Injury. 2025 May 5;56(7):112400. doi: 10.1016/j.injury.2025.112400. Online ahead of print.

ABSTRACT

BACKGROUND: It is becoming increasingly important to evaluate the effectiveness of large language models (LLMs) and query-assisted platforms like Google and ChatGPT in providing clinically relevant and accurate information to patient-initiated inquiries. Limited studies have characterized the performance of these platforms on semi-elective orthopedic trauma surgeries. This study evaluates the function of both interactive online models on frequently queried patient searches on ankle and clavicle fracture operations.

METHODS: An inquiry set consisting of ten prevalent patient questions for each fracture type was extracted using Google and ChatGPT. Responses, alongside their source attributions, were curated for clinical relevance and accuracy. This assessment was conducted in a double-blind fashion. Grading was completed by two researchers with academic and clinical experience in orthopedic trauma (D.E.P, H.F.B), with oversight and validation provided by a board-certified orthopedic trauma surgeon (A.N.M). Descriptive and comparative statistics were used to understand the dataset.

RESULTS: ChatGPT performed better than Google in terms of clinical relevance (p = 0.001) and accuracy (p = 0.004) in ankle fracture patient queries. Clavicle fracture queries showed a significant difference favoring ChatGPT for accuracy (p = 0.04), though relevance did not reach statistical significance (p = 0.06). When answer ground-truth was analyzed, GPT outperformed Google by providing more academic sources (p < 0.05).

CONCLUSIONS: Large Language Models outperformed traditionally used online platforms in delivering clinically precise and contextually relevant information on semi-elective, common orthopedic trauma surgeries. The ability of LLMs to synthesize responses from credible medical sources significantly diminishes the variability and potential inaccuracies inherent in conventional web searches. These insights strongly suggest that LLMs could play a pivotal role in enhancing patient engagement and comprehension in trauma care, meriting further exploration of their integration within clinical frameworks.

LEVEL OF EVIDENCE: Therapeutic Level III.

PMID:40344857 | DOI:10.1016/j.injury.2025.112400

Injury. 2025 May 1;56(7):112374. doi: 10.1016/j.injury.2025.112374. Online ahead of print.

ABSTRACT

BACKGROUND: A small proportion of patients account for a disproportionate use of emergency healthcare services and exhibit an increased mortality. This group includes individuals with different conditions and risk-taking behaviors. Among them are persons diagnosed with personality disorders, who are particularly susceptible to injuries and intoxications-factors that contribute to an increased risk of premature death, especially from unnatural causes.. In this study in women with a personality disorder diagnosis, we hypothesized that the number of inpatient episodes due to injuries or intoxications would be independently related to the mortality risk for both natural and unnatural causes.

METHODS: A cohort of all women who received a personality disorder diagnosis in the Swedish National Patient Register during the years 1997-2015 (n = 44,221) was followed up until December 31, 2015. All inpatient treatment periods with diagnoses of injuries or intoxications were documented. Information on all deaths was obtained from The Swedish Cause of Death Register.

RESULTS: Multivariable Cox proportional hazards regressions, adjusted for relevant confounders revealed that the number of inpatient care episodes due to injuries or intoxications was independently related to later all-cause mortality, as well as mortality from unnatural and natural causes, and suicidal actions.

CONCLUSIONS: The results motivate particular attention to women with recurrent injuries or intoxications with an assessment of the need for non-emergent measures to decrease the risk of early death, including suicide.

PMID:40344856 | DOI:10.1016/j.injury.2025.112374

Injury. 2025 Apr 29;56(7):112364. doi: 10.1016/j.injury.2025.112364. Online ahead of print.

ABSTRACT

INTRODUCTION: The impact of reduction sequence on acetabular reduction quality in combined pelvic and acetabular fractures remains unclear. This study aimed to evaluate whether posterior ring reduction first improves acetabular reduction outcomes in these complex injuries.

METHODS: This retrospective cohort study included adult patients with combined pelvic and acetabular fractures treated at an urban level 1 trauma center between April 2018 and April 2024. Patients with nonoperative acetabular fractures, stable pelvic ring injuries, or nondisplaced acetabular fractures treated percutaneously were excluded. Postoperative CT scans assessed acetabular step-off and gapping. Patients were divided into two groups: the posterior-first group (posterior ring reduced first) and the non-posterior-first group (all other reduction sequences). Demographic data, fracture classification, and surgeon seniority were analyzed for potential confounding effects.

RESULTS: A total of 45 patients were included, with 22 in the posterior-first group and 23 in the non-posterior-first group. The posterior-first group demonstrated significantly higher rates of anatomical reduction for step-off (68.2 % vs 30.4 %, p = 0.017) and gapping (27.3 % vs 4.4 %, p = 0.047). There were no significant differences between groups in demographics, injury mechanism, fracture classification, Injury Severity Score (ISS), or surgeon seniority (p > 0.05). Surgeon seniority did not influence the quality of acetabular reduction (p > 0.05).

CONCLUSIONS: Posterior ring reduction first is associated with improved anatomical reduction in acetabular step-off and gapping in combined pelvic and acetabular fractures. These findings support prioritizing posterior ring reduction to optimize acetabular outcomes.

PMID:40344855 | DOI:10.1016/j.injury.2025.112364

Injury. 2025 May 1;56(7):112401. doi: 10.1016/j.injury.2025.112401. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal femur fractures (DFF) are orthopaedic injuries associated with poor outcomes, despite recent improvements in technology. Perhaps socioeconomic distress is a factor influencing DFF outcomes. The purpose of this study was to investigate the impact of social deprivation via the Area Deprivation Index (ADI) in the perioperative period after DFF.

MATERIALS AND METHODS: This was a retrospective review carried out at a Level I Academic Trauma Center of patients ≥ 55 years old with operatively treated distal femur fractures from 2000-2023. Demographic information, Charlson Comorbidity Index (CCI), Injury Severity Score (ISS), preoperative functional independence, ipsilateral or contralateral lower extremity fracture, mechanism of injury, fracture characteristics, discharge disposition, and length of stay were recorded. ADI was used to categorize patients into least deprived tercile (LDT, 0-33), intermediate deprived tercile (IDT, 34-67), and most deprived tercile (MDT, 68-100). Inpatient length of stay and discharge disposition were compared among LDT, IDT, and MDT.

RESULTS: A total of 427 patients were included in the study, 58 (13.5 %) MDT, 155 (36 %) IDT, and 214 (50.5 %) LDT. The mean age was 60.2+-18.2 years. In comparison to MDT, LDT were significantly more female (67.8 % v 53.4 %, p = 0.043), Caucasian (93.8 % v 68.4 %, P < 0.001), less likely to be injured from a fall from height (6.1 % vs 19.0 %, p = 0.032), have a prolonged length of stay (40.2 % vs 55.2 %, p = 0.041), and be a former smoker (17.7 % vs 27.8 %, p = 0.050). When controlling for gender, race, injury severity, and preoperative functional independence, MDT were 2.1 times more likely to have a prolonged hospital stay in comparison to LDT (95 % CI 1.0 - 4.5, p = 0.049). MDT were 2.9 times more likely to discharge to a skilled nursing facility or inpatient rehabilitation location (95 % CI 1.2 - 7.2, p = 0.019) in comparison to LDT after controlling for age, gender, race, alcohol use, mechanism of injury, and length of hospitalization.

CONCLUSION: Following distal femur fracture fixation, the most socially deprived patients are likely to have a longer stay in the hospital and a greater chance of non-home discharge. Future interventions should be aimed at minimizing socioeconomic barriers that impact discharge timing and location.

LEVEL OF EVIDENCE: III.

PMID:40344854 | DOI:10.1016/j.injury.2025.112401

Injury. 2025 Apr 25;56(7):112356. doi: 10.1016/j.injury.2025.112356. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare between single trans-iliac trans-sacral screw versus dual ilio-sacral screws in Management of unstable pelvic ring disruptions after achieving reduction, to facilitate union of the fracture and early mobilization.

METHODS: In a retrospective cohort study that was done in Assiut University hospital trauma unit between May 2018 to September 2020, 36 patients with unstable fracture pelvis were included in the study. Single trans-iliac trans-sacral screws were done in 16 cases while two ilio-sacral screws were done for the rest of cases. Age ranged from 18 to 57 years old, with exclusion of patients with spino-pelvic dissociation, comminuted fractures, chronic uncontrolled co-morbidities, bilateral sacral fractures. Follow up of the patients radiologically using plain X-ray and Computed Tomography scan to identify union of fractures were reported. Functional follow-up using Majeed score and Visual analogue scale were reported with allowance of weight bearing as tolerated.

RESULTS: The two groups were comparable in terms of baseline characteristics, including age, sex, and comorbidities. A significant difference was observed in Tile classification between the groups (P = 0.05), while there was no significant difference in Denis classification (P = 0.29). Operative parameters such as surgical time, fluoroscopy time, and blood loss were similar between the two groups (P > 0.05). Outcome analysis revealed that patients in the STITSS group experienced significantly less pain at six weeks post-surgery, with lower VAS scores (4.31 ± 0.87 vs. 6.38 ± 1.31; P = 0.000). However, by 3 and 6 months, the VAS scores showed no significant differences between the groups (P > 0.05). Additionally, functional outcomes measured by the Majeed score were significantly better in the STITSS group at six weeks (61.64 ± 8.55 vs. 53.15 ± 7.80; P = 0.037). Similar to pain scores, the Majeed scores equalized between the groups at 3 and 6 months, with no significant differences noted.

CONCLUSION: The study findings indicate that STITSS fixation offers better early outcomes in terms of pain relief and functional recovery compared to dual ilio-sacral screw fixation. Despite the technical challenges associated with STITSS, it allows for faster rehabilitation and a quicker return to functional activities. In the long term, however, both techniques demonstrate comparable results. Further research is needed to validate these findings and optimize fixation strategies for unstable pelvic fractures.

PMID:40344853 | DOI:10.1016/j.injury.2025.112356

Injury. 2025 May 6;56(7):112411. doi: 10.1016/j.injury.2025.112411. Online ahead of print.

ABSTRACT

INTRODUCTION: Ice hockey is a high-contact sport that can often endanger athletes' physical health, especially adolescents. Youth hockey players still learning to properly play the sport tend to be much more prone to serious injury. The goal of this study was to examine the frequency and trends of pediatric hockey-related injuries presenting to United States (US) emergency departments (EDs) amongst youth.

METHODS: Ice hockey-related injuries presenting to US EDs from January 1st, 2014 to December 31st, 2023 were queried using the National Electronic Injury Surveillance System (NEISS). For each injury, patient disposition, demographics, diagnosis, and site of injury were recorded. National estimates (NEs) were calculated using the NEISS statistical sample weights. Injury trends were evaluated by linear regression modeling.

RESULTS: There was a total of 3847 ED visits due to ice hockey-related injuries during the study period, resulting in an NE of 110,293 injuries. Linear regression analysis displayed no significant trend in annual injuries among females (p = 0.079) or males (p = 0.911). The frequency of injuries during 2014-2019 remained relatively steady, aside from a 46.0 % decrease from 2019 (n = 11,001) to 2020 (n = 5944), which returned to the original incidence level by 2022 (n = 12,963). A sudden increase in hospitalization rate post-pandemic was observed (p = 0.109), where the rate dramatically rose from 0.1 % to 5.6 %. Dislocations (8.5 %) had the highest rate of hospitalization amongst diagnoses. The most common injuries amongst all hockey players were injuries to the head (n = 37,816, 34.2 %) and shoulder (n = 16,836, 15.3 %). We observed a significant increase in head (p = 0.041) and shoulder (p = 0.020) injuries after 2020.

CONCLUSION: Although the overall number of injuries amongst youth hockey players did not change significantly over time, we saw a significant increase in head and shoulder injuries. Additionally, the hospitalization rate from these injuries has increased recently post-pandemic. The high and increasing frequency of head and shoulder injuries emphasizes the importance of proper protective equipment to these areas in pediatric athletes.

PMID:40344852 | DOI:10.1016/j.injury.2025.112411

Injury. 2025 Apr 22;56(7):112342. doi: 10.1016/j.injury.2025.112342. Online ahead of print.

ABSTRACT

BACKGROUND: The current standard of care for surgically managed tibia shaft fractures is intramedullary nailing. Chronic postoperative knee pain is the most common complication of the infrapatellar technique in intramedullary nailing. Literature suggests it may be related to infrapatellar nerve injury.

OBJECTIVE: This study compares the incidence of anterior knee pain after tibia nail insertion between conventional longitudinal and transverse incisions.

METHODS: This clinical trial study was conducted in our Level I trauma center from February 2022 to August 2024. Patients with closed diaphyseal tibia fractures were included in this study. All the cases were treated with reamed statically locked intramedullary nailing. The patients were randomly allocated to the longitudinal infrapatellar approach group (LIPAG) and transverse infrapatellar approach group (TIPAG). The primary outcomes measured at every follow-up included anterior knee pain by visual analog scale (VAS), numbness by monofilament test, range of motion, quality of life, and union success. Postoperative follow-up was performed at 2, 6, and 12 weeks and 6, and 12 months.

RESULTS: In our study, significant improvements in pain, quality of life, and functionality were observed in both groups; however, only the changes in numbness sensation and numbness pattern were significantly different between the two groups. TIPAG demonstrated earlier resolution of numbness compared to the LIPAG, and the numbness region significantly differed between the two groups, with LIPAG demonstrating more lateral numbness and TIPAG demonstrating more inferolateral numbness. However, no significant difference was observed between the two groups regarding operation time, length of stay, union outcome, pain, range of motion, or quality of life.

CONCLUSION: Transverse and longitudinal incisions for tibia IMN give comparable long-term results in pain relief, functional recovery, and quality of life.

PMID:40344851 | DOI:10.1016/j.injury.2025.112342

Injury. 2025 May 1;56(7):112371. doi: 10.1016/j.injury.2025.112371. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to estimate the burden of transport and unintentional injuries attributable to occupational injury from 1990 to 2021 and provided a 15-year forecast.

METHODS: Age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate (ASDR) attributable to occupational injury were analyzed using the estimated annual percentage change (EAPC) for transport and unintentional injuries from 1990 to 2021. Future injury forecasts were derived using Bayesian age-period-cohort (BAPC) model.

RESULTS: Between 1990 and 2021, ASMR and ASDR from occupational injury-related transport and unintentional injuries declined in most countries. The Republic of Korea saw the largest reductions, with EAPC for transport injuries at -12.40 (ASMR); and -12.01(ASDR), and for unintentional injuries at -10.65; -8.81, respectively. Males consistently had higher mortality and DALYs rates compared to females. Projections indicate that the mortality and DALYs rates will continue to decrease until 2036, suggesting improvements in occupational injury prevention.

CONCLUSIONS: This study found that ASMR and ASDR of occupational injury decreased. The prediction results show that the burden of occupational injury is still heavy and is a major public health problem, which highlights the need for regions to develop measures to reduce the burden of occupational injury.

PMID:40344850 | DOI:10.1016/j.injury.2025.112371

Injury. 2025 Apr 17;56(6):112346. doi: 10.1016/j.injury.2025.112346. Online ahead of print.

ABSTRACT

INTRODUCTION: Medial malleolar fractures are a common orthopedic injury, especially in osteoporotic bone. These fractures present unique challenges due to fragile tissues and reduced bone density, increasing the risk of fixation failure. This study aims to compare the biomechanical performance of single versus double bicortical screws in medial malleolar fractures in both healthy and osteoporotic bone.

DESIGN: Biomechanical study.

METHODS: Using fourth-generation composite Sawbones models, 32 tibias (16 osteoporotic, 16 healthy) were divided into four groups: one or two bicortical screws in either bone type. Fractures were simulated, and fixation was achieved in a lag-by-technique fashion. Specimens were subject to axial compression until failure, measuring load-to-failure and stiffness. Statistical analysis compared performance across groups.

RESULTS: Constructs with two bicortical screws demonstrated significantly higher load-to-failure in both healthy (mean: 1747 N vs. 1090 N, p = 0.02) and osteoporotic bone (mean: 935 N vs. 509 N, p = 0.01). Stiffness was also greater in two-screw constructs, though not statistically significant. We used a two-tailed t-test to compare the means of the two groups, with a p-value of <0.05, which is considered statistically significant. Osteoporotic bone exhibited lower overall performance than healthy bone, but the two-screw configuration partially mitigated these disadvantages.

CONCLUSION: Our study demonstrates that two bicortical screws provide superior biomechanical stability compared to one screw, particularly in osteoporotic bone. These findings underscore the importance of optimizing fixation strategies for osteoporotic fractures. While prior studies found minimal differences between single and double-screw constructs, our use of bicortical screws highlights their advantage in load distribution and resistance to failure. Implementing these findings in clinical practice could potentially reduce the risk of fixation failure and improve outcomes for patients with osteoporotic fractures.

PMID:40339356 | DOI:10.1016/j.injury.2025.112346

Injury. 2025 Apr 18;56(6):112352. doi: 10.1016/j.injury.2025.112352. Online ahead of print.

ABSTRACT

INTRODUCTION: Quantification of bone healing can be of interest for both clinical and research purposes. However, radiographic assessment of bone healing is challenging, especially in postoperative bone defects and non-union. Scores, such as the (modified) Radiographic Union Score for Tibial fractures ((m)RUST) are widely known. The Lane-Sandhu score, a lesser-known score for bone defects, may have benefits over the mRUST score. The aim of this study is to compare the inter- and intraobserver reliability of the Lane-Sandhu score with the mRUST in human non-unions.

METHODS: First, five postoperative radiographs were scored by five observers using both scores. Pitfalls of the scores were thereafter analyzed in a training session. Then, each observer scored ten new radiographs. The intraclass correlation coefficient was calculated to determine the intra- and interobserver reliability of the scores for each session.

RESULTS: The pilot session resulted in an interobserver reliability of 0.48 for the mRUST and -0.049 for the Lane-Sandhu score. During the training session, the interobserver reliability scores were 0.50 and 0.14 respectively. The final session resulted in a reliability score of 0.79 (95 % CI 0.60-0.91) for the mRUST and 0.76 (0.59-0.88) for the Lane-Sandhu.

CONCLUSION: Both scores are reliable scoring systems for the interpretation of postoperative bone defects and non-union. There is a slight preference for the mRUST because the reliability was less dependent on the training session. For future research, the interpretation of postoperative radiographs should be well described and a training session is recommended.

PMID:40339355 | DOI:10.1016/j.injury.2025.112352

Injury. 2025 May 7:112358. doi: 10.1016/j.injury.2025.112358. Online ahead of print.

NO ABSTRACT

PMID:40335386 | DOI:10.1016/j.injury.2025.112358

Injury. 2025 Apr 29;56(7):112368. doi: 10.1016/j.injury.2025.112368. Online ahead of print.

ABSTRACT

BACKGROUND: Sports-related injuries (SRIs) are a significant cause of public health concern. This study aimed to identify risk factors for spine fracture injuries in sports, focusing on sport type, injury location, and demographic patterns.

METHODS: A retrospective analysis of prospectively collected registry data from the "National Electronic Injury Surveillance System (NEISS)" database was performed for spine injuries. A total of 138,268,340 hospital emergency department records between 1/2/2011 and 12/29/2020 resulted in a weighted national estimate of 29,148 spine fracture injuries (19,791 males and 9357 females) associated with sports.

RESULTS: There were 10,530 (36 %) injuries at sports venues and 5755 (20 %) on the streets. The most prevalent sports activities leading to spine fractures were motorsports/cycling in males (60.4 %) and horseback riding in females (31.2 %). Fractures at the lumbar (40.6 %) and cervical (33.9 %) spine were the most common diagnoses. Males were more likely to have cervical fractures (40.5 % vs. 19.9 %), while females more frequently had lumbosacral injuries (66.4 % vs. 40.8 %) (all p < 0.001). Multivariate regression analysis revealed that ball sports (OR=4.2), water sports (OR=3.89), and trampoline (OR=1.88) significantly increased the risk for cervical fracture. Adults (OR=2.69), males (OR=2.31), and Asians (OR=3.66) were at higher risk for cervical spine fractures. African Americans had a greater risk of spinal cord injuries, particularly among adolescents.

CONCLUSIONS: Specific sports activities and injury locations were identified as primary risk factors for different types of spine fractures. Demographic patterns provide context for targeted prevention strategies. These findings can inform the development of sport-specific safety measures and injury prevention programs across diverse populations.

PMID:40334430 | DOI:10.1016/j.injury.2025.112368

Injury. 2025 Apr 25;56(7):112361. doi: 10.1016/j.injury.2025.112361. Online ahead of print.

ABSTRACT

BACKGROUND: The rise in scooter, skateboard, and e-scooter use in the U.S. has led to increased injuries, with distinct fracture patterns across vehicle types. This study aims to identify trends and patterns in fractures and injuries.

METHODS: This study used the PearlDiver database to examine skateboard, scooter, and e-scooter injuries and associated fractures across the United States from 2010 to 2022, categorized by anatomical site using ICD-9 and ICD-10 codes. E-scooter data were analyzed separately for 2020-2022. Injury and fracture rates were analyzed by age, sex, and state, with annual trends compared over the study period. Fracture incidence was calculated per 100,000 individuals and per 100 injuries.

RESULTS: From 2010 to 2022, skateboards accounted for the highest injury rates, with a rate of 8.72 per 100,000 individuals in 2022. Male injury rates consistently exceeded female rates across all vehicles during the study period. In 2022, late adolescents (15-19 years) had the highest rate of skateboard injuries (43.84), early adolescents (10-14 years) led in scooter-related injuries (32.01), and young adults (20-24 years) were most affected by e-scooter injuries, with a rate of 6.19 per 100,000 individuals. During the study period, 115,783 fractures were recorded for skateboard (56,632), scooter (56,607), and e-scooter (2544) injuries across the United States. In 2022, the fracture rates were 35.39 for skateboards, 35.21 for scooters, and 34.33 for e-scooters per 100 vehicle injuries. Forearm fractures were the most common injury type across all vehicles. In 2022, large states reported the highest number of injuries, with New York leading in e-scooter injuries (381) and California topping both skateboard (1066) and scooter injuries (827), highlighting geographic disparities. E-scooter injuries exhibited a 1310 % increase from 2020 to 2022, underscoring this rising public health burden.

CONCLUSIONS: Skateboards are the leading cause of vehicle-related injuries and fractures. Injury demographics are shifting, with e-scooters affecting a broader, older population, but males remain the most affected group across all vehicle types.

LEVEL OF EVIDENCE: Level III.

PMID:40328080 | DOI:10.1016/j.injury.2025.112361

Injury. 2025 Apr 29;56(7):112357. doi: 10.1016/j.injury.2025.112357. Online ahead of print.

ABSTRACT

Heterotopic ossification (HO) is a frequent complication following spinal cord injury (SCI), yet evidence regarding the efficacy of bisphosphonates in managing this condition remains limited. This systematic review aims to evaluate the role of bisphosphonates in the prevention and treatment of HO in patients with SCI. A comprehensive search of PubMed, CINAHL, ScienceDirect, Cochrane Library, and the Centre for Reviews and Dissemination databases was conducted to identify studies meeting predefined inclusion criteria. Relevant articles were also identified through bibliographic references. A total of 11 studies were included: nine investigating etidronate, one on alendronate, and one on pamidronate. Bisphosphonate administration varied, with oral etidronate provided for a minimum of 12 weeks and intravenous pamidronate given for up to 14 days. Bisphosphonates were used either prophylactically or therapeutically to delay the progression of HO. Findings across all studies highlighted the preventive role of bisphosphonates in reducing the occurrence of HO in SCI patients and demonstrated their therapeutic potential, as evidenced by less extensive heterotopic bone formation. However, the available evidence remains insufficient to draw definitive conclusions about the optimal use of bisphosphonates in this population. Further well-designed clinical trials are required to elucidate their preventive and therapeutic efficacy in managing HO after SCI.

PMID:40328079 | DOI:10.1016/j.injury.2025.112357

Injury. 2025 Apr 28:112363. doi: 10.1016/j.injury.2025.112363. Online ahead of print.

NO ABSTRACT

PMID:40320354 | DOI:10.1016/j.injury.2025.112363

Injury. 2025 Apr 29;56(7):112369. doi: 10.1016/j.injury.2025.112369. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the association of safe firearm storage and reduced risk of injury and death, many children live in homes with unsecured firearms. The Child Opportunity Index (COI) assesses neighborhood resources that impact health; lower COI levels have been linked to higher rates of firearm-related injuries. This study examined the relationship between COI and firearm ownership and storage practices.

METHODS: This was a cross-sectional survey study that took place between November 2022 and October 2023 in two geographically separate Level 1 Emergency Departments in Texas. English and Spanish speaking patients assigned triage acuity levels of 3, 4, or 5 were included, and survey questions were derived from the National Health Interview Survey to examine firearm injury ownership and storage practices.

RESULTS: 4,248 patient families were approached, with 2,882 (68 %) participating. 690 (23.9 %) self-reported as firearm owners, 541(78.4 %) reported storing guns locked and 392(56.8 %) reported keeping the firearm unloaded. Over half (50.4 %) of respondents were in the very low (692) or low COI (750) quintiles. Participants in the very high COI levels were associated with a higher risk of living in a home with firearms compared with those in the very low COI levels (very high COI RR 1.81, p < 0.001, 95 % CI [1.39, 2.37]). There was no association between a respondent's COI level and the method or rates of firearm storage.

DISCUSSION AND CONCLUSIONS: While children in higher COI quintiles were more likely to live in homes with firearms, storage practices are suboptimal across all COI quintiles. Future work should focus on creating effective and consistent messaging on the importance of firearm storage practices across individuals in all COI quintiles.

PMID:40319572 | DOI:10.1016/j.injury.2025.112369

Injury. 2025 May 2;56(7):112360. doi: 10.1016/j.injury.2025.112360. Online ahead of print.

ABSTRACT

Distal radius fractures are common injuries often requiring surgical intervention for effective management. This study compares the biomechanical stability of two osteosynthesis configurations using a palmar locking plate with either four or two epiphyseal screws for extra-articular distal radius fractures. Finite element analysis (FEA) was performed on nine antomical radius models to evaluate displacement, axial stiffness, peri‑implant stresses, and fracture risk using the Mohr-Coulomb criterion. Results demonstrated minimal differences in displacement between the two groups, with both configurations maintaining acceptable levels of stability under a 250 N load. Assemblies with four screws exhibited slightly higher axial stiffness (average 4362 N/mm) compared to two screws (average 3080 N/mm). Peri-implant stresses were generally higher in the two-screw models, yet remained within tolerable ranges. This study is the first to analyze a two-epiphyseal screw configuration, offering insight into the feasibility of reducing screw count without compromising stability. Potential benefits include fewer surgical complications, reduced material use, and lower costs. However, limitations such as the small sample size, simplified loading conditions, and absence of osteodensitometry warrant further experimental validation. The findings suggest that a two-epiphyseal screw assembly could serve as an effective alternative for distal radius fracture management, supporting its potential integration into clinical practice following experimental corroboration.

PMID:40318434 | DOI:10.1016/j.injury.2025.112360

Injury. 2025 Apr 27;56(7):112362. doi: 10.1016/j.injury.2025.112362. Online ahead of print.

ABSTRACT

BACKGROUND: The KNEE Study is a prospective multicentre service evaluation examining the current UK management of fragility fractures around the knee. It aims to describe operative decision making, causes of treatment delays, weight-bearing strategies, and post-operative management.

METHODS: Data were prospectively collected across a 4-month period via a collaborative approach. All patients aged >60 with a fracture of the proximal tibia or distal femur were included. Data collected include injury classification, operative vs non-operative management, time to theatre, post-operative weight bearing, and post-operative optimisation as per BOAST guidelines for frail older patients.

RESULTS: Data were available for 459 patients across 39 centres. This included 252 distal femoral fractures, and 207 proximal tibial fractures. Distal femoral fractures were significantly older (81.5 vs 73.3), had poorer mobility (42 % mobile ≤1 stick vs 79 %), and were more comorbid (median charlson co-morbidity index 5 vs 3) than proximal tibial fractures. Operative management was undertaken in 292/459 cases (198/252 femur, 94/207 tibia). When operative management was undertaken, there was a delay >36 hours to theatre in 62.8 % of cases. The main reasons for this were theatre capacity (42.6 %) and availability of a specialist surgeon (25.1 %). Only 11.5 % of cases were delayed pending medical optimisation or anticoagulant reversal. Patients managed operatively were significantly more likely to weight-bear on the first day post treatment (69.5 % vs 55.8 %). Operatively managed patients were significantly more likely to receive post-operative standards of care including Geriatric review, physio assessment, and bone health assessment.

CONCLUSION: Early return to weight bearing and ongoing secondary prevention are core tenants in the management of fragility fractures. Management of fragility fractures around the knee continues to lag behind that of hip fractures, with lower rates of weight bearing, slower access to theatre, and poorer post-operative care.

PMID:40318433 | DOI:10.1016/j.injury.2025.112362

Injury. 2025 Apr 23:112330. doi: 10.1016/j.injury.2025.112330. Online ahead of print.

ABSTRACT

BACKGROUND: Patients surviving major traumatic injury involving the chest wall experience unpredictable recovery trajectories, typically extending over 12 months or more. While some recover well, others experience ongoing physical and mental health difficulties and reduced quality of life. A nuanced understanding of the meaning and process of recovery is needed to inform the development of interventions to enable patients to access the right help, at the right time. Hence, we examined the experience of recovery and the bio-psycho-social factors shaping recovery in the months after traumatic injury resulting in admission to intensive care.

METHODS: This qualitative inquiry was underpinned by philosophical pragmatism, an approach which promotes development of knowledge that can be applied to solve problems. Participants recruited from a tertiary hospital completed semi-structured interviews encompassing perceived recovery, health as reflected in the EQ-5D-5 L, and factors influencing recovery. Qualitative data were analysed using the framework approach enabling the team to focus on matters pertinent to participants while addressing research questions. EQ-5D-5 L data were analysed descriptively.

RESULTS: Fourteen participants including 13 men, aged 19 to 67 years were interviewed by telephone, video-conference or in-person four- to seven-months post-injury. Duration of interviews was, on average, 50 min. Participants understood recovery as a non-linear process with progress assessed against pre-injury 'normal'; some acknowledged the need to develop and adapt to a new 'normal'. Engagement in the recovery process ranged along a spectrum anchored by passivity and proactivity, with approach taken reflecting the participant's characteristic way of being, and investment in a 'reason to recover'. Recovery was a function of interlinked factors categorised as 'pre-injury life circumstances', 'recovery mindset', 'recovery behaviours' and 'recovery resources'. While EQ-5D-5 L scores indicated substantial impairment across domains, participants generally regarded themselves as recovering well 'given the circumstances'.

CONCLUSIONS: Findings highlight the need for care to be grounded in an appreciation of the 'person' of the patient because pre-injury circumstances inexorably shape approach to recovery, engagement in recovery behaviours and access to resources. The model of recovery developed in this study can guide clinicians undertaking the comprehensive assessment that is fundamental to provision of personalised care, and ongoing evaluation of recovery, potentially using patient-generated outcome measures.

PMID:40312173 | DOI:10.1016/j.injury.2025.112330

Injury. 2025 Apr 15;56(6):112333. doi: 10.1016/j.injury.2025.112333. Online ahead of print.

ABSTRACT

Trauma accounts for around 4.4 million deaths annually and is among the leading causes of death, disproportionately affecting low- and middle-income countries. Trauma quality improvement programmes may reduce adverse patient outcomes but lack robust evidence. This study assessed the effect of implementing a trauma quality improvement programme using audit filters on health-related quality of life in adult trauma patients in urban India. We conducted a controlled interrupted time series study (ClinicalTrials.gov ID NCT03235388) across four tertiary care university hospitals. Adult (≥18 years) trauma patients, who were alive at 90 days post-admission, were included. After a 14-month observation phase, two hospitals were randomized to the intervention arm and implemented the trauma quality improvement programme, while two control hospitals did not implement any interventions. The study spanned from 2017 to 2022. Health-related quality of life was assessed 90 days post-admission using the EuroQol 5-dimensions (EQ-5D) questionnaire. The main outcome was EQ-5D health status, scaled from 0 to 100, analyzed using a difference-in-differences (DiD) approach. Descriptive analysis was performed for the five individual EQ-5D dimensions. 2307 participants were eligible for the analyses. The DiD analysis showed a statistically significant reduction in the EQ-5D health status score in the intervention arm (DiD estimate -4.07 [95 % CI:-7.00; -1.15]). For the 819 patients with major trauma, there was a more pronounced, but statistically non-significant reduction (DiD estimate -4.86 [95 % CI:-9.87; 0.15]). In the intervention arm, mobility, self-care, and pain/discomfort improved, while usual activities and anxiety/depression worsened. Implementing trauma quality improvement programmes using audit filters may reduce the average health-related quality of life of trauma patients if more severely injured patients survive, highlighting the importance of assessing quality of life after the implementation of such programmes and ensuring adequate rehabilitation resources to support long-term recovery.

PMID:40311153 | DOI:10.1016/j.injury.2025.112333