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

{"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}

{"title":"Measurement properties of pulmonary function measurement and patient-reported outcome measures in patients with multiple rib fracture without flail segment; validation study alongside the multicenter FixCon trial.","authors":"Maartje L Luttjeboer, Max R Van Diepen, Jonne T H Prins, Suzanne F M Van Wijck, Michael H J Verhofstad, Mathieu M E Wijffels, Esther M M Van Lieshout","doi":"10.1007/s00068-026-03338-7","DOIUrl":"10.1007/s00068-026-03338-7","url":null,"abstract":"<p><strong>Background: </strong>The reliability and validity of pulmonary function, pain and health related quality of life (HR-QoL) as outcome measures for patients with rib fractures, remain uncertain. Our objective was to evaluate measurement properties in patients with multiple rib fractures by comparing them with generic HR-QoL instruments (EuroQoL-5D-5L [EQ-5D-5L], Short Form-12 [SF-12]).</p><p><strong>Methods: </strong>A multicenter RCT in adults (n = 180) was performed. Spirometry was performed at 30 days, 3, 6, and 12 months after trauma. Patients completed five questions on pain, EQ-5D-5L, SF-12, and two anchor questions on improvement in pulmonary function and thoracic complaints since previous measurement. Reliability, construct validity, responsiveness and floor and ceiling effects were evaluated for all follow-up time-points.</p><p><strong>Results: </strong>EQ-5D and SF-12 (sub)scales showed adequate internal consistency. Construct and longitudinal validity were adequate for all (sub)scales, except for construct validity of the SF-12 Physical Component Summary. Ceiling effects were present for all pain questions from 30 days onwards, for EQ-5D-5L utility score (US) from 3 months onwards. Responsiveness analysis indicated that spirometry values showed trivial (tidal volume), small (inspiratory capacity, FEV1), or moderate (FVC) degree of change from 30 days to 12 months. All five pain levels, EQ-5D-5L and SF-12 (sub)scales showed moderate to large degree of change form 30 days to 12 months.</p><p><strong>Conclusions: </strong>Spirometry and pain are valid instruments for monitoring functional recovery in patients after sustaining multiple rib fractures. Responsiveness was confirmed for pain and spirometry (FVC). EQ-5D-5L and SF-12 are valid, reliable, and responsive. Pain and HRQoL are therefore suitable instruments for measuring treatment effects over time.</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/PMC13652763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148733","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":"Prehospital severity and in-hospital mortality in trauma patients managed by the Friuli-Venezia Giulia helicopter emergency medical service: a 6-year retrospective cohort study.","authors":"Serena Tomasino, Carlo Pegani, Daniele Orso, Cristian Ursella, Annarita Tullio, Giacomo Bacchetti, Chiara Molinari, Anna Marangone, Michele Contadini, Davide Durì, Samantha Saffer, Sabrina Fantin, Alessio Sappada, Alberto Peratoner, Giulio Trillò, Andrea Roncarati, Tiziana Bove, Alessandra Spasiano, Giorgio Della Rocca","doi":"10.1007/s00068-026-03346-7","DOIUrl":"10.1007/s00068-026-03346-7","url":null,"abstract":"<p><strong>Background: </strong>Data on in-hospital mortality among trauma patients managed by Helicopter Emergency Medical Services (HEMS) in Italy remain limited. We aimed to describe the epidemiology and in-hospital mortality of trauma patients transported after management by the Friuli-Venezia Giulia HEMS and to assess prehospital factors associated with death.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study including trauma patients managed by HEMS FVG and transported to hospital, either directly by HEMS or after continuation of transport by ground emergency medical services, between 2018 and 2023. The primary outcome was in-hospital mortality. Jeffreys-prior penalized logistic regression was used to reduce sparse-data bias and instability from separation. The RTS-based model was designated as the primary model and the NACA-based model as a secondary sensitivity analysis. Model performance was assessed internally, and the functional forms of both age and RTS were examined using restricted cubic splines.</p><p><strong>Results: </strong>Of 3,357 trauma records in the source cohort, 205 prehospital deaths were excluded from the in-hospital mortality analysis, leaving 3,152 transported patients. Outcome data were available for 3,143 patients, of whom 107 died in hospital (3.4%). In the primary RTS-based model, older age, lower RTS, tracheal intubation, and prehospital CPR were associated with mortality. Compared with RTS ≥ 7, adjusted ORs were 2.36 (95% CI 1.11-5.50) for RTS 4-<7 and 5.19 (95% CI 1.64-17.04) for RTS < 4. Age was associated with mortality (OR 1.03 per year, 95% CI 1.01-1.04). Continuous RTS analysis was concordant (OR 0.68 per one-point increase, 95% CI 0.54-0.86; p = 0.0013).</p><p><strong>Conclusions: </strong>Among trauma patients transported to hospital after HEMS management, older age, higher prehospital injury severity, tracheal intubation, and prehospital CPR were associated with in-hospital mortality. Intubation and CPR should be interpreted primarily as markers of severe physiological compromise rather than causal determinants of death.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149860","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":"Surgeon-perceived intraoperative complexity is associated with early adverse outcomes after major emergency abdominal surgery: a prospective cohort study.","authors":"Lasse Rehné Jensen, Thea Helene Degett, Trygve Ulvund Solstad, Lukas Schak Nielsen, Dunja Kokotovic, Thomas Korgaard Jensen, Jakob Burcharth","doi":"10.1007/s00068-026-03355-6","DOIUrl":"10.1007/s00068-026-03355-6","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative complexity in major emergency abdominal surgery lacks a standardized definition and is rarely quantified prospectively. Whether surgeon-perceived intraoperative complexity is associated with short-term postoperative outcomes remains unknown.</p><p><strong>Methods: </strong>In this single-center prospective cohort study, 411 patients undergoing major emergency abdominal surgery were included. Immediately after surgery, the operating surgeon rated perceived intraoperative complexity on a 0-10 scale. The association between surgeon-perceived intraoperative complexity and the primary outcome, 30-day unplanned reoperation, was investigated using Fine-Gray regression. The model was adjusted for age, sex, body mass index, performance status, and intraoperative pathology. Secondary outcomes were 30-day mortality, length of stay, and Comprehensive Complication Index.</p><p><strong>Results: </strong>Unplanned reoperation occurred in 15% and 30-day mortality in 11%. Higher surgeon-perceived intraoperative complexity was associated with reoperation (sHR 1.20 per point; 95% CI 1.08-1.34). Complexity was also associated with prolonged LOS (β 1.47 days per unit increase; 95% CI 0.93-2.01), higher CCI category (OR 1.24 per unit increase; 95% CI 1.14-1.35), and increased 30-day mortality (OR 1.25; 95% CI 1.07-1.45).</p><p><strong>Conclusion: </strong>Surgeon-perceived intraoperative complexity was associated with reoperation, morbidity, and 30-day mortality after major emergency abdominal surgery. These findings suggest that the operating surgeon's assessment may capture clinically meaningful prognostic information beyond conventional baseline risk factors. External validation and evaluation of inter-rater reproducibility are needed before clinical implementation.</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":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140340","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 challenges and opportunities of major trauma care in Germany - results of multidisciplinary expert interviews of the LeAf trauma study.","authors":"Anne Neubert, Sebastian Hempe, Dan Bieler, Carina Jaekel, Catharina Gaeth, Christine Höfer, Stefanie Bartha, Elisabeth Schwojer, Rolf Lefering, Gina Royko, Denise Schulz, Katharina Fetz","doi":"10.1007/s00068-026-03350-x","DOIUrl":"10.1007/s00068-026-03350-x","url":null,"abstract":"<p><strong>Background: </strong>The recovery process of major trauma survivors involves various sectors within a complex system of different medical service providers and stakeholders who accompany and support patients throughout the recovery pathway. The aim was to explore experiences and opinions of experts, who are actively involved in the care of major trauma patients in the German healthcare system.</p><p><strong>Methods: </strong>Semistructured in-depth group interviews were used to investigate experiences and opinions of experts with the focus on exploration of expert perspectives on opportunities and challenges of the cross sectoral care. An exploratory analysis was performed with an artificial intelligence-based coding software. In a second step, a system map was developed, and all inter- and intra-sectoral challenges and all opportunities for the optimization of processes were mapped.</p><p><strong>Results: </strong>39 experts from 13 medical specialties and occupational groups who were interviewed highlighted that intersectional issues especially across and within sectors pose a significant challenge to patient care. Four challenges were highlighted that significantly influence patient care: (1) Communication between sectors; (2) Complexity of transitions between sectors; (3) Inadequate aftercare and (4) Lack of psychosocial care.</p><p><strong>Discussion: </strong>In conclusion five key learnings can be derived which could help to transform the healthcare system towards a system in which the complex condition major trauma with its high potential of chronification is enabling patients towards living a self-determined life and is creating opportunities for patients to return to work: (1) interdisciplinary collaboration (2), improved communication (3), early psychosocial screening and intervention (4), continuity of care (5), involvement of relatives.</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":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130219","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":"Costs and health-related quality of life of non-operative and surgical treatment modalities for displaced distal radius fractures: a comprehensive overview based on the CAST study.","authors":"Britt Barvelink, Stella C M Heemskerk, Jan A N Verhaar, Max Reijman, Joost W Colaris","doi":"10.1007/s00068-026-03354-7","DOIUrl":"10.1007/s00068-026-03354-7","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to provide a comprehensive overview of costs and health-related quality of life (HRQoL) associated with three treatment modalities for common displaced distal radius fractures (DRFs): (1) non-operative treatment, (2) direct plate fixation and (3) delayed plate fixation in case of fracture redisplacement during follow-up.</p><p><strong>Methods: </strong>A cost and HRQoL analysis was performed based on data collected during the CAST study, a multicenter cluster-randomized controlled trial including adult patients with a displaced DRF, randomized between immobilization with a plaster splint or circumferential cast. Included patients were prospectively followed for one year. Operatively treated patients also continued questionnaire follow-up. From a societal perspective, healthcare costs, patient and family costs, and indirect (i.e. productivity) costs were collected. Patients completed questionnaires on HRQoL (EQ-5D-5 L), healthcare consumption and work productivity.</p><p><strong>Results: </strong>In total, 693 patients were included in this study (non-operative: 402, direct plate fixation: 165, delayed plate fixation: 126). The estimated mean total costs per patient were €2,212 for non-operative treatment, €4,339 for direct plate fixation and €4,393 for delayed plate fixation HRQoL improved between 3 and 12 months but did not reach pre-injury HRQoL in all groups.</p><p><strong>Conclusions: </strong>This study provides a descriptive overview of societal costs of displaced DRF treatment. Non-operative treatment is least costly. The cost differences between direct and delayed plate fixation is €58 in favor of direct plate fixation. Starting with non-operative treatment and later deciding whether to proceed with operative treatment based on alignment changes during follow-up, could reasonably be considered as a treatment option. HRQoL improved in all groups.</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":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130200","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":"Peri-periprosthetic femoral fractures: a single-centre case series of a rare and challenging clinical scenario.","authors":"Renato Matteotti, Giovanni Dalla Vecchia, Andrea Masotti, Luca Monticelli, Michele Nardi, Lorenzo Fiore","doi":"10.1007/s00068-026-03340-z","DOIUrl":"10.1007/s00068-026-03340-z","url":null,"abstract":"<p><strong>Purpose: </strong>Periprosthetic femoral fractures (PFFs) are an increasingly common complication of hip arthroplasty. A poorly defined scenario is a new femoral fracture after a previously treated PFF has united, which we term a peri-periprosthetic femoral fracture.</p><p><strong>Methods: </strong>We retrospectively reviewed 154 surgically treated PFF episodes in patients aged over 65 years at our institution between 2011 and 2021. A peri-periprosthetic fracture was defined as a new acute femoral fracture after documented radiographic union of a previously treated PFF. Clinical, surgical, and radiographic data were reviewed.</p><p><strong>Results: </strong>Seven patients (4.5% of the institutional PFF cohort) met the criteria. Mean age was 83.1 years and 6 (85.7%) were female. The mean interval to the peri-periprosthetic fracture was 37.3 months (median 27; range 7-105). By the Vancouver classification, 3 fractures were type B1, 1 type B3, and 3 type C. Treatment was individualised to fracture configuration, prosthetic stability, hardware, and bone stock. Radiographic union was documented in all 4 patients with adequate follow-up, at a mean of 4.3 months. Five patients regained ambulation; one with pre-existing limitations did not, and ambulatory status was unavailable for one. Medical complications occurred in 2 patients, and no major orthopaedic complication required reoperation. Mortality was 14.3% at one year and 42.9% at two years.</p><p><strong>Conclusion: </strong>Peri-periprosthetic femoral fractures constitute a rare and technically demanding scenario, distinct from delayed union, nonunion, refracture through an incompletely healed fracture, and fixation failure. Treatment should be individualised to prosthetic stability, pre-existing hardware, fracture morphology, and residual bone stock.</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":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130204","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":"In-hospital mortality in hip fracture patients undergoing surgery later than 24 hours post admission might rather reflect the impact of comorbidities and treatment limitations than additional risks imposed by the mere timely delay itself.","authors":"Moeen Babayi, Christian Walter Müller","doi":"10.1007/s00068-026-03349-4","DOIUrl":"10.1007/s00068-026-03349-4","url":null,"abstract":"<p><strong>Purpose: </strong>Early surgery for proximal femoral fractures is widely recommended, but the association between surgical delay and short-term mortality remains uncertain because observational studies are vulnerable to confounding by patient characteristics and treatment limitation.</p><p><strong>Methods: </strong>We retrospectively studied adults with operatively treated proximal femoral fractures at a DGU-certified regional trauma center in Germany (2022-2025). Time to surgery was measured from emergency department registration to operative start. Delays > 24 h were classified as medical or non-medical where sufficiently documented. The primary outcome was in-hospital mortality. Adjusted analyses included age, sex, ASA category, fracture type, concomitant orthopaedic injury, and treatment limitation (DNR/DNI; not time-anchored to surgery) and used Firth penalized logistic regression.</p><p><strong>Results: </strong>Among 927 patients, 871 (94.0%) underwent surgery within 24 h; 53 (5.7%) died in hospital. Crude mortality was 5.6% after surgery within 24 h and 7.1% after surgery > 24 h. After adjustment, no clear independent association between surgery > 24 h and mortality was detected (aOR 1.03, 95% CI 0.29-2.92). Higher age, male sex, advanced ASA class, and treatment limitation were associated with mortality. In exploratory analyses, mortality was 19.0% among medically delayed patients and 0% among patients with non-medical delay, but adjusted estimates were highly imprecise.</p><p><strong>Conclusion: </strong>No clear association between surgery beyond 24 h and in-hospital mortality was detected after adjustment for measured patient characteristics and treatment-limitation status. The estimate was imprecise and compatible with clinically relevant benefit or harm; these findings do not establish the absence of an effect of surgical delay.</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":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130207","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":"Cumulative operative burden is associated with poorer function after segmental bone transport for lower-extremity long-bone defects.","authors":"Mustafa Yıldız, Muhammed Köroğlu, Mustafa Ertuğrul Karabaş, İpek Balıkçı Çiçek, Thomas Stevenson, Ahmet Harma","doi":"10.1007/s00068-026-03352-9","DOIUrl":"10.1007/s00068-026-03352-9","url":null,"abstract":"<p><strong>Objective: </strong>Segmental bone transport offers biological reconstruction and limb preservation for extensive lower-extremity long-bone defects, but treatment often involves prolonged external fixation, planned stages, and unplanned reoperations. We evaluated reconstructive and functional outcomes and examined the association between cumulative operative burden and final patient-reported function.</p><p><strong>Methods: </strong>This retrospective single-centre study screened 44 patients treated between January 2012 and March 2023. Thirty-six patients, representing 37 reconstructed long bones, had complete final outcome ascertainment. ASAMI bone outcome was reported per reconstructed bone (n = 37); limb preservation and all functional and multivariable analyses were patient-level (n = 36). Outcomes included limb preservation, ASAMI bone and functional results, the Lower Extremity Functional Scale (LEFS), the Karlström-Olerud score, healing indices, treatment-related events, and the cumulative number of formal operations. Multivariable linear regression, bootstrap resampling, sensitivity analyses, and exploratory receiver operating characteristic analysis were performed.</p><p><strong>Results: </strong>Mean defect length was 10.32 ± 4.67 cm and the mean defect-to-bone length ratio was 26.3% ± 12.4%. Patients underwent a mean of 8.08 ± 4.21 operations (median, 7; range, 3-18). Mean follow-up after external-fixator removal was 5.69 ± 3.62 years. Limb preservation was achieved in 35 of 36 patients (97.2%). Combined excellent/good ASAMI bone and functional outcomes were 75.7% and 77.8%, respectively. Pin-site infection occurred in 17 patients and accounted for 32 fixation-element events; premature consolidation occurred in 11 patients and accounted for 18 episodes. After adjustment for age, defect length, and consolidation index, each additional operation was associated with a 1.94-point lower LEFS (β=-1.94, 95% CI - 3.12 to - 0.76; p=.002). Excluding the patient who underwent below-knee amputation and had an LEFS of 0 did not materially alter this association (n = 35; β=-1.86, 95% CI - 2.85 to - 0.86; p<.001). Older age was also independently associated with lower LEFS (β=-0.46 points/year; p=.006). Follow-up duration was not associated with LEFS and did not alter the principal association. Exploratory ROC analysis for LEFS < 40 yielded an AUC of 0.846 (bootstrap 95% CI 0.689-0.968); the internally derived ≥ 11-operation threshold was regarded as hypothesis-generating.</p><p><strong>Conclusion: </strong>Segmental bone transport achieved high limb preservation and largely favourable ASAMI outcomes despite a substantial treatment burden. A greater cumulative number of operations was associated with lower final LEFS. Operation count should be interpreted as a summary marker of case complexity and the treatment course, not as evidence that repeated surgery alone caused poorer function.</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":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122336","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":"Blast injury simulation in pigs using an air-driven shock wave generator: effects of shock waves of lateral shock wave exposure.","authors":"Nobuaki Kiriu, Yasumasa Sekine, Ruka Sasa, Koji Yamamura, Makoto Aoki, Tatsunori Nagamura, Kiyomasa Nishii, Daizoh Saitoh, Tetsuro Kiyozumi, Satoshi Tomura","doi":"10.1007/s00068-026-03348-5","DOIUrl":"10.1007/s00068-026-03348-5","url":null,"abstract":"<p><strong>Purpose: </strong>We have hypothesized that respiratory arrest caused by temporary brainstem dysfunction is the primary cause of death during the hyperacute phase of blast injury and have demonstrated that this is highly likely. To date, we have examined the effects of shock waves on pigs by exposing them to shock waves from both the dorsal and ventral sides. Therefore, in this study, we investigated the effects of lateral shock wave exposure in pigs and identified priority regions for protection against blast injuries.</p><p><strong>Methods: </strong>Eight male hybrid pigs (age, 10-12 weeks; mean weight, 36.6 kg) were anesthetized and fitted with a femoral arterial line and subcutaneous electrocardiography leads for continuous monitoring of vital signs and respiration. Pigs were fixed prone with the right lateral thorax aligned to the aperture. A compressed air-driven shock tube generated a shock wave (driving pressure: 3.0 MPa). Arterial blood gases were obtained before and 0, 3, 5, and 10 min post-exposure. Whole-body computed tomography was performed pre- and post-exposure. Survivors were observed for 3 h, then underwent necropsy. Regarding lung injury, since \"primary blast lung injury\" is defined as \"radiological and clinical evidence of acute lung injury occurring within 12 h of exposure and not due to secondary or tertiary injury\", this study focuses on organ injury and mortality in the hyperacute and acute phases.</p><p><strong>Results: </strong>All pigs developed immediate apnea after blast exposure. Two pigs died: one from persistent apnea leading to progressive hypoxia and cardiac arrest and one from delayed cardiac arrest approximately 1 h later. Necropsy in the delayed death revealed thrombus extending from the right subclavian vein into the superior vena cava, suggesting embolism. Marked bradycardia was absent, and hypotension only occurred in one pig. Computed tomography depicted no air embolism and suggested increased right lung injury. Gross anatomy revealed pulmonary contusion and splenic injury in all the pigs; pulmonary bullae were rare.</p><p><strong>Conclusion: </strong>Lateral shock wave exposure can induce profound apnea and death, likely owing to transient brainstem respiratory dysfunction rather than a vagal reflex mechanism. To reduce mortality, protective strategies should prioritize shielding the brainstem region, specifically the lateral and posterior sides of the occipital region and neck.</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":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121810","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}