Injury. 2025 May 27;56(8):112448. doi: 10.1016/j.injury.2025.112448. Online ahead of print.

ABSTRACT

BACKGROUND: Clavicle fractures account for 2-10 % of skeletal injuries, often resulting from lateral shoulder falls (87 % of cases), and are common in pediatric and young adult populations. Despite their clinical importance, the role of anatomical factors like thoracic inlet dimensions in fracture risk is poorly understood.

METHODS: This STROBE-compliant case-control study evaluated the association between thoracic inlet measurements-anterior-posterior (AP) diameter, transverse diameter, and area-and clavicle fracture risk, with secondary analyses by age, sex, and BMI.

RESULTS: We studied 27 patients with clavicle fractures and 53 matched controls (aged 18-65 years) who underwent chest CT evaluation for suspected clavicle fracture following upper chest trauma but were confirmed to have no fracture; their CTs were then used for thoracic inlet measurements. Statistical analyses compared AP diameter, transverse diameter, and transverse/AP ratio between groups. The fracture group showed a significantly larger AP diameter (5. 80 ± 0.90 cm vs. 5. 34 ± 0.77 cm, p = 0.0181) and a significantly lower transverse/AP ratio (1. 88 ± 0.31 vs. 2. 08 ± 0.39, p = 0.025) than controls, suggesting a relatively broader, narrower inlet shape is associated with fractures. Transverse diameter (10. 68 ± 1.15 cm vs. 10. 85 ± 0.93 cm, p = 0.424) and inlet area (59. 15 ± 10.60 cm² vs. 57. 84 ± 9.34 cm², p = 0.5742) were similar between groups. Subgroup analyses indicated stronger differences in males (e.g., transverse/AP ratio: 1. 77 ± 0.33 vs. 2. 09 ± 0.40, p = 0.005) and those with BMI <23 kg/m ² (e.g., transverse/AP ratio: 1. 69 ± 0.39 vs. 2. 14 ± 0.42, p = 0.007).

CONCLUSIONS: We conclude that increased AP diameter and reduced transverse/AP ratio of the thoracic inlet may elevate clavicle fracture risk, highlighting anatomical influences on susceptibility. Further biomechanical and preventive studies are needed.

PMID:40479941 | DOI:10.1016/j.injury.2025.112448

Injury. 2025 May 22;56(8):112452. doi: 10.1016/j.injury.2025.112452. Online ahead of print.

ABSTRACT

BACKGROUND: Fracture healing is a complex biological process involving multiple cellular and molecular mechanisms. Despite advances in understanding, the molecular regulation of bone regeneration remains incompletely understood. MicroRNAs (miRNAs) are emerging as critical post-transcriptional regulators of gene expression, with growing evidence suggesting their roles in osteogenesis and fracture repair. This study investigates the role of miRNA-130b in fracture healing and its molecular mechanisms, particularly focusing on its interaction with phosphatase and tensin homolog (PTEN) and the Wnt/β-catenin signaling pathway.

METHODS: Bone marrow mesenchymal stem cells (BMSCs) were isolated from rats and transfected with miRNA-130b mimic, inhibitor, or siPTEN. Osteogenic differentiation was assessed via alkaline phosphatase (ALP) activity, alizarin red S staining, and scratch wound healing assays. Pathway activation was evaluated using qRT-PCR and Western blotting. A rat tibial fracture model was established, and miRNA-130b mimic was administered intraperitoneally. Fracture healing was assessed via radiography, histology, and biomechanical testing at 2, 4, and 6 weeks post-surgery.

RESULTS: MiRNA-130b overexpression enhanced BMSC proliferation, migration, and osteogenic differentiation by directly targeting PTEN and activating the Wnt/β-catenin signaling pathway. Conversely, miRNA-130b inhibition reduced osteogenic activity. MiRNA-130b mimic accelerated fracture healing, as evidenced by improved callus formation, enhanced bone mineralization, and superior biomechanical properties compared to control groups.

CONCLUSION: miRNA-130b promotes osteogenesis and fracture healing by targeting PTEN and activating the Wnt/β-catenin signaling pathway. These findings highlight miRNA-130b as a promising therapeutic target for improving fracture repair outcomes.

PMID:40479940 | DOI:10.1016/j.injury.2025.112452

Injury. 2025 May 30;56(8):112468. doi: 10.1016/j.injury.2025.112468. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify platelet hypofunction and its associations in severely injured trauma patients presenting with haemorrhage.

DESIGN: Planned sub-study of data collected from the FEISTY trial; an Australian multicentre, randomised controlled pilot trial investigating early fibrinogen replacement in severely injured trauma patients.

SETTING: Four major trauma centres in Queensland, Australia.

PARTICIPANTS: Adult trauma patients (age ≥18 years) presenting with clinically significant haemorrhage or potential for significant transfusion requirements.

MAIN OUTCOME MEASURES: Platelet function parameters arachidonic acid (ASPI), adenosine diphosphate (ADP), and thrombin receptor-activating peptide (TRAP) assessed via Multiplate® analysis, rotational thromboelastometry (ROTEM®) parameters EXTEM, FIBTEM, and PLTEM (EXTEM - FIBTEM), transfusion requirements, and clinical outcomes.

RESULTS: Significant platelet hypofunction was detected in this cohort of severely injured trauma patients at time of presentation, with 70 % of patients having hypofunction in at least one Multiplate® channel. The median ASPI area under the curve and 95 % confidence interval were below the lower reference range, indicating this population had reduced platelet function. In patients with deranged platelet function, significantly lower platelet count (p ≤ 0.001), EXTEM amplitude at five minutes (A5) and maximum clot firmness (MCF) (p = 0.001, p ≤ 0.001), and PLTEM A5 and MCF (p = 0.005, p = 0.003) were identified compared to patients with normal platelet function. A significant improvement in platelet function parameters was not observed following platelet transfusion.

CONCLUSION: Platelet hypofunction is common in severely injured trauma patients. This was true both before and after platelet transfusion, suggesting trauma precipitates alteration of the vascular circulating milieu in a way that impairs platelet function. Characterisation of this change might lead to targeted interventions to improve haemostasis.

PMID:40479939 | DOI:10.1016/j.injury.2025.112468

Injury. 2025 May 23;56(8):112372. doi: 10.1016/j.injury.2025.112372. Online ahead of print.

ABSTRACT

OBJECTIVES: Tibial non-unions have always been extremely difficult to manage for surgeons. This problem becomes all the more compounded in presence of infection and/or bone loss [1-6] The purpose of this study is to evaluate the management of bone loss of 4 to10cm in patients presenting with tibia non unions through monitored acute shortening and subsequent lengthening using Ilizarov ring fixator METHOD: The present study was carried out in the Department of Orthopaedics, R.D. Gardi Medical College, Ujjain. Madhya Pradesh. The study was carried out between August 2019 to August 2024. A total of 15 adult patients with tibia shaft non union with bone gap of 4 - 10 cm were included in the study. All the patients were operated by the same surgeon with the help of ilizarov ring fixator method RESULT: All patients in the present study had fracture union after primary surgery. Bone gap closure and compression at the fracture ends was achieved by one week postoperatively. There was no recurrence of deep infection nor the procedure was associated with any neurovascular complications.

CONCLUSION: With the use of our Monitored Acute Shortening and Lengthening method we were able to manage tibia non unions with Bone gaps ranging from 4 - 10 cm through Ilizarov ring fixator by utilization of natural bone healing potential. We were able to achieve union in all our cases without the requirement of any secondary union enhancing surgery.

PMID:40472528 | DOI:10.1016/j.injury.2025.112372

Injury. 2025 May 27;56(8):112460. doi: 10.1016/j.injury.2025.112460. Online ahead of print.

ABSTRACT

INTRODUCTION: Post-traumatic arthritis and avascular necrosis are common sequelae following acetabular fractures, often leading to conversion to total hip arthroplasty (THA). Traditionally, conversions to THA have been performed through posterior or direct lateral approaches, which navigate through scar tissue and previously placed implants. The direct anterior approach (DAA) is increasingly adopted for these conversions, as it accesses a 'virgin' surgical plane, potentially reducing the risks of infection and neurovascular injury. This study aims to compare clinical outcomes and complication rates between the DAA and traditional approaches in conversion THA after acetabular fracture fixation.

MATERIALS AND METHODS: A retrospective review was conducted of acetabular fractures treated at a Level-I trauma center between 2008 and 2021. Patients were grouped by surgical approach (direct anterior (DA), posterior (P), or direct lateral (DL)). The study included patients with a minimum of one-year follow-up. Outcomes measured included Harris Hip Score (HHS), complications necessitating reoperation, infections, blood loss, surgical time, transfusions heterotopic ossification (HO) removal, acetabular implants encountered during reaming, and THA implants used.

RESULTS: Seventy-one patients were included: 30 in the DA group, 28 in the P group, and 13 in the DL group. The mean follow-up time was 51 months. No significant differences in demographics were found. The DA group had significantly higher HHS (90.1) compared to the P (70.5) and DL groups (84.8, p < 0.001). Blood loss was significantly lower in the DA (440 mL) and direct lateral (304 mL) groups compared to the posterior group (547 mL, p = 0.04). The DA group had no infections, the posterior group had 4 infections, and the DL group had one infection (p = 0.10). At final follow-up, the DA and DL groups had significantly higher HHS: 90.1 (DA) and 84.8 (DL) compared to 70.5 (P) (p < 0.001).

CONCLUSION: Conversion THA after acetabular fracture remains a high-risk procedure with significant complication rates. The DAA offers a safe and effective approach, with lower complication rates and superior functional outcomes compared to traditional approaches. This approach may reduce infection rates and neurovascular complications in straightforward cases. For complex cases involving extensive bone loss or acetabular defects, a more extensile approach may be necessary.

PMID:40472527 | DOI:10.1016/j.injury.2025.112460

Injury. 2025 May 28;56(8):112463. doi: 10.1016/j.injury.2025.112463. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study is to report on the frequency and correlates of serious unintentional physical injury (SPI), road traffic injury, and near drowning experience as well as the mediation of exposure to interpersonal violence in the relationship between substance use and SPI among adolescents in Philippines in 2019.

METHOD: The 2019 Philippines Global School-based Student Health Survey (GSHS), a nationally representative survey of teenagers aged 11 to 18 (mean age 13.8 years, Standard Deviation-SD=1.5) that used a multistage sampling technique, provided the study's data. In order to determine the variables associated with past 12-month SPI, road traffic injury and near drowning experience, the study used bivariate and multivariable logistic regression analysis as well as causal mediation of interpersonal violence exposure in the relationship between substance use and SPI.

RESULTS: Regression results showed that male sex, food insecurity, psychological distress, suicide attempt, current drug use, bullying victimization, current alcohol use, and school truancy were positively associated with SPI and road traffic injury. Furthermore, soft drink intake, and fast-food consumption were positively associated, and being 15 to 18 years-old and higher parental support were negatively associated with SPI and with near drowning experience, and not aways wearing a seatbelt was associated with road traffic injury. In addition, being religious or spiritual, psychological distress, suicide attempt, current drug use, bullying victimization, and current alcohol use were associated with near drowning experience. Causal mediation analyses found a significant indirect effect of substance use (explaining 5.9 %) on serious injury count via types of bullied, a significant indirect effect of substance use (explaining 42.8 %) on serious injury count via physically attacked counts, and a significant indirect effect of substance use (explaining 54.5 %) on serious injury count via in physical fights counts.

CONCLUSION: Almost half of participants had a SPI and more than one in three had experienced near drowning. Various sociodemographic, protective, and psychosocial associated factors were identified, which can assist in targeting injury prevention among adolescents in the Philippines.

PMID:40472526 | DOI:10.1016/j.injury.2025.112463

Injury. 2025 May 27;56(8):112459. doi: 10.1016/j.injury.2025.112459. Online ahead of print.

ABSTRACT

INTRODUCTION: The gull sign, representing superomedial dome impaction in acetabular fractures, was first described approximately 20 years ago by Anglen and co-workers. They concluded that this sign equates with poor outcomes after open reduction and internal fixation (ORIF), terming it a "harbinger for failure". Since then, the presence of the gull sign has frequently influenced surgical decision-making in geriatric acetabular fractures. The aim of this radiological descriptive study was to revisit the accuracy of the gull sign seen on pelvic radiographs in predicting dome impaction on computed tomography (CT).

PATIENTS AND METHODS: In a retrospective study, conventional pelvic radiographs and CT scans of n = 201 patients (mean age±SD: 68±17y, 75 % male) with acetabular fractures treated surgically between 2009 and 2020 were analyzed. The presence of the gull sign was assessed on anteroposterior pelvic radiographs. CT scans were assessed for true impaction ("brick sign") with focus on the acetabular surface and compared to the findings according to Anglen`s description.

RESULTS: The gull sign was noted on pelvic radiographs in 49 of 201 cases (24 %). In 28 out of these 49 cases (57 %) a dome impaction was noted on CT. In the remaining 21 cases (43 %), CT revealed no actual impaction but rather an elevated dome following displaced fracture fragments. Conversely, among the 152 patients (76 %) without a gull sign, CT identified previously undetected dome impactions in 41 cases. Overall, the gull sign had a sensitivity of 41 %, a specificity of 84 %, and a positive predictive value of 57 % for detecting dome impactions.

CONCLUSION: The gull sign is an unreliable predictor for dome impaction in acetabular fractures for the following reasons: in the presence of the gull sign nearly half of the cases an elevated fragment only (not an impacted fragment) was noted on CT; despite an absence of the gull sign in nearly one-third of these cases dome impactions ("brick sign") were present on CT. Consequently, routine preoperative CT imaging is essential to accurately differentiate true dome impactions ("brick sign") from dome elevation, thereby guiding appropriate surgical decision-making between "disimpaction versus reduction" and in general between the "fix or replace" debate.

PMID:40466585 | DOI:10.1016/j.injury.2025.112459

Injury. 2025 Jun 3;56(8):112461. doi: 10.1016/j.injury.2025.112461. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic acetabular fractures (PPAF) are a rare and serious complication in hip arthroplasty. The increase in the number of hip arthroplasty patients and the long service life of implants are leading to a rise in periprosthetic fractures.

PURPOSE: We hypothesized (1) that modified Stoppa approach in Combination with direct anterior approach of PPAF leads to good patient outcomes in both patients with and without acetabular cup instability; (2) the complication rate of our combined surgical procedures is lower than reported in the literature; (3) that combined surgical procedures for PPAF have a low 1-year mortality.

METHODS: A retrospective analysis was performed from January 2013 to February 2024. Patients were treated with osteosynthesis using the modified Stoppa approach and revision of the cup using the direct anterior approach (DAA). Mobility before and after surgical treatment, modified Harris Hip Score (mHHS), complications, revision rates, and 1-year mortality were recorded using a questionnaire.

RESULTS: A total of 24 PPAF were identified, of which 18 patients were included in this study. Of 18 PPAF that were treated interdisciplinary by the trauma and orthopedic department, 13 cases showed cup instability. Fifty percent of the patients achieved a satisfactory result after mHHS, however, with a mean mHHS of 57±30, showing a wide range between good and poor outcomes. 13 (61.1 %) patients reported the same mobility postoperatively as prior to fracture. The complication and revision rates were 16.6 % and 5.6 %, respectively, which is below the rates reported in the literature. The 1-year mortality rate was 33.3 %.

CONCLUSION: Combined surgery showed low perioperative complication and revision rates. However, a 1/3 mortality rate at 1 year is quite high, which is likely a reflection of these patients' fragility and co-morbidities. Furthermore, there is no advantage for the functional outcome according to the mHHS.

PMID:40466584 | DOI:10.1016/j.injury.2025.112461

Injury. 2025 May 23:112438. doi: 10.1016/j.injury.2025.112438. Online ahead of print.

NO ABSTRACT

PMID:40451656 | DOI:10.1016/j.injury.2025.112438

Injury. 2025 May 24;56(8):112455. doi: 10.1016/j.injury.2025.112455. Online ahead of print.

ABSTRACT

OBJECTIVE: Surgical treatment of scaphoid nonunion after failed screw fixation is a unique challenge for hand surgeons. This retrospective study evaluated the clinical results of revisional reconstruction by a hand trauma plate system with bone grafting for this situation.

METHODS: From 2019 to 2022, 12 patients with scaphoid nonunion after failed closed or open reduction and internal fixation surgery were treated with revisional surgery using a 1.7-mm nonlocking hand trauma plate system. Pure cancellous bone was harvested from the iliac crest or olecranon of the patient to fill the bony defect between the proximal and distal segments of the fracture. Visual analog scale scores and functional outcomes were assessed after at least 2 years of follow-up.

RESULTS: We used computed tomography (CT) to assess the union, and all fractures healed. The mean interval between primary and definitive surgery was 14.4 (range, 6-36) months. The mean follow-up period was 43.4 (range, 27-72) months. The mean union time was 11 (range, 8-16) weeks. The clinical outcomes included active wrist range of motion (67.2 % ± 16.4 % vs. 82.9 % ± 12.0 %, P = 0.002), visual analog scale score (5.0 ± 1.3 vs. 2.3 ± 1.2, P < 0.001), grip strength (69.4 % ± 11.3 % vs. 88.5 % ± 16.6 %, P < 0.001), and modified Mayo wrist score (51.7 ± 16.1 vs. 71.7 ± 8.9, P < 0.001). Three patients complained of clicking at the volar part of the wrist joint, which was resolved by plate removal.

CONCLUSION: A hand trauma plate system can be used to stabilize the scaphoid fracture nonunion in the treatment of failed screw fixation for scaphoid waist fractures. Hardware removal may be considered if impingement symptoms persist after fracture healing.

PMID:40450785 | DOI:10.1016/j.injury.2025.112455

Injury. 2025 May 26;56(8):112457. doi: 10.1016/j.injury.2025.112457. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to systematically compare the clinical efficacy and safety of different surgical approaches in the treatment of posterolateral tibial plateau fractures. Specifically, it evaluated operative time, intraoperative blood loss, fracture healing time, postoperative knee function, and complication rates, to provide evidence-based guidance for clinical surgical approach selection.

METHODS: A comprehensive literature search was conducted in seven major databases-CNKI, PubMed, Web of Science, Cochrane Library, Scopus, VIP, and EMBASE-from their inception to May 2025. Controlled studies comparing different surgical approaches for posterolateral tibial plateau fractures were included. Primary outcomes were operative time, intraoperative blood loss, fracture healing time, postoperative Hospital for Special Surgery (HSS) knee scores, and incidence of postoperative complications. A network meta-analysis was performed using Stata 16.0. A network diagram and league table were generated to present both direct and indirect comparisons among surgical approaches. Surface Under the Cumulative Ranking curve (SUCRA) values were used to rank the interventions. Study quality was assessed using the MINORS scale. Inconsistency testing and publication bias analysis were also conducted to ensure robustness of the results.

RESULTS: A total of 26 studies involving 1864 patients and seven surgical approaches were included. The network meta-analysis showed that the Modified Extended Anterolateral Approach (MEALA) ranked highest across all primary outcomes: operative time (SUCRA: 97.8 %), intraoperative blood loss (94.9 %), fracture healing time (95.0 %), postoperative HSS score (98.2 %), and complication rate (78.5 %). Additionally, the Transfibular Head Approach (TFHA) demonstrated advantages in minimizing intraoperative blood loss and controlling complications. No significant inconsistency or publication bias was detected based on node-splitting analysis and funnel plot assessment, indicating robust results.

CONCLUSION: The Modified Extended Anterolateral Approach demonstrates superior overall performance in the treatment of posterolateral tibial plateau fractures, particularly in reducing operative time, minimizing intraoperative trauma, and enhancing postoperative functional recovery. The Transfibular Head Approach also shows potential benefits in complication management. Surgical approach selection should be individualized based on fracture morphology and surgeon experience. Further high-quality randomized controlled trials are warranted to validate these findings.

PMID:40449183 | DOI:10.1016/j.injury.2025.112457

Injury. 2025 May 24;56(8):112454. doi: 10.1016/j.injury.2025.112454. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal radius fractures (DRFs) are common, with an increasing incidence, particularly among the elderly. Rupture of the extensor pollicis longus (EPL) tendon, essential for thumb extension, is a notable complication, especially in non-displaced DRFs. Several mechanisms, such as local adhesion, ischemic atrophy, and tendon laceration, are associated with EPL tendon rupture. This multicenter retrospective study aims to identify risk factors for EPL tendon rupture in non-displaced DRFs.

MATERIALS AND METHODS: The study reviewed 20 cases of EPL tendon rupture and 52 control cases from 2005 to 2022, excluding those who underwent surgery or had incomplete computed tomography (CT) data. We investigated age, sex, location of fracture line, and the morphology of Lister's tubercle as variables. Logistic regression and decision tree analyses were employed to determine the risk factors for EPL tendon rupture based on these variables.

RESULTS: Fracture lines distal to Lister's tubercle and specific shapes of Lister's tubercle, characterized by shallow peak height and a higher radial peak than the ulnar peak, increased the risk of EPL tendon rupture. Decision tree analysis confirmed them as major risk factors. There was a significant difference in the predicted probability rate of tendon rupture between the case with these factors and those without them (P < 0.001). Conversely, the location and size of Lister's tubercle did not affect the incidence of EPL tendon rupture.

CONCLUSION: The location of fracture line and the shape of Lister's tubercle are key factors influencing EPL tendon rupture in non-displaced DRFs. Understanding these factors can help orthopedic surgeons predict and prevent EPL tendon ruptures, improving patient outcomes following these fractures.

PMID:40449182 | DOI:10.1016/j.injury.2025.112454

Injury. 2025 May 29;56(8):112442. doi: 10.1016/j.injury.2025.112442. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal femur fractures are commonly managed with retrograde femoral nailing or locked lateral plating (LLP). As implant design has evolved, more distal and complex patterns are being treated with intramedullary implants. The aim of the present study was to compare early outcomes in distal femur fractures managed with the novel DePuy Synthes RFN-Advanced (RFNA) Retrograde Femoral Nailing System to a similar cohort treated with locked lateral plating.

PATIENTS AND METHODS: This is a retrospective cohort study of operative distal femur fractures that presented to our Level I trauma center over a 7-year period. We included patients with AO/OTA types 33A2-3, 33C1-2 fractures treated with either the RFNA or a lateral locked plate over two distinct time points. Injury radiographs were reviewed independently by three orthopedic traumatologists to include only cases deemed "nailable." Primary outcomes included coronal and sagittal alignment. Secondary outcomes included nonunion, surgical site infection (SSI), and unplanned reoperation.

RESULTS: We identified 107 patients treated with either the RFNA (n = 45) or LLP (n = 62) over the 7-year study period. No significant differences were identified in the rates of sagittal (2.2 % versus 9.7 %, P = 0.12) or coronal malalignment (2.2 % versus 0 %, P = 0.421). The nonunion rate was 8.9 % in the RFNA cohort versus 19.4 % in the LLP cohort, but this difference was not statistically significant (P = 0.174). We also found no difference in infection or implant failure between groups. Screw backout occurred in 8 RFNA patients (17.8 %), with 7 patients undergoing screw removal (15.6 %) either in clinic (n = 5) or the operating room (n = 2).

DISCUSSION AND CONCLUSIONS: This matched cohort study demonstrated promising results comparing the RFNA to lateral plating of distal femur fractures. The nonunion rate of 9 % in the RFNA cohort adds to recent literature that supports improved union rates with intramedullary nailing of these fractures. Interlocking screw backout was the most common complication with RFNA treatment at a rate of 16 %, with the majority removed in clinic.

LEVEL OF EVIDENCE: Level III.

PMID:40446568 | DOI:10.1016/j.injury.2025.112442

Injury. 2025 May 21;56(8):112450. doi: 10.1016/j.injury.2025.112450. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the safety and efficacy of Pelnac artificial skin one-stage surgical direct repair of significant toenail flap donor area defects.

METHODS: From March 2020 to May 2023, a total of 56 patients with traumatic finger injuries underwent reconstruction using a great toenail flap combined with iliac bone grafting, along with one-stage artificial skin repair of the great toenail flap. These patients were followed prospectively, and their clinical outcomes were systematically evaluated.

RESULTS: The average follow-up was 13.4 months (3 to 30 months). The visual analog scale for pain was 0.23±0.6, and the Vancouver scar scale (VAS) was 2.82±1.06. Among 56 patients, only one case developed postoperative infections. The aesthetic satisfaction of the donor area of the patient's foot was 87.10±5.48 points (out of 100 points). Regarding the sensory recovery, the response "normal or near normal" was obtained in 44 patients (78.6 %). The maximum active mobility of the first metatarsophalangeal joint and the distal interphalangeal joint in the donor area was 66.51±7.38°and 43.21±4.62°, respectively.

CONCLUSIONS: Given its low donor-site morbidity and favorable cosmetic and functional outcomes, one-stage reconstruction of donor site defects using artificial dermis represents an effective and clinically viable treatment option.

PMID:40446567 | DOI:10.1016/j.injury.2025.112450

Injury. 2025 May 22;56(8):112453. doi: 10.1016/j.injury.2025.112453. Online ahead of print.

NO ABSTRACT

PMID:40446566 | DOI:10.1016/j.injury.2025.112453

Injury. 2025 May 21;56(8):112451. doi: 10.1016/j.injury.2025.112451. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the pros and cons of percutaneous kyphoplasty (PKP) and bone-filling mesh containers (BFC) by means of a meta-analysis in the treatment of osteoporotic vertebral compression fractures (OVCFs).

MATERIALS AND METHODS: A comprehensive search of Cochrane Library, PubMed, Embase, CNKI, Wanfang Database, and Chinese biomedical literature database was conducted to identify eligible clinical control studies comparing BFC versus PKP for OVCFs published until December 2022. Meta-analysis was performed utilizing Revman 5.3 to assess the effectiveness and safety of the two procedures.

RESULTS: Thirteen clinical controlled trials with a total of 1025 patients were enrolled, including 487 in the BFC group and 538 in the PKP group. BFC significantly reduced operation time and bone cement leakage rates compared with PKP. No significant differences were found between the two groups in terms of VAS score, ODI score, and Cobb angle at short- and long-term follow-up.

CONCLUSIONS: Both BFC and PKP are effective surgical approaches for the treatment of OVCFs, with BFC having a shorter operative time and a lower incidence of cement leakage.

PMID:40446565 | DOI:10.1016/j.injury.2025.112451

Injury. 2025 May 17;56(8):112445. doi: 10.1016/j.injury.2025.112445. Online ahead of print.

ABSTRACT

Traditionally unstable ankle fractures are surgically managed using open reduction and internal fixation (ORIF) with plate and screws. However, the operative management has gained an innovative technique. In the last decade, intramedullary (IM) nailing was introduced in local guidelines as a treatment for a selective group of elderly patients with compromised soft-tissues, as this technique is minimally invasive and less prone to wound complications including infections. Based on the authors' experience with IM nailing of the fibula using an intramedullary locking fibula nail, common technical challenges are highlighted and tips and tricks are provided to achieve optimal anatomic reduction by optimizing the entry point of the nail. Furthermore, we introduce a flow-diagram for optimal anatomic reduction using a dorsolateral entry point for the nail.

PMID:40446564 | DOI:10.1016/j.injury.2025.112445

Injury. 2025 May 22:112446. doi: 10.1016/j.injury.2025.112446. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, there is a lack of literature reporting on the risk factors associated with various types of subdural effusion (SDE). The purpose of this study is to investigate the incidence, risk factors, and prognosis of different types of SDE that occur secondary to unilateral decompressive craniectomy (DC) in patients with traumatic brain injury (TBI).

METHODS: A total of 417 patients who met the inclusion criteria were analyzed. The incidence, treatment, and prognosis of various types of SDE were examined. Risk factors associated with different types of SDE were identified through univariate analysis followed by multivariable logistic regression analysis.

RESULTS: The overall incidence of SDE was 50.6 %. There was no statistically significant difference in GOS scores among the various types of SDE (P = 0.511). Age (per 10-year increase) (OR, 1.471; 95 % CI, 1.201-1.802; P < 0.001), alcoholism (OR, 2.027; 95 % CI, 1.021-4.022; P = 0.043), combined with contralateral subdural hematoma (OR, 4.874; 95 % CI, 2.676-8.878; P < 0.001), and contralateral pneumocephalus after surgery (OR, 4.051; 95 % CI, 1.837-8.934; P = 0.001) were identified as independent risk factors for the occurrence of contralateral SDE. The type of injury (acute subdural hematoma, ASDH) (OR, 1.918; 95 % CI, 1.367-2.690; P <0.001), was an independent risk factor for the occurrence of ipsilateral SDE. Combined with contralateral subdural hematoma (OR, 2.669; 95 % CI, 1.161-6.139; P = 0.021) and contralateral pneumocephalus after surgery (OR, 2.271; 95 % CI, 1.177-4.381; P = 0.014) were independent risk factors for the occurrence of interhemispheric SDE.

CONCLUSIONS: Various types of SDE do not significantly affect the prognosis of patients with traumatic brain injury (TBI). Independent risk factors for the occurrence of contralateral SDE include age, alcoholism, and the presence of contralateral subdural hematoma and contralateral pneumocephalus following surgery. The type of injury being ASDH is the only risk factor for ipsilateral SDE. Combined with contralateral subdural hematoma and contralateral pneumocephalus after surgery were independent risk factors for the occurrence of interhemispheric SDE.

PMID:40436708 | DOI:10.1016/j.injury.2025.112446

Injury. 2025 May 17:112447. doi: 10.1016/j.injury.2025.112447. Online ahead of print.

ABSTRACT

INTRODUCTION: Open cardiopulmonary resuscitation (OCPR) is a critical treatment for severe torso trauma. While OCPR has shown survival benefits for patients with penetrating traumatic cardiac arrest, its efficacy in blunt trauma patients remains unclear.

MATERIALS AND METHODS: This retrospective cohort study analyzed pulseless blunt chest trauma patients from the National Trauma Data Bank (NTDB) in the United States during 2014-2015. The study excluded patients under 18 years of age, those without initial signs of life, and those with burns, penetrating trauma, unknown mechanisms, incomplete records, severe head injuries, or transportation times over 60 min. The primary outcome was Emergency Department (ED) survival, and the secondary outcome was overall survival.

RESULTS: Out of 1358 pulseless blunt chest trauma patients, 420 met the inclusion criteria, and 15.5 % (65/420) received OCPR. ED survival was significantly greater in the OCPR group (81.5 % [53/65] vs. 46.8 % [166/355], p < 0.001), whereas overall survival was not significantly different between the groups (9.2 % [6/65] vs. 12.4 % [44/355], p = 0.626). A subset analysis of patients with cardiac injuries showed better ED survival (81.3 % [13/16] vs. 40.5 % [17/42], p = 0.012) and a trend of better overall survival (25.0 % [4/16] vs. 3.4 % [2/42], p = 0.086) for those who underwent OCPR.

CONCLUSION: OCPR does not improve overall survival in all pulseless blunt chest trauma patients, but it offers significant benefits for those with cardiac injuries. Further research is needed to refine management strategies for these patients.

PMID:40425418 | DOI:10.1016/j.injury.2025.112447

Injury. 2025 May 14:112437. doi: 10.1016/j.injury.2025.112437. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma-related preventable death is considered death as a consequence of moderate to severe injury under (sub)optimal trauma care conditions and is used as a criterion to evaluate the management and quality of trauma care worldwide. A validated definition of trauma-related preventable death is still lacking due to differences in classification. To reach consensus on a definition and assess the necessity of an additional trauma prediction algorithm, a Delphi procedure was performed.

METHODS: A digital three-round Delphi procedure was performed. Trauma surgeons, neurosurgeons, forensic medicine physicians, anesthesiologists, and emergency care physicians working at a Level 1 or affiliated trauma center in the Netherlands were invited to participate. An electronic questionnaire was administered to assess the most suitable category of trauma-related preventable death (clinical definition, trauma prediction algorithm, clinical definition and trauma prediction algorithm or other) and the additional benefit of a trauma prediction algorithm.

RESULTS: Fifty-four panelists completed the study: 23 trauma surgeons, 13 emergency care physicians, 10 anesthesiologists, 4 neurosurgeons and 4 forensic medicine physicians. In the first round, a clinical definition and a clinical definition and trauma prediction algorithm (Trauma Score and Injury Severity Score and a combination of algorithms) were favored. The results were fed back to the panelists. In the final round, there was a tendency towards group consensus in favor of a clinical definition and trauma prediction algorithm (63 %). Consensus was reached on the most suitable algorithm: the Trauma Score and Injury Severity Score combined with the Probability of survival.

CONCLUSION: The identification of trauma-related preventable death is essential in the evaluation of trauma care. This study elucidates the difficulty of multidisciplinary consensus. However, a propensity towards consensus on a clinical definition, and consensus on the additional benefit of the PS, based on the TRISS, seems to be present.

PMID:40413123 | DOI:10.1016/j.injury.2025.112437