Injury. 2025 Aug 8;56(10):112658. doi: 10.1016/j.injury.2025.112658. Online ahead of print.

ABSTRACT

INTRODUCTION: Open pelvic fractures, though rare, are associated with high morbidity and mortality due to severe soft tissue damage, hemorrhage, and associated injuries. This retrospective study aimed to assess injury patterns, management strategies, complications, and outcomes of open pelvic fractures at a Level 1 trauma center MATERIALS AND METHODS: A retrospective analysis of 30 patients with open pelvic fractures treated between 2014 and 2021 was conducted. Data included demographics, injury mechanism, fracture pattern (Jones-Powell classification), soft tissue injury (Faringer classification), hemodynamic status, transfusion requirements, associated injuries, surgical interventions, and functional outcomes (Merle de Au Binge score) RESULTS: The mean age was 35.7 years, with a male predominance (28 males, 2 females). Road traffic accidents were the most common injury mechanism. Most patients (n = 28) sustained multiple injuries. Fracture patterns were: Class 1 (n = 2), Class 2 (n = 7), and Class 3 (n = 21). Faringer classification revealed 22 Zone 1, 4 Zone 2, and 4 Zone 3 injuries. The mean transfusion requirement was 5.63 units within 24 h. Emergency external fixation was performed in 15 patients. Definitive fixation (internal or external) was performed at a mean of 11.27 days post-injury. Complications included urinary incontinence (n = 5), rectal incontinence (n = 2), and infections. The mortality rate was 20 % (n = 6). Functional outcomes showed 3 excellent, 8 good, 8 fair, and 5 poor results CONCLUSION: Open pelvic fractures are complex injuries requiring multidisciplinary management. Early haemorrhage control, aggressive soft tissue management, and appropriate fracture stabilization are crucial for improving outcomes. Delayed internal fixation after thorough debridement and soft tissue healing may reduce infection risk. High transfusion requirements and unstable fractures were associated with increased mortality.

LEVEL OF EVIDENCE: III.

PMID:40840317 | DOI:10.1016/j.injury.2025.112658

Injury. 2025 Aug 6;56(10):112662. doi: 10.1016/j.injury.2025.112662. Online ahead of print.

ABSTRACT

INTRODUCTION: The primary objective was to analyze the trends in hemiarthroplasty (HA) and total hip arthroplasty (THA) for adult patients with fractures (FNFs), with a focus on geriatric population, over the past two decades. The secondary objectives were to compare outcomes between HA and THA and evaluate its association with patient- and surgeon- specific factors.

METHODS AND MATERIALS: Design: Retrospective cohort.

SETTING: Two Level 1 Trauma Centers. Patient Selection Criteria: Adult patients with FNFs between 2001 and 2023.

RESULTS: A total of 3180 cases of FNF treated with arthroplasty were included in the study, comprising 2497 patients who received HA and 683 patients who received THA. There was an overall increase in both THA and HA performed for geriatric FNFs with THA increasing at a faster rate (223 % vs. 172 %, respectively). Patients receiving THA were younger (70.8 vs. 81.4 years, p < 0.001) and more likely to be female (70.9 % vs. 65.1 %, p = 0.006). Patients receiving HA had lower BMI (24.6 vs. 25.4kg/m2, p = 0.002), higher Charlson Comorbidity Index (7.5 vs. 4.6, p < 0.001), and higher rates of dementia (29.9 % vs. 7.8 %, p < 0.001).Factors associated with selection of THA over HA included arthroplasty fellowship training (21.5 % vs. 10.4 %, p < 0.001) and greater surgical experience, as measured by years in practice (15.1 vs. 12.5 years, p < 0.001).. Patients receiving THA had shorter hospitalizations (6.3 vs. 7.9 days, p < 0.001) and were more likely to be discharged home (24.3 % vs. 5.5 %, p < 0.001). Despite similar reoperation rates (4.5 % vs. 5.1 %, p = 0.58), THA resulted in a higher complication rate (9.2 % vs. 6.1 %, p = 0.006). HA had higher 90-day (11.1 % vs. 1.6 %, p < 0.001) and 1 year (21.1 % vs. 3.8 %, p < 0.001) mortality rates.

CONCLUSIONS: There has been a rising trend in THA for the treatment of FNFs over the past two decades, and factors affecting treatment decision are both patient and surgeon driven.

PMID:40840316 | DOI:10.1016/j.injury.2025.112662

Injury. 2025 Aug 13;56(10):112681. doi: 10.1016/j.injury.2025.112681. Online ahead of print.

NO ABSTRACT

PMID:40840315 | DOI:10.1016/j.injury.2025.112681

J Bone Joint Surg Am. 2025 Aug 21. doi: 10.2106/JBJS.24.00821. Online ahead of print.

ABSTRACT

BACKGROUND: Predicting anterior cruciate ligament reconstruction (ACLR) revision risk using machine learning (ML) regression analyses of large-scale registry data offers an evidence-based approach for clinical decision-making and management at a patient-specific level. We examined the performance of an enhanced ML-Cox regression analysis of the Danish Knee Ligament Reconstruction Registry (DKRR) for predicting ACLR revision risk.

METHODS: We analyzed surgical and patient-reported outcome measure data from 18,753 patients in the DKRR who underwent primary ACLR between 2005 and 2023. Enhanced ML-Cox regression analyses, using the least absolute shrinkage and selection operator (LASSO) and stable iterative variable selection (SIVS) approaches, were applied to predict the risk of ACLR revision (i.e., the risk of repeat surgery to reconstruct the ACL). The SIVS procedure identified key variables, including age at the time of primary ACLR and several Knee injury and Osteoarthritis Outcome Score (KOOS) items from 12-month follow-up surveys, as inputs for the best-performing regression models for predicting ACLR revision risk. The resultant Cox regression models for the prediction of ACLR revision risk, therefore, did not involve an analysis of patients with incomplete 12-month follow-up survey data, including patients with graft ruptures within 12 months after the primary surgery.

RESULTS: The best-performing Cox regression model for predicting ACLR revision risk incorporated age at the time of primary ACLR and 3 KOOS items (Pain P1 and Quality of Life Q2 and Q3) from the 12-month postoperative follow-up assessment. This model demonstrated good prediction accuracy 1, 2, and 5 years after the 12-month follow-up assessment (C-index [and standard error], 0.73 [0.03], 0.73 [0.02], and 0.74 [0.02], respectively). This 4-variable Cox regression model was well-calibrated across these time points. An online clinical point-of-care tool, the Danish KOOS3 Risk Monitoring Tool (DK3), was developed for predicting ACLR revision risk.

CONCLUSIONS: Enhanced ML-Cox regression, incorporating patient age and 3 KOOS items obtained 12 months postoperatively, provided good prediction accuracy for ACLR revision risk from 1 to 5 years after the 12-month follow-up assessment, a period that has been associated with the vast majority of ACLR revisions. The newly developed DK3 point-of-care tool offers a direct-input method to predict and monitor the risk of ACLR revision.

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

PMID:40839712 | DOI:10.2106/JBJS.24.00821

Injury. 2025 Aug 7;56(10):112654. doi: 10.1016/j.injury.2025.112654. Online ahead of print.

ABSTRACT

BACKGROUND: Determine whether native acetabular anteversion angle increased the risk of ipsilateral limb injuries in patients with traumatic hip dislocations.

METHODS: Retrospective clinical series completed at a large, tertiary health care system between February 2016-November 2021. Patients with a native traumatic hip dislocation requiring a closed reduction in the operating room or open reduction internal fixation (ORIF) of an associated fracture were included, identified using current provider terminology (CPT) codes 27,250 and 27,252. Standard acetabular version angles were measured on CT images.

RESULTS: 121 cases were included in the analysis. The average age of our population was 37.5 years and 72 % were male. The median acetabular version was 14.7° (2-27°). Of the 121 cases of dislocations, 28 experienced a knee injury (23 %, p = 0.89) and 40 had a femoral head injury (33 %, p = 0.88). The most common knee injuries were patellar fractures (29 %, n = 8), tibial plateau fractures (29 %, n = 8), meniscal injuries (25 %, n = 7) and ligamentous knee injuries 21 %, n = 6). Median version angle was not associated with an increase in predisposition to femoral head injury or knee injury for patients with a native hip dislocation (p = 0.13).

CONCLUSION: These findings demonstrate that native acetabular anteversion does not predispose, nor protect, patients from experiencing an ipsilateral limb injury in the setting of a traumatic hip dislocation. Future studies should investigate other factors that may influence the occurrence of ipsilateral limb injuries in these settings.

LEVEL OF EVIDENCE: Level IV - Therapeutic (Retrospective Clinical Series).

PMID:40834614 | DOI:10.1016/j.injury.2025.112654

J Bone Joint Surg Am. 2025 Jun 19;107(16):1818-1824. doi: 10.2106/JBJS.24.01225.

ABSTRACT

BACKGROUND: Implant-associated infections (IAIs) require aggressive debridement to eliminate microbial bioburden. The use of irrigants may improve microbial killing during debridement. This study compared the efficacy of surgical irrigants in vitro against Staphylococcus aureus alone and in combination with Candida albicans, in both planktonic and biofilm states.

METHODS: Full-strength Dakin's solution, 0.35% povidone-iodine (PI), 10% PI, 3% hydrogen peroxide (HP), a 1:1 combination of 10% PI and 3% HP (PI + HP), Irrisept, XPERIENCE, Bactisure, and normal saline solution were tested. For planktonic testing, 1 × 106 colony-forming units (CFUs) of S. aureus and C. albicans were utilized, and biofilms were grown in these conditions on 0.8 × 10-mm titanium alloy Kirschner wires for 48 hours. Killing assays were performed using 5-minute dwell times. Success was defined by complete eradication of planktonic or biofilm CFUs.

RESULTS: PI + HP and Bactisure were the only irrigants to eradicate S. aureus in both planktonic and biofilm states. PI + HP was the only irrigant to eradicate polymicrobial S. aureus + C. albicans bioburden in both states.

CONCLUSIONS: PI + HP and Bactisure were superior irrigants against S. aureus, eliminating it in planktonic and biofilm states. PI + HP was the only irrigant to eradicate polymicrobial S. aureus + C. albicans bioburden in both states. In vivo studies are needed to evaluate the clinical effectiveness.

CLINICAL RELEVANCE: Surgical irrigants have variable efficacy in eradicating microbes depending on their state of existence (planktonic versus biofilm). In this study, the most effective eradication of polymicrobial S. aureus + C. albicans bioburden was a 1:1 combination of 10% PI and 3% HP, which is of nominal cost.

PMID:40833422 | PMC:PMC12356552 | DOI:10.2106/JBJS.24.01225

J Bone Joint Surg Am. 2025 Jul 10;107(16):1879-1886. doi: 10.2106/JBJS.24.01287.

ABSTRACT

➢ Glucagon-like peptide-1 (GLP-1) receptor agonists are a promising tool for preoperative weight loss in the patient who is undergoing orthopaedic surgery and has concomitant obesity and type-2 diabetes mellitus.➢ With regard to the perioperative management of GLP-1 receptor agonists for the orthopaedic surgeon, the American Society of Anesthesiologists (ASA) recommends withholding daily-dose GLP-1 therapy on the day of the elective surgical procedure and withholding weekly-dose therapy for the week prior to the procedure.➢ The ASA recommends postponing surgery or proceeding with "full stomach precautions" if the patient undergoing an orthopaedic procedure and taking GLP-1 therapy exhibits gastrointestinal symptoms on the day of the elective procedure.➢ In the trauma setting, patients taking GLP-1 therapy should proceed with the surgical procedure at the discretion of the surgeon with full stomach precautions or a preoperative point-of-care gastric ultrasound.➢ GLP-1 receptor agonists show the potential for disease modification in osteoarthritis and osteoporosis.

PMID:40833394 | PMC:PMC12356572 | DOI:10.2106/JBJS.24.01287

J Bone Joint Surg Am. 2025 Aug 20. doi: 10.2106/JBJS.24.01411. Online ahead of print.

ABSTRACT

BACKGROUND: The effect of home call on the sleep of orthopaedic residents and attending surgeons remains unquantified, despite known negative impacts of poor sleep on cognition, fine motor skills, and decision-making. We prospectively measured the impact of home call on orthopaedic surgery residents' and attending surgeons' sleep patterns (total sleep, slow-wave sleep [SWS], and rapid eye movement [REM] sleep), as well as on heart rate variability (HRV). We hypothesized that orthopaedic home call would negatively impact all phases of sleep and suppress post-call HRV.

METHODS: Sixteen orthopaedic attending surgeons and 14 orthopaedic surgery residents taking home call at multiple Level-I trauma centers in a single program wore WHOOP 3.0 Straps. The WHOOP Strap objectively measures and quantifies total sleep, SWS, and REM sleep. Over a 13-month period, home call nights were prospectively recorded and matched with physiological data to compare on-call, post-call night 1 (PCN 1), and PCN 2 metrics. Fixed-effects regression models were used for statistical analysis.

RESULTS: Over 13 months, we observed 4,574 recorded nights of residents' sleep and 3,573 recorded nights of attending surgeons' sleep. The mean baseline (non-call night) sleep parameters were highly varied among individuals. Overall, the mean sleep time was significantly shorter (p < 0.001) for attending surgeons (6.0 hours) than for residents (6.7 hours). When on home call, residents' total sleep decreased by 20% from baseline (p < 0.001), REM sleep decreased by 12% (p < 0.001), and SWS decreased by 12% (p < 0.001). For attending surgeons, total sleep on call decreased by 10% from baseline (p < 0.001), REM sleep decreased by 7% (p < 0.001), and SWS decreased by 4% (p < 0.01).

CONCLUSIONS: Orthopaedic surgery residents and attending surgeons exhibited low baseline sleep, and taking home call reduced this further. This suggests that there is a previously unmeasured toll of home call on orthopaedic surgeons, upon which further research is required to ensure excellent patient care, maximize educational environments, and develop strategies for resilience.

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

PMID:40834105 | DOI:10.2106/JBJS.24.01411

J Bone Joint Surg Am. 2025 Aug 20;107(16):e81. doi: 10.2106/JBJS.24.01633.

NO ABSTRACT

PMID:40833424 | DOI:10.2106/JBJS.24.01633

J Bone Joint Surg Am. 2025 Aug 20;107(16):e80. doi: 10.2106/JBJS.25.00526.

NO ABSTRACT

PMID:40833398 | DOI:10.2106/JBJS.25.00526

J Bone Joint Surg Am. 2025 Aug 20;107(16):e79. doi: 10.2106/JBJS.25.00583.

NO ABSTRACT

PMID:40833396 | DOI:10.2106/JBJS.25.00583

J Bone Joint Surg Am. 2025 Jul 10;107(16):1841-1847. doi: 10.2106/JBJS.24.01304.

ABSTRACT

BACKGROUND: Researchers employ murine fracture models to study bone healing, but the temporal relationship between mouse and human fracture healing is poorly understood. The hypothesis of this study was that it was possible to quantify specific post-fracture time frames corresponding to the stages of endochondral ossification in both mice and humans.

METHODS: Radiographs of mice and human femoral fractures treated with intramedullary stabilization were reviewed. The study included 330 human femoral fractures (OTA/AO 32A, B, or C injuries) that ultimately healed without complications in patients aged 18 to 55 years and 309 surgically created midshaft femoral fractures in 3-month-old C57BL6/J mice. Multiple orthopaedic surgeons assessed the radiographs using the Modified Radiographic Union Score for Tibia (mRUST). A 4-parameter log-logistic curve was fit to describe fracture healing over time, with 3 parameters allowed to vary: Y∞ (mRUST score at time = ∞), k (healing rate in [1/log(time)]), and X0.5 (time to half-healing).

RESULTS: The values (and 95% confidence interval) for the mice were Y∞ = 14.70 (14.54 to 14.87), k = 4.54/log(days) (4.30 to 4.77), and X0.5 = 11.77 days (11.56 to 11.98). For the humans, the values were Y∞ = 16.78 (16.21 to 17.36), k = 1.37/log(days) (1.28 to 1.45), and X0.5 = 91 days (83 to 99). All parameters differed significantly between the mice and humans (p < 0.05).

CONCLUSIONS: Using mRUST scoring and mathematical modeling, we were able to quantify and compare the temporal progression of fracture healing in mice and humans.

CLINICAL RELEVANCE: These data are relevant for designing and/or interpreting fracture healing studies of mice and humans to promote rational translation of fracture research between species.

PMID:40833385 | PMC:PMC12344732 | DOI:10.2106/JBJS.24.01304

J Bone Joint Surg Am. 2025 Aug 20;107(16):e82. doi: 10.2106/JBJS.ER.23.01346.

NO ABSTRACT

PMID:40833379 | DOI:10.2106/JBJS.ER.23.01346

J Bone Joint Surg Am. 2025 Jun 4;107(16):1825-1832. doi: 10.2106/JBJS.24.00842.

ABSTRACT

BACKGROUND: Surgeons often lack objective data on patient functional outcomes, particularly as compared with the patient's baseline. The present study aimed to determine whether gait parameters recorded on Apple iPhones provided longitudinal mobility data following lower-extremity fracture surgery that matched clinical expectations. We hypothesized that iPhones would detect the mobility changes of injury and early recovery, correlate with patient-reported outcome measures, and differentiate nonunion.

METHODS: This cross-sectional study included 107 adult patients with lower-extremity fractures who owned iPhones and had at least 6 months of follow-up. Participants shared Apple Health data and completed Patient Reported Outcomes Measurement Information System (PROMIS) surveys. The primary outcome was the daily step count. Four other gait-related parameters were analyzed: walking asymmetry, double support, walking speed, and step length. Mixed-effects models compared mobility parameters at pre-injury, immediate post-injury, and 6-months post-injury time points. Correlations between mobility parameters and PROMIS surveys were assessed. A mixed-effect model evaluated the relationship between step count recovery and surgery for nonunion.

RESULTS: There was a 93% reduction in daily step count from the pre-injury period to the immediate post-injury period (95% confidence interval [CI], -94% to -93%). Other gait parameters also showed increased impairment from pre-injury to post-injury. At 6 months, step count improved sixfold relative to the immediate post-injury period but remained 52% below baseline (95% CI, -55% to -49%). PROMIS Physical Function correlated moderately with step count (r = 0.42; 95% CI, 0.25 to 0.57) and weakly with other gait parameters. Patients with a known nonunion had a 55% slower recovery of step count than those without a nonunion (95% CI: 44% to 66%).

CONCLUSIONS: Apple Health mobility parameters captured changes in mobility following lower-extremity fracture and throughout the subsequent recovery period. These metrics distinguished between patients with and without nonunions, demonstrating their potential usefulness as objective, real-world functional outcome measures. These "digital biomarkers" may aid clinical decision-making and research and could be utilized for the early identification of patients at risk for poor outcomes.

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

PMID:40833368 | PMC:PMC12354133 | DOI:10.2106/JBJS.24.00842

J Bone Joint Surg Am. 2025 Aug 20;107(16):e83. doi: 10.2106/JBJS.ER.24.00164.

NO ABSTRACT

PMID:40833364 | DOI:10.2106/JBJS.ER.24.00164

Int Orthop. 2025 Aug 20. doi: 10.1007/s00264-025-06641-x. Online ahead of print.

NO ABSTRACT

PMID:40833496 | DOI:10.1007/s00264-025-06641-x

Int Orthop. 2025 Aug 20. doi: 10.1007/s00264-025-06636-8. Online ahead of print.

NO ABSTRACT

PMID:40833495 | DOI:10.1007/s00264-025-06636-8

Injury. 2025 Aug 6;56(10):112675. doi: 10.1016/j.injury.2025.112675. Online ahead of print.

ABSTRACT

OBJECTIVE: External chest wall fixators may provide a new approach as part of multimodal treatment. This study aimed to investigate the effect of external chest wall fixator on patients' pain level, complication development and hospital stay in patients with rib fractures.

MATERIAL AND METHOD: Patients who were admitted due to trauma and had serial rib fractures between December 2020 and December 2021 were evaluated. There were 14 patients in case group and 20 in control group. External chest wall fixator was applied to the case group in addition to standard treatment. Pain levels, development of complications and duration of hospitalization were recorded.

RESULTS: Pain levels in first and third months were lower in case group than control group. Mean pain levels in the first month were 1.79 (SD 0.80) in case group and 2.85 (SD 1.53) in control group, in the third-month were 0.43 (SD 0.64) in case group and 1.34 (SD 1.59) in control group, and the difference was significant (p = 0.022 and 0.032, respectively). Complications were more common in patients with more rib fractures (p = 0.002). While complications developed in 2 patients in the case group and 8 patients in the control group, the difference was not statistically significant (p = 0.216). Duration of hospital stay was shorter in the case group and the difference was significant (2.7 (SD 0.9) days versus 2.0 (SD 0.7) days, p = 0.049).

CONCLUSION: It has been shown in our study that external fixator can be an effective method in reducing patients' pain and hospital stay. This method can be included as part of multimodal treatment in patients with rib fractures.

PMID:40829526 | DOI:10.1016/j.injury.2025.112675

J Bone Joint Surg Am. 2025 Aug 19. doi: 10.2106/JBJS.25.00524. Online ahead of print.

NO ABSTRACT

PMID:40828958 | DOI:10.2106/JBJS.25.00524

Injury. 2025 Aug 10:112678. doi: 10.1016/j.injury.2025.112678. Online ahead of print.

ABSTRACT

BACKGROUND: High-quality, granular, accessible, and timely data are essential for evaluating regional trauma ecosystems and implementing programs to improve trauma care. State trauma registries play a crucial role in collecting, disseminating, and sharing data for clinicians, researchers, implementation scientists, and policymakers. This study aimed to assess the status and progress of statewide trauma registries in the United States over the past 20 years.

METHODS: A structured electronic survey was administered to eligible and consenting state trauma registry managers or emergency medical services personnel between July 2024 and November 2024. The survey gathered information on registry infrastructure, data collection and reporting processes, and data quality assurance measures. Findings were compared with those from a similar survey conducted in 2004.

RESULTS: All 50 states and the District of Columbia participated in the survey. Forty-seven states (92 %) reported an active trauma registry, an increase of 15 since 2004. Four states have never had a statewide registry, though two are planning to develop one. Among states with registries, only 18 (38 %) mandate data submission from all hospitals. While many registries have transitioned to web-based systems and updated software over the last two decades, 34 registries (72 %) still rely on manual data abstraction, and 28 (60 %) lack integration with electronic health records. Additionally, only 20 (43 %) state registries contribute data to national collection efforts.

CONCLUSIONS: Although progress has been made in establishing and modernizing state trauma registries since 2004, significant gaps remain, particularly in the absence of comprehensive mandatory reporting, the reliance on manual data entry, and the lack of integration with electronic health records and national databases. Addressing these challenges is essential for reducing the burden on registry teams and providing accurate, actionable, and timely data for improving trauma care.

PMID:40825754 | DOI:10.1016/j.injury.2025.112678