Strategies in Trauma and Limb Reconstruction最新文献

{"title":"Feasibility of Virtual Reality Immersion in Reducing Pain and Anxiety during External Fixator Care Procedures.","authors":"Anirejuoritse Bafor, Mackenzie Cannon, Ashley Curcio, Christopher Iobst","doi":"10.5005/jp-journals-10080-1666","DOIUrl":"10.5005/jp-journals-10080-1666","url":null,"abstract":"<p><strong>Introduction: </strong>External fixator care after limb reconstruction often involves pin-site cleaning and frame adjustments that can be painful and anxiety-provoking, particularly for paediatric patients. Virtual reality (VR) immersion may support procedural coping. This feasibility study evaluated the practicality and tolerability of VR during fixator care and explored pain and anxiety trends.</p><p><strong>Patients and methods: </strong>A prospective, randomised feasibility study enrolled 29 patients aged 5-21 years undergoing limb lengthening or reconstruction with external fixators. Participants were randomised to 'VR first' or 'no-VR first' groups and attended four postoperative visits, alternating between visits with and without VR using Aqua VR (KindVR® platform). Pain and anxiety were assessed before, during, and after each procedure using Wong-Baker FACES and Children's Fear Scale (CFS). Parent proxy and provider assessments were collected using Patient-Reported Outcomes Measurement Information System (PROMIS) Parent Proxy, Face, Legs, Activity, Cry, and Consolability (FLACC), and CFS.</p><p><strong>Results: </strong>Twenty-nine participants (16 male, 13 female; mean age, 14.5 ± 3.1 years) completed the study. Median pin sites numbered 7 (range, 7-14). Virtual reality was feasible and tolerated during fixator care. Patient-reported pain scores were similar between VR and non-VR visits. Virtual reality visits showed a trend toward lower anxiety, although differences were not statistically significant. Patients exposed to VR first showed more consistent decreases in pain and anxiety across subsequent visits, suggesting possible carryover.</p><p><strong>Conclusion: </strong>Virtual reality immersion during fixator care appears feasible and well tolerated in paediatric and adolescent patients. Observed trends suggest potential benefit for anxiety reduction, particularly with early VR exposure; however, larger studies are needed to evaluate clinical efficacy.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"21 1","pages":"8-16"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal Diaphyseal Tibial Fracture Stabilisation with a Humeral Nail Before Below-knee Amputation: A Case Report.","authors":"Rimel N Mwamba, Tony Da Lomba, Mary K Erdman","doi":"10.5005/jp-journals-10080-1663","DOIUrl":"10.5005/jp-journals-10080-1663","url":null,"abstract":"<p><strong>Case report: </strong>A 76-year-old female sustained catastrophic bilateral lower extremity trauma following a pedestrian-vs-auto collision, resulting in a traumatic right lower extremity amputation and a vascularly compromised left proximal tibial shaft fracture. The patient's left lower extremity was successfully treated with a proximal humerus nail to stabilise the fracture, immediately followed by a below-knee amputation (BKA) in the same setting.</p><p><strong>Conclusion: </strong>This case highlights a novel application of an upper extremity implant to preserve limb length in the setting of bilateral lower extremity amputations due to polytrauma.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"21 1","pages":"53-58"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibular Graft: An Alternative Option in Calcaneal Lateral Column Lengthening.","authors":"Mohamed Ae Hussein, Fahad A Hayyawi, Mohamed El-Hariry, Hussein A Hussein, Mostafa I Awad","doi":"10.5005/jp-journals-10080-1670","DOIUrl":"10.5005/jp-journals-10080-1670","url":null,"abstract":"<p><strong>Background: </strong>Evan opening wedge osteotomy is a gold-standard option for lateral column lengthening in skeletally immature patients. Various types of grafts are used to support lengthening, including autografts, allografts, xenografts and specialised plate systems. Each of them has its advantages and disadvantages. Iliac crest autograft is the most commonly utilised graft with excellent results. However, it has complications related to donor site morbidity and persistent iliac pain. The study aims to display the clinical and radiological outcomes of mid-fibular autograft used for Evans calcaneal lengthening osteotomy in skeletally immature patients with symptomatic flexible pes planovalgus.</p><p><strong>Patients and methods: </strong>This prospective single-centre case series included 29 teenagers who had symptomatic pes planovalgus and were included in the study from January 2018 to July 2024, with an average age of 10.9 years. Thirteen patients (44.8%) were operated on the right side and sixteen patients (55.2%) on the left side. Worth's classification was used to evaluate the incorporation of the graft from the 6th to 8th week.</p><p><strong>Results: </strong>The graft size taken in the study was 11.9 mm. Full union of the graft was noticed in all patients within 7.2 weeks. Significant improvement was noticed in calcaneal inclination and lateral talus-first metatarsal angle. Significant improvements in the AOFAS ankle-foot scale from 67 preoperatively to 98.2 postoperatively. The graft incorporation was in the third degree in seven patients (24.1%) and the fourth degree in 22 patients (75.9%). Regeneration of the donor site occurred in all cases within 10 months.</p><p><strong>Conclusion: </strong>Fibular autograft demonstrated satisfactory clinical and radiographic outcomes with successful graft incorporation in this cohort. These findings suggest that fibular autograft is a feasible option for Evans calcaneal lengthening osteotomy.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"21 1","pages":"17-21"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of the Systematic Utilitarian Procedure for Extremity Reconstruction of the Hip (SUPERhip) for Congenital Femoral Deficiency with Reference to Recent Extra-network Cohort Findings.","authors":"Jakob Adolf, Dimitar Tenev, Nikolay Dimitrov","doi":"10.5005/jp-journals-10080-1671","DOIUrl":"10.5005/jp-journals-10080-1671","url":null,"abstract":"<p><strong>Aims and background: </strong>Congenital femoral deficiency (CFD) is a rare limb anomaly requiring Hip reconstruction before femoral lengthening. The Systematic Utilitarian Procedure for Extremity Reconstruction of the Hip (SUPERhip), introduced by Paley in 1997, is the principal protocol for type Ib and type II CFD. No systematic review has consolidated outcomes in this population. This review synthesised radiographic outcomes, complications and protocol fidelity.</p><p><strong>Materials and methods: </strong>PubMed, Google Scholar, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and China National Knowledge Infrastructure (CNKI) were searched in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 [International Prospective Register of Systematic Reviews (PROSPERO) CRD420261386450]. Eligible studies were peer-reviewed cohorts of three or more patients with Paley type Ib or type II CFD (subtypes IIa and SUPERhip-eligible IIb) treated with the full SUPERhip protocol. Single-arm narrative synthesis was performed; meta-analysis was not feasible due to outcome reporting heterogeneity.</p><p><strong>Results: </strong>Two cohorts met the inclusion criteria: Paley et al. (106 procedures, 1997-2012) and Violante Júnior et al (26 patients, 2005-2020). Outcome reporting was structurally asymmetric: Paley et al. (pooled <i>n</i> = 106) reported reduction with bone morphogenic protein 2 (BMP2) - delayed ossification (41% → 13%) and recurrent varus (37% → 11%) (<i>p</i> < 0.005 for both); Violante Júnior et al. reported radiographic indices [neck-shaft angle (NSA): 72° → 133°; centre-edge angle (CEA): 17° → 34°; and acetabular index (AI): 28° → 16°, all <i>p</i> < 0.001]. Neither cohort reported medial proximal femoral angle (MPFA). Protocol fidelity ranged from canonical practice through within-network variants to extra-network adaptations.</p><p><strong>Conclusion: </strong>The SUPERhip procedure achieves substantial radiographic correction in Paley type Ib CFD; a within-cohort signal from a single primary dataset suggests that fixed-angle fixation with intra-osseous BMP2 may reduce late complications. Outcomes are reported asymmetrically; no peer-reviewed type-II-specific cohort outcomes exist; MPFA is reported in no cohort; and the evidence base remains concentrated within a single methodological lineage.</p><p><strong>Clinical significance: </strong>Hip reconstruction before femoral lengthening is supported by comparator literature for both type Ib and type Ia CFD. Within this limited evidence base, canonical SUPERhip with fixed-angle fixation and BMP2 is the best-evidenced approach for type Ib; a within-network supply-constrained variant achieved comparable radiographic correction. Late Hip instability is a post-lengthening risk in type Ia CFD.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"21 1","pages":"37-44"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of a Pilon Fracture Complicated by Drug-induced Hypersensitivity Syndrome, Fungal Infection and Limb Length Discrepancy: A Case Report.","authors":"Kanu Shimokawa, Hidenori Matsubara, Yusuke Nakazawa, Satoru Demura","doi":"10.5005/jp-journals-10080-1667","DOIUrl":"10.5005/jp-journals-10080-1667","url":null,"abstract":"<p><strong>Aim and background: </strong>Pilon fractures are rare but severe injuries associated with high-energy trauma, often resulting in significant articular and soft tissue damage. Their management is challenging due to complications such as infection, nonunion, and post-traumatic arthritis, which often require complex staged surgical interventions. Drug-induced hypersensitivity syndrome (DIHS), a life-threatening reaction characterised by rash and systemic involvement, presents additional challenges in orthopaedic contexts due to its association with high-dose corticosteroid therapy and increased infection risk.</p><p><strong>Case description: </strong>We report the case of a 70-year-old man with a Gustilo-Anderson type IIIA open pilon fracture complicated by fungal infection, leg length discrepancy (LLD), and DIHS. Initial treatment involved debridement, and stabilisation with a modular external fixator. Due to fungal infection and LLD, the external fixator was replaced with a Taylor Spatial Frame (TSF) for limb lengthening at the proximal tibia. The patient subsequently developed a skin rash, fever and liver damage, and was diagnosed with DIHS. High-dose prednisolone (PSL) was started and gradually tapered over 2 months. During this period, limb lengthening progressed effectively, achieving a total elongation of 42 mm. During definitive reconstruction, plate conversion was performed to stabilise the lengthened bone. A tantalum spacer was used to correct the remaining LLD, and tibio-talo-calcaneal arthrodesis with retrograde intramedullary nailing was employed for distal reconstruction. Postoperatively, the patient achieved solid bone fusion, minimal LLD (5 mm), and independent ambulation at 1 year. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 90 points.</p><p><strong>Conclusion: </strong>This case highlights the complexities of managing pilon fractures complicated by infection, LLD, and DIHS. It underscores the importance of staged treatment strategies, including limb lengthening, and planning for definitive reconstruction.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"21 1","pages":"59-65"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical Report: Two-stage Approach for Limb Reconstruction in Open Tibial Fractures with Bone Loss or Infection Using Soft Tissue Flap Coverage, Bone Resection, and Frame-guided Mono- or Bifocal Corticotomy-based Bone Transport, Including Video Demonstration.","authors":"Sander V Ianniello, Thylane E Vancastell, Joseph Muscat, Matija Krkovic","doi":"10.5005/jp-journals-10080-1668","DOIUrl":"10.5005/jp-journals-10080-1668","url":null,"abstract":"<p><strong>Aim and background: </strong>Orthopaedic surgeons face a complex challenge in managing open fractures of the lower leg or infected bones with significant segmental bone loss. The aim of this technical guide and video demonstration is to describe and standardise a two-stage approach, combining bone resection, soft tissue reconstruction and bone transport using a Taylor spatial frame (TSF), as management for such injuries.</p><p><strong>Technique: </strong>We describe a two-stage surgical technique: In the first stage, all infected, potentially infected, or necrotic bone is meticulously resected, and soft tissue coverage is provided using either local or free flaps. After soft tissue recovery and infection/contamination eradication, a TSF is applied with uni- or bifocal corticotomies to facilitate bone transport for reconstructing segmental bone loss. Bone transport is guided by frame-specific software that instructs daily micro-adjustments, carried out by the patient in their home setting. Regular follow-up and radiographic imaging allow for re-adjustment of software parameters, if required. Technical considerations, indications and limitations of the approach are also discussed.</p><p><strong>Conclusion: </strong>This technical guide outlines a detailed description of a staged reconstructive surgical approach to address open fractures of the lower leg with significant segmental tibial bone loss. Use of the TSF system allows multiplanar adjustment and reduced risk of mal- or non-union. The technique requires careful pre-operative planning and significant patient compliance and engagement due to the prolonged treatment duration.</p><p><strong>Clinical significance: </strong>This guide and video demonstration highlight an effective surgical technique for the management of open tibial fractures that utilises precision and advanced technology-guided frame adjustments.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"21 1","pages":"45-52"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitation Following External Fixation for Lower Limb Trauma: A Service Evaluation Mapping the Gaps in Practice and Evidence.","authors":"Lydia A Heins, Ceri E Battle","doi":"10.5005/jp-journals-10080-1665","DOIUrl":"10.5005/jp-journals-10080-1665","url":null,"abstract":"<p><strong>Background: </strong>Definitive external fixation is commonly used in the management of complex lower limb fractures. Holistic pre- and post-operative rehabilitation is considered essential; however, rehabilitation practices vary considerably, with limited supporting evidence and no validated outcome measures for this population.</p><p><strong>Aim: </strong>To describe rehabilitation provision for adults with lower limb injuries managed with definitive external fixation at a single NHS Trust, with secondary evaluation of post-operative mobility outcomes, patient demographics, and exploratory factors associated with return to baseline mobility.</p><p><strong>Materials and methods: </strong>A retrospective, single-site, service evaluation was conducted including adult patients treated with definitive external fixation between 2022 and 2025. Descriptive statistics summarised the data and univariate analyses explored factors associated with return to baseline mobility.</p><p><strong>Results: </strong>Seventy-four patients were included, with a median age of 46 years. Fifty-three percent regained baseline mobility post-operatively. Rehabilitation showed poor compliance with national guidelines across multiple phases of recovery. Few individual rehabilitation variables were associated with return to baseline mobility in univariate analysis.</p><p><strong>Conclusion: </strong>This study provides descriptive evidence regarding rehabilitation provision, patient characteristics, and mobility recovery following definitive external fixation at a single NHS Trust. Findings highlight variation in rehabilitation delivery, poor compliance with national guidelines, and ongoing uncertainty regarding optimal rehabilitation pathways for this patient population.</p><p><strong>Clinical significance: </strong>These findings highlight the need for prospective, multicentre research to evaluate rehabilitation pathways, develop standardised outcome measures, and strengthen the evidence base for rehabilitation following definitive external fixation. Future research should capture acute and long-term recovery and include functional, psychological, and socioeconomic outcomes.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"21 1","pages":"1-7"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure Modes in Ilizarov Limb Salvage: A Narrative Review of Technical, Biological, Patient-related and Systemic Determinants.","authors":"Jsrg Saran, Natasha V Isaac, Syed A Mubdi, Ajai Patil, Anurag Shrikanth, Chethan Gangadhar","doi":"10.5005/jp-journals-10080-1672","DOIUrl":"10.5005/jp-journals-10080-1672","url":null,"abstract":"<p><strong>Aim and background: </strong>The Ilizarov circular external fixator remains a cornerstone of limb salvage for infected non-unions, segmental bone defects, limb-length discrepancies and severe deformities. Despite consistently high union rates, treatment is prolonged and associated with a substantial burden of Paley-defined problems, obstacles and complications. This narrative review examines the technical, biological, patient-related and environmental determinants of failure and suboptimal outcomes following Ilizarov reconstruction, with particular emphasis on resource-limited settings.</p><p><strong>Materials and methods: </strong>A narrative synthesis of evidence from meta-analyses, large retrospective cohorts and representative case series was performed. Failure mechanisms were categorised into four domains: Technical factors, biological factors, patient-related factors and environmental/systemic influences. Evidence from low- and middle-income countries (LMICs) was specifically evaluated.</p><p><strong>Results: </strong>Reported bony union rates ranged from 85 to 95%; however, adverse event rates must be interpreted within Paley's framework. Most reported events represent expected and largely reversible treatment-related problems or obstacles inherent to prolonged external fixation rather than reconstructive failure. Aggregate rates of 90-406 Paley-defined events per 100 cases therefore reflect treatment burden rather than failure. Clinically significant complications, including persistent non-union, refracture and secondary amputation, comprised a smaller subset of adverse outcomes. Technical shortcomings contributed to malalignment regenerate deformity and docking-site non-union. Biological factors, particularly pin-site and deep infection, impaired regenerate formation and prolonged treatment. Patient noncompliance, psychological intolerance, malnutrition, smoking and metabolic disease increased failure risk, while socioeconomic constraints and limited rehabilitation resources exacerbated complications in resource-constrained settings.</p><p><strong>Conclusion: </strong>Successful Ilizarov reconstruction depends on technical precision, biological viability, patient engagement and environmental context. Multidisciplinary planning, realistic counselling and context-specific preventive strategies are essential to optimise outcomes in complex limb salvage reconstructions.</p><p><strong>Clinical significance: </strong>Recognition of modifiable failure pathways may help surgeons anticipate complications, refine treatment strategies and improve functional outcomes.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"21 1","pages":"29-36"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Does Intra-operative Hypothermia Affect Peri-operative Outcomes in Hip Fracture Surgery?","authors":"Henry Morar, Alex Stratton-Moore, Kyle B Stump, Huaqing Zhao, S Sharon Ashok, Saqib Rehman","doi":"10.5005/jp-journals-10080-1673","DOIUrl":"10.5005/jp-journals-10080-1673","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims and background: &lt;/strong&gt;Intra-operative hypothermia is a potentially modifiable peri-operative risk factor of uncertain clinical significance in hip fracture surgery. This study examines whether intra-operative hypothermia is associated with adverse peri-operative and mortality outcomes, and whether the nature of that association differs when hypothermia is quantified using a conventional binary threshold (core temperature &lt;36.0 °C) vs a continuous cumulative burden metric [area under the curve (&lt;i&gt;AUC&lt;/i&gt;) below 36.0 °C, expressed as °C·minutes].&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We conducted a retrospective cohort study of patients aged 55-89 years undergoing operative fixation or arthroplasty for hip fracture at a Level I Trauma Centre (2018-2025). Patients were classified by binary intra-operative hypothermia status, with 102 hypothermic patients and 102 randomly selected normothermic controls. Continuous intra-operative core temperature data were used to calculate hypothermia burden (&lt;i&gt;AUC&lt;/i&gt; &lt; 36.0 °C, °C·minutes). Outcomes included intra-operative blood transfusion (primary), estimated blood loss (EBL), surgical site infection (SSI), length of stay (LOS), 30 days readmission and mortality, and 1 year mortality. Associations were evaluated using logistic and linear regression models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 204 patients (mean age 73.4 ± 8.7 years; 58.8% female), binary hypothermia was associated with increased intra-operative transfusion [17.6 vs 5.9%; odds ratio (OR) 3.43, 95% confidence interval (&lt;i&gt;CI&lt;/i&gt;): 1.30-9.04; &lt;i&gt;p&lt;/i&gt; = 0.013]. Although transfused patients exhibited higher mean hypothermia burden (31.6 vs 17.5 °C·minutes), continuous modelling demonstrated no statistically significant association between hypothermia burden and transfusion (&lt;i&gt;OR&lt;/i&gt; 1.08 per 10 °C·minutes; &lt;i&gt;p&lt;/i&gt; = 0.097) or any secondary outcome. Hypothermia burden correlated modestly with longer operative duration and lower pre-operative haemoglobin but not with clinical endpoints.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;An association between binary hypothermia and intra-operative transfusion was observed, but this association was not robust when hypothermia was quantified as a continuous cumulative burden. The relationship between intra-operative hypothermia and transfusion risk in hip fracture surgery therefore remains uncertain, and may reflect operative complexity or confounding rather than a direct causal effect. Studies with larger event numbers and prospective design are needed to clarify this relationship.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical significance: &lt;/strong&gt;These findings highlight a nuanced relationship between intra-operative hypothermia and transfusion risk in hip fracture surgery. The divergence between binary and continuous analyses may reflect the non-linear nature of thermal effects, limited statistical power for rare events, or confounding by operative complexity. Hypothermia remains an important peri-opera","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"21 1","pages":"22-28"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative Patient Positioning for Proximal Femoral Nailing in a Bilateral Above-knee Amputee: A Case Report and Technical Note.","authors":"Deepak R Patro, Saroj K Patra, T T Unais, Gandharav Mehta","doi":"10.5005/jp-journals-10080-1674","DOIUrl":"10.5005/jp-journals-10080-1674","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal femur fractures in amputees present unique surgical challenges, primarily due to the inability to use standard traction table attachments. Bilateral above-knee amputations further add to this difficulty. The literature mainly describes unilateral amputees and delayed fractures in previously amputated limbs, while reports involving bilateral above-knee amputations are rare. The challenge becomes greater when the fracture and bilateral traumatic amputations occur in the same index trauma, because stump length, soft-tissue condition, fluoroscopic access and infection risk all constrain conventional positioning and reduction methods.</p><p><strong>Case presentation: </strong>A 47-year-old male who sustained bilateral lower-limb traumatic amputations and a left intertrochanteric fracture following a railway accident. He underwent staged revision amputations and stump management, resulting in bilateral healthy above-knee stumps before definitive fixation of the left proximal femur fracture. Traction-table positioning was achieved by inserting a Steinmann pin through the left above-knee stump and coupling it to the traction apparatus, while the contralateral stump was secured to the side post to permit reduction, rotational control and unobstructed fluoroscopic imaging. Closed reduction and fixation with a short Proximal Femur Nail Anti-rotation II (PFNA2) were done.</p><p><strong>Conclusion: </strong>It is a safe, reproducible and effective technique for traction, rotational control and C-arm access in a polytrauma patient with bilateral transfemoral stumps.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"21 1","pages":"66-68"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}