Injury. 2026 Apr 3:113213. doi: 10.1016/j.injury.2026.113213. Online ahead of print.

NO ABSTRACT

PMID:41966891 | DOI:10.1016/j.injury.2026.113213

Injury. 2026 Apr 2:113211. doi: 10.1016/j.injury.2026.113211. Online ahead of print.

NO ABSTRACT

PMID:41966890 | DOI:10.1016/j.injury.2026.113211

Injury. 2026 Apr 3:113240. doi: 10.1016/j.injury.2026.113240. Online ahead of print.

ABSTRACT

This correspondence addresses the recent study by Yeo et al., which identified polytrauma and night-time presentation as independent risk factors for missed injuries (MIs) in trauma patients. While acknowledging the study's contribution to trauma system evaluation, we highlight three critical methodological limitations that affect the interpretation of these findings. First, the significantly longer hospital stay in the MI group (41.3 days vs. 21.5 days) suggests a substantial detection bias, where prolonged hospitalization increases the likelihood of incidentally diagnosing Type II injuries. Second, a "history bias" exists due to the absence of orthopaedic trauma surgeons during the majority of the study period (2019-2023), which likely accounts for the prevalence of musculoskeletal MIs rather than night-time risk alone. Third, the broad definition of "night-time" (8:00 PM - 8:00 AM) conflates shift handover errors with circadian fatigue, obscuring the underlying mechanism of failure. We suggest that future research must control for length of stay and utilize granular time-series analysis to guide precise system-level interventions.

PMID:41966889 | DOI:10.1016/j.injury.2026.113240

Injury. 2026 Apr 6:113220. doi: 10.1016/j.injury.2026.113220. Online ahead of print.

NO ABSTRACT

PMID:41966888 | DOI:10.1016/j.injury.2026.113220

Injury. 2026 Apr 6:113228. doi: 10.1016/j.injury.2026.113228. Online ahead of print.

NO ABSTRACT

PMID:41966887 | DOI:10.1016/j.injury.2026.113228

Injury. 2026 Apr 7;57(6):113254. doi: 10.1016/j.injury.2026.113254. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic spinal injury (TSI) is a devastating condition with a disproportionately high burden in low-resource settings. Data on its management and outcomes in semi-urban Cameroon is limited.

OBJECTIVE: To describe and analyse the management and outcomes of TSI patients at the Buea Regional Hospital in Southwest Cameroon.

METHODS: A retrospective review was conducted for all TSI patients admitted between 2017 and 2022. Data on patient management, complications, mortality, and functional neurological improvement were collected and analysed using inferential statistics and modelling to identify associated factors.

RESULTS: 51 TSI patients aged 38.3±15.7 years were included. CT scan was the initial imaging in 63.7% of patients. Surgery was performed in 31.4% of cases, with a median time from injury to surgery of 31.0 (IQR: 13.0-41.1) days. In-hospital complication rate was 52.9% (95% CI: 38.6%, 66.8%), predominantly pressure ulcers and paralytic ileus (27.5% each). A multivariable model (Hosmer-Lemeshow P = 0.95; AUC=0.87) identified age >40 years (aOR=6.64) and delayed spine surgery (≥ 6 days post injury, aOR=84.8) as significant predictors of complications. Functional neurological improvement occurred in 27.9% (95% CI: 15.8%, 43.9%) of patients and was associated with non-cervical injuries (p = 0.03), specific initial Frankel grades A and C (p = 0.04), and administration of multi-vitamin/mineral medications (p = 0.007). The overall in-hospital mortality rate was 20.4% (95% CI: 10.7%, 34.8%), with higher mortality observed in patients over 40 (p = 0.03), those with cervical spine injuries (p = 0.004), and those presenting with urinary dysfunction (p = 0.04).

CONCLUSION: TSI care in our setting is associated with high complication and mortality rates, especially among older patients and those with delayed spine surgery. These critical challenges in TSI care suggest a possible need for targeted interventions to improve timeliness of care and complication prevention to enhance overall patient outcomes in this resource-limited setting.

PMID:41966794 | DOI:10.1016/j.injury.2026.113254

Injury. 2026 Apr 7;57(6):113255. doi: 10.1016/j.injury.2026.113255. Online ahead of print.

ABSTRACT

Achieving accurate reduction of a displaced hemipelvis in vertically unstable posterior pelvic ring injuries remains technically challenging. We describe a reproducible posterior reduction technique, termed the Anchored-Free Inter-Screw with Cobb Leverage (AFIS-CL) technique, which utilizes an anchored reference screw, a plate-independent free screw, controlled compression with a Jungbluth clamp, and adjunctive leverage using a Cobb's elevator. Reduction is performed through a posterior approach without skeletal traction, allowing direct intraoperative control of hemipelvic alignment. Sequential correction of vertical, anteroposterior, and rotational displacement is achieved under fluoroscopic guidance, followed by definitive posterior fixation while maintaining the achieved reduction. The technique was applied in five patients with vertically unstable posterior pelvic ring injuries. Satisfactory radiographic reduction was achieved and maintained in all cases without neurovascular complications, and no secondary displacement was observed at final follow-up. The AFIS-CL technique provides a practical and reproducible posterior reduction strategy that may facilitate three-dimensional correction and stable maintenance of reduction in vertically unstable pelvic ring injuries.

PMID:41966793 | DOI:10.1016/j.injury.2026.113255

Injury. 2026 Apr 8;57(6):113261. doi: 10.1016/j.injury.2026.113261. Online ahead of print.

ABSTRACT

INTRODUCTION: Hand fragility fractures are often excluded from routine osteoporosis screening, yet they may represent a sentinel event for future morbidity. This study aimed to assess the fracture risk profile of older adults presenting with hand fragility fractures, quantify the 'treatment gap' in current practice, and evaluate the utility of the Second Metacarpal Cortical Index (2MCI) as a pragmatic triage tool.

METHODS: A retrospective cohort study was conducted across three seasonal timepoints at a UK Major Trauma Centre. Patients aged ≥50 presenting with low-energy hand fractures were included. Fracture risk was stratified using the Fracture Risk Assessment Tool (FRAX) calculated retrospectively from primary care records. Care pathways were audited for DEXA referral and treatment initiation. 2MCI was measured on standard radiographs and correlated with FRAX and hip T-scores.

RESULTS: 134 patients were included (median age 71; 56% female). FRAX scoring classified 88% as intermediate, high or very high risk. Despite this, only 8% (11/134) of the total cohort underwent a DEXA scan. Of those scanned, 64% had osteopenia or osteoporosis. Eleven patients (8%) sustained subsequent fractures. 2MCI demonstrated excellent inter-rater reliability (ICC=0.81) and strong correlation with hip T-scores (r = 0.64). A 2MCI threshold of <45% yielded 100% specificity for detecting low bone mass, though sensitivity was limited.

CONCLUSION: Patients with hand fragility fractures represent a high-risk cohort that is currently underserved by osteoporosis screening pathways. While 2MCI shows promise as an adjunctive triage tool, the primary finding is a significant missed opportunity for secondary prevention. Hand surgeons should routinely consider fracture risk assessment in this population.

PMID:41966792 | DOI:10.1016/j.injury.2026.113261

Injury. 2026 Mar 30;57(6):113163. doi: 10.1016/j.injury.2026.113163. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric tennis participation has grown steadily, yet limited research exists on sex- and age-based injury differences in this population. Understanding these patterns can inform tailored injury prevention efforts.

MATERIALS AND METHODS: We queried the National Electronic Injury Surveillance System (NEISS) for tennis-related emergency department (ED) visits in patients under 18 years old from 2014 to 2023. Injuries were analyzed by sex, age group, injury type, and body region. National estimates (NEs) were calculated using NEISS sample weights. Statistical comparisons were performed to assess gender differences in injury patterns.

RESULTS: A total of 1679 pediatric tennis-related injuries were reported, corresponding to a national estimate of 48,368 cases based on the database's sample weighting system. Males accounted for 53.1% of injuries, with a peak incidence at age 14; females made up 46.9%, peaking at age 16. Significant sex-based differences emerged across multiple domains. Males were more likely to experience fractures (p < 0.001), lacerations (p < 0.001), and upper extremity injuries, particularly to the elbow, eyeball, and face. In contrast, females sustained more ankle injuries (p < 0.001) and had a higher prevalence of strains and sprains (p < 0.001). By age, males sustained significantly more injuries in elementary school years (p < 0.001), while females had more injuries during high school (p < 0.001).

DISCUSSION AND CONCLUSION: Distinct injury patterns exist between sexes in pediatric tennis injuries. Males more frequently experienced high-impact trauma, likely reflecting play style and biomechanics, while females showed a higher rate of lower extremity overuse injuries, especially at the ankle. These findings align with known neuromuscular and biomechanical differences in movement and landing strategies between sexes. The high rate of head and ocular trauma in males further supports the need for facial and eye protection in youth tennis. These findings support the need for sport and sex-specific injury prevention strategies which include neuromuscular training and protective equipment to promote safety among young tennis players.

PMID:41966791 | DOI:10.1016/j.injury.2026.113163

Injury. 2026 Apr 6:113229. doi: 10.1016/j.injury.2026.113229. Online ahead of print.

NO ABSTRACT

PMID:41963186 | DOI:10.1016/j.injury.2026.113229

Injury. 2026 Apr 9;57(6):113253. doi: 10.1016/j.injury.2026.113253. Online ahead of print.

ABSTRACT

BACKGROUND: Pelvic fractures, including pelvic ring fractures and acetabular fractures, are relatively rare but often severe and associated with a significant physical and societal burden. Outcome data on long-term health related quality of life (HRQoL) following pelvic fractures remains scarce. This study aimed to evaluate long-term HRQoL outcomes in a patient cohort with pelvic fractures up to 8 years post injury.

MATERIALS AND METHODS: A long-term prospective follow-up study of the Brabant Injury Outcome Surveillance (BIOS) pelvic fractures cohort was performed. HRQoL was assessed at 1, 2, and 8 years post injury using the EQ-5D-3L among adult patients (≥ 18 years) with pelvic fractures. Longitudinal trajectories of HRQoL and subgroup differences by sex, age, and trauma mechanism over time were assessed using linear mixed models.

RESULTS: Of the 184 included patients, the response rate was 86% (n = 159) at 1 year follow-up, 63% (n = 115) at 2 years follow-up, and 34% (n = 63) at 8 years follow-up. The mean EQ-5D-3L VAS score at 1 year follow-up was 74.8 (SD 16.2) and improved over time to a mean score of 78.0 (SD 16.6) at 2 years follow-up. At 8 years follow-up the mean EQ-5D-3L VAS has decreased to 72.7 (SD 20.4). The mean EQ-5D-3L index score was 0.80 (SD 0.24) at 1 year follow up. At 2 years follow-up, the mean EQ-5D-3L index score increased to 0.81 (SD 0.21) and plateaued thereafter with a mean score of 0.81 (SD 0.24) at 8 years follow-up. Pain/discomfort remained the most affected domain with almost half of patients reporting problems at 8 years follow-up. Female sex, higher ISS, and pre-injury health complaints were identified as significant risk factors for long-term limitations across multiple domains.

CONCLUSION: Although improvements in HRQoL were observed over time, persistent complaints and decreased HRQoL were reported at 8 years follow-up. These findings underscore the importance of monitoring HRQoL and tailored interventions to manage the ongoing impact of pelvic fractures on HRQoL.

PMID:41962197 | DOI:10.1016/j.injury.2026.113253

Injury. 2026 Apr 8;57(6):113257. doi: 10.1016/j.injury.2026.113257. Online ahead of print.

ABSTRACT

OBJECTIVES: Acute cervical spine injury is an uncommon but serious sequela of blunt trauma. Patients presenting with multi-trauma to the Emergency Department usually receive CT imaging for cervical spine clearance; however, many of these patients have ongoing pain despite a negative CT and proceed to an MRI. This can entail delays in care, transfer between hospitals, prolonged periods of cervical spine immobilisation, and increased healthcare costs. The aim of the study is to identify the rate of acute cervical spine injury detected on MRI following negative CT and the impact of these findings on subsequent patient management.

METHODS: A retrospective analysis was conducted to identify adults presenting with blunt trauma from 2015 to 2023 who underwent MRI following a negative CT for possible cervical spine injury.

RESULTS: Of 849 patients who proceeded to MRI after a negative CT, 161 (19.0%) demonstrated evidence of cervical spine injury on MRI. 19 patients (11.8% of patients with positive findings; 2.2% of the overall cohort) had radiological injuries which were unstable or potentially unstable. 70 patients (8.3% of all patients who proceeded to MRI, 43.5% of those with abnormal findings) had a change in management based on MRI findings. In most cases, this was a hard collar with no need for surgery. 7 patients in the cohort (0.82%) required acute neurosurgical intervention. Patients with positive findings were older (OR 1.01 (1.01-1.02), p = 0.003) and less likely to have had a motor vehicle accident (OR 0.69 (0.48-0.997), p = 0.048). Increasing age and focal neurology were predictors of need for acute neurosurgical intervention.

CONCLUSIONS: MRI for evaluation of suspected cervical cord injury has low yield for alert patients following blunt trauma with a negative CT, with a minority of patients requiring change in management and very few proceeding to acute neurosurgical intervention. More judicious patient selection including consideration of age, mechanism and presence of neurology may improve resource use and avoid unnecessarily prolonged immobilisation.

PMID:41962196 | DOI:10.1016/j.injury.2026.113257

Injury. 2026 Mar 30:113168. doi: 10.1016/j.injury.2026.113168. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic brain injury (TBI) in children and adolescents is a leading cause of disability and mortality, with long-term health-related consequences. There is little evidence describing the children and adolescents most at risk of TBI.

OBJECTIVE: To identify the demographic and clinical predictors of TBI in secondary school-aged children in England.

PARTICIPANTS AND SETTING: Linked Clinical Practice Research Datalink and Hospital Episode Statistics Admitted Patient Care data were used to identify patients aged 11-18 years registered with a GP surgery in England between 2013 and 2021.

METHODS: Multivariable Cox regression was used to assess the association between demographic and clinical risk factors and time to medically attended TBI.

RESULTS: The analytical sample included 402,249 children, 2.3% of which had a TBI presenting to primary or hospital care when aged 11-18 years. In the fully adjusted model, increased risk of TBI was associated with being male; less socioeconomically deprived; having a history of fracture, abuse, depression, or previous TBI; having two or more previous GP visits, having more previous Emergency Department visits; and having fewer hospital admissions.

CONCLUSION: Using a nationally representative dataset we were able to identify which children were most at risk of TBI in their secondary school years. TBI is often preventable and targeted interventions could be aimed at these children and their families.

PMID:41936468 | DOI:10.1016/j.injury.2026.113168

Injury. 2026 Mar 25;57(6):113171. doi: 10.1016/j.injury.2026.113171. Online ahead of print.

ABSTRACT

Open fractures are at risk for fracture-related infection (FRI) due to environmental contamination, with 40-80% of bacteria existing in biofilms. Standard treatment includes prophylactic antibiotics, surgical debridement, and irrigation; however, bacteria can persist in a biofilm/sessile form on bones and orthopedic implants. While some infections show clear clinical symptoms, others may remain subclinical for long periods. These biofilm-associated infections are difficult to treat due to their reduced susceptibility to antibiotics. This study aims to develop a clinically relevant rat model for FRI, overcoming limitations of existing models that use non-clinical materials like Polyetheretherketone (PEEK) and planktonic bacteria. By inoculating the fracture site with bacteria isolated from biofilms and utilizing stainless steel surgical implants, which are standard in clinical practice, we aim to create a more accurate representation of FRI. This improved model will provide a valuable tool for preclinical research for improving the management of FRIs, enabling the evaluation of therapeutic interventions on biofilm infections in the presence of clinically relevant implants. The experimental procedure involved creating a femur fracture in an anesthetized rat and inoculating it with 104-105 CFUs/ml Staphylococcus aureus bacteria derived from biofilms grown in vitro on glass slides for three days. The fracture was stabilized with a stainless-steel plate and screws, and the wound was closed. After one week, the anesthetized rats underwent surgical debridement and irrigation and received one dose of systemic antibiotic cefazolin. Three weeks after fracture, rats were euthanized, and the hardware and bone were harvested, washed of planktonic bacteria, and separately analyzed for CFUs. The results showed the rats demonstrated S. aureus biofilm growth in the bone and hardware with > 106 CFUs/ml. There were no differences between CFUs/ml in bone and on hardware. Our FRI model is uniquely valuable as a model for evaluating novel therapeutics against implant-associated infections.

PMID:41936238 | DOI:10.1016/j.injury.2026.113171

Injury. 2026 Apr 1;57(6):113201. doi: 10.1016/j.injury.2026.113201. Online ahead of print.

NO ABSTRACT

PMID:41936237 | DOI:10.1016/j.injury.2026.113201

Injury. 2026 Apr 1:113198. doi: 10.1016/j.injury.2026.113198. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of trauma follow-up care after hospital discharge is to support patients with serious injuries recover to their fullest extent. Whilst the physical health of patients is a central focus of follow-up care, psychosocial support is described as challenging and inadequate, with few trauma follow-up services able to provide integrated psychosocial support inclusive of routine access to psychosocial experts. As trauma follow-up care within Australia and New Zealand (Australia and New Zealand) is predominantly provided by nursing and medical trauma clinicians, exploring how psychosocial care and support is provided by these clinicians is warranted. The broad aim of this qualitative study was to explore trauma clinicians' experiences in providing trauma follow-up care with this paper focusing on the provision of psychosocial care and support.

METHODS: Semi-structured interviews were used to explore the experiences of trauma clinicians in providing follow-up care after hospital discharge to patients who have experienced serious injury. Twenty participants were purposively selected from public hospitals throughout Australia and New Zealand who provided trauma follow-up care after hospital discharge. Qualitative data were transcribed verbatim and analysed using inductive content analysis.

RESULTS: Psychosocial care and support provided by trauma service clinicians during follow-up appointments to patients who have experienced serious injuries can be separated into three categories: (i) recognising the importance of psychosocial health after injury; (ii) components of psychosocial care which has three sub-categories of (a) comprehensive psychosocial care and support; (b) variability in assessment; (c) health care practitioner preparedness to provide psychosocial support; and (iii) access to psychological services.

CONCLUSION: Trauma clinicians recognise the importance of providing psychosocial care and support to patients who experience serious injury. In the absence of routine access to expert psychosocial/psychological practitioners, trauma clinicians provided psychosocial support using a variety of approaches which results in disparities in how psychosocial care is provided to patients in Australia and New Zealand. Implementation of a standardised assessment to psychosocial health, in conjunction with an anticipatory framework to assist trauma clinicians in providing psychosocial care and support, may provide a partial solution, and reduce the incidence of psychosocial issues and improve an individual's quality of life following serious injury.

PMID:41934055 | DOI:10.1016/j.injury.2026.113198

Injury. 2026 Mar 25;57(6):113194. doi: 10.1016/j.injury.2026.113194. Online ahead of print.

ABSTRACT

BACKGROUND: While the short-term risks of severe injury among older adults (age≥65) are well studied, little is known about long-term functional outcomes in this population. This knowledge gap impacts clinicians' ability to counsel patients and provide care aligned with their values. Our objective was to evaluate the association between severe injury and the likelihood of an older adult remaining alive and living in their own home five years later.

METHODS: This was a retrospective, matched, population-based cohort study using administrative health data in a large regional trauma system (2006-2019). Community-dwelling older adults presenting with severe injury were matched with uninjured controls from the general population on age, sex, rurality, social determinants of health, comorbidity, and frailty. Time from injury to nursing home admission or death was compared between injured patients and matched controls using Kaplan-Meier analysis and extended Cox models.

RESULTS: A total of 20,217 older adults admitted with severe injury were identified and matched with controls. Median ISS was 16 (IQR 16-21), and in-hospital mortality was 22.8% (n = 4615). After five years, the probability of remaining alive and home was 40% for all included cases and 64% for controls. Median time spent alive and home for cases was 2.7 years and exceeded the 5-year follow-up period for controls. While the risk of nursing home admission or death decreased over time, cases remained at elevated risk compared to controls for at least 5 years (years 2-5, HR 1.18, 95% CI 1.13-1.24).

CONCLUSION: Most severely injured older adults survive to live in their own home for several years following injury. Nonetheless, patients who survive their injury have an increased risk of nursing home admission or death for at least five years. Long-term supports are necessary to ensure that patients remain alive and independent for years following their injury.

PMID:41932165 | DOI:10.1016/j.injury.2026.113194

Injury. 2026 Mar 31;57(6):113165. doi: 10.1016/j.injury.2026.113165. Online ahead of print.

ABSTRACT

BACKGROUND: Spinopelvic dissociation (SPD) is an infrequent high-energy injury, which is often associated with lumbosacral plexus and cauda equina deficits Sexual dysfunction (SD) is a common comorbidity of the SPD, caused by direct or indirect trauma to the neurovascular structures within the pelvic cavity. The objective of this retrospective study was to to compare the sexual functions of patients with SPD underwent triangular osteosynthesis (TOS) with the normal population.

METHODS: The study was approved by the medical school's institutional review board (IRB). Between 2012 and 2023, 23 consecutive patients (9 women and 14 men) with SPD (16H-type and 7 U-type) were treated using TOS with a minimum follow- up of 36 months. The sexual functions of the patients were evaluated and compared with the Female Sexual Functional Index (FSFI) questionnaires for women and the International Index of Erectile Function (IIEF) questionnaires for men. A control group was formed from the normal population of the same age and gender group as these patients.

RESULTS: The average age of patients was 31.9 years (range, 18-65 years). Mean follow-up was 37.8 months (range 36-51 months). No significant difference was found in the male gender group compared to the normal population in terms of erectile function (P > 0.05), but a significant difference was found in orgasmic function, sexual desire, sexual satisfaction, and general satisfaction (P < 0.05). In the female gender group, no significant difference was found in sexual desire, lubrication, and pain during intercourse compared to the normal population (P > 0.05), but a significant difference was found in sexual arousal, orgasmic function, satisfaction, and total score (P < 0.05).

CONCLUSION: Compared to the normal population, sexual functions can be preserved partially in patients with SPD underwent TOS. The results of our preliminary data did not demonstrate a significant association between neurogenic etiology and sexual dysfunction following SPD.

PMID:41932164 | DOI:10.1016/j.injury.2026.113165

Injury. 2026 Mar 20;57(6):113166. doi: 10.1016/j.injury.2026.113166. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to model the cost-effectiveness of continuous pressure monitoring (CPM) in a hypothetical cohort of patients with a fracture of the tibial diaphysis.

METHODS: Decision-tree model structure was utilised to capture 60-day costs and health related quality of life (HRQoL) following a fracture of the tibial diaphysis. Depending on the effectiveness of the diagnostic method, patients were allocated to one of six validated outcome grades for acute compartment syndrome (ACS). Mean costs, utilities, and hospital length of stay were applied to each of these grades. Parameter inputs and costs were obtained from UK-specific published literature where possible. Analysis was performed from the UK National Health Service (NHS) perspective to determine the estimated impact in a hypothetical cohort of 1000 patients with a tibial diaphyseal fracture using CPM versus current standard diagnostic methods for ACS.

RESULTS: Base case results indicated that the utilisation of CPM was associated with significant cost savings of £ 452/patient when compared with the standard care of clinical assessment and/or single point pressure measurement (SPPM). An associated additional 2733 NHS bed days were saved. Incremental quality-adjusted life year (QALY) gain of 0.02 was found, resulting in a dominant incremental cost effectiveness ratio (ICER). When analyses were performed considering different diagnostic outcome grade distributions and for a varying time horizon, CPM was found to have both increased cost savings and cost-efficacy.

CONCLUSIONS: This early economic model suggests that CPM of patients with a tibial diaphyseal fracture could be a cost-effective diagnostic option, although more data is required in order to validate the model assumptions. However, given the established evidence demonstrating the superior diagnostic performance characteristics of CPM when compared to clinical symptoms and/or SPPM, this economic data adds further support to the use of CPM as an essential diagnostic adjunct in patients at risk of ACS.

PMID:41932163 | DOI:10.1016/j.injury.2026.113166

Injury. 2026 Mar 25;57(6):113191. doi: 10.1016/j.injury.2026.113191. Online ahead of print.

ABSTRACT

BACKGROUND: Healthcare is an energy and resource intensive sector, imparting significant environmental burden on a global scale. Minimizing avoidable resource utilization within hospitals can help achieve environmental sustainability amongst healthcare systems. Reducing surgical complications, such as tibial fracture-related infections (FRIs), which require resource-rich healthcare activities can be an impactful approach to achieve environmental sustainability, while maintaining or advancing patient health outcomes. The objective of this study was to leverage healthcare resource utilization data to evaluate the environmental impact of tibial FRIs amongst patients undergoing surgical treatment.

METHODS: An environmental model was developed using inputs informed from a systematic literature review and synthesized in a meta-analysis. Healthcare resource utilization data were used to compare the environmental impact for patients with and without a tibial FRI in relation to key healthcare activities such as hospital length of stay, reoperations, antibiotic therapy, and emergency room visits. A subgroup analysis was conducted to understand the environmental implications of more severe open fractures complicated by FRI, to supplement the mixed (open/closed) fracture population presented in the base case. Sustainability data was obtained from the Sustainable Healthcare Coalition's Care Pathways Guidance document and other published sources. Outcomes assessed were greenhouse gas (GHG) emissions, water use, and waste generated.

RESULTS: The results of this environmental impact assessment demonstrated that effectively preventing tibial FRIs can lead to a substantial reduction in carbon footprint. Preventing one FRI may result in an average reduction of 1025.3 kg CO2, water savings of 1778.6 m3, and waste savings of 79.4 kg. Results of the subgroup analysis, which included patients with open tibial fractures, further substantiated the environmental impact associated with tibial FRIs.

CONCLUSION: Preventing tibial FRIs may have a substantial environmental impact leading to a reduction in GHG emissions, water use, and waste generation. Interventions that reduce the incidence of tibial FRIs may contribute to the global goal of environmental sustainability. The results of this study are intended to empower healthcare providers and decision makers within the healthcare sector to make informed decisions that contribute to improved environmental sustainability, while maintaining or advancing patient health outcomes.

PMID:41932162 | DOI:10.1016/j.injury.2026.113191