Injury. 2025 Apr 18;56(6):112350. doi: 10.1016/j.injury.2025.112350. Online ahead of print.

ABSTRACT

BACKGROUND: Avascular necrosis (AVN) of the femur head (FH) is an incapacitating disease caused by chronic overconsumption of alcohol and corticosteroids. AVN impairs blood circulation to the FH, causing varying degrees of cell death. AVN progressively reduces the macroscopic mechanical strength of the bone's necrotic area, leading to FH collapse.

MATERIAL AND METHOD: This study aims to comprehend the efficacy of core decompression (CD) on biomechanical, microstructural, and compositional determinants of bone quality. In this work, 30 FH are taken of the patients who underwent total hip replacement due to AVN. These 30 samples are categorized into two groups (15 each), i.e. with CD (individuals who underwent core decompression treatment at the early stages of AVN) or without CD (individuals who did not receive any invasive therapy in the past following a hip fracture due to AVN). Bone morphometry, biomechanical, material, and nano-level properties are analyzed across necrotic and sclerotic zones of FH through micro-CT scanning, histo-pathology, Uni-axial compression, and Nano-indentation tests.

RESULTS: The obtained results demonstrated a notable increment in bone volume fraction, ultimate strength, and osteocytes of the sclerotic zone of both groups compared to the necrotic region. A significant improvement was observed in the quality of trabecular bone at multiple scales of human bone tissue including higher bone volume fraction (22.87 %, P < 0.05), increased Young's modulus (28.80 %, P = 0.0183) and increment in Mineral/Matrix ratio (53.20 %, P = 0.0429) and reduction in % of empty lacunae (22.39 %, P < 0.01) in the necrotic region of patients with core decompression compared to patients without any invasive treatment.

CONCLUSION: The optimum core decompression enhances the stability of the femur head by increasing the macroscopic mechanical strength of necrotic bone and decreasing the strength of sclerotic bone. This brings the strength of both bones nearly equal, further reducing the stress gradient and probability of collapse of the AVN femur head.

PMID:40306042 | DOI:10.1016/j.injury.2025.112350

Injury. 2025 Apr 4;56(6):112281. doi: 10.1016/j.injury.2025.112281. Online ahead of print.

ABSTRACT

Management with a functional brace results in successful union in the majority of patients with a humeral shaft fracture. An important factor in a patient's decision for operative vs. nonoperative management is how long it will take to know if the fracture will unite if treated nonoperatively. In this prospective multicenter evaluation subset analysis, we sought to address the following: (1) What is the positive and negative predictive value of gross motion at the fracture site on physical exam at 8 weeks post-injury for union in patients with humeral shaft fractures treated nonoperatively? (2) does callus present on radiographs correlate with clinical exam findings in terms of gross motion?

METHODS: We performed a prospective multicenter observational trial to evaluate the PPV and NPV of gross motion at 8 weeks on the outcome of union. There was a proscription against surgery for a minimum of 12 weeks. We additionally evaluated the presence of callus on each cortex for those with gross motion.

RESULTS: Of those available from the enrolled 101 patients, 62 (77 %) had no gross motion at 8 weeks following injury and went on to union (PPV=100 %). and 18 (23 %) patients had gross motion at the fracture site and 9 went on to nonunion (NPV =56 %), Callus was present on 3 of 4 cortices in 6 of the 7 patients with gross motion who went on to union and only 3 of the 9 who went on to nonunion (p = 0.06).

CONCLUSIONS: The lack of gross motion at the fracture site in patients treated nonoperatively for a humeral shaft fracture is highly predictive of union. The presence of gross motion does not predict nonunion as well, especially if callus is present on at least 3 of the 4 cortices. This information can be used to counsel patients at the inception of treatment and at 8 weeks.

LEVEL OF EVIDENCE: II.

PMID:40294453 | DOI:10.1016/j.injury.2025.112281

Injury. 2025 Apr 18;56(6):112347. doi: 10.1016/j.injury.2025.112347. Online ahead of print.

ABSTRACT

Finding a suitable replacement tissue for bone loss in comminuted fractures and bone tumors with large bone defect or for treatment of delayed unions and non-unions is still the main challenge for orthopedic surgeons. The present study has been designed in vivo to evaluate the effects of xenogenic calf fetal bone and cartilage grafts in treatment of experimental critical bone defect in a rabbit model. 30 native male rabbits, 12 months old, weighing 3.0±0.5 kg were used in this study. Rabbits were randomly divided into five groups of six (negative control (NC), osteochondral group (OstCar), bone group (Ost), cartilage group (Car), and positive control (PC)). In the NC group the created empty space was left intact. In the OstCar group the osteochondral fragment of the same size as the expulsion was inserted into place. In the Ost group, the bone fragment of the fetal calf replaced the extracted bone fragment from the radius bone. The created defects were filled in 6 rabbits of the Car group with cartilage fragments of the fetal calf. In the PC group, after separating the fragment of radius bone midsection and removing from the site, it was re-placed at the site. This study investigated three types of replacement tissue for the missing bone and compared the results of radiology, CT scan, biomechanics and histopathology evaluations with positive and negative control groups. In conclusion, this study demonstrated that the calf's fetal bone fragment could promote bone regeneration in the long bone defects like the autograft in the rabbit model.

PMID:40294452 | DOI:10.1016/j.injury.2025.112347

Injury. 2025 Apr 17:112353. doi: 10.1016/j.injury.2025.112353. Online ahead of print.

ABSTRACT

INTRODUCTION: Ophthalmic care of incarcerated individuals is understudied, particularly in the inpatient setting. We evaluated ophthalmic consultation findings, interventions and outcomes at a tertiary care center.

METHODS: For this retrospective noncomparative cohort study, data were collected on demographics, diagnoses, interventions, and outcomes for incarcerated patients for whom ophthalmic consultation was ordered at an academic medical center between December 2011 and December 2022.

RESULTS: The study cohort included 163 patients (mean age = 38 years) in custody at Maryland state correctional facilities. The majority of patients were male (95.7 %) and/or Black (71.8 %). The most common reason for consultation was trauma (135 of 163, 82.8 %). Among patients presenting for trauma, the mechanism of injury was documented as assault in 117 cases (86.7 %). Among trauma patients, 56 (41 %) required surgical intervention. In total, 20 open reduction and internal fixation of orbital fractures, 11 open globe repairs, and 36 eyelid laceration repairs, as well as 3 other surgeries (anterior chamber washout, vitrectomy, and placement of an orbital implant after autoenucleation) were performed. Loss to follow-up was high; 68 patients (42 %) had no follow-up visits despite recommendations for follow-up at discharge.

CONCLUSION: Ocular trauma was the most common reason for ophthalmic consultation for incarcerated patients in the hospital setting, accounting for >80 % of consults. Over 40 % of prisoners presenting for ocular trauma required surgery. Even in the custody of the state, inmates are not protected from ocular trauma. These findings suggest a need for creative, humane interventions and policy initiatives to address violence in correctional facilities.

PMID:40280775 | DOI:10.1016/j.injury.2025.112353

Injury. 2025 Apr 15;56(6):112349. doi: 10.1016/j.injury.2025.112349. Online ahead of print.

ABSTRACT

BACKGROUND: Radial nerve injury is one of the most common peripheral nerve injuries and can be effectively treated with nerve grafting. However, the efficacy of nerve grafting combined with exercise therapy for the treatment of radial nerve injury remains unclear.

METHODS: In this study, we conducted a follow-up of at least one year in 40 patients with radial nerve injuries who received nerve grafting combined with exercise therapy, to evaluate their rehabilitation outcomes and identify the prognostic factors influencing the combined treatment.

RESULTS: 62.5 % (n = 25) patients achieved M3+ extension strength. Shorter defect length and delayed repair time and more cables of nerve graft were significantly associated with the recovery of finger extension. Moreover, multivariate analysis showed that defect length and delay in repair were the independent predictors of extensor digitorum communis reinnervation. Additionally, receiver operating characteristic (ROC) curve suggested that both delay in repair (AUC = 0.808) and cables of nerve graft (AUC = 0.837) had a high accuracy in predicting the prognosis of nerve graft combined with exercise therapy, while delay in repair+cables of nerve graft (AUC = 0.960) had the highest accuracy. The optimal time for transplantation is 6.89 months (sensitivity = 86.7 %, specificity = 58.7 %) post-injury, and the optimal number of nerve grafts is 2.5 (sensitivity = 80 %, specificity = 53.3 %).

CONCLUSION: We demonstrated that the effectiveness of nerve grafting combined with exercise therapy in treating radial nerve injury, and delay in repair and cables of nerve graft may act as the prognostic predictors of nerve graft combined with exercise therapy. These findings may provide a novel therapeutic method for radial nerve injury.

PMID:40279806 | DOI:10.1016/j.injury.2025.112349

Injury. 2025 Apr 18;56(6):112348. doi: 10.1016/j.injury.2025.112348. Online ahead of print.

ABSTRACT

BACKGROUND: Distal radius diaphyseal-metaphyseal junction (DRDMJ) fractures in children often require surgical intervention due to the unique anatomical characteristics and high failure rate of nonoperative treatment. However, the choice of internal fixation remains a challenge for pediatric orthopedic surgeons. Traditional fixation methods, including plate and screw fixation, crossed Kirschner wires (K-wires), and external fixators, have drawbacks such as extensive local trauma and the risk of physeal injury. This study evaluates the clinical efficacy of antegrade elastic stable intramedullary nailing (ESIN) for DRDMJ fractures in children, comparing it with the crossed K-wire technique.

METHODS: A retrospective analysis was conducted on 47 pediatric patients with DRDMJ fractures treated between June 2018 and January 2023. Patients were divided into an antegrade ESIN group (n = 20) and a crossed K-wire group (n = 27). Demographic data, perioperative parameters (operative time, radiation exposure), and postoperative recovery indicators (duration of internal/external fixation, radiographic healing time, wrist function recovery) were collected. All patients were followed up for at least 12 months, and complications were recorded. The Garland-Werley score was used to assess wrist function. Additionally, a cadaveric study was performed to validate the neurovascular safety of antegrade ESIN insertion via the middle third of the radial head-radial tuberosity axis within the Kocher interval.

RESULTS: All patients achieved radiographic union, with no cases of dorsal interosseous nerve injury, tendon rupture, or refracture. There were no significant differences between the two groups in terms of radiographic healing time or wrist function scores at 12 months postoperatively (P > 0.05). However, compared to the crossed K-wire group, the antegrade ESIN group demonstrated a significantly shorter operative time by 10.71 min (P = 0.002), reduced fluoroscopy use by 2.74 exposures (P = 0.001), and a shorter postoperative cast immobilization duration by 9.11 days (P < 0.001). Additionally, the antegrade ESIN group exhibited a higher rate of excellent wrist function scores at the 3-month follow-up. The cadaveric study confirmed that needle insertion through the middle third of the Kocher interval safely avoided the dorsal interosseous nerve, with no risk of nerve injury in either pronation or supination positions.

CONCLUSION: Antegrade ESIN and crossed K-wire fixation provide comparable long-term functional and radiographic outcomes for pediatric DRDMJ fractures. The antegrade ESIN technique, performed through the middle third of the radial head-radial tuberosity axis within the Kocher interval, effectively avoids dorsal interosseous nerve injury while significantly reducing operative time, minimizing intraoperative radiation exposure, and promoting early functional recovery. This technique may serve as a valuable surgical option for treating DRDMJ fractures in children.

PMID:40279805 | DOI:10.1016/j.injury.2025.112348

Injury. 2025 Apr 8;56(6):112304. doi: 10.1016/j.injury.2025.112304. Online ahead of print.

ABSTRACT

BACKGROUND: Standard antibiotic therapy for abdominal gunshot wounds (GSWs) with hollow viscus injury involves up to 24 h of prophylactic broad-spectrum antibiotics. However, antibiotic management strategies are poorly defined in treating gunshot wounds with bowel-to-bone trajectories. These injuries threaten fracture-related infection as missiles can carry contaminating material along their intracorporeal trajectory. This study seeks to determine whether the duration of prophylactic antibiotic therapy used in bowel-to-bone injuries is associated with fracture-related infection prevention or overall infectious sequelae.

METHODS: This six-year retrospective review identified all patients experiencing abdominal GSWs with a trajectory causing bowel injury and simultaneous fracture. Patient demographics, duration of antibiotic therapy, and subsequent infectious complications were compared with nonparametric tests as indicated.

RESULTS: 140 patients experienced GSWs with bowel-to-bone trajectory; the median duration of prophylactic antibiotic therapy was four days (IQR 2 - 5 days); two patients were diagnosed with fracture-related infection and 65 patients experienced an infectious complication during their index hospitalization. Duration of prophylactic antibiotic therapy was not associated with the development of overall infection (p = 0.31). Comparing three days of prophylactic antibiotic therapy to more than three days of therapy, no difference occurred in overall infection (p = 1.0).

CONCLUSION: The development of fracture-related infections in bowel-to-bone gunshot wounds is rare. The duration of prophylactic antibiotic therapy in bowel-to-bone injuries did not correlate with an increase in overall infectious complications. Notably, three days of prophylactic antibiotic therapy was not inferior compared to longer-duration therapy in the development of infectious sequelae. Thus, patients with a bowel-to-bone gunshot trajectory likely do not require extended antibiotic coverage for prevention of fracture-related infections.

PMID:40279804 | DOI:10.1016/j.injury.2025.112304

Injury. 2025 Apr 18;56(6):112355. doi: 10.1016/j.injury.2025.112355. Online ahead of print.

ABSTRACT

BACKGROUND: Blunt mechanism chest wall injury (CWI) is a common traumatic presentation to acute hospitals globally and it is associated with high levels of mortality and morbidity. The role of the physiotherapist in the management of this injured population needs clearer definition.

AIM: To synthesise existing evidence relating to the 'work' of physiotherapists in the assessment, management and evaluation of patients with blunt mechanism CWI.

DESIGN: A systematic integrative review of relevant literature with a narrative synthesis.

DATA SOURCES: Embase (Ovid), MEDLINE (Ovid), CINAHL Plus with Full Text (EBSCO), Cochrane Central Register of Controlled Trials (Wiley), PEDro (Physiotherapy Evidence Database), AMED (Ovid). Further searches for grey literature and hand searches were applied. Databases were searched from their inception to December 2024. Analysis and data integration was undertaken through narrative synthesis following a process of thematic coding.

RESULTS: From 7433 identified papers, 92 were included in the final evidence synthesis. Fifty were full published empirical studies, 14 were evidence reviews, 19 were conference abstracts, three were case presentations and six were opinion pieces. Analysis identified the broad scope of clinical care provided by physiotherapists covering (i) initial assessment and emergency care; (ii) acute care priorities and care planning; (iii) patient education and optimising patient self-management; and (iv) post-acute care and follow-up.

CONCLUSION: There is a need for a more standardised approach to the care provided to this patient group. Clinicians need to acquire and develop formal competencies and capacities and knowledge in a more structured approach.

PMID:40279803 | DOI:10.1016/j.injury.2025.112355

Injury. 2025 Apr 10;56(6):112339. doi: 10.1016/j.injury.2025.112339. Online ahead of print.

ABSTRACT

AIMS: A soft-tissue sparing posterior surgical approach (SPAIRE) for hip hemiarthroplasty after femoral neck fractures is hypothesized to provide better functional results than the standard direct lateral approach, while maintaining a low dislocation rate. The aim of this study was to compare rate of complications and functional results between these approaches in a clinical cohort.

METHODS: Prospectively collected registry data on all femoral neck fracture cases treated with hemiarthroplasty between September 2018 and November 2022 in a single Norwegian hospital were analyzed grouped by SPAIRE versus direct lateral approach. Outcomes were prosthesis dislocation, surgical site infection, 30-day mortality, and tests of function three months postoperatively. Linear regression was used for continuous outcomes, and dichotomous outcomes were analyzed by logistic regression and contingency tables.

RESULTS: Of 858 cases, 430 were operated using SPAIRE, and 428 using direct lateral approach. There were no group differences in prosthesis dislocation rate (SPAIRE 0.7 % vs direct lateral 0.9 %, p = 0.725), and no differences in surgical site infections or 30-day mortality. In the patients with three months follow-up (total n = 372; SPAIRE n = 192; direct lateral n = 180) the SPAIRE group had better functional outcomes; New Mobility Score: 6.1 vs 5.0 (difference 1.1, p < 0.001), New Mobility Score change from preoperative: -1.3 vs -1.8 (difference 0.5, p = 0.024), Short Physical Performance Battery: 7.3 vs. 5.9 (difference 1.4, p < 0.001), Walking speed: 0.8 vs 0.7 m/s (difference 0.1, p < 0.001).

CONCLUSION: We found no differences in the rate of prosthesis dislocations, infections, or mortality between the SPAIRE and the direct lateral approach. Functional outcomes were better in patients operated with the SPAIRE approach.

PMID:40279802 | DOI:10.1016/j.injury.2025.112339

Injury. 2025 Apr 8;56(6):112337. doi: 10.1016/j.injury.2025.112337. Online ahead of print.

ABSTRACT

BACKGROUND: Intra-abdominal injuries (IAIs) are often associated with thoracic or lumbar flexion distraction injuries (TLFDIs) or Chance fractures. The incidence ranges from 10 to 50 % in previous literature.

AIM: To synthesize data about the incidence of IAIs associated with TLFDIs.

METHODS: We searched PubMed, WOS, and Cochrane databases for all studies reporting the incidence of IAIs associated with TL FDIs. The primary outcome was the overall pooled incidence of IAIs, surgical intervention, and specific organ injuries. A subgroup analysis was done for studies that included adults, pediatrics, and mixed populations. We assessed the methodological quality of the included studies using the Newcastle-Ottawa Scale. We used A random effects model to calculate pooled incidence rates and heterogeneity. This systematic analysis followed PRISMA guidelines.

RESULTS: A total of eight retrospective studies with 652 patients met the inclusion criteria. The pooled incidence of overall IAIs associated with TLFDIs was 36.2 % (95 % CI: 32.2 % %-57.2 %), with high heterogeneity (I² = 90.71 %, p = 0.0001). The incidence of surgical interventions was 29.03 % (95 % CI: 22.0 %-48.3 %), with high heterogeneity (I² = 92.3 %, p < 0.0001). Small bowel injuries occurred in 19.17 % of cases, large bowel injuries in 10.92 %, liver injuries in 7.6 %, splenic injuries in 7.2 %, kidney injuries in 5.36 %, and pancreatic injuries in 3.7 %. Pediatric populations showed significantly higher rates of IAAs (55.8 % vs. 23.03 %) and surgical intervention (45.5 % vs.10.6 %) than adults.

CONCLUSION: The pooled incidence of IAAs associated with TL FDIs is 36.2 %, and surgical intervention is 29.03 %. Small bowels, large bowels, liver, and splenic injuries were the most frequent injuries. These rates are probably overestimated due to the retrospective design of studies and the variability in the definition of TLFDIs. Therefore, prospective, well-designed studies are needed to estimate the true incidence of IAAs associated with TLFDIs accurately.

PMID:40273660 | DOI:10.1016/j.injury.2025.112337

Injury. 2025 Apr 12;56(6):112343. doi: 10.1016/j.injury.2025.112343. Online ahead of print.

ABSTRACT

BACKGROUND: Major trauma (MT) is a significant cause of morbidity and mortality worldwide, with older adult patients facing unique challenges due to age-related vulnerabilities and higher risks of falls. This study aimed to investigate differences in trauma characteristics, injury mechanisms, and outcomes of older adults compared to all younger patients with MT on a national level.

METHODS: This retrospective cohort study analysed the national Major Trauma Audit data from 23,765 eligible patients with MT in Ireland of all ages and stratified into two age groups: those under 65 years (n = 12,620) and those aged 65 years or older (n = 11,145). The Major Trauma Audit follows the methodology of National Major Trauma Registry in the UK. Variables assessed included injury severity, comorbidities, length of stay (LOS), and mortality rates. Statistical comparisons were made between the two age groups.

RESULTS: Older adults represent 47 % of the total Irish patient population with MT, with a significantly higher proportion of females (56 %) compared to younger patients (31 %) (P<0.001). Falls of less than two meters were the leading mechanism of injury for older adults (82 %), while road traffic accidents (RTA) were more common among younger patients (25 %). Severe injuries were observed in 34 % of both age groups, but <10 % of older adults were received by a trauma team. Comorbidities were significantly more prevalent in older adults (75 %) compared to 39 % in younger patients, (P<0.001). Median hospital LOS was twelve days for older adults, compared to seven days for younger patients. Mortality rates were significantly higher among the older patient population, who were also more likely to be discharged to long-term care, (P<0.001).

CONCLUSION: In comparison to younger patients, the present study highlights that older adults who experience major trauma are frequently under-triaged as suspected MT, leading to delays in care, inadequate treatment, or worse clinical outcomes.

PMID:40273659 | DOI:10.1016/j.injury.2025.112343

Injury. 2025 Apr 8;56(6):112332. doi: 10.1016/j.injury.2025.112332. Online ahead of print.

ABSTRACT

BACKGROUND: Rapid population growth and urbanisation raise a critical need to better understand the burden of injuries in sub-Saharan Africa. We assessed the pattern of service demand for injuries at emergency department (ED) in urban areas of Mozambique.

METHODS: This prospective, multi-centric, observational study was conducted in EDs in southern (Maputo), central (Beira) and northern (Nampula) of Mozambique. We randomly selected 7809 cases (age ≥1 years) during the seasonally distinct months of April/2016-2017 and October/2017. Data on patients' demographics, nature of injury and clinical outcomes were collected.

RESULTS: Overall, 1881/7809 (26.2 %) emergency cases comprising 518 children (58.5 % male, aged 4.6 ± 2.5 years), 324 adolescents (64.8 % male, 14.7 ± 3.0 years) and 10,39 adults (60.8 % male, 34.5 ± 13.0 years) presented with injury. The arms, legs and head were most affected in both children (518 with 795 injuries) and adults (1039 with 1496 injuries). The diversity of injuries increased with older age. Injury cases predominantly presented during daylight hours (from 0900 to 1900) with age-differentials evident. There were proportionately more injury presentations in the hotter and wetter October than in colder and drier April. The most common mechanisms of injury were falls, physical violence and road traffic injuries. Overall, 9.1 % of injury cases were admitted to hospital and 0.2 % died.

CONCLUSIONS: Injuries corresponded to around one-quarter of all emergency admissions in urban Mozambique, and were predominantly caused by falls, physical violence, and road traffic injuries. Understanding distinctive variations in the pattern and timing of these presentations according to the age, location and season will assist in future planning for more efficient injury prevention and health care services in Mozambique.

PMID:40273658 | DOI:10.1016/j.injury.2025.112332

Injury. 2025 Apr 17:112306. doi: 10.1016/j.injury.2025.112306. Online ahead of print.

ABSTRACT

BACKGROUND: The popularity of electric bicycles (E-bikes) in The Netherlands has surged in recent years. Simultaneously, bicycle-related traffic injuries in The Netherlands have reached record levels. Given the significant societal and individual impact of traumatic brain injury (TBI) we investigated the relationship between E-bike usage and the occurrence of severe TBI.

METHODS: All bicycle crash victims aged twelve years and older admitted to the Isala Hospital from 1 January 2018 to 31 December 2022, were included from the National Trauma Registry. Data on bicycle type, anticoagulants, alcohol intoxication, and helmet use, was obtained from the hospitals' electronic patient record. The primary outcome variable was severe TBI verified on CT- or MRI-imaging. The secondary outcome variable was a skull fracture verified on X-ray or CT-imaging. Adjusted odds ratios (ORs) and 95 %-confidence intervals (CIs) were calculated using multivariable binary logistic regression analyses, adjusting for the risk factors alcohol intoxication, anticoagulant use, not wearing a helmet, health status before the accident, age and gender.

RESULTS: From 1 January 2018 to 31 December 2022, a total of 1878 patients were admitted following a bicycle crash. This group consisted of 1359 (73.4 %) regular cyclists and 519 (27.6 %) E-bikers. Multivariable regression analyses resulted in an OR of 1.64 (CI 1.20-2.22) for severe TBI and an OR of 1.50 (CI 1.08-2.08) for skull fractures.

CONCLUSION: In our study sample, E-bike usage was found to be an independent predictor for severe traumatic brain injury and skull fractures following a bicycle crash.

PMID:40268590 | DOI:10.1016/j.injury.2025.112306

Injury. 2025 Apr 15;56(6):112345. doi: 10.1016/j.injury.2025.112345. Online ahead of print.

ABSTRACT

INTRODUCTION: Describing surgical wounds accurately poses challenges due to the diverse terminology used for complications. Existing evaluation methods do not cater specifically to surgical wounds from post-ankle fracture surgery with osteosynthesis. Given the unique anatomical challenges and treatment considerations (limited tissue coverage and blood supply as well as the surgical treatment with osteosynthesis), a targeted wound score is essential for ensuring consistent evaluation and high-quality care and thereby optimizing patient outcomes and satisfaction. The study aimed to develop a wound score specifically for evaluating surgical wounds following ankle fracture surgery.

METHOD: Development of the Wound after Osteosynthesis Kolding score (WOK) proceeded through three phases: 1) identifying WOK domains, 2) developing item and response options, and 3) pilot testing the WOK score.

RESULTS: Five domains were identified: erythema, swelling, dehiscence, exudate and warmth. Response options were derived from literature and clinical insights. Content validity was assessed with an S-CVI/Ave of 0.93 for nurses and 0.82 for orthopedic surgeons. Orthopedic surgeons perceived erythema and warmth as less relevant, while nurses considered all five domains to be fairly or very relevant. High agreement between scores was found, but varying kappa scores were observed when assessing intra-rater reliability. Inter-rater reliability was acceptable across all domains (κ = 0.44 to 1.00). Warmth was omitted from the final WOK score due to low content validity among orthopedic surgeons and poor inter-rater reliability. Additionally, assessing warmth in a clinical setting was challenging because ankle brace stabilization affects overall skin humidity and warmth.

CONCLUSIONS: The Wound after Osteosynthesis Kolding score (WOK) has proven to be a content-valid and reliable tool for assessing minor complications in surgical wounds following ankle fracture surgery.

PMID:40267859 | DOI:10.1016/j.injury.2025.112345

Injury. 2025 Apr 17;56(6):112354. doi: 10.1016/j.injury.2025.112354. Online ahead of print.

ABSTRACT

History - A 38yo man was injured in a rugby match. He suffered an isolated, Achilles tendon rupture. He immediately went to his local emergency department. He was keen on the best treatment so that he could get back into playing rugby with his community team. Past Medical History and Social History - He was a married man and lived with his wife. He was a nonsmoker. He had no medical problems that he saw a physician about. He worked as an executive with an oil company and was also involved in many sports year-round. He had had surgery for previous sports related broken bones with no complications. He had no allergies and took no medications. He was a regular beer drinker after sports matches.

PMID:40267858 | DOI:10.1016/j.injury.2025.112354

Injury. 2025 Apr 12;56(6):112338. doi: 10.1016/j.injury.2025.112338. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to investigate the outcomes of fasciotomy, including infection, amputation, and complications, in patients with crush injuries from the 2023 Turkey-Syria earthquake.

MATERIAL AND METHODS: Out of 210 patients presenting from the earthquake zone, 46 patients (23 male-23 female, mean age: 21 years) who underwent 52 extremity fasciotomies were included. Data collected included infection rates, need for grafts/flaps, amputation rates, creatinine, CK levels, need for dialysis, and neurologic injuries. Early fasciotomy was defined as ≤12 h and late as >12 h after the earthquake. Patients were categorized by fasciotomy timing and location (earthquake-zone or university hospital). Time to first debridement was also evaluated.

RESULTS: The median time to fasciotomy was 24 h (2-97 h, (IQR 12.5-65)). Fasciotomies performed in the earthquake zone had a higher infection rate (68 % vs. 25 %, p = 0.061), though this difference was not statistically significant, likely due to the small sample size. There was no significant difference in infection rates between patients who underwent early fasciotomy (8/13, 62 %) and those who underwent late fasciotomy (20/33, 61 %) (p = 1.0).Amputation was required in 7/46 patients (15 %), with 1/13 patient (8 %) in the early fasciotomy group and 6/33 patients (18 %) in the late fasciotomy group (p = 0.698). Skin grafting was performed for wound closure in 19 patients (42 %). In patients undergoing early fasciotomy, 75 % (9/12) required skin grafts for wound closure, whereas the rate in the late fasciotomy group was significantly lower at 30 % (10/33) (p = 0.019). The mean time to first debridement was significantly higher in infected patients [65.5 (SD 11.8) vs 57.8 (SD 11.4 h), p = 0034]. For wounds that required skin grafts, the average duration between the fasciotomy and initial debridement was significantly higher (68.5 vs 54 h), p = 0.001.

CONCLUSION: Fasciotomies performed in earthquake zones had higher infection rates compared to hospitals, though not statistically significant. Infections with potentially multi-drug resistant bacterias may increase the risk of complications like amputations. Timely debridement and efficient patient transfer remain essential to minimizing risks and improving outcomes.

PMID:40267857 | DOI:10.1016/j.injury.2025.112338

Injury. 2025 Apr 14:112344. doi: 10.1016/j.injury.2025.112344. Online ahead of print.

ABSTRACT

INTRODUCTION: Adverse Childhood Experiences (ACEs), such as violence exposure, are linked with numerous long-term health consequences. Adult firearm and other injury survivors presenting to level I trauma centers frequently report having youth family members exposed to firearm violence and other traumatic life events. Few investigations have examined the demographic and familial characteristics, or cumulative trauma burden of exposed family members.

METHODS: The investigation was a secondary analysis of data collected as part of a 25-site national US level I trauma center randomized clinical trial (N = 635). Baseline characteristics of firearm injury survivors (n = 128) versus all other injury survivors (n = 507) were compared, including number of children, pre-injury trauma history, and post-admission recurrent traumatic and stressful life events. Analyses were conducted on baseline characteristics of firearm injury survivors, including trauma history, and compared to non-firearm injury survivors. For injury survivors with children, mixed model regression was used to assess whether firearm injury was independently associated with an increased risk of childhood injury leading to hospitalization over the course of the year after the index parental injury admission.

RESULTS: There were few demographic and clinical differences between firearm and non-firearm injury survivors. Approximately 70% of adult injury survivors had at least one child. Over 10% of adult injury survivors had a child hospitalized in the year after the index admission; firearm injury survivors were no more likely than all other injury survivors to have a child hospitalized after the index admission. For injury survivors with children, mixed model regression analyses revealed a significant association between pre-injury childhood exposure to life-threating illness/injury and child injury hospitalization in the year after the index parental injury admission (Relative Risk = 1.92, 95% Confidence Interval = 1.08, 3.42).

CONCLUSIONS: Over 10% of adult injury survivors reported that their children were hospitalized for an injury in the year after an index injury admission. Prehospital childhood illness or injury admission was significantly associated with childhood injury hospitalization in the year after parental injury. Trauma centers could be harnessed as a public health point-of-contact for screening, intervention, and referral of ACEs, such as childhood injury.

PMID:40263031 | DOI:10.1016/j.injury.2025.112344

Injury. 2025 Apr 8;56(6):112315. doi: 10.1016/j.injury.2025.112315. Online ahead of print.

ABSTRACT

AIMS: In an increasingly frail population, simultaneous "fix and replace" surgery (fixation of the acetabulum to accommodate a press fit cup and total hip arthroplasty (THA)) is a novel alternative to open reduction and internal fixation (ORIF) alone in the management of acetabular fractures. We aimed to determine whether patients managed with "fix and replace" have comparable survivorship to those undergoing staged THA following previous open reduction and internal fixation for acetabular fracture.

METHODS: All Patients with acetabular fractures surgically managed within our Tertiary centre over a five year period (01/01/2018-30/05/2023) were identified. Thirty-four patients underwent simultaneous "fix and replace" surgery and 133 underwent acetabular ORIF alone. Twenty-one of these patients required staged THA (6 %).

RESULTS: Follow up mean was 2.7 years (SD ±1.7) for 'fix and replace' versus 3.3 years (SD ± 1.5) for staged THA. There was no statistically significant difference between the two groups with regards to BMI or sex. The fix and replace group were older (p = 0.001), had higher American Society of Anesthesiologists (ASA) grade (p = 0.006) and Charlson Comorbidity Index (CCI) (p = 0.027), respectively. High energy mechanism of injury accounted for 56 % of the "fix and replace" group compared to 48 % in the ORIF to THA. 74 % of 'fix and replace' were associated/complex fractures (LeTournel) compared to 53 % of staged THA. Mean wait to surgery was 3 days in the 'fix and replace' group compared to 186 days from listing to operation in the staged THA group. Survival analysis demonstrated acceptable results for both groups with greater than 85 % survival at 2 years and no statistical significantly worse survivorship in the 'fix and replace' group (p = 0.13). Complications were comparable in both groups (41 % versus 43 %, p = 0.58).

CONCLUSIONS: 'Fix and replace' is a good option for the elderly, co-morbid patient. It enables early weight bearing and has acceptable survivorship compared to staged THA following acetabular ORIF.

PMID:40262410 | DOI:10.1016/j.injury.2025.112315

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

ABSTRACT

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

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

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

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

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

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

ABSTRACT

STUDY DESIGN: Retrospective study.

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

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

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

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

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