Injury. 2025 Sep 15;56(11):112764. doi: 10.1016/j.injury.2025.112764. Online ahead of print.

ABSTRACT

BACKGROUND: A nonvascularized fibular graft (NVFG) is considered to be an alternative option in managing segmental bone loss of the tibia. Nevertheless, there has been no consensus on optimal graft position and graft fixation technique. The purposes of the present study were to mechanically test the influences of various NVFG fixation techniques on the overall stability of the fixation construct by use of finite element analysis.

METHODS: Seven FE models of tibias with segmental bone loss stabilized with various fixation techniques were developed including medial and lateral plate-screw, medial and lateral plate-screw with a NVGF on the opposite cortex, medial and lateral plate-screw with an additional locking screw inserting into a NVGF, and intramedullary nail. Single-legged loading with 388 N applying on the tibial plateau was under consideration.

RESULTS: A NVGF placed on opposite cortex to the plate played an important role in withstanding bending moment which could reduce implant stress. An additional locking screw inserted into the NVGF helped to keep the NVGF in position and was essential for maintaining fracture gap width.

CONCLUSION: A NVFG with locking screw fixation could be an effective modality in managing segmental bone loss of the tibia. A construct of lateral LCP with a NVFG stabilized by a locking screw was mechanically superior to the others.

PMID:41004973 | DOI:10.1016/j.injury.2025.112764

Injury. 2025 Sep 22;56(11):112769. doi: 10.1016/j.injury.2025.112769. Online ahead of print.

NO ABSTRACT

PMID:41004972 | DOI:10.1016/j.injury.2025.112769

Injury. 2025 Sep 19;56(11):112768. doi: 10.1016/j.injury.2025.112768. Online ahead of print.

ABSTRACT

INTRODUCTION: The osteosynthesis of supracondylar fractures (SC) using pins buried under the skin (PB) or externalized (PE) is a subject of debate. The aim of this study was to compare two treatment protocols, one using PB and the other using PE, in terms of clinical and radiographic outcomes, complication rates.

HYPOTHESIS: The hypothesis of the study was that both protocols are equivalent in terms of clinical, radiological outcomes, and complication rates.

MATERIALS AND METHODS: This was a retrospective bicentric comparative study analyzing 296 boys and 267 girls (mean age 6.2 ± 2.7 years) who underwent SC fracture surgery between 1/1/2010 and 31/12/2020 using two therapeutic protocols. The first protocol (group A; n = 210) involved osteosynthesis with PB, immobilization (6-7 weeks), and pin removal in the operating room under general anesthesia. The second protocol (group B; n = 353) was characterized by osteosynthesis with PE, immobilization (4-6 weeks), and pin removal in an outpatient setting. Functional outcomes were assessed using the QuickDASH questionnaire, radiographic outcomes [Baumann angle, lateral capitulum-humeral angle (LCHA), rotational disorders according to the Von Laer quotient], and postoperative complication rates (infection, recurrent fracture, stiffness, vasculo-nerve complications).

RESULTS: No patients were lost to follow-up (n = 563) and the mean follow-up was 6.6 ± 7.3 months (3-70). The mean immobilization duration was longer in group A (45.8 ± 7.4 vs 39.7 ± 12.0 days; p < 0.001). Clinical and functional outcomes were similar (p = 0.316), and the pre- and postoperative complication rates were comparable between the two groups (A-B = 8 %/8.6 %-6 %/7.1 %; p = 0.733 and p = 0.512), while the postoperative Baumann angle, LCHA, number of rotational disorders, and Von Laer quotient were significantly different [A-B = 71.5°-74° (p < 0.001); A-B = 32.8°-35.6° (p < 0.001); A-B = 32-10 (p < 0.001); A-B = 0.2-0.1 (p = 0.020)].

DISCUSSION: This retrospective study compared two surgical protocols for pediatric supracondylar (SC) fractures in 563 children. Functional and clinical outcomes were similar between groups, with no significant difference in complication rates. Group B had better radiographic results and a lower rate of postoperative rotational deformities. Pin buried (Group A) increased costs and required a second general anesthesia for removal. Group B's protocol allowed outpatient pin removal under nitrous oxide, reducing risks and costs. Infection rates were no significant different between both groups. Whereas the decrease of number of rotational disorsders, the increase of Baumann angle and decrease of LCHA in this patient show that decrease of rotational disorders is more likely related to osteolysis of rotational spur than bone remodeling. Despite limitations, this is the largest French series comparing these two protocols, showing equivalent functional outcomes but greater efficiency and safety in Group B.

CONCLUSION: Both therapeutic protocols have comparable clinical outcomes and complication rates. Leaving pins exposed does not increase the risk of infection.

LEVEL OF EVIDENCE: III comparative retrospective study.

PMID:41004971 | DOI:10.1016/j.injury.2025.112768

Injury. 2025 Sep 17;56(11):112763. doi: 10.1016/j.injury.2025.112763. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to assess the effect of an acute traumatic meniscus tear that required repair in association with a tibial plateau fracture repair on outcomes.

METHODS: Over a 17-year period, 843 patients presented with a tibial plateau fracture and were followed prospectively. 721 patients with Schatzker I-VI fractures were treated operatively via a standardized algorithm. 161 tibial plateau fractures (22.3 %) had an associated meniscus tear that underwent acute repair at the time of bony fixation. These patients were compared to operatively repaired tibial plateau fracture patients with no meniscus injury (NMR). Demographics were collected and outcomes including: radiographic healing, knee range of motion (ROM), and complication rates, were recorded. In addition, re-operation rates were compared and any reoperation for meniscus repair failure identified. All patients had a minimum of 1 year follow up.

RESULTS: A total of 524 patients with a mean of 21.4 (range: 12-120) months follow up met inclusion criteria. Patients in the meniscus repair (MR) cohort had poorer knee extension (1.01 degrees, range: 0-30 degrees) compared to the NMR cohort (0.07 degrees, range: 0-10 degrees) (p < 0.001), in addition to poorer knee flexion (123 degrees, range: 0-145 degrees, p = 0.024). Additionally, MR patients reported higher pain scores (mean: 3 and range: 0-8, p = 0.005) at latest follow up. Finally, MR patients had higher rates of infection (8.1 % vs. 3.3 %, p = 0.025) and lateral collapse of the joint (p = 0.032).

CONCLUSION: Patients who had a meniscus repair at the time of tibial plateau fracture repair were found to have poorer knee ROM, more patient reported pain at minimum 12 (mean 24) months post-operation. Additionally, these patients developed more post-operative complications than those patients who did not undergo a meniscus repair.

PMID:41004970 | DOI:10.1016/j.injury.2025.112763

Injury. 2025 Sep 17:112766. doi: 10.1016/j.injury.2025.112766. Online ahead of print.

ABSTRACT

Not applicable.

PMID:40992972 | DOI:10.1016/j.injury.2025.112766

Injury. 2025 Sep 17;56(11):112767. doi: 10.1016/j.injury.2025.112767. Online ahead of print.

ABSTRACT

Lower limb amputations have a prevalence of about 26 per 100,000 in the United Kingdom. A significant proportion of these patients suffer from chronic pain and/or phantom limb pain. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) have been found to help improve these symptoms, however these are usually used as a treatment as opposed to prevention. These techniques work on the principle of giving the nerves somewhere to go and something to do, but it is not yet standard practice. Central neural reorganisation and adaptation to chronic/phantom limb pain suggest that preventing the symptom in the first place could yield a superior result to treatment after the problem has arisen. We present a series of 24 cases of where TMR and/or RPNI were performed primarily at the time of initial amputation. Patients were followed up approximately one year after procedure and assessed their pain scores according to a numerical rating scale (NRS) and the PROMIS Pain Interference Short form 6b Significant improvements of pain scores were found for these patients when compared to patients without previous TMR or RPNI. PLP is a debilitating, life limiting and an economic burden on patients who have undergone limb amputations, and with no clear medical or surgical intervention yet widely accepted to offer a definitive management option for this problem, TMR and RPNI may be able to fill a void. This is a good proof of principle showing promising results, and suggests that further investigations with randomised control studies are warranted.

PMID:40992116 | DOI:10.1016/j.injury.2025.112767

Injury. 2025 Sep 18;56(11):112765. doi: 10.1016/j.injury.2025.112765. Online ahead of print.

ABSTRACT

PURPOSE: Tibial tuberosity fractures are rare physeal injuries in adolescents and are frequently overlooked on radiographs, despite a high risk of associated soft tissue injury. This study analyzed magnetic resonance imaging (MRI) findings and concurrent injuries in 63 cases to improve diagnostic accuracy and guide clinical management. This study aimed to investigate the MRI features and associated injury patterns of tibial tuberosity fractures in adolescents.

METHODS: A retrospective analysis was performed on 63 adolescent patients with tibial tuberosity fractures admitted to our hospital between June 2017 and January 2025. The cohort comprised 62 males and 1 female, with ages ranging from 11 to 16 years (mean: 13.9 years). Fractures occurred on the right side in 22 cases, the left side in 40 cases, and bilaterally in 1 case. Body mass index (BMI) ranged from 20.8 to 33.3 kg/m², with a mean of 26.8 kg/m². Upon admission, all patients underwent MRI examinations within 48 h (3.0 T, including T1-, T2-, and STIR-weighted sequences). Fracture types were classified according to the Ogden classification, and associated injuries involving ligaments and the meniscus were simultaneously documented.

RESULTS: MRI revealed patellar tendon injuries in all patients (patellar tendon rupture in 6 cases). Associated injuries included anterior cruciate ligament (ACL) injuries in 28 cases (44.4 %) and posterior cruciate ligament (PCL) injuries in 3 cases (4.8 %). Meniscal injuries were observed in 25 cases (39.7 %), comprising 9 cases of grade I, 12 cases of grade II, and 4 cases of grade III. Peripatellar retinacular injuries were present in 28 cases (44.4 %), and medial or lateral collateral ligament injuries of the knee were identified in 13 cases (20.6 %). Additional associated injuries included 1 case (1.6 %) of fibular fracture, 10 cases (15.9 %) of patellar fracture, and 5 cases (7.9 %) of patellar subluxation.

CONCLUSION: Plain radiography is the preferred imaging modality for diagnosing tibial tuberosity fractures in adolescents, while computed tomography (CT) can be useful for further classification of fracture types. In cases where concomitant soft tissue injuries-such as those involving the patellar ligament or meniscus-are suspected, MRI provides significant diagnostic value and plays a crucial role in surgical planning and complication prevention.

LEVEL OF EVIDENCE: Level III.

PMID:40992115 | DOI:10.1016/j.injury.2025.112765

Injury. 2025 Sep 11;56(11):112759. doi: 10.1016/j.injury.2025.112759. Online ahead of print.

ABSTRACT

PURPOSE: The disability and pain after a neglected scaphoid non-union fracture are well recorded in the literature. We aimed to compare and detect the short-term results of non-united scaphoid waist fracture treated by internal fixation and bone graft with the volar buttress plate utilization versus the Herbert screw.

METHODS: This is a therapeutic study. This randomized, prospective comparative an intervention study was carried out on 30 cases with non-union scaphoid waist fractures. They were randomly categorized into two equal groups, group (A) treated by volar buttress plate fixation with bone graft, and group (B) managed by Herbert screw fixation along with bone graft. Bone graft in both groups was taken from the distal radius. All cases underwent clinical examination and radiological evaluation.

RESULTS: With an average of 18 months, thirty cases were followed up. Both groups had similar baseline characteristics. The union rate and time were insignificant difference between both groups. Insignificant differences were determined across either intervention groups in terms of grip strength, the visual analogue pain scale (VAS), the Mayo wrist score, and the quick disabilities of arm, shoulder and hand score (quick DASH score) during the early interval of follow-up postoperatively (at 3, 6, 9 and 12 months). Group (A) demonstrated shorter operative time and lower numbers of image intensifier intraoperatively in contrast to group (B). Hardware removal after union was needed in 3 patients of group (A) in variance to group (B), in which no cases need implant removal. The Radio-scaphoid (RS) impingement and flexor carpi radialis (FCR) tenosynovitis exhibited a significant elevation in group (A) in contrast to group (B). Among the patients with scaphoid fracture non-union who underwent surgery, some cases did not achieve union after the initial procedure. We had to employ an alternative fixation method for these cases, and we followed them until union was achieved, and their function was restored. Specifically, three patients from group (A) (20%) [one case was fixed with a miniplate 2 mm, and two cases were fixed with a microplate 1.5 mm] and two patients from group (B) (13.3 %) required this approach.

CONCLUSIONS: The functional and radiological outcomes are comparable between volar buttress plate and Herbert screw in the treatment of non-united waist scaphoid fracture. The rate of removal of the implant is higher in the volar buttress plate.

PMID:40987252 | DOI:10.1016/j.injury.2025.112759

Injury. 2025 Sep 14;56(11):112760. doi: 10.1016/j.injury.2025.112760. Online ahead of print.

ABSTRACT

INTRODUCTION: Posterior sternoclavicular joint (SCJ) dislocations are rare, accounting for <1 % of all joint dislocations. Despite their rarity, these injuries warrant urgent recognition due to the SCJ's proximity to mediastinal structures, including the trachea, esophagus, and great vessels. While not always surgical emergencies, delayed or unstable cases can result in life-threatening complications if not managed in an appropriately equipped hospital setting.

CASE PRESENTATION: A 28-year-old male presented two weeks after sustaining a right SCJ injury while sliding during a softball game. He reported persistent pain, difficulty breathing, and limited shoulder function. Initial radiographs were unremarkable; however, CT imaging revealed a posterior dislocation of the medial clavicle. Given the delayed presentation and potential mediastinal involvement, the patient underwent open reduction and internal fixation (ORIF) with cardiothoracic surgical assistance. Fixation was achieved using unicortical screws in the sternum and bicortical screws in the clavicle. He recovered without complications and returned to full activity CONCLUSION: : Posterior SCJ dislocations are challenging to diagnose on radiographs and often require CT for accurate assessment. Although closed reduction is an option in acute cases, delayed presentations typically necessitate surgical stabilization. Plate fixation offers reliable alignment and secure fixation. This case underscores the importance of timely diagnosis, hospital-based care, and multidisciplinary surgical planning when managing posterior SCJ dislocations.

PMID:40982998 | DOI:10.1016/j.injury.2025.112760

Injury. 2025 Sep 15:112761. doi: 10.1016/j.injury.2025.112761. Online ahead of print.

ABSTRACT

INTRODUCTION: Blunt Thoracic trauma (BTT) affects over 10 % of trauma patients and may lead to delayed respiratory complications. The STUMBL (STUdy of the Management of BLunt chest wall trauma) score was developed to identify patients at high risk of complications. This study aimed to validate the STUMBL score in a Canadian setting.

METHODS: We conducted a retrospective cohort study of adult patients with isolated BTT presenting to a Canadian emergency department (ED) of a Level-1 trauma center between 2018 and 2020. STUMBL scores were calculated for each patient. The primary outcome was a composite of in-hospital mortality, early pulmonary complications, ICU admission, or prolonged hospital stay (≥7 days). Secondary outcomes were delayed pulmonary complications and unplanned return to the ED. Receiver operating characteristic (ROC) curves were used to evaluate predictive performance, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed for each score cutoff.

RESULTS: Among 344 included patients (mean age: 57.8 ± 17.0, male sex: 64.2 %), 18.3 % experienced the primary outcome. The STUMBL score showed good discrimination (AUROC 0.87). A cutoff of ≤10 yielded a sensitivity of 90.5 % and NPV of 97.0 %, while a cutoff of ≤15 showed a sensitivity of 66.7 % and NPV of 92.2 % to predict the composite outcome. In patients with a score ≤15, delayed pulmonary complications occurred in <2 %, and unplanned ED visits in <7 %. Conversely, 82.4 % of patients with STUMBL scores ≥21 experienced the composite outcome. This cutoff was associated with a specificity of 97.9 % and PPV of 82.4 %.

CONCLUSIONS: The STUMBL score demonstrated good performance in predicting early adverse outcomes in Canadian patients with isolated BTT. Patients with a STUMBL score ≤15 and no early complications represent a low-risk group that may be safely discharged. Those with scores ≥21 warrant ICU evaluation. Further prospective validation or refinement is recommended before widespread implementation.

PMID:40976766 | DOI:10.1016/j.injury.2025.112761

Injury. 2025 Sep 14;56(11):112762. doi: 10.1016/j.injury.2025.112762. Online ahead of print.

ABSTRACT

OBJECTIVE: To predict the risk of spontaneous tendon rupture (STR) in dialysis patients using a low-variable, clinically implementable model and to perform internal validation.

MATERIALS AND METHODS: In a single-centre case-control study, 102 individuals were analysed (34 STR cases, 68 controls). Pre-specified candidate predictors comprised four clinical variables: frailty (Clinical Frailty Scale, CFS), dialysis vintage, calcium-phosphate (Ca-P) product, and quinolone exposure within the past 6 months. Group comparisons were conducted; multivariable analysis used logistic regression. Discrimination and calibration were assessed with an L2-penalised approach, 5-fold cross-validation, and bootstrap optimism correction; decision curve analysis (DCA) was undertaken.

RESULTS: Compared with controls, cases had higher CFS, longer dialysis vintage, higher Ca-P product and intact parathyroid hormone (iPTH), and lower albumin; C-reactive protein did not differ materially. In the multivariable model, CFS and dialysis vintage were independently and positively associated with STR; Ca-P and quinolone coefficients were positive but did not cross conventional significance thresholds. Discrimination was good: apparent AUC 0.806 and optimism-corrected AUC 0.786; Brier score 0.247. Calibration was visually acceptable, with greater uncertainty at higher predicted probabilities. On DCA, across a 15 %-25 % risk threshold range, the model provided higher net benefit than a treat-none strategy and a net benefit comparable to a treat-all strategy. Among cases, the operative rate was 100 %, complications 11.8 %, recurrence 8.8 %, 12-month mortality 6.3 %, and median length of stay 3.7 days. Rupture sites were quadriceps in 44.1 % and patellar tendon in 32.3 %.

CONCLUSIONS: In dialysis patients, STR risk appears predictably estimable using readily obtainable indicators such as CFS and dialysis vintage. The Ca-P/iPTH axis may contribute directionally to risk, while the effect of quinolone exposure warrants confirmation in larger cohorts. The model has potential to inform clinical decision-making; further calibration refinement and external validation are recommended before routine implementation.

PMID:40976189 | DOI:10.1016/j.injury.2025.112762

Injury. 2025 Sep 4;56(11):112725. doi: 10.1016/j.injury.2025.112725. Online ahead of print.

ABSTRACT

INTRODUCTION: The reverse oblique fracture patterns accounts for about 5-10 % of all intertrochanteric fractures. This type of fracture is regarded as highly unstable and is still associated with high complication and failure rates. Cut-off values for the use of short or long implants are not yet defined. An easy-to-use and comprehensive classification system is still lacking.

MATERIALS AND METHODS: This study was performed as a single center retrospective data analysis. Between 2008 and 2018, 4003 patients with per/subtrochanteric fractures, were screened. A total of 286 (7 %) patients with a reverse-oblique fracture pattern were included. Fracture patterns were analyzed and classified according to a new classification system with 4 main types (I-IV), which are subdivided in to subtypes a and b. The choice of implants, complication rates, revision surgery and time of surgery were raised. Radiological outcome parameters (TAD, calTAD, Parker's Ratio) and loss of reduction were measured.

RESULTS: The distribution between the various subgroups was IIa and IVa (21 %), IIb (20 %), Ia (12 %), IVb (9 %), IIIa (8 %), Ib (6 %) and IIIb (3 %). A rate of 39 (14 %) complications, which needed revision surgery were recorded. Open reduction significantly increased the complication rate (p= 0.0356) as well as an increase in time of surgery (p = 0.0107). The additional use of cerclage wires had no additional influence. There was a trend to more complications after the use of a long implant in patients with type-a fractures (p= 0.056). Radiological parameters did not have any predictive value. Loss of reduction of the medial or lateral cortex shows a trend to a higher complication rate. After a primary complication, the necessity of repeating revision surgery is likely to happen.

CONCLUSION: The novel classification system depicts all relevant fracture patterns. Open reduction and prolonged time of surgery increase the complication rate. In type-a fractures, the use of short implants is recommended. Additional use of cerclage wires does not have a negative impact on outcome.

PMID:40974891 | DOI:10.1016/j.injury.2025.112725

Injury. 2025 Sep 10;56(11):112745. doi: 10.1016/j.injury.2025.112745. Online ahead of print.

ABSTRACT

BACKGROUND: Finger defect reconstruction requires functional and aesthetic restoration. The great toenail flap demands advanced microsurgical skills. We propose a staged approach: initial pedicled flap coverage, followed by second-stage exchange of the great toenail flap with the finger flap, enhancing donor site repair while reducing complexity and expanding access in resource-limited settings.

METHOD: Sixteen patients (2017-2024) underwent staged reconstruction: primary pedicled flap followed by great toenail flap-finger flap exchange. Outcomes included complications, functional metrics (Semmes-Weinstein monofilament test, Michigan Hand Outcomes Questionnaire [MHQ], static two-point discrimination [2-PD]), and donor foot pain (Visual Analog Scale [VAS]). Healthy sides served as controls.

RESULTS: At mean 12-month follow-up, reconstructed fingers showed mean static 2-PD of 5 mm and Semmes-Weinstein result of 3.67 g; MHQ averaged 89.6. Foot donor sites demonstrated mean 2-PD of 5.5 mm and VAS of 1. Complications included partial flap necrosis (1 case) and significant donor foot pain (1 case). Interphalangeal joint motion, 2-PD, and MHQ scores differed significantly from healthy sides (p < 0.001)..

CONCLUSION: This staged protocol provides a safe, practical solution for finger reconstruction, particularly in settings with limited microsurgical resources. It reduces primary hospital treatment thresholds and addresses suboptimal aesthetic/functional outcomes.

THERAPEUTIC: Level III.

PMID:40972085 | DOI:10.1016/j.injury.2025.112745

Injury. 2025 Sep 10;56(11):112754. doi: 10.1016/j.injury.2025.112754. Online ahead of print.

ABSTRACT

INTRODUCTION: Posterior malleolus fractures are frequently associated with varying degrees of comminution. This comminution often leads to osteochondral fragment loss from the posterior articular surface of the tibial plafond. The purpose of this study is to use finite element modeling to determine whether osteochondral defects at the posterior malleolus fracture interface significantly influence tibiotalar contact stress.

METHODS: 3D models of 10 randomly selected patients were created of the tibia and talus from CT scans. A layer of cartilage was added to simulate contact at the tibiotalar joint. Different circular osteochondral defects were modeled at the fracture interface 3 mm, 5 mm, 10 mm in diameter. Two sizes of fractures were modelled (5 mm and 10 mm), from the posterior-most point on the articular tibial surface. Models with fractures and without osteochondral defects, were tested as controls. Models were loaded in finite element software under single-leg-stance at average body weight. Scenarios were repeated for maximal dorsiflexion and plantarflexion. Differences between the sizes of osteochondral defects across different fracture sizes for each ankle range of motion scenario were determined.

RESULTS: No significant differences in maximum articular contact stresses were observed between different sized osteochondral defect sizes in the 5 mm fracture size and ankle range of motion scenarios. However, significant differences in maximum articular contact stresses were observed between different sized osteochondral defect sizes with 10 mm fracture sizes. These differences were observed in neutral and dorsiflexion, but not in plantarflexion.

CONCLUSION: Larger posterior malleolus fractures with osteochondral defects, when loaded with the ankle in neutral and dorsiflexion, resulted in larger tibiotalar articular stresses.

PMID:40972084 | DOI:10.1016/j.injury.2025.112754

Injury. 2025 Sep 9;56(11):112756. doi: 10.1016/j.injury.2025.112756. Online ahead of print.

ABSTRACT

The fifth metatarsal is essential for balance control during gait and remains susceptible to proximal fractures such as the Jones fracture due to its limited vascularity, making the choice of fixation method of critical importance. The study was conducted to biomechanically compare conventional fixation techniques and identify the most effective strategy for Jones fracture management, culminating in the design and rigorous evaluation of a novel biodegradable implant. A volumetric model of the fifth metatarsal with fixation constructs was developed using medical imaging and digital design tools, and its mechanical performance was assessed by finite element analysis. The proximal end of the metatarsal bone was immobilized, and a 60 N-according to literature-was applied to the distal end; frictional interaction was incorporated at the fracture interface to simulate realistic mechanical conditions. The mechanical properties of Ti6Al4V and CrNiMo alloys were used for the implant models. The intramedullary screw model registered the lowest stress values for both materials, prompting subsequent material and design modifications. A magnesium-based biodegradable material was adopted, and mechanical analyses were conducted again following the implementation of requisite design refinements. The modified biodegradable implant was verified to provide adequate structural performance, indicating its suitability for Jones fracture fixation.

PMID:40967129 | DOI:10.1016/j.injury.2025.112756

Injury. 2025 Sep 9;56(11):112757. doi: 10.1016/j.injury.2025.112757. Online ahead of print.

ABSTRACT

BACKGROUND: Literature on quality of life and functionality following various types of surgically treated foot injuries is limited, despite the significant impact on patients' daily lives. As a result, managing patient expectations becomes challenging. The current objective is to prospectively evaluate long-term patient-reported and clinical outcomes of surgically treated foot injuries.

METHODS: A multicentre prospective cohort study was conducted. Adult patients undergoing operative treatment for traumatic foot fractures and/or dislocations were eligible for inclusion. Data on patient demographics, treatment, patient-reported outcomes (health-related quality of life assessed using the EuroQol questionnaires, functionality evaluated by the American Orthopaedic Foot and Ankle Society scales, satisfaction, and return to work/sports), complications, and reoperations were collected. Follow-up lasted two years. Statistically significant and clinically relevant changes in outcomes were determined using the Friedman test and minimally important differences.

RESULTS: The follow-up response rate was 92%. Patients showed significant and relevant differences in EuroQol scores during follow-up compared to pre-trauma, not returning to their baseline levels. The EQ-VAS™ showed clinically relevant improvement between 1 and 2 years postoperatively. Patients with forefoot injuries had better EuroQol and sports function scores, but lower satisfaction compared to those with midfoot and hindfoot injuries. The EuroQol pain domain exhibited the largest increase in reported problems, followed by usual activities, mobility, anxiety, and self-care. In the forefoot, midfoot, and hindfoot subgroups, the complication rates were 50%, 19%, and 44% respectively. Most complications were related to posttraumatic arthrosis (26%) and infections (24%). Over half of the patients (52%) underwent implant removal. The majority of reoperations involved secondary arthrodesis (37%) or revision surgery (32%).

DISCUSSION AND CONCLUSION: Strengths of this study include the prospective multicentre setting, the high response and follow-up rates, its epidemiological nature, and the inclusion of various injury types with stratified data presentation. Limitations include recall bias, suboptimal minimal important differences, group heterogeneity, and the use of the suboptimal AOFAS scales. The overview of patient-reported and clinical outcomes for patients treated surgically for acute foot injuries presented in this study show persisting impairment in functionality at the two-year follow-up. The data will help manage patient expectations effectively.

PMID:40967128 | DOI:10.1016/j.injury.2025.112757

Injury. 2025 Sep 9;56(11):112751. doi: 10.1016/j.injury.2025.112751. Online ahead of print.

NO ABSTRACT

PMID:40967127 | DOI:10.1016/j.injury.2025.112751

Injury. 2025 Sep 6:112747. doi: 10.1016/j.injury.2025.112747. Online ahead of print.

ABSTRACT

INTRODUCTION: Augmented reality (AR) technology is rapidly evolving and is finding an increasing application in education, including medical training. This feasibility study aimed to explore the usability and didactic potential of AR with the HoloLens2™ for medical students, teaching the primary survey of burn wounds.

METHODS: This feasibility study was conducted using a prospective observational cohort design. Test groups consisted of participants with limited (n = 18), moderate (n = 10), or high (n = 5) experience in burn care, and filled in a questionnaire after training with the HoloLens2™.

RESULTS: Outcomes of the questionnaires show AR to be a promising technology for educating medical students in the primary survey of burn wounds.

DISCUSSION: However promising, there is further need for development in usability and image quality. The ability to simulate realistic scenarios in a safe and scalable environment could pave the way for a new era for medical education, where AR becomes a valuable supplement or even replacement for traditional learning methods.

PMID:40947373 | DOI:10.1016/j.injury.2025.112747

Injury. 2025 Sep 8:112758. doi: 10.1016/j.injury.2025.112758. Online ahead of print.

ABSTRACT

PURPOSE: Ecuador has seen a dramatic increase in violence, with homicides rising from 6.4 per 100,000 inhabitants in 2015 to 47.25 in 2023. In response, the government declared a state of internal armed conflict and a "state of emergency" This study aims to analyze the impact of this political measure on the admission of patients who are victims of violence to a hospital in the coastal region of the country.

METHODS: This is an analytical cross-sectional study conducted over nine months, from October 2023 to July 2024, divided into three-month periods. The independent variable was the period of surgical trauma: pre-exception, during the state of exception, and post-exception. The dependent variable was surgical trauma due to violence. A bivariate analysis was performed and a p-value of <0.05 was considered statistically significant.

RESULTS: The study included 160 cases of surgical trauma. Of the traumas reported during the nine months, 80 % (N=128) were due to violence. 78 % (N=125) of patients underwent surgery for penetrating trauma, with 77 % (96/125) of these due to firearms. The proportion of penetrating injuries due to firearms varied significantly according to period (p = 0.020). During the state of exception it fell to 60 % (21/35) from 79 % (31/39) pre-exception, but rose again in the post-exception period to 86 % (44/51).

CONCLUSION: The strategies implemented did not significantly reduce trauma admissions due to violence at this hospital, underscoring the imperative for additional interventions and a comprehensive understanding of the social determinants underlying this public health issue.

PMID:40946074 | DOI:10.1016/j.injury.2025.112758

Injury. 2025 Sep 8;56(11):112752. doi: 10.1016/j.injury.2025.112752. Online ahead of print.

ABSTRACT

The impact of gun violence on the well-being of children in the United States is a vital public health issue. Gaps remain in characterizing the population health burden, exacerbated by gun violence data limitations and research policy restrictions. This study explores the association between neighborhood-level gun violence and the general health status of children nationwide in the Environmental influences on Child Health Outcomes (ECHO) study. 13,450 children ages 0-17 and parents reported general health status. Gun violence incidents, defined as any death or injury caused by a gun, were extracted from the publicly available Gun Violence Archive by census tract between 2020 and 2023. Census tracts were categorized as low gun violence (< 2 incidents between 2020-2023) and high gun violence (≥ 2 incidents). A generalized estimating equation logistic model with robust variance was used to estimate the association between binary general health status (Good/Fair/Poor vs. Excellent/Very good) and neighborhood-level gun violence events adjusting for individual and census tract-level sociodemographic covariates. 11,329 (84 %) reported Excellent/Very Good general health and 2121 (16 %) reported Good/Fair/Poor general health. The adjusted odds of Excellent/Very Good general health were 20 % lower among children living in census tracts with high gun violence compared to low gun violence (OR 0.804; 95 % CI: 0.721, 0.897). When stratified by age group, the odds of Excellent/Very Good general health among younger children (ages 0 - 7) were 17.3 % lower (OR 0.827; 95 % CI: 0.687, 0.997) and 19.7 % lower among older children (ages 8 - 17) among those living in census tracts with high gun violence compared to those with low gun violence (OR 0.803; 95 % CI: 0.702, 0.919). Among children living in high socioeconomic vulnerability census tracts, the odds of Excellent/Very Good general health were 23 % lower in children living in census tracts with high gun violence compared to those with low gun violence (OR 0.767, 95 % CI 0.669, 0.880). Findings underscore the importance of community violence prevention efforts and the need to strengthen our understanding of community risk factors such as gun violence that hinder optimal child growth and development.

PMID:40945226 | DOI:10.1016/j.injury.2025.112752