Injury. 2025 Jun 3:112514. doi: 10.1016/j.injury.2025.112514. Online ahead of print.

ABSTRACT

INTRODUCTION: Major Trauma Hospitals are receiving increasing numbers of older patients after serious injury. Outcomes in these patients vary with the nature of the injury and other factors such as frailty. We aimed to determine the prevalence of frailty and adverse events in older patients managed by acute trauma services during the index hospital admission, and the frequency of adverse outcomes at three, six and twelve months after discharge in an Australian setting.

METHODOLOGY: This study assessed the prevalence of frailty in a prospective multicentre cohort study of seriously injured patients aged ≥ 70 years admitted to three Major Trauma Services in Australia. Patients were followed for twelve months after injury to assess for adverse outcomes associated with the presence of frailty or other factors. During the index admission patients were assessed for frailty, co-morbidities, Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Patients were monitored for adverse events and whether a Geriatrician review occurred. Outcomes assessed at three, six and twelve months included increased dependency, falls, confusion, readmission to hospital, transfer to a Residential Aged Care Facility and death.

RESULTS: 217 patients were recruited between 2018 and 2023 across the three hospitals. At index admission, 32 (14.7%) patients were frail and another 28 (12.9%) were near frail. Geriatrician review was more likely for frail patients and there were similar rates of inpatient complications for both frail and non-frail patients. Frailty at index admission was associated with increased dependency, falls, readmission and confusion at three, six and twelve months and with an increased risk of death at three and six months.

CONCLUSIONS: Frailty was associated with delayed adverse outcomes up to 12 months following admission for serious trauma in older people at three major Australian trauma services. Assessment of frailty on admission may be useful in stratifying outcome risk for older patients. Further research into frailty interventions and pathways is recommended.

PMID:40506331 | DOI:10.1016/j.injury.2025.112514

Injury. 2025 Jun 7;56(8):112520. doi: 10.1016/j.injury.2025.112520. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical outcomes of a novel hybrid bone transport technique using an antibacterial-coated nail for the treatment of infected segmental tibial bone defects.

METHODS: This retrospective study included 19 patients with infected segmental tibial bone defects treated using hybrid bone transport with an antibacterial-coated nail, the ZNN™ Bactiguard® nail. Patients were divided into two groups: nailing after bone transport (NABT, n = 11) and bone transport over nail (BTON, n = 8). These groups were compared with a control group of 10 infected patients treated with conventional external fixation bone transport (EFBT). The primary endpoint was infection eradication, while secondary endpoints included external fixation time (EFT), external fixation index (EFI), complications, and bone regeneration quality.

RESULTS: The mean external fixation time (EFT) for the entire cohort was 280.2 ± 142.7 days. The BTON group had the shortest EFT (150 ± 45 days), significantly lower than both NABT (279 ± 99 days) and EFBT (927 ± 1710 days, p = 0.001). The external fixation index (EFI) was also significantly lower for BTON compared to EFBT (25 ± 10.7 vs. 77.5 ± 38.7 days/cm, p = 0.009). A single case of a recurrent infection was reported in the BTON group (5.3 %), which was managed with nail removal and the continuation of external fixation bone transport without further complications. The infection was fully resolved in all cases (29/29) at the end of the follow-up period. Complication rates were similar across groups. The primary docking site union rate was 89.7 %, with no significant differences between groups.

CONCLUSIONS: The BTON technique using an antibacterial-coated nail reduces EFT by threefold compared to traditional external fixation bone transports methods, without increasing complications. A notable reduction was also observed in the NABT group, although it did not reach statistical significance. This approach offers a promising alternative to conventional methods for the treatment of infected tibial bone defects.

PMID:40505442 | DOI:10.1016/j.injury.2025.112520

Injury. 2025 Jun 4;56(8):112519. doi: 10.1016/j.injury.2025.112519. Online ahead of print.

ABSTRACT

INTRODUCTION: A Fracture-related infection (FRI) is a rare but serious complication of surgical fracture treatment in children and adolescents. Exact data on the incidence of FRI in children and adolescents are not available in the literature. In adults, criteria for the diagnosis and treatment of FRI were published in 2018 by an expert group and divided into suggestive and confirmatory categories. However, there is no recommended approach for diagnosing and treating FRI in children or adolescents.

PURPOSE OF THE STUDY: This study aimed to determine the incidence of FRI in children and adolescents who underwent operative fracture treatment at a Level I trauma center between 2019 and 2023, to evaluate age distribution, anatomical sites and bacterial spectrum of FRI in children and adolescents, to evaluate risk anatomical locations and initial fracture treatment methods in relation to the development of FRI and to assess the applicability of FRI diagnostic criteria in the pediatric patients.

MATERIALS AND METHODS: It is a retrospective monocentric study conducted by reviewing hospital database. The study included all patients under 18 years of age with present growth plates who underwent surgical fracture treatment between 2019 and 2023.

RESULTS: The incidence of FRI in children was 0,95 % among 1156 osteosynthesis procedures performed between 2019 and 2023. The average age of pediatric patients with FRI was 11,18 years. The most common anatomical site of FRI in out cohort was the forearm (36,36 %). High-risk locations in terms of developing FRI relative to the number of osteosyntheses performed included the proximal femur (20 %) and the diaphysis of the humerus (7.69 %). The most common pathogen causing FRI in children was S. aureus (63,6 %). On average, 2.1 additional surgical procedures were required to eradicate the infection.

CONCLUSION: FRI in children is a rare but serious complication, which most commonly occurs in the upper extremity, specifically in the forearm area. However, some anatomical sites with a lower incidence of fractures demonstrate a significantly higher relative risk for the development of FRI. The recommended guidelines developed in 2018, including diagnostic criteria for FRI, can be successfully applied to the pediatric population.

PMID:40505441 | DOI:10.1016/j.injury.2025.112519

Injury. 2025 Jun 3;56(8):112512. doi: 10.1016/j.injury.2025.112512. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if 4-8-week radiographs are useful for predicting nonunions in patients with femoral shaft fractures treated with an intramedullary nail (IMN).

METHODS: A retrospective case-control study; 1:2 ratio was conducted at a level I trauma center. Adult patients with a femoral shaft fracture (OTA/AO 32) treated with IMN between 2016 and 2022 were identified via Current Procedural Terminology code. The included cases underwent nonunion surgery a minimum of 3 months after the index procedure. The controls were randomly selected from the cohort and had a minimum of 6 months postoperative follow-up and evidence of radiographic union. The modified Radiographic Union Score of the Tibia (mRUST) applied to femur fractures was determined on radiographs obtained 4-8 weeks after the index surgery.

RESULTS: One hundred forty-eight patients (mean age, 35 [SD, 15] years) were included. A significant difference was found between cases and controls relating to the distribution of mRUST scores at 4-8 weeks postoperatively (median, 6 versus 9; p < 0.0001). Logistic regression analysis demonstrated that the mRUST score at 4-8 weeks is a strong predictor of union with an area under the curve of 0.85 (95 % CI: 0.78-0.92). If the mRUST score at 4-8 weeks postoperatively is 9 or above, the probability of eventual union is 99 % (95 % CI: 94-100 %).

CONCLUSION: The results suggest that healing on 4-8-week radiographs after IMN fixation for femoral shaft fractures may help identify patients at elevated risk of nonunion. Patients with mRUST scores 9 or above on the 4-8-week postoperative radiographs have a low likelihood of nonunion and less frequent radiographic follow-up may be needed.

PMID:40505440 | DOI:10.1016/j.injury.2025.112512

SICOT J. 2025;11:35. doi: 10.1051/sicotj/2025029. Epub 2025 Jun 11.

ABSTRACT

Patello-femoral arthroplasty (PFA) is an effective treatment option for isolated patello-femoral osteoarthritis. However, challenges remain regarding implant positioning and patellar tracking. Recent advances in implant design and robotic-assisted techniques have contributed to more personalized and reproducible procedures. Functional positioning (FP), a three-dimensional alignment concept, introduces a customized approach to optimize trochlear resurfacing and restore joint kinematics of the anterior compartment. This article presents a step-by-step surgical technique for PFA using FP principles in combination with an image-based robotic system. The technique ensures accurate preoperative planning, real-time intraoperative adjustments, and precise component placement. The key steps of this surgical technique include trochlear resurfacing assisted by an image-based robotic system and the restoration of patellar tracking, following a step-by-step approach that is both effective and reproducible. The use of FP enables personalized anterior compartment restoration, avoiding overstuffing and improving patellar tracking. Future studies will help refine FP strategies and further optimize outcomes in these patients.

PMID:40498989 | PMC:PMC12158211 | DOI:10.1051/sicotj/2025029

SICOT J. 2025;11:34. doi: 10.1051/sicotj/2025028. Epub 2025 Jun 11.

ABSTRACT

Unicompartmental knee arthroplasty (UKA) compared to total knee arthroplasty, offers several benefits, though it is associated with a higher revision rate, primarily due to suboptimal implant positioning. Recent advances in robotic-assisted techniques have contributed to more personalized and reproducible procedures. Functional Positioning (FP), a three-dimensional alignment concept, introduces a tailored approach based on a surgical technique that is both effective and reproducible. This article presents a step-by-step surgical technique for medial UKA using FP principles in combination with an image-based robotic system. The technique ensures accurate preoperative planning, real-time intraoperative adjustments, and precise component placement. The key steps of this surgical technique include achieving congruent contact points between the femur and tibia under load across the full range of motion, positioning the implant based on the compliance of the medial soft tissues, planning for a targeted laxity that results in an "eagle-wing" appearance, and the use of robotic tools to map cartilage for optimal resurfacing. Future studies will help refine FP strategies and further optimize outcomes in these patients.

PMID:40498988 | PMC:PMC12158242 | DOI:10.1051/sicotj/2025028

Int Orthop. 2025 Jun 11. doi: 10.1007/s00264-025-06576-3. Online ahead of print.

NO ABSTRACT

PMID:40498111 | DOI:10.1007/s00264-025-06576-3

Int Orthop. 2025 Jun 11. doi: 10.1007/s00264-025-06578-1. Online ahead of print.

ABSTRACT

BACKGROUND: Adequate postoperative analgesia is critical for elderly patients undergoing total hip arthroplasty (THA). The pericapsular nerve group (PENG) block relieves pain while preserving motor function, but its limited duration necessitates adjuncts. This study evaluates the efficacy of perineural dexamethasone in prolonging PENG block analgesia in geriatric THA patients.

METHODS: In this double-blinded, randomized controlled trial, 60 patients (≥ 65 years) undergoing THA under spinal anaesthesia were assigned to the PENG group - PENG block with 20 mL 0.2% ropivacaine and the PENG + DEX group - PENG block with 20 mL 0.2% ropivacaine + 4 mg perineural dexamethasone. The primary outcome was time to first rescue opioid administration. The secondary outcomes included total opioid consumption, pain scores (NRS), quadriceps strength, and adverse effects over 48 h.

RESULTS: Dexamethasone significantly prolonged analgesia (16.0 ± 1.3 vs. 9.0 ± 1.7 h, p < 0.0001) and reduced opioid use (0.9 ± 1.2 vs. 2.1 ± 1.4 mEQ, p = 0.0003). Pain scores were lower at six, 12, and 24 h (p < 0.05). Quadriceps strength remained intact in both groups. No nerve injuries were observed (p > 0.9999). Blood glucose levels at 12, 24, and 48 h showed no significant differences between groups (p > 0.05).

CONCLUSIONS: Perineural dexamethasone effectively prolongs PENG block duration, reduces opioid consumption, and does not compromise motor function, nerve integrity, or glycaemic control. It is a promising strategy for optimizing pain control in elderly THA patients.

PMID:40498110 | DOI:10.1007/s00264-025-06578-1

Int Orthop. 2025 Jun 11. doi: 10.1007/s00264-025-06574-5. Online ahead of print.

ABSTRACT

PURPOSE: Bone deformities, such as cubitus varus, can lead to abnormal joint alignment and impaired function. Corrective osteotomy aims to restore anatomical alignment, and its precision may be enhanced using various guidance methods. Emerging mixed reality systems allow for the placement and manipulation of virtual objects and may offer effective surgical navigation. This study aimed to validate the accuracy and precision of holographic guidance compared with classic visual estimation and a printed triangle gauge in a controlled laboratory setting.

METHODS: Closed-wedge osteotomies at angles of 15° and 30° were performed on fresh-frozen porcine femora. Three techniques were evaluated: Group EB (eyeballing)-visual estimation; Group PW (printed wedge)-using 15° and 30° plastic templates; and Group HW (holographic wedge)-using a mixed reality system (RSQ HOLO, RSQ Technologies, Poznań, Poland, and HoloLens 2, Microsoft). In the HW group, a holographic wedge tool guided the osteotomy. The angle of the excised bone wedge and post-osteotomy alignment in the anteroposterior (AP) and lateral planes were measured physically (goniometer) and digitally (radiographs). Statistical analysis assessed accuracy (closeness to 15°/30°) and precision (standard deviation [SD], mean deviation, coefficient of variation [CV]).

RESULTS: At 15°, the PW and HW techniques demonstrated greater accuracy and lower error compared with EB (T = 3.60; p < 0.01), with HW yielding the lowest systematic error (SE = 0.12). Alignment in the AP plane was similar across groups (T < 2.11; p > 0.05), whereas lateral alignment showed significant differences (T > 2.11; p < 0.05). At 30°, HW achieved the best alignment in both AP (T = 2.48; p = 0.01) and lateral views (T = 2.35; p = 0.02). Lateral alignment was improved by more than 5° with holographic guidance compared to other techniques (p = 0.01). The HW group exhibited the highest precision for both 15° and 30° angles (lowest SD and CV; p < 0.05).

CONCLUSIONS: Augmented reality provides accurate and precise intraoperative guidance, outperforming both visual estimation and printed wedge templates in deformity correction.

PMID:40498109 | DOI:10.1007/s00264-025-06574-5

Injury. 2025 May 28;56(8):112464. doi: 10.1016/j.injury.2025.112464. Online ahead of print.

ABSTRACT

AIMS: The aim of this study was to compare clinical outcomes of the Femoral Neck System (FNS) (Depuy Synthes) and the Dynamic Hip Screw (DHS) (Depuy Synthes) in the head preserving treatment of femoral neck fractures.

METHODS: A multicenter retrospective study was performed in three level II trauma centers in The Netherlands. All patients younger than 90 years treated with the DHS or the FNS for a femoral neck fracture between 2012 and 2022 were included. The follow-up of the included patients was two years. The primary outcome was treatment failure, defined as avascular necrosis, non-union or implant cut-out. Secondary outcomes were postoperative infections, total hip prosthesis conversion rates and mortality.

RESULTS: A total of 505 patients were included in this study: 239 patients with the DHS and 266 patients with the FNS. Patients treated with the FNS had a higher prevalence of Garden I type fractures and a lower prevalence of Pauwels' type III fractures. Treatment failure occurred in 77 patients, with 39 in the DHS and 38 in the FNS group. After correction for Garden and Pauwels' classification, no significant difference was noted regarding treatment failure within 2 years follow-up between both groups. No differences in conversion rates to total hip arthroplasty (coxarthrosis as surgical indication) was observed. However, patients treated with the DHS underwent implant removal more often. No differences in mortality rate between the groups was observed during two years of follow-up.

CONCLUSION: This multicenter study showed that no difference in treatment failure was found between the two groups, making the FNS a viable alternative for head preserving treatment of femoral neck fractures.

PMID:40494184 | DOI:10.1016/j.injury.2025.112464

J Bone Joint Surg Am. 2025 Jun 10. doi: 10.2106/JBJS.24.01574. Online ahead of print.

NO ABSTRACT

PMID:40493677 | DOI:10.2106/JBJS.24.01574

J Bone Joint Surg Am. 2025 Jun 9. doi: 10.2106/JBJS.24.00737. Online ahead of print.

ABSTRACT

BACKGROUND: Sciatic neuropathy can result from pressure, injury, or inflammation around the sciatic nerve. In rare instances, sciatic neuropathy is caused by an intraneural ganglion cyst (IGC) originating from the hip joint. However, an effective treatment modality for this condition has not yet been established. The purpose of the present study was to evaluate the clinical and radiographic outcomes of hip arthroscopy for the treatment of IGCs involving the sciatic nerve.

METHODS: We reviewed the records on a consecutive series of hip arthroscopy procedures that had been performed by a single surgeon for the treatment of sciatic IGCs between July 2016 and February 2022. Thirteen Asian patients (13 hips) with symptomatic sciatic neuropathy were included. During arthroscopic surgery, IGCs were decompressed by enlarging their periarticular connection. Magnetic resonance imaging (MRI) and electrodiagnostic evaluation were routinely performed. The visual analog scale (VAS) for pain and modified Harris hip score (mHHS) were used for clinical evaluations. The mean age at the time of surgery was 57 years (range, 23 to 72 years), and the mean duration of follow-up was 41 months (range, 24 to 87 months).

RESULTS: The mean VAS score decreased from 8.3 preoperatively to 1.9 at the latest evaluation (p < 0.001). Satisfactory pain relief was reported by 12 patients (92%), including 9 patients (69%) who had complete remission. Four of the 6 patients with sensory impairment and 3 of the 4 patients with motor weakness reported complete recovery. The mean mHHS improved from 51.5 to 94.1 (p < 0.001). In MRI comparisons, the mean largest diameter and length of IGCs decreased from 2.6 to 0.5 cm (p < 0.001) and from 6.8 to 0.6 cm (p < 0.001), respectively. IGCs completely disappeared on MRI in 9 patients (69%). The latest electrodiagnostic studies confirmed improvement in all 12 patients with preoperative abnormalities. One patient (8%) with symptomatic recurrence was successfully treated with revision arthroscopic decompression.

CONCLUSIONS: In patients with sciatic neuropathy, the possibility of IGCs arising from the hip should be considered. Our findings suggest that arthroscopic hip surgery is a less-invasive and more-effective treatment for relieving neuropathic pain and neurological deficits associated with sciatic IGCs.

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

PMID:40489564 | DOI:10.2106/JBJS.24.00737

Injury. 2025 May 31;56(8):112470. doi: 10.1016/j.injury.2025.112470. Online ahead of print.

ABSTRACT

BACKGROUND: Plastic surgeons must document initial facial injuries before surgery for medicolegal purposes. Distinguishing between accidental and assaultive injuries poses a challenging issue. Therefore, this study explored the features that differentiate assaultive facial soft tissue injuries from accidental injuries.

METHODS: This prospective cross-sectional study included 179 patients with facial soft tissue injuries. We recorded sex, age, occupation, marital status, residence, and history of drug abuse. Additionally, the traumatic events were analyzed, and injuries were assessed. All patients received standard medical care.

RESULTS: Males constituted 82.7 % of patients. 62.57 % of patients had accidental facial injuries, while the rest of the patients attributed their injuries to assaults. A significantly higher percentage of assaultive injuries were located on the left side of the face, with p < 0.001 (OR = 5.966, 95 % CI=3.013- 11.813). Whereas a significantly higher percentage of accidental injuries were located on the midface, with p < 0.001. A multivariate binary logistic regression analysis that identified strong predictors of assaultive facial injuries, including a history of drug abuse (OR = 44.998, 95 % CI: 3.049-661.107), injury with sharp instruments (OR = 638.601, 95 % CI: 20.296-20,093), and a cutting/piercing mechanism of injury (OR = 89,298.81, 95 % CI: 196.963-404,861). Regarding the characteristics of soft tissue facial injuries, the probability of assaultive trauma increases with the presence of injuries on the left side of the face (OR = 27.309, 95 % CI: 1.653-451.157), involvement of the mandibular zone (OR = 40.780, 95 % CI: 1.147-1449.419), neurovascular or duct injury (OR = 121.806, 95 % CI: 1.110-13,369.2), and the presence of multiple associated injuries (OR = 1.005, 95 % CI: 1.001-1.254).

CONCLUSIONS: Accidental facial injuries are more common than assaultive injuries, and males are particularly vulnerable to both traumas. This study helps differentiate between assault-related and accidental facial injuries. A history of drug abuse, injuries caused by sharp instruments, and mechanisms involving cutting or piercing are strong indicators of assaults. Clinical signs that strongly suggest assault-related injuries include injuries on the left side of the face, involvement of the mandibular area, damage to neurovascular structures or ducts, and the presence of multiple associated injuries.

PMID:40483942 | DOI:10.1016/j.injury.2025.112470

Injury. 2025 Jun 3;56(8):112511. doi: 10.1016/j.injury.2025.112511. Online ahead of print.

ABSTRACT

PURPOSE: With no clear consensus on absorbable verses non-absorbable suture-usage for glabrous skin closures, the purpose of this study was to investigate whether incisions closed with Monocryl sutures displayed higher wound complication rates than nylon sutures following carpal tunnel and trigger finger release surgery.

METHODS: A total of 155 carpal tunnel or trigger finger release surgeries in 138 patients performed in an outpatient academic medical center were analyzed. Patients with pre-operative trauma or infection, or who received concurrent surgeries were excluded. Incisions were closed using either 4-0 poliglecaprone 25 (Monocryl) or 4-0 nylon (Ethilon). Suture choice was determined via a pseudo-randomized method: Monocryl sutures were utilized in surgeries performed on even dates (e.g. 4/10/2024) and nylon sutures on odd dates (e.g. 4/11/2024). The medical records were reviewed for demographics and wound-related complications occurring within 90 days post-surgery. Criteria including additional medical encounters, co-morbidities, and assisting resident level-of-training between Monocryl and nylon cohorts were also evaluated for differences in complication rates.

RESULTS: There were 86 carpal tunnel release (55.5 %) and 69 trigger finger release (44.5 %) surgeries. The average age at surgery was 62.4 ± 11.6 years, with Monocryl used in 73 (47.1 %) and nylon in 82 (52.9 %) procedures. The rates of infection requiring antibiotics were similar between Monocryl (4.1 %, n = 3) and nylon cohorts (2.4 %, n = 2). However, higher rates of dehiscence were observed with Monocryl (11.0 %, n = 8) compared to nylon (2.4 %, n = 2). Multivariable logistic regression showed that inflammatory arthritis, immunosuppressant drug use, and junior resident assistance were independent predictors of wound complications.

CONCLUSION: In conclusion, we found usage of Monocryl sutures following carpal tunnel and trigger finger release associated with higher a dehiscence rate within 90 days post-operation. Additionally, factors including resident training level, immunosuppression, and inflammatory arthritis were associated with increased complications.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

PMID:40483941 | DOI:10.1016/j.injury.2025.112511

Injury. 2025 May 31;56(8):112462. doi: 10.1016/j.injury.2025.112462. Online ahead of print.

ABSTRACT

OBJECTIVES: Non-surgical management (NSM) of posterior pelvic fragility fractures (PFF) can lead to prolonged disability, morbidity, and death. Surgical management (SM) also has risks but has been reported to rapidly restore mobility. This study sought to compare improvement in mobility between NSM and SM in a prospective cohort of patients with PFF.

METHODS: Design: Prospective, randomized controlled trial of SM vs NSM SETTING: Academic and community trauma centers PATIENT SELECTION CRITERIA: PFF patients without significant cognitive impairment who are bedbound OUTCOME MEASURES AND COMPARISONS: The primary endpoint was time to regain two points on a modified functional mobility scale (MFMS). Secondary endpoints included PROMIS physical function and pain interference, Oswestry Disability Index (ODI), and numeric rating scale (NRS) pain score. A 12-month CT scan was performed in the SM group only.

RESULTS: Enrollment was challenging despite modifying the study to include an observational cohort. 28 subjects were enrolled (age 78±9.8); 16 underwent SM and 12 received NSM. The primary endpoint occurred at a median of 10 days in the SM group and 16 days in the NSM group (p = .1). 100 % of SM and 83 % of NSM subjects achieved the primary endpoint by 6 weeks. Five subjects who received SM could be considered NSM failures; including these failed subjects in the NSM group widened the difference in primary endpoint success rates (100 % in SM vs. 48 % in NSM, p < 0001). Some trends in secondary outcome measures favored SM, but they did not reach statistical significance. There were no device- or procedure-related serious adverse events.

CONCLUSION: Despite enrollment challenges, consistent trends were observed to suggest that SM may be superior to NSM in patients with painful PFF. Key challenges in enrollment in geriatric fracture trials comparing NSM to SM were identified. It is conceivable that studies such as this may represent the most robust investigations possible in comparing SM to NSM in PFF.

LEVEL OF EVIDENCE: II.

PMID:40483940 | DOI:10.1016/j.injury.2025.112462

Injury. 2025 May 30;56(8):112469. doi: 10.1016/j.injury.2025.112469. Online ahead of print.

ABSTRACT

INTRODUCTION: There were concerns about depleting trauma care capabilities due to the significant strain on healthcare services and resources during the COVID-19 pandemic. We aimed to describe the epidemiology of trauma care in New York State (NYS) during this period to elucidate how a healthcare crisis, such as a pandemic, can alter trauma care delivery.

MATERIALS AND METHODS: We conducted a retrospective review of trauma and non-trauma hospital discharges in New York State from 2016 to 2022 using the Statewide Planning and Research Cooperative System (SPARCS) database. The years 2016-2019 served as the baseline, March 2020 to December 2021 as the COVID period, and 2022 as the post-COVID recovery period. Changes in case volumes were analyzed by trauma center levels and non-trauma centers, presenting demographic characteristics, injury mechanisms, health services areas, illness severity, and in-hospital fatalities.

RESULTS: Level 1 trauma centers accounted for the highest percentage of trauma admissions, making up 44 % of the total, and also had the majority of non-trauma cases. During this period, pediatric trauma admissions decreased in these centers. However, trauma admissions for individuals categorized as Black or African American, Multi-racial, and Other increased. There was a notable rise in motorcycle-related injuries, other land transport injuries, and assaults involving firearms during the COVID period, which increased by up to 53 %, 49 %, and 48 %, respectively. Severity of illness scores revealed a significant increase in extreme cases. Additionally, trauma-related fatalities rose in trauma centers during the COVID period, whereas they decreased in most non-trauma centers during the same time frame.

DISCUSSION: During the COVID-19 pandemic, trauma centers in NYS continued to treat critically injured patients despite increased healthcare strain. There was a disproportionate impact across age groups and racial backgrounds, with a rise in violent injuries observed in both trauma and non-trauma centers. Higher fatality rates in trauma centers may be due to the admission of more severely injured patients. We recommend that regional and local trauma stakeholders tailor trauma care services preparedness to the vulnerability of their served communities to anticipate the accommodation of resources in the face of future healthcare crises.

PMID:40483939 | DOI:10.1016/j.injury.2025.112469

Int Orthop. 2025 Jun 9. doi: 10.1007/s00264-025-06575-4. Online ahead of print.

NO ABSTRACT

PMID:40484887 | DOI:10.1007/s00264-025-06575-4

Injury. 2025 May 26;56(8):112458. doi: 10.1016/j.injury.2025.112458. Online ahead of print.

ABSTRACT

The purpose of the study was to examine and compare the tensile characteristics of 1.8 mm smooth Kirschner wires (K-wires) fixed with four different clamping mechanisms:Ilizarov and Taylor Spatial Frame (TSF) are two widely used types of external fixation devices, in both of which fine K-wires are used as transosseous elements. The K-wires are pretensioned and fixed to the rings using specialised fixation bolts. In this study, two types of fixation bolts, namely slotted and cannulated bolts, are used to clamp wires to Ilizarov as well as TSF rings, resulting in a total of four groups of tests. Each of the four groups of tests were carried out three times. A fixation torque of 15 Nm was applied to all bolts. The wires were then subjected to tensile loads up to failure. The results for load-deflection characteristics, ultimate load and elastic stiffness, and maximum deflection are presented. The results show the TSF rings had a better grip on the wires than the Ilizarov rings.

PMID:40482343 | DOI:10.1016/j.injury.2025.112458

Int Orthop. 2025 Jun 7. doi: 10.1007/s00264-025-06567-4. Online ahead of print.

ABSTRACT

PURPOSE: Bone nonunion, a condition where fractures fail to heal within an expected timeframe, presents significant physical, psychological, and socioeconomic challenges. While various risk factors for nonunion have been extensively studied, the role of psychological factors, particularly anxiety, remains underexplored. This study aims to assess anxiety levels in patients with nonunion fractures and examine its associations with demographic factors such as age and gender.

METHODS: This cross-sectional study included 180 adults with a history of repeated surgical interventions due to nonunion diaphyseal fractures of long bones. Participants' anxiety levels were measured using the State-Trait Anxiety Inventory (STAI), a validated psychological assessment tool. Data were retrospectively collected from hospital records, and statistical analyses were conducted to compare anxiety levels across different age groups and between genders.

RESULTS: A substantial proportion of participants with a history of nonunion fractures exhibited moderate to high anxiety levels, with 70.6% reporting moderate to high state anxiety and 85.6% experiencing moderate to high trait anxiety. While state anxiety was not significantly associated with age, trait anxiety levels were notably higher in older adults. No significant gender-based differences in anxiety levels were observed.

CONCLUSION: The findings underscore the psychological burden of nonunion fractures, particularly among older patients, highlighting the need for integrating mental health assessments into orthopaedic care. Given the potential impact of anxiety on fracture healing, future studies should employ prospective designs to evaluate the role of anxiety in long-term orthopaedic outcomes. Addressing psychological factors in nonunion patients may improve overall recovery and quality of life.

PMID:40481834 | DOI:10.1007/s00264-025-06567-4

Int Orthop. 2025 Jun 7. doi: 10.1007/s00264-025-06560-x. Online ahead of print.

ABSTRACT

PURPOSE: Central sensitization (CS) plays a critical role in prolonged pain and poor outcomes after total knee arthroplasty (TKA), but its prevalence and impact in high-altitude populations remain unexplored. This study aims to examine the prevalence of CS, its associated factors, and short-term postoperative outcomes in high-altitude TKA patients.

METHODS: This prospective, single-centre cohort study included high-altitude (above 2,500 m) TKA patients with primary knee osteoarthritis (OA). Central sensitization (CS) was diagnosed using the Central Sensitization Inventory (CSI), with a cutoff score of ≥ 40. Propensity score matching (PSM) was applied to balance baseline characteristics between the CS and non-CS groups. Preoperative factors, postoperative outcomes (pain levels, complications, opioid consumption, hospital stay), and the incidence of chronic pain and dissatisfaction at six months were collected and analyzed using SPSS software.

RESULTS: A total of 230 patients were included, with 36 (15.7%) classified as having CS. Multivariable logistic regression identified female gender (OR: 3.9, 95% CI: 1.0-14.3, P = 0.043), higher body mass index (BMI) (OR: 1.2, 95% CI: 1.1-1.3, P = 0.006), and residence above 4,000 m (OR: 5.1, 95% CI: 1.7-15.1, P = 0.003) as significant factors associated with CS. After PSM, the CS group had significantly worse short-term outcomes, with higher pain scores at 24, 48, and 72 h (P < 0.001), increased incidence of postoperative nausea and vomiting (PONV) (P < 0.001), longer hospital stays (P < 0.001), greater cumulative opioid consumption (P < 0.001), higher rates of chronic postoperative pain (46.9% vs. 21.9%, P = 0.014), and greater patient dissatisfaction (25.0% vs. 6.3%, P = 0.039) compared to the non-CS group.

CONCLUSION: This study found a 15.7% prevalence of CS among high-altitude TKA patients. Female gender, higher BMI, and residence at altitudes above 4,000 m were identified as factors associated with CS. Furthermore, CS was linked to worse short-term postoperative outcomes, including higher pain levels, increased incidence of PONV, greater opioid consumption, longer hospital stays, and a higher prevalence of chronic postoperative pain and dissatisfaction.

PMID:40481833 | DOI:10.1007/s00264-025-06560-x