Injury. 2025 Apr 8;56(6):112328. doi: 10.1016/j.injury.2025.112328. Online ahead of print.

ABSTRACT

INTRODUCTION: Bone fractures are recognized as the second most prevalent cause of pain for patients seeking treatment in medical facilities. This study aims to evaluate the efficacy of intranasal and intravenous ketamine in comparison to intravenous morphine in alleviating severe pain in patients presenting to emergency departments with various bone fractures.

METHOD & MATERIAL: The clinical trial was conducted on patients over the age of 18 who presented at the emergency department of Imam Reza Educational and Medical Center with bone fractures. These patients were divided into three groups for treatment: intranasal ketamine at a dose of 1 mg/kg body weight, intravenous ketamine at a dose of 0.5 mg/kg body weight, and intravenous morphine at a dose of 0.1 mg/kg body weight. The severity of pain experienced by patients was documented using the numerical pain rating scale at the time of admission, and then at 15 min, 30 min, and 60 min after drug administration.

RESULTS: The results of the study revealed that there was no statistically significant difference in the efficacy of pain relief among the three study groups (p=0.77). The interaction of (time*type of drug) had no significant effect on pain intensity (p=0.58). There was no statistically significant difference in side effects reported by patients between the three study groups, with the intranasal ketamine group reporting only minor side effects.

CONCLUSION: The results of this study showed significant effects of intranasal ketamine and intravenous ketamine in reducing pain in patients with bone fractures. The findings further suggest that the analgesic effect of intranasal ketamine is comparable to that of intravenous ketamine and morphine, with no significant adverse effects observed.

PMID:40253928 | DOI:10.1016/j.injury.2025.112328

Injury. 2025 Apr 9;56(6):112326. doi: 10.1016/j.injury.2025.112326. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective study.

OBJECTIVES: To identify outcomes, in particular employment, >5 years following traumatic thoracic and/or lumbar fracture/s.

METHODS: 235 patients between the ages of 18 and 65 were identified from hospital radiology databases having sustained a traumatic thoracic and/or lumbar fracture on CT and/or MRI between 01/01/2013 and 31/12/2017. Questionnaires were sent via post and available emails, with a reminder letter and phone calls. Retrospective data was gathered about employment status pre-fracture and > 5 years post-injury.

RESULTS: 26 (11 %) patients died before follow-up, leaving 209 patients. 108 (52 %) were treated surgically and 101 (48 %) conservatively. 106 replies were received, with 85 (80 %) opting in and 21 (20 %) out. 68 (80 %) patients completed full questionnaires, and 17 (20 %) filled out a shortened questionnaire via phone conversation. Of the 85 enrolled patients, 52 (61 %) had undergone surgery, and 33 (39 %) had been treated conservatively. The mean follow-up time was 7.9 years (range 5-11 years). Prior to injury, 66 patients (78 %) were employed and 19 (22 %) unemployed (6 were full-time students, 8 retired). 49 (74 %) previously employed patients had returned to work at follow-up, with 35 (53 %) working the same or increased hours. Regarding employment, there was no significant difference between the treatment groups (p = 0.355) or the fracture classification (p = 0.303). 16 (19 %) patients reported back pain before their injury, whilst 69 (81 %) did not. There were 58 (68 %) cases of new pain, with the most affected area being the lumbar region in 43 (51 %) patients. 32 (38 %) patients reported neurological deficit post-injury: 19 with subjective symptoms, 9 objective symptoms and 4 suffered paralysis.

CONCLUSION: After 5 years or more following a traumatic thoracic and/or lumbar fracture, most individuals return to employment. There was no significant difference between the severity of the fracture or treatment on their employment outcomes.

PMID:40253927 | DOI:10.1016/j.injury.2025.112326

Injury. 2025 Apr 3;56(6):112329. doi: 10.1016/j.injury.2025.112329. Online ahead of print.

NO ABSTRACT

PMID:40250091 | DOI:10.1016/j.injury.2025.112329

Injury. 2025 Apr 8;56(6):112317. doi: 10.1016/j.injury.2025.112317. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Percutaneous screw osteosynthesis is the gold standard for managing sacral fragility fractures in geriatric patients with immobilizing pain. However, comparative evidence regarding the optimal type, length, or insertion position of sacroiliac screws remains limited.

PURPOSE: This study aimed to compare outcomes between long transsacral screws bridging both sacroiliac joints and short sacroiliac screws.

STUDY DESIGN/SETTING: Retrospective cohort single-center study.

PATIENT SAMPLE: Geriatric patients treated with percutaneous sacroiliac screws for sacral fragility fractures.

OUTCOME MEASURES: Primary outcome: screw loosening at 3-, 6-, and 12-month follow-ups.

SECONDARY OUTCOMES: surgical duration, postoperative pain, mobility improvement, and hospital stay length.

METHODS: Data from 122 patients (median age 81, 84 % female) treated between 2018 and 2021 were analyzed. Patients were categorized into three groups [1]: two long transsacral screws [2], a combination of one long and two short screws, and[3] four short sacroiliac screws. Fracture characteristics, FFP classification, and risk factors for screw loosening were evaluated.

RESULTS: Fractures were bilateral in 73 %, with FFP classifications of type 2 (48 %), type 3 (12 %), and type 4 (40 %). Anterior pelvic fractures were present in 63 %, comminuted fractures in 34 %, and H-type fractures in 29 %. Loosening rates were 17 % in the long-screw group, 6 % in the combination group, and 4 % in the short-screw group. Surgical duration was shortest for long screws (mean 52.6 min) compared to the combination (61.8 min) and short-screw (83.4 min) groups. Pain scores decreased below 5 in 88 % of patients at 3 months and 92 % at 12 months. Screw length was a significant risk factor for loosening (p = 0.04).

CONCLUSIONS: Long transsacral screws offer minimally invasive fixation with reduced surgical duration but higher loosening rates. Osteosynthesis with four short sacroiliac screws demonstrates superior long-term stability, making it a promising option for sacral fragility fractures.

PMID:40245455 | DOI:10.1016/j.injury.2025.112317

Injury. 2025 Apr 9:112321. doi: 10.1016/j.injury.2025.112321. Online ahead of print.

ABSTRACT

BACKGROUND: Multimodal pain control is the cornerstone of managing acute traumatic rib fractures. We employed surgeon-administered, ultrasound-guided percutaneous cryoneurolysis of intercostal nerves (USPCNIN) as an adjunct opioid-sparing analgesic modality at the bedside.

METHODS: This was a single-institution case series. Patients between 18-64 years of age who sustained traumatic rib fracture between ribs 3-9, deemed ineligible for surgical stabilization, and had pre-procedure numeric pain scores ≥5 underwent USPCNIN within 24 h of study enrollment by an attending chest wall surgeon. Primary outcomes were changes in daily narcotic use and numeric pain score from pre-intervention up to 30-day follow-up visits. Additional outcomes included hospital length of stay, procedure-related adverse events, and rib-specific readmission.

RESULTS: Fifteen patients were identified. Median (IQR) patient age was 52 (43, 58) years and four (27 %) were female. Median (IQR) number of rib fractures was 5 (4, 8). Median (IQR) hospital length of stay was 4 (3, 7) days. Daily opioid use (measured in morphine milligram equivalents, MME) and present pain intensity (PPI) decreased significantly from pre-intervention to hospital discharge (median MME 96.5 vs. 49.5, p = 0.043; median PPI 10 vs. 7, p = 0.020). Twelve patients completed 30-day follow-up and had significantly decreased MME and PPI from hospital discharge (median MME 62.3 vs. 5, p = 0.014; median PPI 6.5 vs. 3, p = 0.001). There were no complications directly attributable to the procedure. There were no rib-specific readmissions.

CONCLUSION: USPCNIN is a minimally-invasive, bedside procedure that can be safely performed by trauma surgeons and augment pain control for acute traumatic rib fractures.

PMID:40240230 | DOI:10.1016/j.injury.2025.112321

Injury. 2025 Apr 7:112331. doi: 10.1016/j.injury.2025.112331. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency finger thoracostomy (EFT) has been implemented in several European prehospital settings for intubated and ventilated patients with chest injuries. The indication for intervention in cardiac arrest and peri‑arrest situations is clear. EFT may also be applicable in ventilated but macrohemodynamically compensated patients. This study aims to help prehospital providers understand the benefits and applicability of EFT.

PATIENTS AND METHODS: A retrospective analysis was conducted consisting of 114 EFT cases over 53 months. All chest-injured patients had suspected intrapleural pathology and potential compensated obstructive shock state. Two groups were compared: I. Positive clinical finding after EFT: audible air (pneumothorax (PTX)) and/or blood (hemothorax (HTX)) (n = 85); II. Negative clinical finding: no audible air and/or blood escaping during the procedure (n = 29). The primary endpoint was the effect of EFT on the physiologic parameters. The secondary endpoint was the association between intrathoracic pathology observed during EFT and the physiologic effect.

RESULTS: In 75 % of all cases, after EFT, intrapleural pathology was detectable by on-site physical examination. After EFT SpO2 levels increased from 89.6 % (SD 10.7) to 94.9 % (SD 6.7) (p < 0.001). The other physiological parameters did not change significantly (p = 0.346 or higher). In subgroup analysis, there were appreciable increases in SpO2 for those with PTX or PTX with HTX, that were not seen in those with HTX alone or those with negative clinical findings (p < 0.001). No significant adverse effects of EFT were noted during the prehospital phase or in the hospital follow-up period.

DISCUSSION: EFT performed in ventilated patients with suspected compensated obstructive shock (and stable macrohemodynamic) resulted in audible air and/or blood escape and an improvement in oxygenation if PTX or PTX with HTX were the underlying pathology.

CONCLUSION: Performing an EFT should be considered not only for deteriorating obstructive shock state but also for potentially compensated shock. Even with diagnostic uncertainty, the benefits of an EFT may outweigh the risks.

PMID:40234110 | DOI:10.1016/j.injury.2025.112331

Injury. 2025 Apr 12:112323. doi: 10.1016/j.injury.2025.112323. Online ahead of print.

ABSTRACT

BACKGROUND: Neck reconstruction for burn sequelae can be effectively achieved through release procedures and lower abdomen skin transplantation. This article describes cases in which full-thickness skin grafts (FTSGs) from the lower abdomen were used as donor areas. Although the benefits of negative pressure wound therapy (NPWT) for graft integration are known, its dual use for recipient site preparation and intraoperative graft fixation, specifically in the neck, has been scarcely described. This study evaluates both applications of NPWT-preoperative wound bed optimization and intraoperative graft fixation-highlighting their combined impact on graft take and patient outcomes.

METHODS: Patients treated at a referral burn center between March 2021 and October 2023 with severe neck contractures underwent scar release and FTSG transplantation. Two techniques for graft fixation were compared: the traditional tie-over method and NPWT. Graft integration rates, necrosis percentages, and postoperative complications were assessed.

RESULTS: The study included six patients (tie-over group: 2; NPWT group: 4). The NPWT group demonstrated clinically favorable graft integration rates (92.5 %) and lower necrosis rates (7.5 %) compared with the tie-over group (76.5 % and 23.5 %, respectively). The NPWT technique also resulted in shorter hospital stays and fewer complications.

CONCLUSIONS: The combined use of NPWT for recipient site preparation and intraoperative graft fixation clinically improves graft integration and reduces complications in neck burn reconstruction. These findings suggest that NPWT should be considered a standard of care in settings where resources allow.

PMID:40222842 | DOI:10.1016/j.injury.2025.112323

Injury. 2025 Apr 1;56(6):112325. doi: 10.1016/j.injury.2025.112325. Online ahead of print.

ABSTRACT

BACKGROUND: Biologics, particularly platelet-rich plasma (PRP), have gained attention for promoting bone healing. This study assesses the efficacy of PRP-enhanced therapy in treating aseptic femoral shaft nonunion.

METHODS: This retrospective study analyzed patients who underwent femoral fracture nonunion revision surgery at a high-level trauma center between January 2021 and April 2024. Patients were divided into two groups: Group 1 (PRP-enhanced) and Group 2 (non-PRP). Group 1 received internal fixation with auxiliary plate reinforcement, PRP-enriched grafts, and bioactive center creation. The primary endpoint was bone healing rate and time to healing; secondary endpoints included lower limb function, pain scores, complications, and risk factors for nonunion at final follow-up.

RESULTS: Sixty-six patients were included (25 in Group 1, 41 in Group 2). At final follow-up, all patients in Group 1 healed, while 80.49 % of Group 2 healed (p = 0.049). The average healing time was shorter in Group 1 (7.61 months) compared to Group 2 (11.19 months) (p < 0.001). Group 1 had superior lower limb function and pain scores (p < 0.001). Long-term smoking (OR = 9.47, 95 % CI 1.39-64.51, P = 0.022) and inappropriate post-operative weight bearing (OR = 7.62, 95 % CI 1.12-51.57, P = 0.038) were identified as risk factors for nonunion.

CONCLUSION: In nonunion revision surgery, PRP-enhanced therapy significantly improves bone healing rates, reduces healing time, and carries fewer safety risks than traditional bone grafting. It offers an effective approach for nonunion treatment and provides a standardized clinical application for PRP in fracture nonunion surgeries.

PMID:40222318 | DOI:10.1016/j.injury.2025.112325

Injury. 2025 Apr 9:112336. doi: 10.1016/j.injury.2025.112336. Online ahead of print.

NO ABSTRACT

PMID:40221248 | DOI:10.1016/j.injury.2025.112336

Injury. 2025 Apr 4;56(6):112314. doi: 10.1016/j.injury.2025.112314. Online ahead of print.

ABSTRACT

BACKGROUND: Wound healing is a complex and regulated process that involves the coordinated action of key signaling pathways. Activating transcription factor 3 (ATF3) is a stress-inducible protein that has recently emerged as a critical modulator of cellular responses to injury, including those involved in wound healing.

AIM: The aim of this study was to explore the repurposing of existing pharmacological agents to activate ATF3 and evaluate their potential to enhance wound healing factors.

METHODS: We selected three compounds: retin-A, furosemide, and acrivastine based on their ability to modulate ATF3 expression and assessed their effects on wound healing processes in primary cell cultures. We evaluated wound healing-related genes such as LL-37, HBD-2, HBD-3, and VEGFA by qPCR, and a wound healing scratch assay using keratinocytes was conducted to evaluate cell migration.

RESULTS: Interestingly, retin-A induced the expression of key wound healing-related genes, including HBD-2, HBD-3, LL-37, and VEGF. Also, retin-A was the only compound showing wound healing effects, while furosemide and acrivastine did not exhibit any noticeable activity.

CONCLUSION: Our research highlights the potential of retin-A as therapeutic agents to improve wound healing, particularly in chronic wound models.

PMID:40220516 | DOI:10.1016/j.injury.2025.112314

Injury. 2025 Apr 3;56(6):112318. doi: 10.1016/j.injury.2025.112318. Online ahead of print.

ABSTRACT

INTRODUCTION: Transpubic screw fixation is a valuable option for stabilization of superior pubic ramus fractures. However, insertion of a transpubic screw can be challenging or sometimes even impossible due to a narrow or curved transpubic screw corridor, which is present in 38 % of cases. To overcome this problem, a modified technique for insertion of a transpubic screw by advancing a pre-bent guidewire in an ESIN-like fashion is described.

MATERIALS AND METHODS: A retrospective, non-inferiority pilot study with patients, who received a transpubic screw, was performed to investigate potential procedure-associated complications as well as short-term radiological and clinical outcomes of the modified technique in comparison to the classical technique for insertion.

RESULTS: From 01/2021 to 04/2024, 24 transpubic screws were inserted at two major trauma centers, of which nine screws were inserted using the modified technique. Ten patients with a total of eleven transpubic screws (modified technique: 5; classical technique: 6) were available for this pilot study. One patient from the modified technique subgroup experienced a screw migration without affecting fracture healing and without necessitating hardware removal. The complication rate of the modified technique was not significantly inferior to the classical technique (p = 0.50). Residual displacement of the pubic ramus fracture was not significantly inferior using the modified technique compared to the classical technique (modified: 5.0 ± 2.2 mm; classical 4.4 ± 3.3 mm; p = 0.38). The clinical outcome was not significantly inferior using the modified technique compared to the classical technique regarding VAS pain (modified: 2.4 ± 4.3; classical 2.6 ± 2.5; p = 0.47), VAS satisfaction (modified: 8.8 ± 1.8; classical 9.0 ± 1.0; p = 0.42) and Majeed score (modified: 82.0 ± 12.6; classical 90.0 ± 12.5; p = 0.17).

CONCLUSION: The modified technique for insertion of a transpubic screw using a pre-bent guidewire is feasible in narrow and particularly curved transpubic corridors. It was not inferior compared to the classical technique regarding complications as well as short-term radiological and clinical outcomes.

PMID:40215699 | DOI:10.1016/j.injury.2025.112318

Injury. 2025 Mar 27;56(6):112301. doi: 10.1016/j.injury.2025.112301. Online ahead of print.

ABSTRACT

BACKGROUND: In some multi-fragment tibial plateau fracture patterns, it may be more technically demanding to provide the appropriate support when using anatomic pre-contoured proximal tibial plates or other small fragment plates, especially when buttressing smaller apex-directed fracture fragments. The purpose of this study is to describe our surgical technique and highlight the potential role of low profile, mini fragment (2.0_2.7 mm) plates in the surgical management of different types of tibial plateau fractures.

METHODS: This is a retrospective study of 45 cases (45 patients, 31 males, mean age of 43.5 years) who had unicondylar or multicondylar tibial plateau fractures and were surgically managed using mini fragment plates, either as supplementary or standalone implants. The clinical notes and radiographs were reviewed to determine performance and complications, with particular focus on bony union, loss of reduction, implant failure, and soft tissue complications.

RESULTS: No intraoperative complications were recorded, and after a mean of 50.7 months, all the fractures have united. Two cases had knee stiffness and required manipulation under anesthesia, while only one case of secondary mild joint space depression was noted in the follow-up radiographs. No cases of nonunion, implant failure, or other cases of loss of reduction were recorded at the last radiolographic follow-up. Two patients required plate removal, at 4 months (a skeletally immature patient) and 18 months (another patient presented with secondary wound infection) postoperatively after fracture union. At the last radiographic follow-up, the average postoperative knee flexion was 121 degrees (range, 100-140), and the average postoperative Kellgren-Lawrence OA grade was 1 (range, 0-4).

CONCLUSIONS: The low-profile mini fragment plates are effective implants that may be safely used, either in association with other proximal tibial anatomic plates or as standalone implants, depending on the fracture configuration, with overall good outcomes.

PMID:40209613 | DOI:10.1016/j.injury.2025.112301

Injury. 2025 Apr 2;56(6):112316. doi: 10.1016/j.injury.2025.112316. Online ahead of print.

ABSTRACT

PURPOSE: This study investigates Japanese trends in Open Reduction and Internal Fixation (ORIF) surgeries for acetabular and pelvic fractures, focusing on age, gender, regional disparities, and how orthopedic surgeon distribution affects surgical volumes, aiming to identify factors contributing to geographic variations.

METHODS: Surgical volumes for acetabular (K124-2) and pelvic (K125) fractures were categorized by age, gender, and prefecture in the National Database of Health Insurance Claims and Specific Health Checkups of Japan (2016-2022). Correlation analyses assessed relationships between surgical volumes, aging populations, and orthopedic surgeon availability.

RESULTS: Surgical volumes of the elderly increased among individuals over 65, with a notable rise in female pelvic fractures. Acetabular fractures were more prevalent in younger males. Urban areas with more orthopedic surgeons showed higher surgical volumes (p < 0.0001), while aging population rates correlated negatively (p < 0.0001).

CONCLUSION: ORIF for acetabular and pelvic fractures is increasing in Japan's aging population. Surgeon distribution influences surgical volumes, highlighting the need for treatment guidelines in primary care and telemedicine-based strategies.

PMID:40209612 | DOI:10.1016/j.injury.2025.112316

Injury. 2025 Apr 1;56(6):112324. doi: 10.1016/j.injury.2025.112324. Online ahead of print.

ABSTRACT

INTRODUCTION: Dual plating for distal femoral fractures, especially with a metaphyseal comminution, is biomechanically superior compared to single lateral plating, promotes fracture union and prevents complications. However, the optimal placement and length of the additional medial plate are still unknown. Thus, we aimed to biomechanically compare three different double plate constructs for distal femoral fractures.

MATERIALS AND METHODS: A distal femoral fracture with a metaphyseal comminution (AO/OTA 33-A3) was created in synthetic femora and stabilized according to the following groups of 6 specimens each: Single lateral plate (SP), double plate with anteromedial oblique locking plate (DPOB), double plate with parallel medial locking plate with 4 screws (DP4S) and double plate with parallel medial locking plate with 6 screws (DP6S). Afterwards, the femora were tested axially with a quasi-static load of 400 N as well as torsionally with 5 Nm of internal and external rotation. Interfragmentary motion and rotation were measured with an optical 3D motion analysis system.

RESULTS: Fracture gap motion and varus-valgus tilt under axial testing were significantly lower with DPOB, DP4S and DP6S than with SP (p = 0.02) without a significant difference between the double plate constructs. DP4S and DP6S showed a significant lower anteroposterior tilt under axial loading than SP (p = 0.02), whereas DPOB showed no significant difference compared to SP but had a significantly higher anteroposterior tilt than DP6S (p = 0.02). Under internal and external rotation testing, anteroposterior shift was significantly different, and axial rotation was significantly lower with DPOB, DP4S and DP6S compared to SP (p = 0.02) without a significant difference between the double plates.

CONCLUSION: Dual plating is biomechanically superior under axial and torsional loading compared to the traditional single lateral plating for distal femoral fractures with metaphyseal comminution. A parallel arrangement of double plates is biomechanically more effective in resisting anteroposterior tilt, whereas the length of parallel medial plates (with 4 or 6 screws) has no influence on the biomechanical performance.

PMID:40203770 | DOI:10.1016/j.injury.2025.112324

Injury. 2025 Apr 1;56(6):112319. doi: 10.1016/j.injury.2025.112319. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic spinal injuries are a significant public health issue due to their high frequency and severity, impacting the entire healthcare system, especially when neurological sequelae are involved. These injuries require comprehensive resuscitative management, prioritizing spinal injuries within the context of associated injuries. Understanding the epidemiology of spinal fractures in polytraumatized patients is essential for improving care planning, primary prevention methods, and hospital management.

METHODS: This retrospective, single-center, observational study used the TRAUMABASE database from 2018 to 2022 to provide an epidemiological overview of polytraumatized patients with spinal fractures treated in a level I trauma center. Patients admitted to the Post-Anesthesia Care Unit (PACU) with at least one spinal fracture were included, excluding those with isolated transverse process fractures or incomplete clinical files. Data collected included demographics, injury mechanism, Injury Severity Score (ISS), type of spinal lesion, Glasgow Coma Scale (GCS), surgical management, length of hospital stay, and mortality.

RESULTS: From 2018 to 2022, 561 patients with spinal fractures in the context of polytrauma were treated, with 386 patient records analyzed after exclusions. The mean age was 43 years, with a majority being male (75.1 %). The main injury mechanisms were falls from height (47.7 %) and traffic road accidents (46.4 %). Spinal surgery was performed on 53 % of patients, with a mean delay of 2.8 days from trauma to surgery. The overall mortality rate was 14.8 %, with neurological impairment, higher age, higher ISS score, lower GCS score, and absence of spinal surgery as unfavorable prognostic factors. The mean cost of hospitalization per patients was 76.854 ± 53.719 euros [3.502; 65.6623].

DISCUSSION: This study highlights the severity of polytraumatized patients with spinal lesions, with a mean ISS score of 24.4 and frequent associated severe traumatic brain injuries. The main injury mechanisms were falls from height and traffic road accidents, with a high representation of self-inflicted injuries. Overall, the study provides valuable insights into the management and outcomes of polytraumatized patients with spinal injuries.

PMID:40203769 | DOI:10.1016/j.injury.2025.112319

Injury. 2025 Mar 24;56(6):112294. doi: 10.1016/j.injury.2025.112294. Online ahead of print.

ABSTRACT

BACKGROUND: Spontaneously reduced hip dislocation or reduced hip dislocation with a missing reduction history are challenge to the treating surgeon as the signs are usually subtle in such cases. The purpose of this study is to investigate and report on the incidence of the signs of femoral head notching and the presence of intracapsular air bubble in the computed tomography (CT) scans of hip dislocation cases in our center.

METHODS: Cases of traumatic hip dislocation, either without associated acetabular fractures or with acetabular fractures that did not require surgery from 2002 to 2021 were included retrospectively. Their CT scan films were analyzed to look for the presence and direction of femoral head notching and appearance of intracapsular air-bubble.

RESULTS: 30 hips with traumatic hip dislocation and 28 hips with acetabular posterior wall fracture without dislocation were included in this study. We noted notching on the femoral head in the CT axial scans of 23 of 30 hips (76.7 %). 17 cases of notching were noted in association with posterior dislocation, and there were 6 cases associated with anterior dislocation (p = 0.543). We observed intracapsular air bubbles in the CT scans of 28 of the 30 hips in our series (93.3 %). The sensitivity and specificity of notching sign were 56.7 % (95 % CI 37.4∼74.5 %) and 100 % (95 % CI 87.7∼100 %), respectively. For the bubble sign, the sensitivity and specificity were 90 % (95 % CI 73.5∼97.9 %) and 100 % (87.7∼100 %), respectively.

CONCLUSION: We recommend an early CT scan in patients presented with a history of suspected hip dislocation without an obvious finding on plain radiography. The presence of femoral head notching or intracapsular air-bubble would strongly suggest a history of hip dislocation.

LEVEL OF EVIDENCE: Diagnostic Level III, Retrospective cohort study.

PMID:40198971 | DOI:10.1016/j.injury.2025.112294

Injury. 2025 Mar 25;56(6):112303. doi: 10.1016/j.injury.2025.112303. Online ahead of print.

ABSTRACT

BACKGROUND: Open fractures of the lower extremity have a higher risk of fracture-related infections (FRI) or nonunion. The purpose of this study was to identify risk factors for complications and evaluate outcomes.

METHODS: In this retrospective, single center study, we identified and included 187 patients with extraarticular and intraarticular fractures of the tibia or fibula between 2010 and 2018. Patient characteristics, treatment protocols, and complications were assessed, with a focus on soft tissue management and timing of wound closure versus fracture fixation. To analyze risk factors for FRI and nonunion, a univariate logistic regression model was used.

RESULTS: The open fractures included were 52 Gustilo-Anderson type-I (28 %), 99 type-II (53 %), and 36 type-III (19 %) fractures. The mean time from admission to first surgical intervention was 3.47 h (SD 1.4), with 122 (60 %) patients treated within 3 h and 182 (97 %) patients, within 6 h. During primary surgery, definitive fracture fixation was carried out in 112 (60 %) patients and wound closure in 122 (65 %) patients. FRI was reported in 27 (14 %) patients with the highest prevalence in type-III fractures (31 %). Secondary wound closure was associated with a significantly higher risk for FRI than primary wound closure (odds ratio [OR] = 3.3; p = 0.004). Nonunion was reported in 37 (20 %) patients. Significant risk factors for nonunion were FRI (OR=11.9, p < 0.001) and definitive fracture fixation before wound closure compared to fracture fixation and wound closure at the same time (OR = 8.2, p < 0.001). Gustilo-Anderson type-IIIb and -IIIc fractures had a significant lower FRI-free survival compared to other fractures. No patient underwent amputation during the follow-up.

CONCLUSION: Open fractures of the tibia and fibula are associated with a high risk of FRI and nonunion. FRI is the strongest predictor of nonunion in open fractures of the lower extremity. Primary wound closure and simultaneous definitive fracture fixation are protective even in higher Gustilo-Anderson fracture types and prevent complications. Early antibiotic therapy and surgical treatment are crucial, as evidenced by all cases receiving treatment within 6 h post trauma.

PMID:40198970 | DOI:10.1016/j.injury.2025.112303

Injury. 2025 Apr 2;56(6):112322. doi: 10.1016/j.injury.2025.112322. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to investigate incidence rates of acetabular, pelvic, and proximal femur fractures in The Netherlands over a 10-year period (2012-2022). With an aging population, understanding trends in these osteoporotic fractures is essential for improving patient outcomes and guiding healthcare strategies.

METHODS: A retrospective cohort study was conducted using data from two national databases, forming a 'hospitalised' and an 'all patients' cohort. The study population included patients diagnosed with acetabular, pelvic, and proximal femur fractures in The Netherlands during the study period. Incidence rates were calculated per 100,000 person-years and linear regression was used to assess temporal trends. Age-adjustments were performed using Dutch population data from the Central Bureau of Statistics (CBS). Comparative analyses between the two cohorts were conducted to identify discrepancies.

RESULTS: A total of 283,991 patients were identified (12,020 acetabular, 70,595 pelvic and 201,376 proximal femur fractures). Of these patients, 159,563 were hospitalised (7123 acetabular, 24,192 pelvic, and 128,252 proximal femur fractures). Incidence rates of acetabular fractures increased by 26 % (hospitalised) and 98 % (all patients), while pelvic fractures showed stagnation in hospitalised patients (-0.13 %) but a 44 % rise in all patients. Proximal femur fractures increased by 5 % (hospitalised) and 15 % (all patients). Significant differences between the databases were noted across all fracture types.

CONCLUSION: The incidence of acetabular, pelvic, and proximal femur fractures has significantly increased in the last decade, most notably in acetabular and pelvic fractures. Furthermore, a shift toward out-patient treatment of acetabular and pelvic fractures was found. These findings highlight the need for improved fracture prevention and out-patient management strategies, while also underscoring the need for a nationwide registration for these injuries.

PMID:40198969 | DOI:10.1016/j.injury.2025.112322

Injury. 2025 Apr 1;56(6):112320. doi: 10.1016/j.injury.2025.112320. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare outcomes of lateral compression LC2 and LC3 pelvic ring injuries when posterior ring fixation is applied and different anterior ring constructs are used.

METHODS: A retrospective analysis from two Academic Level I Trauma Centers of all operatively treated LC2 and LC3 (AO/OTA 61-B2/B3) pelvic ring injuries from January 2019-January 2024. A comparison of anterior ring constructs was made: no fixation vs. fixation; indirect fixation (external fixators and InFix)) vs. internal fixation; long vs. short percutaneous screws. Long percutaneous screws were defined as either bicortical bypassing all 3 Nakatani zones or bypassing the fracture by 2 Nakatani zones with intramedullary juxtacortical or bicortical finishing. A short screw was defined as all other screws, regardless of direction. Primary outcome measure was >1 cm of pelvic ring displacement from post-operative to final radiographs showing fracture healing with sufficient callus. Secondary outcomes were unplanned major reoperation, removal of implants or non-union repair, and other surgical complications.

RESULTS: 67 patients met inclusion criteria. Most were female (n = 35, 52 %), mean age was 48.3 (SD 21.7) and most injuries were LC3 (n = 39, 58 %). All cases had posterior ring fixation. Twelve (18 %) had no anterior ring fixation and there was a statistically higher rate of deformity compared with patients with anterior ring fixation (n = 55, 82 %) (58 % vs. 16 %, p = 0.005). Indirect fixation (n = 12, 18 %) had a statistically higher rate of deformity compared with internal fixation (n = 43, 64 %) (50 % vs. 7 %, p = 0.002). There was a statistically higher rate of deformity when a short percutaneous screw (n = 6, 9 %) rather than long screw was used (n = 26, 39 %) (50 % vs. 0 %, p = 0.004).

CONCLUSIONS: Routine anterior ring fixation in conjunction with posterior ring fixation is strongly encouraged for LC2 and LC3 injuries. A long percutaneously-applied anterior screw provides optimal stability to maintain reduction and prevent deformity.

LEVEL OF EVIDENCE: Therapeutic Level 3.

PMID:40198968 | DOI:10.1016/j.injury.2025.112320

Injury. 2025 Apr 5;56(6):112327. doi: 10.1016/j.injury.2025.112327. Online ahead of print.

ABSTRACT

BACKGROUND: Patients undergoing surgery are at significant risk of developing pressure injuries due to immobility and fixed positioning on the operating table, particularly during lengthy procedures. Therefore, implementing effective prevention strategies for pressure injuries should begin as early as the surgical phase. This study aims to compare the two methods of curvilinear position and micromovement in preventing pressure injuries among patients undergoing general surgery in the supine position.

METHOD: This was a double-blind, prospective, randomized, controlled trial conducted from October 2024 to January 2025. The study included a sample size of 120 patients randomly divided into three groups: control (n = 40), micromovement (n = 40), and curvilinear (n = 40). Skin assessments were conducted using the National Pressure Ulcer Scale immediately after surgery and again one day later.

RESULTS: A total of 114 patients were included in the analysis: 39 in the control group, 38 in the micromovement group, and 37 in the curvilinear group. A significant difference was found between the three groups regarding the incidence of pressure injuries (p < 0.05). However, there was no considerable difference regarding the location and stage of the pressure injury between groups (p > 0.05).

CONCLUSION: Micromovement and curvilinear supine position can significantly reduce the incidence of intraoperative acquired pressure injuries. Therefore, it is recommended that these methods be utilized as an effective intervention by the surgical team, especially for high-risk patients and those undergoing prolonged surgeries.

PMID:40194328 | DOI:10.1016/j.injury.2025.112327