Injury. 2025 Jul 11;56(8):112596. doi: 10.1016/j.injury.2025.112596. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma team activation criteria (TTAC) are used within Trauma Activation Systems (TAS) to facilitate the rapid identification of patients with major traumatic injuries requiring a hospital trauma system response, including the attendance of a multidisciplinary trauma team. The value of individual activation criteria available at the time a decision to activate the system response is made is uncertain. We conducted a systematic review to identify TTAC associated with the presence of major traumatic injuries in adult trauma patients.

METHODS: We searched MEDLINE, EMBASE, and CINAHL (01-01-2000 to 5-07-2024) for studies using multivariable methods to evaluate associations between physiological, anatomical and mechanism of injury variables available or obtained at emergency department triage and the presence of major traumatic injuries. Risk of bias was assessed using the QUIPs tool, meta-analysis was conducted using a random effects approach, and certainty of evidence assessed using GRADE.

RESULTS: We included 7 studies from major trauma centres in North America (n = 3), Australia (n = 2), Israel (n = 1) and Italy (n = 1). Studies were predominantly retrospective, evaluated a wide range of activation criteria, and used varying definitions of major trauma. We demonstrated with moderate certainty that low Glasgow Coma Score (OR 9.4 95 %CI 4.6-19.3), systolic hypotension (OR 4.4 95 %CI 2.2-8.8), abnormal vital signs (OR 3.7 95 %CI 2.6-5.3) and multi-region trauma (OR 4.7 95 %CI 3.5-6.5) were associated with the presence of major trauma. The certainty of evidence for the association between mechanism of injury and other physiological criteria and major trauma was low or very low.

CONCLUSION: Low GCS, systolic hypotension, abnormal vital signs at emergency department triage and the presence of multi-region trauma predict the presence of major trauma in adult trauma patients. These criteria could form the foundation of evidence-based TTAC. Remaining TTAC should reflect the trauma population and local major trauma response capabilities, with audit and revision necessary for optimal TTAC.

PMID:40683057 | DOI:10.1016/j.injury.2025.112596

Injury. 2025 Jul 13;56(8):112607. doi: 10.1016/j.injury.2025.112607. Online ahead of print.

ABSTRACT

INTRODUCTION: There is a strong demand for research on the long-term outcomes of tibial plateau fractures (TPFs) in large cohorts. Stringent data protection regulations and high ethical standards are essential for safeguarding participants' rights, but they can increase the logistical complexity of conducting multicentre studies. This study aims to evaluate clinical outcome data collected over more than a decade through a collaborative data network in surgically treated TPFs.

PATIENTS AND METHODS: This retrospective cohort study was conducted at two level-I trauma centers and included 364 adult patients with operatively TPFs, classified according to the Schatzker system. Eligible patients were treated between January 2010 and September 2022, were ≥18 years of age at the time of injury, resided in Germany, and had a minimum follow-up of 1.25 years with completed patient-reported outcome measures. Patients with cognitive or physical impairments preventing survey participation were excluded. Data collection occurred between September 2022 and January 2023. Outcome measures included the International Knee Documentation Committee (IKDC) form, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm Score. Multiple linear regression was used to assess associations between outcome scores, follow-up duration, and Schatzker classification.

RESULTS: Longer follow-up times were associated with significantly higher scores for IKDC (p < 0.05), KOOS Pain (p < 0.05), Activities of Daily Living (ADL) (p < 0.05), Sports (p < 0.05), and Quality of Life (QoL) (p < 0.00001). Complex fractures (Schatzker IV-VI) were consistently linked to worse outcomes, particularly in the KOOS Sports (p < 0.001) and Quality of Life (p < 0.00001) subscores. Adjusted R-squared values ranged from 2 % to 10 %, with the highest values observed in KOOS QoL scores.

CONCLUSIONS: Patient-reported outcomes (PROMs) were found to be positively associated with longer follow-up durations, up to 12 years postoperatively emphasizing the need for prolonged aftercare in TPFs. Complex fractures, in particular, might benefit from tailored, long-term follow-up. Given the severity of TPFs, it is crucial to manage patient expectations and address psychosocial factors to optimize the outcome. Collaborative data networks, like the one used here, hold promise for expanding research and improving treatment strategies across multiple centers.

PMID:40683056 | DOI:10.1016/j.injury.2025.112607

Injury. 2025 Jul 12;56(8):112606. doi: 10.1016/j.injury.2025.112606. Online ahead of print.

ABSTRACT

BACKGROUND: Indirect calorimetry (IC) is the gold standard method for measuring resting energy expenditure (REE). Although clinical guidelines recommend nutrition be delivered based on measured REE, easily applied predictive equations are most commonly used in practice, with potential for over-and under-estimation of energy needs. We aimed to 1) determine the feasibility and acceptability of using IC to measure REE and 2) compare measured to estimated REE in self-ventilating patients with a traumatic injury.

METHODS: In a single-centre prospective observational study, REE was measured using IC via a canopy hood in patients admitted to a trauma ward with ≥7day hospital stay. Feasibility was set at >50 % of IC measurements being valid (≥5 min with a respiratory quotient between 0.67 - 1.3, and ≤10 % variation in VO2 and VCO2). Following the measurement, patients and staff completed an acceptability survey. Measured REE (kcal) was compared to estimated REE (kcal) using predictive equations (Schofield, 25kcal/kg and 30kcal/kg), with ±10 % difference considered clinically significant.

RESULTS: Of 30 IC measurements, 25 (83 %) were valid. Measurements were not completed or valid in 5 (17 %) participants due to discomfort (n = 1), pain (n = 1), difficult bedspace (n = 1) and high CO2 variability (n = 2). Of those that completed the survey, 83 % of participants (n = 24) reported that the test was comfortable, and all staff (n = 11) agreed IC was acceptable to incorporate into usual care. Measured REE was within ±10 % of estimated REE with the Schofield equation, 25 kcal/kg and 30 kcal/kg in 44 %, 28 %, and 60 % cases, respectively.

CONCLUSION: Measured REE using IC is feasible and acceptable following traumatic injury. Estimated REE using predictive equations were not commonly within 10 % of measured REE, which may lead to under or over-feeding of patients following traumatic injury. Further research is warranted to evaluate whether IC-guided energy delivery improves patient outcomes.

PMID:40683055 | DOI:10.1016/j.injury.2025.112606

Injury. 2025 Jul 1;56(8):112570. doi: 10.1016/j.injury.2025.112570. Online ahead of print.

ABSTRACT

Artificial intelligence (AI) has emerged as a transformative technology in healthcare, with significant applications in orthopedic trauma. This comprehensive review analyzes 217 studies published between 2015 and 2025 to evaluate the current state, applications, and future directions of AI in orthopedic trauma. The field has experienced exponential growth, with 52.5 % of all studies published in 2024 alone. Deep learning approaches (43.3 %) and traditional machine learning methods (39.2 %) dominated the research landscape. Fracture detection (24.4 %) and classification (12.0 %) were the most common applications, followed by prediction (21.2 %) and segmentation (8.3 %). Hip/femur (19.4 %), spine (18.9 %), and wrist fractures (12.0 %) represented the most frequently studied anatomical sites. AI systems frequently matched or exceeded specialist performance in detection and classification tasks, with sensitivities and specificities above 90 % commonly reported. Predictive models for complications and mortality consistently outperformed traditional scoring systems, with improvements in AUC typically between 0.10-0.15. However, only 14.5 % of studies underwent external validation, and just 3.2 % reported prospective clinical validation. Despite remarkable progress in developing accurate AI systems for orthopedic trauma, significant challenges remain in clinical integration, data standardization, and validation across diverse populations. Future development should focus on multimodal approaches integrating diverse data sources, transparent algorithms providing rationales for predictions, and rigorous clinical validation. Point-of-care applications and integration with emerging technologies offer promising directions for clinical impact. As these challenges are addressed, AI has the potential to significantly enhance orthopedic trauma care by improving diagnostic accuracy, optimizing treatment selection, and identifying high-risk patients for targeted interventions.

PMID:40683054 | DOI:10.1016/j.injury.2025.112570

Int Orthop. 2025 Jul 19. doi: 10.1007/s00264-025-06604-2. Online ahead of print.

ABSTRACT

PURPOSE: The Both Column Screw (BCS) fixation technique is a recently introduced, innovative method for the treatment of acetabular posterior column fractures. This study aims to biomechanically compare the BCS technique with conventional posterior column lag screw fixation methods using finite element analysis.

METHODS: Five different internal fixation models were simulated using five distinct screw fixation techniques: antegrade posterior column screw (APCS), retrograde posterior column screw (RPCS), magic screw (MS), anterior BCS (aBCS), and posterior BCS (pBCS). The modeling process included meshing, assignment of material properties, and definition of boundary conditions. Each model was subjected to three different loading conditions: level walking, stairs up, and stairs down. The biomechanical performance of each fixation technique was evaluated based on five parameters: maximum stress in the screw, maximum stress in the bone, total deformation, gap in fracture surfaces, and sliding distance in the fracture surface.

RESULTS: Finite element analysis demonstrated biomechanical differences among the five fixation techniques. The APCS model consistently showed the highest stress values and deformation across all loading conditions, whereas the MS, aBCS, and pBCS models exhibited lower deformation and stress parameters. Among these, pBCS generally displayed the most favorable performance in terms of stress reduction and fracture stability. Overall, the BCS configurations (aBCS and pBCS) showed improved biomechanical behavior compared to conventional fixation methods.

CONCLUSION: The BCS fixation technique, due to its superior biomechanical properties, may serve as a valuable addition to current methods for acetabular posterior column fractures. It broadens surgical options and may support clinical decision-making for orthopaedic surgeons.

PMID:40682622 | DOI:10.1007/s00264-025-06604-2

Injury. 2025 Jul 3:112586. doi: 10.1016/j.injury.2025.112586. Online ahead of print.

NO ABSTRACT

PMID:40681385 | DOI:10.1016/j.injury.2025.112586

J Bone Joint Surg Am. 2025 Jul 18. doi: 10.2106/JBJS.24.00996. Online ahead of print.

ABSTRACT

BACKGROUND: Workers' Compensation (WC) status has been associated with inferior outcomes in orthopaedic procedures. The purpose of this study was to determine the impact of WC on the long-term outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) and labral tears and to compare these findings with those of a propensity-matched control group.

METHODS: A retrospective analysis was conducted that included patients with a WC claim who underwent hip arthroscopy for FAI and labral tears between 2008 and 2013. Included patients had complete preoperative and minimum 10-year postoperative questionnaires for patient-reported outcomes (PROs) or a documented end point. Patients were propensity-matched to a control group without a WC claim in a 1:3 ratio on the basis of age at the time of surgery, sex, body mass index, acetabular Outerbridge grade, and capsular treatment. Clinically meaningful thresholds, complications, survivorship, work type, and return-to-work rates were analyzed.

RESULTS: A total of 280 patients (WC group, 70; control group, 210) were included in the study. The WC group had a mean follow-up time of 123.9 ± 22.6 months. Compared with the matched control group, the WC group had worse preoperative PRO scores but a greater magnitude of improvement. The groups had similar (p > 0.05) rates of reaching the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) values for the modified Harris hip score (MCID: 93.0% [WC group], 79.2% [control group]; PASS: 83.7% [WC], 77.8% [control]), the Non-Arthritic Hip Score (MCID: 90.7% [WC], 77.8% [control]; PASS: 74.4% [WC], 63.2% [control]), and the Hip Outcome Score Sport-Specific Subscale (MCID: 87.5% [WC], 72.3% [control]; PASS: 72.7% [WC], 55.6% [control]). In the WC group, 82.9% of patients returned to work, with a mean time to return to work of 8.0 ± 7.4 months. The WC group had a higher rate of revision hip arthroscopy than the control group, with a threefold relative risk (95% confidence interval, 1.6 to 5.7; p < 0.001) and a mean time to revision of 28.3 ± 37.1 months.

CONCLUSIONS: Hip arthroscopy for the treatment of FAI and labral tears in patients with a WC claim was associated with favorable outcomes and a high return-to-work rate at a minimum 10-year follow-up. These results were comparable with those of a benchmark control group. However, the WC group had a significantly higher rate of revision hip arthroscopy than the control group.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40680109 | DOI:10.2106/JBJS.24.00996

Int Orthop. 2025 Jul 18. doi: 10.1007/s00264-025-06615-z. Online ahead of print.

ABSTRACT

PURPOSE: A proper balance of soft tissues is essential in total knee arthroplasty (TKA) for varus knees, but assessing soft tissue tension preoperatively is challenging. This study aimed to determine whether lower limb alignment angles can predict the necessary degree of soft tissue release.

METHODS: A retrospective cohort study was conducted on 953 patients with varus knees (> 10°) who underwent primary TKA from 2018 to 2020. The patients' data, release stage data, and three-joint alignment radiograph parameters were extracted from the Joint Reconstruction Research Center Knee registry, focusing on variables such as age, sex, body mass index (BMI), femoral mechanical‒anatomical angle (FMAA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line congruent angle (JLCA), and varus angle (VA). Data analysis was performed via SPSS 26.0.

RESULTS: The mean age of the patients was 65.4 (43-86) years, with a predominance of females (57.9%). Findings revealed significant associations between soft tissue release and FMAA, LDFA, MPTA, JLCA, MPTA/VA, and JLCA/VA. ROC curve analysis indicated that the JLCA/VA ratio had the highest predictive accuracy (0.997). A cutoff value of 0.49 for JLCA/VA was used to predict the soft tissue release grade, with a sensitivity of 98.8% and specificity of 99.9%.

CONCLUSION: Angular parameters from three-joint alignment radiographs can effectively predict soft tissue release needed for TKA in varus knees, with the JLCA/VA being the most reliable parameter.

PMID:40679593 | DOI:10.1007/s00264-025-06615-z

Int Orthop. 2025 Jul 17. doi: 10.1007/s00264-025-06614-0. Online ahead of print.

ABSTRACT

PURPOSE: Medial open-wedge high tibial osteotomy (MOWHTO) is an effective treatment for medial compartment knee osteoarthritis. However, there is no consensus regarding the optimal management of the pes anserinus during the procedure. This study aimed to investigate the effects of pes anserinus release on radiological healing, alignment correction, and functional outcomes after MOWHTO.

MATERIALS AND METHODS: This retrospective cohort study included 73 patients who underwent MOWHTO with locking plate fixation. Patients were divided into two groups based on surgical preference: pes anserinus release (n = 35) and non-release (n = 38). Functional outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, six months, and 12 months. Radiographic parameters included the hip-knee-ankle (HKA) angle, medial proximal tibial angle (mMPTA), tibial slope, and time to bone union. Complications were also documented.

RESULTS: Both groups were comparable in demographic characteristics and preoperative alignment. The non-release group achieved bone union significantly earlier (median 4.0 vs. 5.0 months, p = 0.019). There were no significant differences in HKA angle, mMPTA or tibial slope between the groups. At six months, KOOS scores were significantly higher in the non-release group (p < 0.001); however, by 12 months, both groups demonstrated similar functional outcomes. No major complications or nonunions were observed in either group.

CONCLUSIONS: Preserving the pes anserinus during MOWHTO does not compromise alignment correction and may enhance early bone healing and functional recovery. Routine release of the pes anserinus may be unnecessary, and its preservation could offer clinical benefits during the early postoperative period. Further prospective, randomized studies are needed to validate these findings.

PMID:40676248 | DOI:10.1007/s00264-025-06614-0

SICOT J. 2025;11:40. doi: 10.1051/sicotj/2025035. Epub 2025 Jul 16.

ABSTRACT

INTRODUCTION: Osteoporotic vertebral fractures (OVFs) are the most common type of fragility fractures. They have a significant and usually detrimental impact on the patient's functional status and mortality rate, constituting a substantial burden for the patients, their families, and the healthcare system. This narrative review aims to summarize the current knowledge of osteoporotic vertebral fractures and secondary fracture prevention.

METHODS: A comprehensive literature search was conducted across major medical databases, including PubMed, Scopus, and Web of Science. Relevant studies, guidelines, and reviews published were analyzed to provide a broad perspective on the topic.

RESULTS: Diagnosis of OVFs is based on history, clinical examination, and plain lateral radiographs of the spine. Their management is mainly non-operative, with surgery being reserved for specific indications. Successful management of osteoporotic vertebral fractures entails alleviating pain, early restoration of mobility, and secondary fracture prevention. Prevention of the next osteoporotic fracture is paramount and should be an integral element of their management. The Fracture Liaison Service (FLS) is the main contemporary service that serves this purpose.

DISCUSSION: Diagnosis of OVFs is simple but requires vigilance from the clinicians. Early, accurate diagnosis is essential to initiate appropriate treatment and provide the opportunity for secondary fracture prevention.

PMID:40668980 | PMC:PMC12266666 | DOI:10.1051/sicotj/2025035

SICOT J. 2025;11:39. doi: 10.1051/sicotj/2025034. Epub 2025 Jul 16.

ABSTRACT

BACKGROUND: Dementia patients with femoral neck fractures (FNFs) are unable to understand their dislocated limb positioning, which may impair rehabilitation and result in poorer functional recovery. Recently, good clinical results have been reported for the direct anterior approach for total hip arthroplasty (DAA-THA) using a dual mobility cup (DMC) for displaced FNFs. This study aimed to investigate differences in the clinical outcome of THA for displaced FNFs in patients with and without dementia.

METHODS: This study was retrospective and included 151 patients who underwent DAA-THA with DMC for displaced FNFs. Patients diagnosed with dementia prior to injury were classified into a dementia group (43 patients) and a non-dementia control group (control group, 108 patients). The evaluation items were age, sex, body mass index (BMI), preoperative Fracture Mobility Score (FMS), waiting period, preoperative anesthetic assessment, blood loss, operation time, complications, 1-year mortality, and 1-year FMS after surgery. The FMS was scored as: walking alone: 1, walking with a cane: 2, walking with a walker: 3, hand-guided walking: 4, and wheelchair: 5.

RESULTS: Significant differences were found in age, weight, BMI, and operation time. Postoperative dislocation was not observed in both groups. FMS was compared before and after injury in three categories: (1) unchanged from before injury, (2) one rank down, and (3) two or more ranks down. No significant differences were found in any of these categories (p = 0.09). Functional outcomes showed no significant difference in mobility recovery. The 1-year mortality rate was 9.35% (16 patients), with no significant difference between the two groups (p = 0.17).

DISCUSSION: DAA-THA using DMC for displaced FNFs may have similar functional outcomes and mortality rates in both patients with and without dementia.

PMID:40668979 | PMC:PMC12266661 | DOI:10.1051/sicotj/2025034

SICOT J. 2025;11:38. doi: 10.1051/sicotj/2025032. Epub 2025 Jul 16.

ABSTRACT

INTRODUCTION: Venous thromboembolism (VTE) is a rare but potentially serious complication following anterior cruciate ligament reconstruction (ACLR). There is no guideline for the routine use of anticoagulants post-ACLR surgery.

METHODS: This retrospective case-control study reviewed 199 patients who underwent ACLR between February 2020 and November 2024. Two groups were compared: Group A (n = 113) received no pharmacological prophylaxis, while Group B (n = 86) received low-molecular-weight heparin (LMWH) for 2 weeks postoperatively. The incidence of symptomatic VTE, postoperative bleeding, and related complications was evaluated.

RESULTS: No symptomatic VTE or bleeding complications were observed in either group. There was no statistically significant difference between the groups in terms of age, BMI, smoking, comorbidities, and postoperative weight bearing. There was a significant difference in surgical duration, graft type, and meniscal procedure.

DISCUSSION: Our findings support a risk-stratified approach rather than universal pharmacologic prophylaxis in ACLR patients.

PMID:40668978 | PMC:PMC12266665 | DOI:10.1051/sicotj/2025032

SICOT J. 2025;11:37. doi: 10.1051/sicotj/2025037. Epub 2025 Jul 16.

ABSTRACT

INTRODUCTION: This study explored a minimally invasive technique for harvesting the superficial band of the quadriceps tendon. By using a conventional graft tendon stripper, the procedure aims to obtain the full length of tendon fibers necessary for anterior cruciate ligament (ACL) reconstruction. The study aimed to determine if this technique can produce grafts of sufficient length and diameter.

METHODS: From September to October 2023, we conducted a study using full-body Thiel-embalmed cadavers over 18 years of age without pathology-related alterations in lower limb anatomy. The mid-diameter of the graft was measured at its midpoint, and the peripheral diameter was taken at the ends. The length of the triple-folded graft was measured from end to end. A digital vernier caliper measured the length and mid-diameter, and a graft sizer measured the peripheral diameter.

RESULTS: Sixteen quadriceps tendon autografts were harvested from 16 knees of 8 cadavers (mean age: 64.7 ± 9.9 years). The minimally invasive harvesting technique yielded a mean graft length of 289.0 ± 10.3 mm before folding, a mean mid-diameter of 9.7 ± 0.7 mm, a mean peripheral diameter of 8.5 ± 0.4 mm, and a mean length of 93.1 ± 4.7 mm after triple folding. Gender-based comparisons showed no significant differences. Correlations between graft dimensions and height were not statistically significant.

DISCUSSION: The findings of this study indicate that the minimally invasive harvesting of the superficial band of the quadriceps tendon resulted in adequate graft dimension. Gender-based comparisons revealed no statistically significant differences in these dimensions between males and females. Additionally, correlation analysis showed weak to moderate correlations between graft dimensions and height, none of which were statistically significant, indicating no meaningful relationship between height and graft dimensions.

PMID:40668977 | PMC:PMC12266663 | DOI:10.1051/sicotj/2025037

SICOT J. 2025;11:36. doi: 10.1051/sicotj/2025036. Epub 2025 Jul 16.

ABSTRACT

BACKGROUND: Perioperative blood loss remains a challenge in total hip arthroplasty (THA). Although tranexamic acid (TXA) is widely used for hemostasis, the efficacy of oxidized regenerated cellulose (ORC) powder as an adjunct in blood management for THA via the direct anterior approach (DAA) remains underexplored. This study aimed to evaluate the effects of ORC powder on perioperative blood loss, hematological parameters, and clinical outcomes in direct anterior THA.

METHODS: A total of 133 patients who underwent primary THA via the DAA were enrolled in the study. The patients were divided into two groups: the ORC powder group (combination of ORC powder and topical TXA, n = 53) and the control group (topical TXA alone, n = 80). The demographic and clinical information, operative time, intraoperative bleeding volume, estimated total blood loss (eTBL), hidden blood loss (HBL), trends in hemoglobin, hematocrit, postoperative pain scores using a numeric rating scale (NRS), and adverse events were analyzed. Clinical outcomes were assessed using the Japanese Orthopedic Association score.

RESULTS: The ORC powder group had significantly lower eTBL (679.1 ± 230.1 mL vs. 875.8 ± 292.9 mL, p < 0.0001) and HBL (424.1 ± 194.5 mL vs. 558.6 ± 264.2 mL, p = 0.002). Postoperative pain scores at postoperative day 7 were lower in the ORC powder group (1.9 ± 1.6 vs. 2.9 ± 2.2, p = 0.009). The clinical outcomes were excellent, and no significant differences were observed in complication rates between the groups.

CONCLUSION: ORC powder effectively reduced perioperative blood loss in THA via the DAA without increasing complication rates. ORC powder has the potential to be a valuable adjunct in optimizing blood management strategies in THA.

PMID:40668976 | PMC:PMC12266662 | DOI:10.1051/sicotj/2025036

Injury. 2025 Jul 8:112590. doi: 10.1016/j.injury.2025.112590. Online ahead of print.

NO ABSTRACT

PMID:40670206 | DOI:10.1016/j.injury.2025.112590

Injury. 2025 Jul 8:112603. doi: 10.1016/j.injury.2025.112603. Online ahead of print.

NO ABSTRACT

PMID:40670205 | DOI:10.1016/j.injury.2025.112603

Injury. 2025 Jul 15;56(8):112588. doi: 10.1016/j.injury.2025.112588. Online ahead of print.

NO ABSTRACT

PMID:40669261 | DOI:10.1016/j.injury.2025.112588

Injury. 2025 Jul 11;56(8):112610. doi: 10.1016/j.injury.2025.112610. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to compare the safety and efficacy of ultrasound-guided and arthrogram-guided techniques in the treatment of radial neck fractures in early childhood using the percutaneous leverage technique.

METHODS: This retrospective case series study included children under 7 years of age with closed radial neck fractures who underwent surgery between November 2015 and July 2021. Patients were divided into two groups based on the guidance techniques employed: the ultrasound guidance group (19 cases) and the arthrogram guidance group (14 cases). The primary outcomes included operative time, radiation exposure, and postoperative functional outcomes assessed using the Métaizeau criteria and the Mayo Elbow Performance Score (MEPS).

RESULTS: No statistically significant differences were observed between the two groups concerning age, gender, injured side, or type of fractures. The ultrasound guidance group had a significantly shorter operative time (23.7 ± 5.9 min) compared to the arthrogram guidance group (33.1 ± 10.0 min) (P < 0.05). The ultrasound guidance group did not require radiation exposure (mean 0), in contrast to the arthrogram guidance group (mean 60.55±46.46 mGy) (P = 0.000). According to the Métaizeau criteria, there were no significant differences in the postoperative anatomical reduction between the two groups. Similarly, no significant differences were observed in the functional outcomes based on MEPS, with excellent results in 94.7 % of the ultrasound guidance group and 85.7 % of the arthrogram guidance group (P = 0.380). Complications were comparable between the groups, with no cases of secondary displacement, pin tract infection, or nerve injury.

CONCLUSION: Ultrasound-guided reduction offers several distinct advantages, including enhanced real-time visualization, the absence of radiation exposure, and reduced operative times. Although outcomes are comparable, ultrasound may be considered a viable alternative to arthrogram for guiding percutaneous leverage reduction in the early childhood population.

LEVEL OF EVIDENCE: Therapeutic Level III.

PMID:40669260 | DOI:10.1016/j.injury.2025.112610

Injury. 2025 Jul 11;56(8):112580. doi: 10.1016/j.injury.2025.112580. Online ahead of print.

ABSTRACT

OBJECTIVES: Hardware removal is a common procedure performed by orthopaedic surgeons, yet there is not a consensus on the disposition of explanted hardware. There seems to be increasing discordance between institutional policy and surgeon or patient preference. The purpose of this study was to gain insight on hardware removal polices across North America and determine surgeons' opinions regarding the return of orthopedic fixation devices to patients and if these opinions are related to surgeon-specific demographic factors.

METHODS: A voluntary Qualtrics Survey was created and distributed to orthopedic surgeons with a self-identified substantial practice in trauma. Survey items included information about the surgeon's practice, hospital hardware removal policy, and personal opinion on institutional explant management. We also sought to evaluate variability in hospital policy among different geographic regions and types of hospitals/institutions.

RESULTS: One hundred forty-two surgeons met inclusion criteria for this survey. 88 % of respondents believe that patients should be entitled to keep their explanted hardware. Years in practice, frequency of hardware removal procedures, and subspecialty were not correlated with surgeon opinion. 66 % of hospitals have a policy allowing patients to keep their explanted hardware. There was no correlation between hospital policy and region or type of institution.

CONCLUSIONS: While 88 % of surgeons believe that patients should be allowed to keep their explanted hardware, only 66 % of hospitals currently allow this practice. Despite the clear consensus among orthopedic surgeons, hospital policy across North America is not standardized and does not correlate with the opinions held by the majority of surgeons.

PMID:40669259 | DOI:10.1016/j.injury.2025.112580

Injury. 2025 Jul 11;56(8):112608. doi: 10.1016/j.injury.2025.112608. Online ahead of print.

ABSTRACT

Eighty-eight patients with chronic wounds with financial difficulties were enrolled in a philanthropic programme implemented in Zhejiang Province (China) from August 1, 2021 to July 31, 2022. The patients were divided into surgical and non-surgical groups based on their demographic and wound characteristics, and the outcomes were then compared between the groups. In total, 54 (61.36 %) patients were males and 34 (38.64 %) females. The mean age of the patients was 55.27 ± 19.80 years, and the (81.82 %) had physical disabilities. The most common type of chronic wound was pressure injury (46.59 %), followed by traumatic wounds (19.32 %). In the surgical group, the average hospital stay was 24.50 days (range: 18.00-44.50 days), and the treatment efficacy rate was 76.92 %. In the non-surgical group, the average treatment duration was 35 days (range: 21.75-78.25 days), and the efficacy rate was 51.61 %. The overall wound healing rate was 60 % on the 1-year follow-up. In conclusion, most chronic wound patients were middle-aged or elderly, and pressure injury was the most common wound type. Although dressing change was the most common treatment, surgical treatment could get a better result in large and deep chronic wounds.

PMID:40669258 | DOI:10.1016/j.injury.2025.112608