Injury. 2025 Jul 1:112569. doi: 10.1016/j.injury.2025.112569. Online ahead of print.

ABSTRACT

INTRODUCTION: Rib fractures are associated with substantial morbidity and mortality. Ultrasound-guided erector spinae plane block (ESPB) is increasingly used to manage pain in patients with rib fractures. However, ESPBs are often performed by proceduralists with extensive experience in regional anesthesia. The purpose of this study was to determine whether nonspecialized physicians could effectively perform ESPBs in patients with rib fracture pain in the emergency department.

METHODS: In a prospective convenience sample of 19 patients who came to the emergency department with rib fractures, ESPBs were performed by resident physicians under the supervision of experienced attending physicians. Pain scores, opioid use in morphine milligram equivalents (MME) per day, forced vital capacity, and maximum inspiratory pressure (MIP) were compared before and at several time points after ESPB.

RESULTS: Pain scores were higher before ESPB (median [IQR], 7.0 [6.0-8.0]) than at any time point after the procedure (P = .018). Median (IQR) opioid usage before ESPB was 57.6 (43.5-92.6) MME/d, which was significantly reduced at 24 h after ESPB (median [IQR], 51.5 [29.5-82.9] MME/d; P = .020) and during the remainder of the patients' stay (median [IQR], 33.8 [9.6-50.7] MME/d; P = .003). Further analyses showed that MIP before ESPB (median [IQR], 27.5 [6.3-32.5] cm H2O) was significantly lower than that at 0 to 6 h (median [IQR], 40.0 [35.0-60.0] cm H2O; P = .040), 12 to 18 h (median [IQR], 49.0 [30.0-60.0] cm H2O; P = .039), and 18 to 24 h (median [IQR], 60.0 [35.0-60.0] cm H2O; P = .028) after ESPB. No complications, 30-day readmissions, adverse events, or deaths occurred.

CONCLUSION: When adequately educated and supervised by experienced physicians, nonspecialized proceduralists can safely perform the ESPB procedure in the emergency department to provide effective analgesia to patients with rib fractures. ESPBs significantly decreased pain scores, reduced opioid usage, and improved respiratory mechanics.

PMID:40628600 | DOI:10.1016/j.injury.2025.112569

Injury. 2025 Jun 27:112565. doi: 10.1016/j.injury.2025.112565. Online ahead of print.

NO ABSTRACT

PMID:40628599 | DOI:10.1016/j.injury.2025.112565

Injury. 2025 Jul 3:112582. doi: 10.1016/j.injury.2025.112582. Online ahead of print.

NO ABSTRACT

PMID:40628598 | DOI:10.1016/j.injury.2025.112582

Injury. 2025 Jul 3;56(8):112584. doi: 10.1016/j.injury.2025.112584. Online ahead of print.

NO ABSTRACT

PMID:40627998 | DOI:10.1016/j.injury.2025.112584

Injury. 2025 Jul 2;56(8):112572. doi: 10.1016/j.injury.2025.112572. Online ahead of print.

ABSTRACT

BACKGROUND: There is a plethora of literature regarding hip fracture care, including care standards, use of registry/clinical audit data for improvement, benchmarking and outcomes. There is, however, very little published information describing how to establish and govern a national hip fracture audit. To explore the availability of information about hip fracture national clinical audit (NCA) development and governance, a scoping review was conducted.

METHODS: Electronic searches of MEDLINE (Ovid), Embase (Elsevier) and CINAHL (EBSCOHost) were conducted for articles describing national hip fracture clinical audits, published in English between 1988 and 2024. Factors for establishing the governance of a national hip fracture clinical audit were extracted and reported. Findings were shared with knowledge users from the Global Fragility Fracture Network (FFN) Hip Fracture Audit Special Interest Group and the Irish Hip Fracture Database Governance Committee to ascertain their completeness and validity. Descriptive analysis was used to summarise findings.

RESULTS: Thirteen articles were eligible for inclusion, representing 60 % of the known established hip fracture NCAs. From these, 11 components for the governance of hip fracture NCAs were identified, however the level of detail varied across the included articles. At least one of these components appeared in 83 % of the included articles, suggesting substantial consistency across hip fracture NCAs. Notably, five articles provided descriptions of all 11 components.

CONCLUSIONS: Overall, there was congruency in the approach taken to establish the governance of hip fracture NCAs and therefore the components identified could be used to support existing and emerging hip fracture NCAs in their development and sustainability.

PMID:40627997 | DOI:10.1016/j.injury.2025.112572

J Bone Joint Surg Am. 2025 Jul 8. doi: 10.2106/JBJS.24.01429. Online ahead of print.

ABSTRACT

BACKGROUND: Privacy-preserving large language models (PP-LLMs) hold potential for assisting clinicians with documentation. We evaluated a PP-LLM to improve the clinical information on radiology request forms for musculoskeletal magnetic resonance imaging (MRI) and to automate protocoling, which ensures that the most appropriate imaging is performed.

METHODS: The present retrospective study included musculoskeletal MRI radiology request forms that had been randomly collected from June to December 2023. Studies without electronic medical record (EMR) entries were excluded. An institutional PP-LLM (Claude Sonnet 3.5) augmented the original radiology request forms by mining EMRs, and, in combination with rule-based processing of the LLM outputs, suggested appropriate protocols using institutional guidelines. Clinical information on the original and PP-LLM radiology request forms were compared with use of the RI-RADS (Reason for exam Imaging Reporting and Data System) grading by 2 musculoskeletal (MSK) radiologists independently (MSK1, with 13 years of experience, and MSK2, with 11 years of experience). These radiologists established a consensus reference standard for protocoling, against which the PP-LLM and of 2 second-year board-certified radiologists (RAD1 and RAD2) were compared. Inter-rater reliability was assessed with use of the Gwet AC1, and the percentage agreement with the reference standard was calculated.

RESULTS: Overall, 500 musculoskeletal MRI radiology request forms were analyzed for 407 patients (202 women and 205 men with a mean age [and standard deviation] of 50.3 ± 19.5 years) across a range of anatomical regions, including the spine/pelvis (143 MRI scans; 28.6%), upper extremity (169 scans; 33.8%) and lower extremity (188 scans; 37.6%). Two hundred and twenty-two (44.4%) of the 500 MRI scans required contrast. The clinical information provided in the PP-LLM-augmented radiology request forms was rated as superior to that in the original requests. Only 0.4% to 0.6% of PP-LLM radiology request forms were rated as limited/deficient, compared with 12.4% to 22.6% of the original requests (p < 0.001). Almost-perfect inter-rater reliability was observed for LLM-enhanced requests (AC1 = 0.99; 95% confidence interval [CI], 0.99 to 1.0), compared with substantial agreement for the original forms (AC1 = 0.62; 95% CI, 0.56 to 0.67). For protocoling, MSK1 and MSK2 showed almost-perfect agreement on the region/coverage (AC1 = 0.96; 95% CI, 0.95 to 0.98) and contrast requirement (AC1 = 0.98; 95% CI, 0.97 to 0.99). Compared with the consensus reference standard, protocoling accuracy for the PP-LLM was 95.8% (95% CI, 94.0% to 97.6%), which was significantly higher than that for both RAD1 (88.6%; 95% CI, 85.8% to 91.4%) and RAD2 (88.2%; 95% CI, 85.4% to 91.0%) (p < 0.001 for both).

CONCLUSIONS: Musculoskeletal MRI request form augmentation with an institutional LLM provided superior clinical information and improved protocoling accuracy compared with clinician requests and non-MSK-trained radiologists. Institutional adoption of such LLMs could enhance the appropriateness of MRI utilization and patient care.

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

PMID:40627696 | DOI:10.2106/JBJS.24.01429

J Bone Joint Surg Am. 2025 Jul 8. doi: 10.2106/JBJS.24.01030. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative urinary retention (POUR), a common complication after spine surgery, can contribute to longer hospital stays, urinary tract infection, pain, and morbidity. This study aimed to determine the incidence of POUR in patients who underwent lumbar decompression and to construct a predictive model for preoperatively identifying high-risk patients.

METHODS: This was a retrospective review of patients undergoing primary lumbar decompression from 2017 to 2023. Demographic characteristics, comorbidities, and perioperative data were collected. Factors associated with POUR were assessed, and multivariable logistic regressions were performed to identify independent predictors of the development of POUR. A nomogram to predict the development of POUR was developed within a training subset, based on a multivariable logistic regression model of preoperative variables, followed by the internal validation of the model in a validation subset and assessment of its performance.

RESULTS: Of the 1,938 patients included in this study, 133 (6.9%) developed POUR. Following multivariable analysis, the following risk factors for POUR were identified: a history of urinary retention (odds ratio [OR], 4.956 [95% confidence interval (CI), 2.157 to 11.383]; p < 0.001), insurance that was not commercial (private) (OR, 2.256 [95% CI, 1.298 to 3.922]; p = 0.004), intraoperative Foley catheter use (OR, 5.967 [95% CI, 3.506 to 10.156]; p < 0.001), inpatient opioid consumption of >93 morphine milligram equivalents (OR, 1.898 [95% CI, 1.220 to 2.952]; p = 0.004), and anticholinergic medication use during hospitalization (OR, 3.450 [95% CI, 2.313 to 5.148]; p < 0.001). The nomogram, which included the preoperative variables of male sex, age of >65 years, history of urinary retention, history of benign prostatic hyperplasia, not having commercial insurance, and American Society of Anesthesiologists (ASA) classification of >2, demonstrated good discrimination in the training subset (area under the curve [AUC], 0.725 [95% CI, 0.673 to 0.776]) and the validation subset (AUC, 0.709 [95% CI, 0.599 to 0.819]). The Hosmer-Lemeshow goodness-of-fit test demonstrated that the model fit the data well (chi-square test = 9.063; p = 0.170).

CONCLUSIONS: The incidence of POUR after lumbar decompression surgery was found to be 6.9%. A history of urinary retention, not having commercial (private) insurance, intraoperative Foley catheter usage, inpatient opioid consumption of >93 morphine milligram equivalents, and the administration of anticholinergic medication during hospitalization increased the risk of developing POUR. Furthermore, we constructed a preoperative predictive model with good performance metrics to help clinicians to identify patients at elevated risk for developing POUR.

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

PMID:40627681 | DOI:10.2106/JBJS.24.01030

J Bone Joint Surg Am. 2025 Jul 8. doi: 10.2106/JBJS.24.01169. Online ahead of print.

ABSTRACT

BACKGROUND: Whether the fixation of pertrochanteric and intertrochanteric fragility fractures impacts the risk of subsequent peri-implant fracture remains unclear. We hypothesized that peri-implant fracture after an index pertrochanteric or intertrochanteric fragility fracture is associated with fixation that does not reach the distal metaphysis (non-spanning fixation).

METHODS: Retrospective chart review was performed of patients treated for index pertrochanteric and intertrochanteric femoral fragility fractures at 2 health-care systems between January 1, 2005, and January 1, 2018. Cases were categorized by whether or not fixation reached the distal metaphysis (spanning compared with non-spanning). Kaplan-Meier survival analyses estimated cumulative incidences of peri-implant fracture stratified by patient, injury, and treatment characteristics, with hazard ratios (HRs) reported when significant. We also assessed whether spanning or non-spanning fixation was associated with a contralateral femoral fracture (a proxy for patient-related fracture risk). Significance was set at p < 0.05.

RESULTS: In this study, 913 patients with a median age of 80 years had a median follow-up of 5 months (interquartile range [IQR], 3 weeks to 2.7 years). The OTA/AO classification included 388 type 31-A1 fractures, 324 type 31-A2 fractures, and 201 type 31-A3 fractures. There were 18 subsequent peri-implant fractures (1.9%) and 40 subsequent contralateral femoral fractures (4.4%). The cumulative incidence of peri-implant fracture was lower over time (p < 0.01) with spanning fixation (0% prior to 1 year) compared with non-spanning (3.3% prior to 1 year). The HR of spanning fixation for the entire time period was 0.14 (95% confidence interval, 0.03 to 0.62; p < 0.01). Peri-implant fracture risk was greater with non-spanning plates (p < 0.01) and non-spanning nails (p < 0.01) than spanning fixation, with cumulative 1-year incidences of 3.5% for non-spanning plates, 2.6% for non-spanning nails, and 0% for spanning fixation. Peri-implant fracture was not associated with other variables (p > 0.05). Contralateral fracture was not associated with the fixation group (p = 0.77), tempering concern regarding potential bias.

CONCLUSIONS: Spanning fixation following pertrochanteric and intertrochanteric femoral fragility fractures mitigates the risk of a peri-implant fracture. However, the choice of fixation for a given patient requires that this risk be considered within the greater context of surgical decision-making.

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

PMID:40627679 | DOI:10.2106/JBJS.24.01169

Int Orthop. 2025 Jul 7. doi: 10.1007/s00264-025-06602-4. Online ahead of print.

NO ABSTRACT

PMID:40622391 | DOI:10.1007/s00264-025-06602-4

Injury. 2025 Jun 30;56(8):112576. doi: 10.1016/j.injury.2025.112576. Online ahead of print.

ABSTRACT

BACKGROUND: Bone mineral density (BMD) is a known risk factor for fragility fractures, yet its relationship with specific sacral fracture morphologies, particularly H-type fractures, is not well understood.

OBJECTIVES: To evaluate whether CT-derived Hounsfield Units (HU) correlate with the complexity of sacral fractures, focusing on H-type fracture patterns.

METHODS: A retrospective study was conducted involving 164 elderly patients (≥60 years) with sacral fractures. HU values were measured at the L5 vertebral body using CT imaging. Fractures were classified by Fragility Fractures of the Pelvis (FFP) classification and Denis zones. Logistic regression models were developed to identify predictors of H-type fractures. Model performance was evaluated using accuracy, AUC, precision, and recall.

RESULTS: Among 164 patients, 59 (36 %) had H-type fractures. FFP classifications were distributed as follows: FFP II (n = 68), FFP III (n = 18), and FFP IV (n = 78). HU did not significantly differ across FFP categories. A weak but significant negative correlation was observed between HU and age (r = -0.22, p = 0.0039). In multivariate logistic regression, FFP classification (OR = 10.03, p < 0.001), Denis zone involvement (OR = 8.58, p < 0.001), and HU (OR = 1.14, p = 0.63) were evaluated for their predictive value. The model achieved 92 % accuracy (AUC = 0.93).

CONCLUSION: HU alone is not a strong standalone predictor of H-type sacral fractures but improves multivariate model performance when combined with anatomical and clinical variables. HU's inverse relationship with age supports its utility as a surrogate marker for bone quality, especially when DXA is unavailable.

PMID:40618422 | DOI:10.1016/j.injury.2025.112576

Injury. 2025 Jul 2;56(8):112577. doi: 10.1016/j.injury.2025.112577. Online ahead of print.

ABSTRACT

INTRODUCTION: Hip fracture repair is one of the most common urgent procedures performed in hospitals. Having a high burden of mortality, hip fracture repair is frequently targeted for health system quality improvement and hospital performance monitoring. In the present study, we measure hospital variability and explore factors associated with 90-day mortality and the time from emergency department (ED) visit until surgery.

METHODS: Patients were 50-105 years of age at the time of their hip fracture surgery between fiscal years 2015/16 and 2023/24 in Ontario Canada. Hospital variation was measured using random intercept models, risk-adjusted mortality rates, and funnel plots. Risk-adjusted mortality was computed as observed/expected (O/E) ratios multiplied by the population mortality rate. Expected mortality was estimated using logistic regression or CatBoost machine learning methods adjusted for age, sex, comorbidity, and other measures of healthcare utilization. Funnel plots were presented using crude and risk-adjusted mortality by hospital volume. Bootstrap sampling was used to compute 95 % confidence intervals.

RESULTS: A total 12,607 deaths (12.1 %) occurred within 90 days of hip fracture repair (N = 103,887), 4488 (36 %) of which occurred in hospital. Hospitals only accounted for 0.6 % of the total variation in 90-day mortality. Other predictors of mortality included older age, male, higher comorbidity score, facility transfer, pre-operative anemia, home care, residence in long-term care, no prior receipt of anti-osteoarthritic medication, and no previous bone-mineral density scan (p < 0.0001 for all). Hospitals accounted for 9.2 % of the variability in the odds of receiving surgery within 48 h of ED visit. There was no clear cut-point of the time from ED arrival until surgery on the risk of 90-day mortality. There was no ecological association between hospital performance on timeliness (receipt of surgery within 48 h) and performance on 90-day mortality.

CONCLUSION: There was little hospital variation in 90-day mortality. Using three different approaches, there were a few hospitals that consistently stood out as performing better/worse than expected. There was more substantial variation in the time until treatment across hospitals, but the relationship between the time until surgery and 90-day mortality was tenuous.

PMID:40618421 | DOI:10.1016/j.injury.2025.112577

Injury. 2025 Jun 25:112561. doi: 10.1016/j.injury.2025.112561. Online ahead of print.

NO ABSTRACT

PMID:40617779 | DOI:10.1016/j.injury.2025.112561

Injury. 2025 Jun 26:112564. doi: 10.1016/j.injury.2025.112564. Online ahead of print.

NO ABSTRACT

PMID:40617778 | DOI:10.1016/j.injury.2025.112564

Injury. 2025 Jun 26:112552. doi: 10.1016/j.injury.2025.112552. Online ahead of print.

NO ABSTRACT

PMID:40617777 | DOI:10.1016/j.injury.2025.112552

Injury. 2025 Jun 25;56(8):112560. doi: 10.1016/j.injury.2025.112560. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to identify risk factors for elbow stiffness following surgery for AO/OTA type C distal humerus fractures with a follow-up investigation.

METHODS: Data were collected from patients who underwent treatment for AO/OTA type C distal humerus fractures between March 2015 and March 2022.The patients were divided into a stiffness group and a control group based on whether their elbow flexion-extension or rotation range of motion was less than 100°at the final follow-up. Univariate analysis and multivariate logistic regression analysis was performed to identify independent risk factors. A nomogram prediction model was then constructed based on the factors identified. Receiver operating characteristic (ROC), calibration curve and decision curve analysis (DCA) were used to evaluate its discriminant and calibration. The subjects were randomly divided into modeling set and validation set according to 7:3, and the model was internally validated by random split validation.

RESULTS: Of the 207 patients, 68 developed elbow stiffness after ORIF for AO/OTA type C distal humerus fracture. Multivariate logistic regression analysis identified age,AO/OTA fracture classification,time from injury to surgery,postoperative professional functional rehabilitation, transverse screw,and modified trochleocapitellar index (mTCI), as independent risk factors for postoperative elbow stiffness (all P < 0.05). The modeling set curve demonstrated an AUC value of 0.877, while the validation set curve showed an AUC of 0.869. The calibration curve of the nomogram closely approximated the diagonal line, and decision curve analysis (DCA) revealed that utilizing the nomogram for prediction yielded greater net benefits within the threshold probability range of 0.3-0.8.

CONCLUSION: Age, AO/OTA type C classification, transverse screw, postoperative professional functional rehabilitation, mTCI and time from injury to surgery were identified as risk factors for postoperative elbow stiffness.

PMID:40617199 | DOI:10.1016/j.injury.2025.112560

Int Orthop. 2025 Jul 5. doi: 10.1007/s00264-025-06595-0. Online ahead of print.

ABSTRACT

PURPOSE: This study compares short-segment (2-level) versus longer-segment (> 2-level) fusion after posterior hemivertebra resection in congenital scoliosis (CS) and identifies preoperative thresholds to guide fusion strategy selection.

METHODS: Eighty-eight CS patients (mean age: 5.42 years) undergoing hemivertebra resection with fusion (31 short-segment [Fused_2], 57 longer-segment [Fused_GT2]) were retrospectively analyzed. Radiographic parameters, complications, and reoperations were assessed. Logistic regression derived predictive thresholds for fusion length.

RESULTS: Both groups achieved comparable initial (~ 77%) and final (~ 61%) main curve correction. The Fused_2 group had shorter operative time (154 vs. 204 min, p < 0.001) and lower blood loss (249 vs. 356 mL, p = 0.011). Reoperation rates (20.5% overall), crankshaft phenomenon (25.0%), and neurological complications (5.7%) did not differ between groups. Preoperative main curve ≤ 41.8° and thoracic kyphosis ≤ 30.2° predicted suitability for 2-segment fusion.

CONCLUSION: Short-segment fusion reduces invasiveness without compromising correction in select CS patients. Preoperative thresholds (main curve ≤ 41.8°, kyphosis ≤ 30.2°) may guide strategy, though individualized assessment remains essential.

PMID:40616658 | DOI:10.1007/s00264-025-06595-0

Int Orthop. 2025 Jul 5. doi: 10.1007/s00264-025-06601-5. Online ahead of print.

ABSTRACT

PURPOSE: Low-intensity pulsed ultrasound (LIPUS) is a non-invasive physiotherapy that is often utilized to treat swelling and pain caused by musculoskeletal trauma. We aimed to evaluate the efficacy and safety of LIPUS in reducing lower-extremity swelling and pain following total knee arthroplasty (TKA).

METHODS: This randomized, controlled study evaluated 116 patients undergoing primary TKA, randomly assigning them to either an LIPUS group receiving active LIPUS therapy (0.8 MHz, 1.35 W) or a control group receiving sham treatment. The LIPUS intervention was administered to the operated knee for 25-minute sessions, three times daily for three consecutive days, beginning four hours postoperatively. The primary study outcome measured lower extremity swelling during the first 14 postoperative days, while secondary outcomes included knee pain (assessed by visual analogue scale ranging from 0 to 10 points), Hospital for Special Surgery (HSS) score, range of knee motion (ROM), serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), myoglobin, and complications.

RESULTS: The LIPUS (n = 55) and control (n = 56) groups showed similar baseline characteristics. LIPUS treatment significantly improved clinical outcomes compared to sham treatment, reducing calf swelling by 2.37-2.74%, thigh swelling by 2.76-4.81%, and patellar swelling by 2.30-3.28% (all p < 0.001). Patients receiving LIPUS also reported less walking pain (1.16-2.48 point reduction, p < 0.001) and showed lower inflammatory markers (CRP reduction of 2.53-13.85 mg/L, p = 0.047; IL-6 reduction of 3.64-17.27 pg/mL, p = 0.041). However, the treatment did not significantly affect resting pain, HSS scores, ROM, serum myoglobin levels, or complication rates.

CONCLUSION: This study found that short-term LIPUS use markedly decreased lower-extremity swelling and walking pain post-TKA, with no major safety concerns. However, future studies are needed to determine the optimal protocol and long-term safety of LIPUS in TKA patients.

PMID:40616657 | DOI:10.1007/s00264-025-06601-5

Injury. 2025 Jun 25:112555. doi: 10.1016/j.injury.2025.112555. Online ahead of print.

NO ABSTRACT

PMID:40615282 | DOI:10.1016/j.injury.2025.112555

Injury. 2025 Jun 26:112544. doi: 10.1016/j.injury.2025.112544. Online ahead of print.

NO ABSTRACT

PMID:40615281 | DOI:10.1016/j.injury.2025.112544

Injury. 2025 Jun 25;56(8):112563. doi: 10.1016/j.injury.2025.112563. Online ahead of print.

ABSTRACT

BACKGROUND: The fracture-related infection (FRI) consensus definition, published in 2018, marked a crucial advance for clinical practice and research, enabling treatment standardization and better comparison of clinical studies. However, a lack of clear, standardized outcome parameters still impedes the evaluation of treatment success, potentially leading to a misreporting of treatment failure in current literature. This scoping review provides an overview of outcome parameters used in the current literature to describe treatment success or failure in FRI.

METHODS: A comprehensive literature search across four databases (PubMed, Embase, Scopus and Web of Science) was performed. Studies that reported on treatment outcome in adults with long-bone FRI, published between 2018 and 2023, were eligible for inclusion. The primary outcomes were the reporting of the persistence, eradication or recurrence of infection as well as radiological and functional outcome and the need for a return to theatre for infection control. The secondary aim was to screen the current FRI literature for applied follow-up duration.

RESULTS: A total of 111 studies were included for analysis and synthesis. Only 15.3 % (17/111) of the included studies used a clear definition of treatment success and/or failure in their methodology. Despite a high general reporting (85.6 %; 95/111) of infection eradication, recurrence and/or persistence, only few studies defined these parameters accurately: 16.2 % for eradication (18/111), 15.3 % for recurrence (17/111), 0 % for persistence. Bone healing was reported by 90.9 % (101/111) of the studies, with a standardized approach of radiological evaluation in 64.4 % (65/101). In total, 76 studies (68.5 %) assessed functional outcome, whereas no standardized score set was used. Correspondingly, no standardized follow-up duration could be identified. An unplanned return to theatre was considered by 16.2 % of the studies (18/111) to report outcome.

CONCLUSION: This scoping review highlights the lack of standardized outcome reporting in FRI. A clear definition on outcome reporting in FRIs is urgently needed to promote comparability and transparency in clinical research.

PMID:40614539 | DOI:10.1016/j.injury.2025.112563