European journal of trauma and emergency surgery : official publication of the European Trauma Society最新文献

{"title":"Emergency surgery for blunt abdominal trauma in polytrauma - the impact of time to laparotomy on outcomes.","authors":"Gianmaria Rausch, Yannik Kalbas, Sascha Halvachizadeh, Jonin Zumsteg, Alba Shehu, Ester Mikova, Kuno Lehmann, Ladislav Mica, Roman Pfeifer, Hans-Christoph Pape, Valentin Neuhaus, Felix Karl-Ludwig Klingebiel, Michel Paul Johan Teuben","doi":"10.1007/s00068-026-03332-z","DOIUrl":"https://doi.org/10.1007/s00068-026-03332-z","url":null,"abstract":"<p><strong>Purpose: </strong>Blunt abdominal trauma (BAT) is common in polytrauma patients. Emergency surgery is required for haemodynamically significant solid organ injury and intra-abdominal hollow organ injury. The effect of time to surgery on outcomes in patients requiring emergency laparotomy remains uncertain.</p><p><strong>Materials & methods: </strong>Adult polytrauma patients (ISS > 16) who underwent emergency laparotomy for blunt abdominal trauma between 1996 and 2020 from a trauma registry of a single level one trauma centre were included. Patients were divided into two groups based on the time elapsed from admission to emergency laparotomy: \"Super Early\" (≤ 60 min) and \"Early\" (60-180 min). Length of stay (LOS), intensive care unit (ICU)-LOS, ventilation time, re-look operations and mortality were assessed. Adjusted logistic regression was used to determine the independent predictive parameters, including timing of surgery, for mortality.</p><p><strong>Results: </strong>The study included 190 polytrauma patients with concomitant blunt abdominal trauma (mean age 42 years (± 17), median ISS of 36 (IQR: 19)). There were 95 patients in each group. Patients in the \"Super Early\" group had a compromised haemodynamic status and a higher ISS. Liver injury and serous membrane injury were more common in the super early group. The mortality rate was significantly higher in the \"Super Early\" group (51.6%) compared to the \"Early\" group (26.3%) (p < 0.001). Death due to haemorrhagic shock was significantly more frequent in the \"Super Early\" group (36.8%) compared to the \"Early\" group (13.7%) (p < 0.001). A regression model was adjusted to determine the independent predictors of mortality. Time to emergency laparotomy was not an independent predictor of mortality. However, increased ISS (OR = 1.04, p = 0.049), age (OR = 1.03, p = 0.037) and decreased systolic blood pressure (OR = 0.98, p = 0.025) were found to be significant predictors of mortality.</p><p><strong>Conclusion: </strong>The timing of surgery showed no independent association with mortality as long as an emergency laparotomy was performed within 3 h of admission. The data suggests that patient-specific characteristics, injury severity and clinical status are more important for survival than the timing of an early emergency laparotomy. Future research should focus on determining the role of delayed laparotomy on outcomes in specific subgroups of patients.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"52 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-velocity trauma by social media: a new mechanism of injury in pediatric traumatology?","authors":"Michael Sennert, Benjamin Schoof, Merle Körner, Monika Le, Jan Kolman, Omid Madadi-Sanjani, Kristofer Wintges","doi":"10.1007/s00068-026-03361-8","DOIUrl":"https://doi.org/10.1007/s00068-026-03361-8","url":null,"abstract":"<p><strong>Purpose: </strong>Over the past two decades, social media challenges have emerged as a significant cause of injuries among adolescents. This study evaluates a sudden cluster of severe upper limb injuries resulting from the viral \"Superman challenge\" to raise clinical awareness of digital behaviors in pediatric trauma.</p><p><strong>Methods: </strong>A retrospective study at a tertiary pediatric trauma center evaluated patients aged < 18 years admitted in December 2024 following the \"Superman challenge.\"</p><p><strong>Results: </strong>Eight patients were admitted within a 10-day window following high-energy injuries from the challenge. The cohort showed a female predominance (62.5%) with a mean age of 13.25 (±1.03) years. The high-velocity mechanism led to atypical, severe injury patterns distinct from routine accidental falls. We observed an unusual cluster of severe distal forearm fractures in five patients, which uniformly required surgical treatment. Three patients even suffered bilateral distal radius fractures. Additional associated injuries included fractures of the ulnar styloid process (n = 5) and concomitant TFCC tears (n = 2), reflecting the high-energy nature of the challenge.</p><p><strong>Conclusions: </strong>The rapid, viral spread of physical social media challenges such as the 'Superman Challenge' can lead to dangerous injury mechanisms involving high-velocity trauma among children and adolescents. These trends could lead to sudden, localized clusters of atypical high-energy injuries-a scenario that, under specific conditions, risks overtaxing conventional healthcare systems, as previously demonstrated in the literature. Medical staff need to be aware of changing digital behaviors, which represent a new mechanism of injury in pediatric trauma.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"52 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical stabilization of rib fractures in a high-altitude trauma cohort: in-hospital clinical outcomes and resource use in a propensity score-weighted retrospective cohort study.","authors":"Qian Wan, Qiang Sun, Weinan Li, Ciren Yundan, Liwen Hu, Yi Shen","doi":"10.1007/s00068-026-03366-3","DOIUrl":"https://doi.org/10.1007/s00068-026-03366-3","url":null,"abstract":"<p><strong>Purpose: </strong>Surgical stabilization of rib fractures (SSRF) is increasingly used in the management of traumatic rib fractures, but its in-hospital outcomes in high-altitude trauma settings remain uncertain. We evaluated the association of SSRF with in-hospital pulmonary complications and length of stay in a high-altitude (≈ 3,500 m) trauma system.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of adults with CT-confirmed traumatic rib fractures admitted from 2015 to 2023 and managed with SSRF or non-operative management. Confounding was addressed using stabilized inverse probability of treatment weighting (IPTW) with augmented outcome models; overlap weighting, propensity score matching, and time-dependent exposure analysis were used as sensitivity analyses. The primary outcome was a composite of in-hospital pneumonia, atelectasis, or respiratory failure. Pulmonary risk ratios (RRs) were estimated using modified Poisson regression, while ICU and hospital length of stay were analyzed using log-transformed weighted models.</p><p><strong>Results: </strong>Among 324 patients, 121 underwent SSRF and 203 received non-operative management. Before adjustment, SSRF patients had greater injury severity. In IPTW-augmented analyses, the pulmonary estimate was imprecise (RR 0.86, 95% CI 0.23-3.21; P = 0.822), and no significant difference was detected in ICU length of stay (exp[β] 1.04, 95% CI 0.97-1.10; P = 0.286). Hospital length of stay was longer with SSRF (exp[β] 2.31, 95% CI 2.02-2.65; P < 0.001).</p><p><strong>Conclusion: </strong>Adjusted analyses found no statistically detectable difference in pulmonary complications or ICU length of stay, although the pulmonary estimate remained imprecise and does not establish equivalence or safety. SSRF was associated with longer hospital length of stay.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"52 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The new trochanteric nail TFN-A has a higher complication rate in the treatment of proximal femoral fractures than the predecessor model PFN-A.","authors":"Hannes Kuttner, Michel Schläppi, Christoph Meier, Emanuel Benninger, Peter Wahl","doi":"10.1007/s00068-026-03304-3","DOIUrl":"10.1007/s00068-026-03304-3","url":null,"abstract":"<p><strong>Aims: </strong>Trochanteric fractures (TF) are among the most frequent fractures and have major impact on the affected patients and the healthcare system. Cephalomedullary nails (CMN) are widely used for these fractures. Complications remain frequent, either due to comorbidities or concerning the implant. The goal of this retrospective, single-centre study was to compare the complication rates of two CMN from one manufacturer.</p><p><strong>Materials and methods: </strong>All internal fixations TF performed between 01/2017 and 07/2021 in our institution were analysed retrospectively. Follow-up was at least two years. The CMN were the PFN-A or the TFN-A. Demographic data, all reoperations and revisions were recorded. Reoperations and revisions were estimated using the Kaplan-Meier method, with subgrouping as minor reoperation, minor revision or major revision, including conversion to total hip arthroplasty.</p><p><strong>Results: </strong>A total of 492 CMN, used in 475 patients, could be included. Among these, 248 were PFN-A and 244 were TFN-A. The overall reoperation rate was 15%, 12.9% for the PFN-A and 17.2% for the TFN-A, respectively. The TFN-A group had significantly more major revisions (hazard ratio 3.57 (95% confidence interval 1.42-9.94; p = 0.004). No relevant differences were found regarding demographic data or the quality of reduction and internal fixation.</p><p><strong>Discussion: </strong>The TFN-A had a significantly higher rate of complications leading to major revision than the former PFN-A. This may have been missed when considering only the reoperation rate for all causes due to a camouflage effect by minor complications.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"52 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198780","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":"Pelvic hemorrhage in the context of demographic change: frequency and CT-based characterization of pelvic bleeding.","authors":"Florentine Gerhardt, Andreas Höch, Dmitry Notov, Jeanette Henkelmann, Suzanne Zeidler, Stephanie Einhorn, Christian Kleber","doi":"10.1007/s00068-026-03363-6","DOIUrl":"10.1007/s00068-026-03363-6","url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic pelvic hemorrhage is a major driver of morbidity and mortality in pelvic fractures. Classic literature described pelvic hemorrhage as predominantly venous, whereas arterial injury is considered less common. We evaluated the frequency, anatomical distribution, and presumed sources of pelvic hemorrhage in a contemporary trauma cohort using contrast-enhanced CT (CECT).</p><p><strong>Methods: </strong>We conducted a single-center, retrospective cohort study of consecutive patients with pelvic fractures treated at a level-I trauma center between 2020 and 2022. All patients underwent CECT at initial presentation. Two experienced pelvic trauma surgeons independently reviewed all scans. Radiologically relevant hemorrhage was defined by contrast extravasation, soft-tissue asymmetry/displacement, or a contained intrapelvic hematoma. Patients with and without hemorrhage were compared regarding age, sex, trauma mechanism, anticoagulation, and fracture type. The presumed bleeding sources were categorized as arterial, venous, cancellous, or mixed.</p><p><strong>Results: </strong>Radiologically relevant hemorrhage occurred in 95/512 (18.6%) patients and was more frequent after high-energy trauma and in men. Iliac sites predominated, whereas presacral bleeding was uncommon. The presumed bleeding source was cancellous in 44.2%, mixed in 29.5%, arterial in 18.9%, and isolated venous in 7.4%. Overall mortality was 7.0% and was significantly higher in patients with hemorrhage (14.7% vs. 5.3%; p < 0.001).</p><p><strong>Conclusion: </strong>In this contemporary CECT-based cohort, pelvic hemorrhage was less frequent than historically reported, with CT findings most commonly suggesting cancellous or mixed bleeding sources. These findings suggest that the traditional concept of predominantly venous pelvic hemorrhage may not fully reflect current CT-based observations.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"52 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198796","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":"Surgical management of orbital wall fractures in juveniles: a European multicenter study.","authors":"Paolo Boffano, Anssi Lahtinen, Matteo Brucoli, Muhammad Ruslin, Andrea Melle, Panagiotis Stathopoulos, Dimitra Maniati, Emil Dediol, Boris Kos, Adam Michcik, Adam Polcyn, Thomas Starch-Jensen, Ivana Mijatov, Branislav V Bajkin, Annabelle Cailleaux, Eugénie Bertin, Christophe Meyer, Aurélien Louvrier, Andrii V Kopchak, Tetiana A Pavlychuk, Sergi Herrera I Nogués, Ana Martínez-Carrillo, Juan Carlos de Vicente, Linas Zaleckas, Rūta Rastenienė, Augustinas Stasiūnas, Jan Naberoj, Luka Prodnik, Tadej Dovsak, Johanna Snäll","doi":"10.1007/s00068-026-03344-9","DOIUrl":"10.1007/s00068-026-03344-9","url":null,"abstract":"<p><strong>Introduction: </strong>Isolated orbital floor fractures in juveniles are a challenge, as children and adolescents may experience diplopia and limited ocular motility, even with little to no periorbital edema or visible signs of injury to the eye. The aim of the present study is to assess the demographic and clinical variables, and the outcomes of pediatric patients affected by isolated orbital wall fractures at several European oral and maxillofacial surgery centers.</p><p><strong>Methods: </strong>Pediatric patients (less than 18 years) with hospitalized and surgically treated for unilateral isolated orbital blow out fractures of the orbital floor and/or the medial wall were included. The following data were recorded for each patient: gender, age, etiology of trauma, site of orbital wall fracture(s), timing of intervention, surgical approach, orbital reconstruction material/implant, post-operative complications RESULTS: A total of 51 pediatric patients (45 boys, 6 girls) with a mean age of 12.1 years were included. Most patients (43 children, 84.3%) presented with an isolated orbital floor fracture. Clinically, the most frequently observed sign was diplopia / double vision (43 patients, 84.3%). More than two thirds (68.6%) of cases were surgically treated within the first two days from injury. In 6 patients (11.8%) one or more persistent postoperative disturbances were found six months postoperatively, including diplopia in 3 subjects (5.9%), infraorbital nerve paresthesia in 2 patients (3.9%), and enophthalmos in 2 patients (3.9%).</p><p><strong>Conclusions: </strong>The rarity of pure orbital wall fractures in pediatric patients makes it difficult to establish uniform evidence-based guidelines for their management. These injuries must also be recognized promptly, as surgical intervention may be required at a very early stage. A reasoned and individualized choice of the optimal surgical approach appears to be the most appropriate strategy for this specific type of facial fracture in the pediatric population.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"52 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187678","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 and outcomes of moderate-to-severe pelvic ring fractures: a 10-year experience from an Australian Level 1 Trauma Centre.","authors":"Tze Hee Tay, Muhammad Rosley, Bhavik Patel, Martin Wullschleger","doi":"10.1007/s00068-026-03360-9","DOIUrl":"10.1007/s00068-026-03360-9","url":null,"abstract":"<p><strong>Purpose: </strong>Moderate-to-severe pelvic ring fractures are associated with high morbidity and mortality despite advances in resuscitation, development in trauma systems and multispecialty haemorrhage control. This study aimed to describe the management strategies and clinical outcomes of moderate-to-severe pelvic ring fractures over a 10-year period at an Australian Level I Trauma Centre.</p><p><strong>Methods: </strong>A retrospective observational cohort study was performed of patients aged ≥ 16 years with moderate-to-severe pelvic ring fractures (Abbreviated Injury Scale (AIS) ≥ 3) treated between January 2015 and December 2024. Data were obtained from the institutional prospectively collected trauma registry.</p><p><strong>Results: </strong>A total of 313 patients met the inclusion criteria. The mean age was 47.0 years and 69.3% were male. Motor vehicle (35.1%) and motorcycle collisions (24.9%) accounted for 60.1% of injuries. Median ISS was 26 (IQR 19-34), with 70.6% sustaining pelvic AIS 4-5 injuries. 20.1% of patients underwent at least one haemorrhage-control intervention, including angioembolisation (14.4%), preperitoneal pelvic packing (5.8%) and external fixation (5.8%). Angioembolisation utilisation increased from 6.7% in 2015 to 40.0% in 2024. In-hospital mortality was 7.7%, with traumatic brain injury accounting for 62.5% of deaths and haemorrhagic shock for only one death.</p><p><strong>Conclusion: </strong>Moderate-to-severe pelvic ring fractures remained characterised by high-energy mechanisms and severe multisystem injury over the study period, while management evolved with increasing utilisation of angioembolisation. In-hospital mortality was numerically lower compared with historical cohorts, with most deaths attributable to associated traumatic brain injury rather than pelvic haemorrhage.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"52 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of two immobilization techniques for radiological outcomes in fifth metacarpal neck fractures: a prospective controlled study.","authors":"Uğurcan Süner, Mahmut Tunçez, Doğukan Sağıroğlu, Yılmaz Önder, Mehmet Özdemir, Tuğrul Bulut","doi":"10.1007/s00068-026-03362-7","DOIUrl":"https://doi.org/10.1007/s00068-026-03362-7","url":null,"abstract":"<p><strong>Purpose: </strong>Although fifth metacarpal neck fractures are commonly managed conservatively, there is no consensus regarding the optimal immobilization strategy. The aim of this study was to compare the radiographic outcomes of the Jahss Position Splint (JPS) and the conventional Ulnar Gutter Splint (UGS) in the treatment of fifth metacarpal neck fractures.</p><p><strong>Methods: </strong>A total of 78 adult male patients treated for isolated closed fifth metacarpal neck fractures between January 2023 and June 2024 were prospectively evaluated. Patients were allocated to either the JPS group (n = 42) or the UGS group (n = 36). Patients were assigned to JPS or UGS according to the predefined odd/even-calendar-day duty schedule of two surgeons, each of whom routinely applied one of the techniques. All patients underwent closed reduction using the Jahss maneuver followed by three weeks of immobilization. Radiographic outcomes included initial fracture angulation (IFA), post-reduction angulation (PRA), final follow-up angulation at 12 weeks (FFA), metacarpal shortening, and malunion rates.</p><p><strong>Results: </strong>No significant differences were observed between the groups regarding age or IFA (p > 0.05). Correction during reduction and splint application was greater with JPS than with UGS (15.2 ± 9.6° vs. 8.9 ± 11.0°; p = 0.009), whereas subsequent loss of reduction during immobilisation did not differ significantly between the groups (2.8 ± 8.4° vs. 1.0 ± 9.8°; p = 0.388).The JPS group demonstrated significantly lower PRA (p < 0.001) and FFA (p = 0.003) compared with the UGS group. Metacarpal shortening was significantly less in the JPS group (p = 0.036). The malunion rate was 5% in the JPS group and 28% in the UGS group (p = 0.009).</p><p><strong>Conclusion: </strong>JPS was associated with greater immediate angular correction and more favourable final radiographic outcomes than UGS but did not reduce subsequent loss of reduction during immobilisation. Because functional and patient-reported outcomes were not assessed, the clinical relevance of these radiographic differences remains uncertain.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"52 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical validation of the DRoPH score: a preoperative tool for estimating reduction difficulty in proximal humerus fractures.","authors":"Christiane Barthel, Franziska Rudolph, Hans-Christoph Pape, Florin Allemann","doi":"10.1007/s00068-026-03359-2","DOIUrl":"10.1007/s00068-026-03359-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Proximal humerus fractures are common injuries that are frequently associated with considerable technical challenges during surgical reduction and fixation. Although anatomical reduction is crucial for fracture healing and functional recovery, the anticipated difficulty of achieving satisfactory reduction is difficult to estimate preoperatively. The Difficulty of Reduction of Proximal Humerus Fractures (DRoPH) score was recently developed through a structured expert consensus process to estimate anticipated reduction difficulty based on predefined fracture- and patient-related characteristics. The aim of this study was to perform an initial clinical validation of the score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively analyzed patients who underwent plate fixation of proximal humerus fractures at a tertiary trauma center between January 2014 and December 2024. DRoPH scores (0-10 points) were stratified into low (0-3), moderate (4-6), and high (7-10) difficulty categories. Validation was based on operative duration, postoperative reduction quality according to the criteria described by Schnetzke et al., and postoperative complications. Multivariable regression analyses were performed to assess the independent association of the DRoPH score with the primary outcomes after adjustment for age, sex, and surgical approach. Inter- and intra-rater reliability were assessed using intraclass correlation coefficients (ICC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 1,012 patients treated for proximal humerus fractures, 392 met the inclusion criteria and had complete datasets available for analysis. Of these, 151 (38.5%) were classified as low, 186 (47.4%) as moderate, and 55 (14.0%) as high difficulty according to the DRoPH score. Operative duration increased significantly with increasing DRoPH scores, with an adjusted increase of 7.3 min per score point (95% CI 5.7-9.0; p &lt; 0.001). Reduction quality deteriorated across difficulty categories, and higher DRoPH scores were independently associated with malreduction (OR 1.30 per point, 95% CI 1.12-1.50; p = 0.001). Overall complication rates increased from 15.2% in low-difficulty fractures to 34.5% in high-difficulty fractures, and the DRoPH score remained independently associated with complications in multivariable analysis (OR 1.15 per point, 95% CI 1.03-1.28; p = 0.012). Inter- and intra-rater reliability of the overall DRoPH score were excellent (ICC 0.96 and 0.95, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study provides initial clinical validation of the DRoPH score as a reliable and clinically applicable tool for estimating reduction difficulty in proximal humerus fracture fixation. Higher DRoPH scores are independently associated with longer operative duration, increased risk of malreduction, and higher complication rates. The score may therefore serve as a useful adjunct for preoperative planning and risk stratification in surgically treated proximal humerus ","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"52 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal trauma in a pediatric Level 1 trauma center: morbidity, mortality, and the role of renal scintigraphy.","authors":"Sem A M Jansen, Bouchra Haouli, Manouk Backes, Tjarda N Tromp, Dennis Vriens, Michael J R Edwards, Allon van Uitert, Stijn D Nelen","doi":"10.1007/s00068-026-03341-y","DOIUrl":"10.1007/s00068-026-03341-y","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric renal trauma is uncommon but potentially serious, and is often managed conservatively. Complications may occur, and the clinical value of renal scintigraphy during follow-up remains unclear. This study aimed to assess morbidity and mortality after pediatric renal trauma and to assess the clinical value of renal scintigraphy during follow-up.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included pediatric trauma patients (< 18 years) with renal injuries admitted to a Level 1 trauma center in the Netherlands between January 1, 2001, and December 31, 2024. Mortality and in-hospital complications were assessed, and associations between renal scintigraphy abnormalities and complications during follow-up were evaluated.</p><p><strong>Results: </strong>A total of 72 patients were included, of whom all injuries resulted from blunt trauma. Conservative management was applied in 88% of cases; embolization and nephrectomy were performed in 8% and 3% of patients, respectively. In-hospital mortality was 11% and was attributed exclusively to concomitant traumatic brain injury. Complications occurred in 25% of patients, primarily infections (19%), followed by hypertension during follow up (4%). Renal scintigraphy was performed in 53% of patients, predominantly in those with high-grade injuries; abnormalities were frequently observed (77%) but did not correlate with the occurrence of hypertension, proteinuria, or renal insufficiency during follow-up.</p><p><strong>Conclusion: </strong>Pediatric renal trauma, including high-grade injuries, can often be managed conservatively, and most complications can be treated using medical therapy or minimally invasive interventions. Renal scintigraphy showed no clear association with long-term morbidity and had limited additional value in routine follow-up. Given the potential for late-onset hypertension, structured long-term clinical surveillance with periodic monitoring of blood pressure, proteinuria, and renal function is warranted, particularly after high-grade injuries.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"52 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149579","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}