2025.112816

Int Orthop. 2025 Oct 29. doi: 10.1007/s00264-025-06677-z. Online ahead of print.

ABSTRACT

OBJECTIVE: Debridement, antibiotics, and implant retention (DAIR) is a widely used surgical approach for managing acute prosthetic joint infection (PJI) following knee arthroplasty (KA). However, limited studies have explored its application across different KA types. This study aims to compare the clinical outcomes of DAIR in acute PJI following unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA), with a focus on microbial profiles, treatment characteristics, and patient outcomes.

METHODS: We retrospectively reviewed clinical data from 67 consecutive patients diagnosed with acute PJI, as defined by the Musculoskeletal Infection Society (MSIS) criteria, who underwent DAIR at our institution between January 2016 and April 2023. Patients were categorized into two groups based on the type of primary arthroplasty: 51 in the TKA-DAIR group and 16 in the UKA-DAIR group. Comparative analyses included pre- and postoperative serological inflammatory markers, microbiological findings, knee functional outcomes, and infection recurrence rates.

RESULTS: Coagulase-negative staphylococci were the most frequently isolated organisms in both the TKA-DAIR (37.3%) and UKA-DAIR (43.8%) groups. On postoperative day one, ESR and CRP levels showed no significant differences between groups. However, by postoperative day three, the UKA-DAIR group exhibited significantly lower ESR (P = 0.005) and CRP (P = 0.007) levels, a trend that persisted through day five (ESR, P = 0.014; CRP, P = 0.015). At two year follow-up, there were no significant differences between groups in HSS knee scores (P = 0.107), VAS pain scores (P = 0.531), or range of motion (ROM; P = 0.128). Notably, Kaplan-Meier survival analysis demonstrated a significantly lower infection recurrence rate in the UKA-DAIR group over the two year follow-up period (P = 0.041).

CONCLUSION: In cases of acute PJI following UKA, where MRI confirms that the contralateral compartment remains uninvolved and the causative pathogen is clearly identified, DAIR yields superior clinical outcomes compared to TKA. This may be attributed to the reduced prosthetic surface area in UKA and the retention of native cartilage, which may serve as an effective barrier against infection. Based on these findings, we recommend DAIR as the preferred treatment strategy for acute UKA PJI under these conditions.

PMID:41152479 | DOI:10.1007/s00264-025-06677-z

Injury. 2025 Oct 20;56(12):112837. doi: 10.1016/j.injury.2025.112837. Online ahead of print.

ABSTRACT

AIM: The presence of bacteria in bones may lead to osteolysis, potentially compromising fracture healing. While radiographic assessment is essential for identifying osteolysis, the relationship between causative pathogens and visible radiolucency in fracture-related infections (FRI) remains poorly understood. This study aimed to evaluate the association between causative organisms, host factors, and radiographic osteolysis in unhealed FRIs.

METHODS: This retrospective study included 79 patients with unhealed FRIs, with available microbiological data and serial radiographs from the time of initial fracture fixation to index surgery for infection. Osteolysis was scored using a modified Mirel's-based severity scale, classifying cortical, medullary, and combined bone loss relative to adjacent normal bone. Pathogens were categorized as: (1) Gram-negative bacteria (GN), (2) Staphylococcus aureus, (3) other Gram-positive bacteria (GP), (4) polymicrobial (PM) (Gram-positive and Gram-negative bacteria), and (5) culture negative (CN).

RESULTS: Patients had a median of two radiographs (IQR 1.5-4) over a median of 81 days (IQR 28-216), after fracture fixation. Host factors were not associated with osteolysis severity. The 79 cases were distributed as: 17 GN, 19 S. aureus, 17 GP, 17 CN, and 9 PM infections. All pathogens induced degrees of osteolysis but the progression of bone loss over time was different between groups. Gram-negative infections showed the fastest and most aggressive bone loss, with a 4.3-fold increase in osteolysis severity compared to CN cases (p = 0.001). S. aureus and polymicrobial infections showed 1.8- and 2.9-fold increases, respectively.

CONCLUSION: Gram-negative pathogens pose significant clinical challenges and there is an urgent need to broaden the focus on GN infections in FRIs. This study provides new clinical insights into the role of pathogen-specific osteolytic patterns in FRIs. Gram-negative bacteria exhibit the most rapid and destructive bone loss, emphasizing the need for early recognition and timely intervention. Radiographic osteolysis appearing early should raise suspicion for GN infections. These findings also highlight the need for basic science models to expand beyond S. aureus and better address the underexplored osteolytic potential of GN organisms.

PMID:41151183 | DOI:10.1016/j.injury.2025.112837

Injury. 2025 Oct 19;56(12):112838. doi: 10.1016/j.injury.2025.112838. Online ahead of print.

ABSTRACT

PURPOSE: To assess whether weight-bearing impaction of the femoral head may be a valid predictor of joint failure in patients with geriatric acetabular fractures treated with open reduction and internal fixation (ORIF).

METHODS: We retrospectively analyzed data from consecutive elderly patients (including 60 men and 52 women) with acetabular fractures treated with ORIF between January 2015 and January 2022 at the largest orthopedic hospital in western China. The patients had an average age of 69.9 years. Preoperative and postoperative computed tomography scans were evaluated for the presence of medial displacement of the femoral head and femoral head impaction. Impaction of the femoral head was identified on coronal-plane CT images and then classified based on its anatomic characteristics as large, medium, or small. To determine whether total hip arthroplasty (THA) was eventually required over a 24-month follow-up period, binary logistic regression analyses were performed to assess whether impaction of the femoral head was an independent predictor of joint failure in patients with geriatric acetabular fractures treated by ORIF.

RESULTS: Impaction of the femoral head was found in 33.9 % (38 out of 112) of all geriatric acetabular fractures. Preoperative and postoperative radiological data, along with the characteristics of acetabular fractures, were compared between patients with impaction (group 1) and those without (group 2). There were no significant inter-group differences in the quality of reduction, acetabular dome impaction, and acetabular fracture type (P > 0.05). Medialization displacement of the femoral head was more frequent in group 1, being present in 76.3 % of weight-bearing impactions (29/38) compared with 23.7 % of those without medialization (9/38). This difference between the two groups was statistically significant. Large or medium impaction was present in 50.0 % (19 out of 38) of the patients with impaction and 84.2 % (16 out of 19) of the patients with joint failure, while small impaction was present in 50.0 % (19 out of 38) of the patients with impaction and 21.1 % (4 out of 19) of the patients with joint failure. Logistic regression analysis revealed that femoral head impaction was significantly and independently associated with a higher risk for joint failure (odds ratio 24.77, P < 0.001).

CONCLUSIONS: Femoral head impaction frequently occurs in geriatric acetabular fractures, and is a valid predictor of joint failure in patients with geriatric acetabular fractures treated with ORIF. The preferred treatment option for such patients is acute THA, especially if impaction is large or medium.

PMID:41151182 | DOI:10.1016/j.injury.2025.112838

Injury. 2025 Oct 19;56(12):112842. doi: 10.1016/j.injury.2025.112842. Online ahead of print.

ABSTRACT

BACKGROUND: Posterior pelvic ring restoration and stabilization are widely recognized as the primary goal in managing pelvic ring injuries. However, anterior pelvic ring (APR) stabilization is also essential in certain cases. Traditional methods, including open plating or intramedullary screw fixation alone, may be insufficient for addressing several challenging situations. The intramedullary screw and plate combination (SPC) technique for APR stabilization offers a feasible solution for these complex cases while achieving favorable clinical outcomes. Therefore, the present study aimed to introduce the SPC technique for APR stabilization and evaluate its clinical and radiological outcomes.

METHODS: This retrospective study analyzed the data of patients who underwent APR stabilization with the SPC technique at two urban university hospitals. The indications for the SPC technique included straddle fractures involving Nakatani zone III, symphysis pubis diastasis with ramus fractures, segmental ramus fractures, and cases requiring construct length augmentation. The radiologic and functional outcomes, including bone union, pelvic displacement index (PDI), symphysis pubis width (SPW), Matta and Tornetta grading, and Majeed scores, were assessed.

RESULTS: Altogether, 17 patients were included in the present study. Bone union was achieved in 94.12 % of the patients, with a mean union time of 3.88 ± 1.34 months. The PDI significantly improved from 1.10 ± 0.08 preoperatively to 1.05 ± 0.07 postoperatively (p = 0.015) and remained stable at the last follow-up. SPW showed a significant reduction postoperatively (p = 0.041) and remained stable at the last follow-up. According to the Matta and Tornetta grading system, 82.35 % of the patients demonstrated good or excellent outcomes, and the mean Majeed score was 93.19 ± 8.91. No implant-related complication was observed.

CONCLUSION: The SPC technique is a feasible and effective approach for stabilizing challenging APR injuries, offering favorable clinical and radiologic outcomes while minimizing the risks associated with traditional plating.

PMID:41151181 | DOI:10.1016/j.injury.2025.112842

Int Orthop. 2025 Oct 28. doi: 10.1007/s00264-025-06678-y. Online ahead of print.

NO ABSTRACT

PMID:41148295 | DOI:10.1007/s00264-025-06678-y

Int Orthop. 2025 Oct 28. doi: 10.1007/s00264-025-06686-y. Online ahead of print.

ABSTRACT

PURPOSE: Hemiarthroplasty with concentric glenoid reaming (ream-and-run [RnR] arthroplasty) may be considered in patients with glenohumeral arthritis who want to avoid activity restrictions of prosthetic glenoid components. However, there are concerns of glenoid wear and medialization following RnR. While the factors responsible for glenoid medialization are unclear, the presence of bacteria may lead to weakening and osteolysis of the glenoid bone. This study sought to correlate the presence and amount of Cutibacterium cultured from RnR arthroplasties that were revised with the amount of radiographic glenoid medialization.

MATERIALS AND METHODS: Patients who underwent open revision surgery after primary RnR with a minimum of six months between primary and open revision surgery were included. Semi-quantitative Cutibacterium load from cultures at the time of revision was calculated. Glenoid medialization was measured from radiographs taken post-primary RnR and before revision surgery. Glenoid medialization amount and rate were assessed against Cutibacterium presence and load.

RESULTS: Radiographs of 39 shoulders with average follow-up of 2.6 ± 2.4 years were analyzed. Twenty-five (64.1%) were culture-positive (≥ 2 positive deep cultures with Cutibacterium). Patients in the culture-positive and negative cohorts had similar glenoid wear rates of 1.4 and 1.3 mm per year, respectively (p = 0.892). There was no significant association between the amount of glenoid medialization and the presence or load of Cutibacterium.

CONCLUSIONS: We found no association between glenoid medialization after RnR arthroplasty and the presence or load of Cutibacterium at subsequent revision surgery. Longer follow-up studies are needed to better assess Cutibacterium's role in glenoid medialization after RnR arthroplasty.

LEVEL OF EVIDENCE: Level IV; Case Series.

PMID:41148294 | DOI:10.1007/s00264-025-06686-y