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

{"title":"Re-evaluating risk factors for avascular necrosis in pediatric femoral neck fractures: comment on the study by Mueller et al.","authors":"Sitanshu Barik, Vikash Raj, Vishal Kumar","doi":"10.1007/s00068-025-02899-3","DOIUrl":"https://doi.org/10.1007/s00068-025-02899-3","url":null,"abstract":"","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"223"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236736","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":"Prediction of traumatic hemorrhagic shock using a Multi-scale exogenous variable model (MS-TimeXer-MoE).","authors":"Wenxin Wang, Bing Chen, Qiuyi Wang, Jian Rong","doi":"10.1007/s00068-025-02878-8","DOIUrl":"https://doi.org/10.1007/s00068-025-02878-8","url":null,"abstract":"<p><strong>Objective: </strong>To predict the likelihood of hemorrhagic shock in trauma patients using a multi-scale exogenous variable model, MS-TimeXer-MoE.</p><p><strong>Methods: </strong>This study is the first to use the TimeXer method incorporating exogenous variables to establish a predictive model for traumatic hemorrhagic shock, achieving notable prediction results. Data from trauma patients were extracted from the MIMIC IV database according to inclusion and exclusion criteria. After data processing, the most relevant indicators were selected, including endogenous variables (e.g., vital signs, laboratory indicators) and exogenous variables (e.g., cause of trauma, gender, age, injury site). By integrating exogenous variables and multi-scale feature learning, and innovatively combining the multi-expert mechanism with the TimeXer method, a multi-expert mixed model, MS-TimeXer-MoE, was developed to predict hemorrhagic shock occurrence with higher accuracy and specificity. A total of 4,870 patients were included, divided into an experimental group of 2,432 cases and a control group of 2,438 cases based on the occurrence of hemorrhagic shock post-admission. The dataset was split into training, validation, and testing sets in a 60%:20%:20% ratio RESULTS: The AUC value of the MS-TimeXer-MoE model in predicting hemorrhagic shock in trauma patients was 0.8995, with a recall rate of 0.8607, demonstrating high efficiency in shock identification, indicating that the model can distinguish positive and negative samples with high accuracy and recall rate. In regression tasks, the MS-TimeXer-MoE model's mean absolute error (MAE) was 3.4397, mean squared error (MSE) was 8.2735, mean absolute percentage error (MAPE) was 5.9933%, and the coefficient of determination (R²) reached 87.3436%, showing good fitting and accuracy in time-series data prediction. In the five-fold cross-validation experiment, the variances of MAE and MSE were 0.031 and 0.174, respectively, further reflecting the model's low error fluctuation across different folds, ensuring accurate prediction of shock occurrence time.</p><p><strong>Conclusion: </strong>Compared to existing mainstream modeling methods for predicting shock occurrence, the MS-TimeXer-MoE model can more accurately predict the occurrence of hemorrhagic shock in trauma patients.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"222"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228331","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 the O-arm-based navigation system with conventional fluoroscopy for percutaneous screw fixation in patients with fragility fractures of the pelvis.","authors":"Masaya Mizutani, Toshiaki Kotani, Ryo Ogawa, Sei Yano, Shunji Kishida, Shun Okuwaki, Shuhei Ohyama, Yosuke Ogata, Yasushi Iijima, Tsuyoshi Sakuma, Sumihisa Orita, Kazuhide Inage, Yasuhiro Shiga, Shohei Minami, Seiji Ohtori","doi":"10.1007/s00068-025-02901-y","DOIUrl":"10.1007/s00068-025-02901-y","url":null,"abstract":"<p><strong>Purpose: </strong>Fragility fractures of the pelvis (FFPs) are increasingly common owing to aging populations of several countries and the increasing osteoporosis incidence. Surgical interventions, including percutaneous screw fixation, are performed to avoid complications associated with prolonged bed rest for FFP management. However, conventional fluoroscopy for surgical navigation is difficult owing to issues such as insufficient tissue imaging, difficulty achieving accurate screw placement, and high radiation exposure to surgeons. This study aimed to compare the effectiveness of the O-arm-based navigation system with that of conventional fluoroscopy for percutaneous screw fixation in patients with FFPs, focusing on surgical outcomes, radiation exposure, and screw-placement accuracy.</p><p><strong>Methods: </strong>This retrospective multicenter study was conducted between April 2020 and May 2024. Seventy-two patients with FFPs were divided into two groups: O-arm (O, n = 14) and the conventional fluoroscopy (C, n = 58) groups. Primary evaluation parameters were radiation exposure and screw-placement accuracy. Demographic and surgical data, including surgery duration and intraoperative blood loss, were collected for secondary evaluation.</p><p><strong>Results: </strong>There was no significant differences in demographic data between groups. Surgeon radiation exposure was lower in the O group (0.1-0.2 µSv) than in the C group (mean exposure: 109.8 ± 61.3 mGy). The screw-perforation rate was lower in the O group (5.7%) than in the C group (20%). No patients in the O group required reoperation; however, three patients in the C group did.</p><p><strong>Conclusion: </strong>Compared with conventional fluoroscopy, the O-arm-based navigation system improves screw-placement accuracy and significantly reduces surgeon radiation exposure.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"221"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201309","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":"Ultrasound-guided closed reduction of distal radius Salter-Harris I and II fracture in children.","authors":"Xing Wu, Xijun Meng, Si Wang, Xiantao Shen","doi":"10.1007/s00068-025-02889-5","DOIUrl":"10.1007/s00068-025-02889-5","url":null,"abstract":"<p><strong>Background: </strong>Distal radial physeal fractures are the most common type of physeal fracture. However, few studies have been dedicated to the role of ultrasound-guided closed reduction in these fractures. This study aimed to investigate the utility of ultrasound-guided closed reduction in paediatric distal radial physeal fractures.</p><p><strong>Methods: </strong>Consecutive patients undergoing ultrasound-guided closed reduction of fractures in our department between November 2017 and October 2019 were included. The adequacy of realignment according to the ultrasound and radiography was recorded.</p><p><strong>Results: </strong>A total of 51 patients were included in the study. Closed reduction was successfully achieved in all cases who underwent ultrasound-guided cases. The sensitivity for confirming successful anatomical manipulation with ultrasound was 95.3% (95% CI: 82.9 ~ 99.2%), while the specificity was 87.5% (95% CI: 46.7 ~ 99.3%). The positive predictive value (PPV) was 97.6% (95% CI: 85.9 ~ 99.9%), and the negative predictive value (NPV) was 77.8% (95% CI: 40.2 ~ 96.1%). The corresponding positive and negative likelihood ratios were 7.63 (95% CI: 1.22 ~ 47.77) and 0.05 (95% CI: 0.01 ~ 0.21). There was a high level of agreement between ultrasound and radiographs assessments of anatomical reduction [κ: 0.788 (± 0.117)]. Redisplacement occurred in three cases (5.9%) based on radiographic assessment with one case being a Salter-Harris type I injury and two cases being a Salter-Harris type II injury. At the final follow-up, all fractures had healed, resulting in excellent cosmesis without any other complications.</p><p><strong>Conclusions: </strong>Our data suggest that ultrasound-guided closed reduction can be considered an excellent alternative method for the treatment of distal radial physeal fractures.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"220"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164621","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":"Association between fibrinogen levels and prognosis in critically bleeding patients: exploration of the optimal therapeutic threshold.","authors":"Bingkui Ren, Yuping Zhang, Siying Chen, Jinglong Dai, Junci Chong, Zhigang Chang","doi":"10.1007/s00068-025-02886-8","DOIUrl":"10.1007/s00068-025-02886-8","url":null,"abstract":"<p><strong>Background: </strong>Severe bleeding is a leading cause of ICU admission and mortality. Fibrinogen plays a crucial role in prognosis, yet optimal thresholds and supplementation targets remain unclear.</p><p><strong>Method: </strong>Patients with major bleeding were extracted from the MIMIC-IV database. Restricted cubic splines (RCS) identified the optimal pre-treatment fibrinogen threshold, and propensity score matching adjusted for confounders. Multiple analytical methods, including multivariable regression and machine learning models, were applied. Post-treatment fibrinogen levels were stratified based on guideline recommendations, and Cox regression assessed survival outcomes.</p><p><strong>Results: </strong>Among 7,063 patients (6,666 survivors, 397 non-survivors), RCS analysis revealed a nonlinear relationship between pre-treatment fibrinogen and ICU mortality (P-non-linear < 0.001), with a threshold at 1.3 g/L. Patients with Fib > 1.3 g/L had a significant 28-day survival benefit (OR = 0.65, 95% CI: 0.48-0.87, p < 0.01). Post-treatment stratification showed that fibrinogen ≥ 1.3 g/L was associated with improved survival (p < 0.01). RCS analysis identified an optimal post-treatment target of 2.0-2.5 g/L.</p><p><strong>Conclusion: </strong>Fibrinogen levels are predictive of ICU outcomes in massive hemorrhage. A pre-treatment threshold of 1.3 g/L indicates poor prognosis, while post-treatment levels of 2.0-2.5 g/L may optimize survival.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"219"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130038","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":"Sulforaphane regulates hepatic autophagy and apoptosis by modulating Kupffer cells' polarization via Nrf2/HO-1 pathway in the murine hemorrhagic shock/resuscitation model.","authors":"Kang Qin, Weiqiang Liang, Athanassios Fragoulis, Weining Yan, Xing Zhang, Qun Zhao, Chunxia Ma, Zhizhen He, Eva Miriam Buhl, You Li, Johannes Greven","doi":"10.1007/s00068-025-02890-y","DOIUrl":"https://doi.org/10.1007/s00068-025-02890-y","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to explore how sulforaphane (SFN), a well-known nuclear factor erythroid 2-related factor 2 (Nrf2) pathway activator, regulates hepatic autophagy and apoptosis by modulating the polarization of Kupffer cells via the Nrf2/HO-1 pathway in a hemorrhagic shock/resuscitation (HS/R) model in mice.</p><p><strong>Methods: </strong>Male c57/BL6 mice were subjected to hemorrhagic shock (HS) for 90 min under blood pressure control. Resuscitation was performed by reinfusing the withdrawn blood and infusing 0.9% NaCl, and SFN was administered intraperitoneally. All animals were euthanized 24 h after resuscitation, and liver tissue samples were collected for TUNEL staining, western blot analysis, immunohistochemical staining, immunofluorescence staining, and observation using transmission electron microscopy (TEM). Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) was performed to verify the SFN distribution in the liver.</p><p><strong>Results: </strong>SFN reached the liver within the first hour after it was injected. SFN was found to promote the hepatic Nrf2/HO-1 pathway and the polarization of Kupffer cells to the M2 phenotype rather than the M1 phenotype after HS/R. Furthermore, SFN inhibited hepatic apoptosis after HS/R, as demonstrated by a decrease in the Bax/Bcl-2 ratio, fewer TUNEL-positive cells, and changes in cleaved caspase 3 expression. Enhanced hepatic autophagy was observed after HS/R, as shown by an increase in the number of autophagosomes, a higher LC3-II/LC3-I ratio, and decreased expression of p62 and beclin-1.</p><p><strong>Conclusions: </strong>In this study, SFN administration inhibited hepatic apoptosis and promoted hepatic autophagy by inducing Kupffer cells to polarize to the M2 phenotype rather than the M1 phenotype via the Nrf2/HO-1 pathway.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"218"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130055","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":"Development and description of a porcine model of combat casualty care for traumatic-hemorrhagic shock research and medical training.","authors":"Venetia Cardona, Frédérique Dufour-Gaume, Florent Montespan, Audrey Bordone, Nicolas J Prat","doi":"10.1007/s00068-025-02892-w","DOIUrl":"https://doi.org/10.1007/s00068-025-02892-w","url":null,"abstract":"<p><strong>Purpose: </strong>Despite the high incidence of death among cases of hemorrhagic shock associated with polytrauma, few animal models are representative of this combined type of aggression, as most essentially reproduce soft tissue injury. To improve trauma research and its applicability to battlefield situations, appropriate animal models simulating battlefield trauma care must be defined. As anesthesia itself influences physiological and hemodynamic variables, we studied three different types of anesthesia, ketamine-midazolam (KM), isoflurane (ISO), and alfaxalone (ALFA), in a porcine model of combat-related hemorrhagic shock injury.</p><p><strong>Methods: </strong>A total of 19 pigs were randomized to the KM (n = 5), ISO (n = 6), and ALFA (n = 8) groups and subjected to a hemorrhagic shock associated with bilateral femoral fractures and delayed resuscitation.</p><p><strong>Results: </strong>The combined traumatic insult with severe hemorrhage resulted in characteristic signs of severe shock. The KM and ISO groups were representative of the hemodynamic perturbation of hemorrhagic shock, whereas the ALFA group showed signs of low tolerance, with extreme and persistent tachycardia even after resuscitation.</p><p><strong>Conclusions: </strong>We concluded that ALFA was not the most suitable anesthetic for our hemodynamically compromised model and that KM or ISO were two relevant anesthesia regiments to study traumatic-hemorrhagic shock in pigs. However, KM was the most clinically relevant to medical practices in prehospital medical care or an austere environment.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"215"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121681","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":"Locking pegs versus locking screws in volar plating of distal radius fractures.","authors":"Nicole M van Veelen, Matija Horvat, Björn-Christian Link, Bryan J M van de Wall, Frank J P Beeres","doi":"10.1007/s00068-025-02876-w","DOIUrl":"10.1007/s00068-025-02876-w","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to compare the radiological outcome of patients with distal radius fractures stabilized with a volar plate using either locking screws or pegs.</p><p><strong>Material & methods: </strong>For this retrospective study all adult patients that received volar plating of a distal radius fracture at a trauma center between 06/2019 and 06/2022 were eligible for inclusion. Only patients who received an implant allowing both locking pegs and screws were included. Primary outcome was radiological loss of reduction at the 6-week and at the 12-month follow-up. Secondary outcomes were duration of surgery, implant removal, fracture union and complications.</p><p><strong>Results: </strong>Fourty-nine patients treated with pegs and 39 with screws were included. Patient demographics were comparable, however there were more complex fractures in the peg group. There was no significant difference in the occurrence of radiological loss of reduction between the groups at 6 weeks or 12 months (p = 1). Patients treated with pegs were more frequently operated upon by experienced surgeons while screws were more often used by more junior staff. The duration of surgery was longer for patients who received screws (p = 0.003). Union was achieved in all fractures for which a 12-month x-ray was available. There was no significant difference in implant removal rate or other complications.</p><p><strong>Conclusions: </strong>Regarding secondary loss of reduction both locking pegs and screws show similar results. Considering the potential benefits of pegs, such as the smooth surface which may reduce the risk of joint penetration, pegs are a viable alternative to screws.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"217"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129965","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":"Validation of the emergency surgery score's predictive accuracy for postoperative outcomes and ICU admissions in MENA vs. non-MENA emergency surgery patients.","authors":"Mohamed Said Ghali, Samer A Hasan, Ahmad R Al-Qudimat, Mohammed Alabidi, Omar S Moustafa, Raed M Al-Zoubi","doi":"10.1007/s00068-025-02888-6","DOIUrl":"10.1007/s00068-025-02888-6","url":null,"abstract":"<p><strong>Background: </strong>The Emergency Surgery Score (ESS) has demonstrated strong predictive value for morbidity, mortality, and long-term survival outcomes. However, its applicability and validity in the Middle East and North Africa (MENA) region remain understudied. This research seeks to validate ESS's ability to predict postoperative outcomes, including 30-day mortality, complications, and ICU admissions, among patients undergoing emergency laparotomies (EL).</p><p><strong>Methods: </strong>This retrospective study analyzed 230 EL cases from 2017 to 2021. ESS scores were calculated for each patient, and its predictive accuracy was compared with the American Society of Anesthesiologists (ASA) classification using c-statistic methodology. We also compared postoperative outcomes between MENA and non-MENA cohorts to assess potential regional variations in ESS performance.</p><p><strong>Results: </strong>Out of 230 patients, 118 were from MENA and 112 from non-MENA regions. Sepsis was the most common diagnosis (69.6%). ICU admission was recorded in 63.4% of cases, and the 30-day mortality rate was 13.91%. ESS scores did not differ significantly between MENA and non-MENA patients (median: 7.5 vs. 7; P = 0.45). ESS outperformed ASA in predicting postoperative outcomes: complications (c-statistic: 0.79 vs. 0.73), ICU admissions (0.81 vs. 0.76), and mortality (0.86 vs. 0.78). Optimal ESS cutoffs for complications, ICU need, and mortality were 6, 8, and 10, respectively. ESS performed similarly across both MENA and non-MENA populations in predicting mortality, complications, and ICU admissions.</p><p><strong>Conclusion: </strong>The ESS is a superior tool compared to ASA for predicting postoperative outcomes in emergency surgical patients, and it is applicable to diverse populations, including those from the MENA region. ESS enhances preoperative risk stratification, informs counseling decisions, and supports quality benchmarking across different healthcare settings. Future studies should address potential biases, including selection and information bias, and further explore ESS's role in different cultural contexts.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"216"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121674","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":"Outcome of femoral fractures treated with cerclages and intramedullary nailing.","authors":"Franziska Ziegenhain, Claudio Canal, Sascha Halvachizadeh, Anne Mittlmeier, Hans-Christoph Pape, Christian Hierholzer, Valentin Neuhaus","doi":"10.1007/s00068-025-02883-x","DOIUrl":"10.1007/s00068-025-02883-x","url":null,"abstract":"<p><strong>Introduction: </strong>Femoral shaft fractures are a common entity in trauma surgery. The gold standard is closed reduction and intramedullary nailing. However, in some fracture patterns, the surgeon may choose to open the fracture for reduction. The purpose of this retrospective study was to analyze the outcome of femoral shaft fractures treated with open reduction, cerclage wiring and intramedullary nailing.</p><p><strong>Methods: </strong>We included adult patients with femoral shaft fractures treated with open reduction, cerclage wiring and intramedullary nailing at a level 1 trauma center in Switzerland during an 11-year period. The data collection was conducted retrospectively. Patient characteristics including age, sex and existing comorbidities were analyzed. Detailed information regarding the fracture patterns and surgical procedures was recorded. Outcome measures included the rates of malunion and nonunion, the time required for union, incidence of surgical site infections, and the frequency of revision surgeries.</p><p><strong>Results: </strong>We included a total of 69 patients, comprising 48 males and 21 females with a mean age of 50 years. A majority suffered a high velocity trauma (67%). The most common fracture type was multifragmentary subtrochanteric fracture. Approximately 57% of the patients underwent definitive surgical care within the first 24 h. Number of cerclages applied ranged from 1 to 4, with 18% positioned above the lesser trochanter. Delayed union occurred in 10% of cases, while nonunion was noted in 19% of patients. Complications included femoral head necrosis in 3 (4%) patients, and surgical site infections were documented in 3 (4%) cases.</p><p><strong>Conclusion: </strong>Our findings give rise to closed reduction and internal fixation as a treatment of choice of femoral shaft fractures. We suggest the use of ORIF combined with cerclages, if closed reduction cannot be sufficiently achieved. However, a risk-benefit ratio should be assessed to minimize the risk of a higher complication rate with the use of ORIF.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"211"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113244","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}