Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Development of a cost-effective osteoporosis risk scoring system for early detection in low-resource settings: A community-based approach","authors":"Muhammad Muzzammil ,&nbsp;Muhammad Owais Minhas ,&nbsp;Amna Jamil","doi":"10.1016/j.jcot.2025.103018","DOIUrl":"10.1016/j.jcot.2025.103018","url":null,"abstract":"<div><h3>Background</h3><div>Osteoporotic fractures pose a significant public health burden, particularly in resource-constrained settings where diagnostic tools like DXA scans are unavailable. This study aimed to develop and validate a simple, community-based osteoporosis risk scoring system that incorporates demographic, clinical, and radiographic parameters to identify high-risk individuals for early intervention.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted in Karachi, Pakistan, involving 750 participants aged 40 years and above. Data on demographic characteristics, clinical risk factors, and lifestyle habits were collected using a structured questionnaire. Radiographic assessments identified vertebral compression fractures, generalized osteopenia, and trabecular bone loss. Participants were stratified into four risk categories: low, moderate, high, and very high risk. The predictive validity of the scoring system was evaluated using logistic regression and receiver operating characteristic (ROC) curve analysis.</div></div><div><h3>Results</h3><div>The developed tool classified participants into low (38 %), moderate (32 %), high (20 %), and very high (10 %) risk groups. Fracture incidence ranged from 11.29 % in the low-risk group to 28.23 % in the very high-risk group. The scoring system demonstrated strong predictive accuracy, with a sensitivity of 83 %, specificity of 75 %, and an area under the curve (AUC) of 0.82. Odds ratios for fractures progressively increased with higher risk categories, confirming the model's validity.</div></div><div><h3>Conclusion</h3><div>This Muzzammil's osteoporosis risk scoring system is a cost-effective and practical tool for early identification of high-risk individuals in low-resource settings. Its implementation could aid in targeted prevention strategies, reducing osteoporotic fracture incidence and improving public health outcomes. Further validation in diverse populations is recommended to optimize its utility.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"65 ","pages":"Article 103018"},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912991","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":"Finite element analysis of sliding vs static configuration of partial threaded cannulated compression screws for Pauwels type III fracture neck of femur","authors":"Amit Kumar ,&nbsp;Somesh Kumar ,&nbsp;Ajeet Kumar ,&nbsp;Kumar Keshav ,&nbsp;Anurag Baghel ,&nbsp;Pulak Sharma","doi":"10.1016/j.jcot.2025.103024","DOIUrl":"10.1016/j.jcot.2025.103024","url":null,"abstract":"<div><h3>Background</h3><div>Cannulated Cancellous Screws fixation is done either as a sliding or static configuration according to the number, thread length and orientation of the screws. This study aims to compare the biomechanical properties of 3-CCS as sliding configuration and BDSF &amp; 4-CCS (Alpha configuration) as static configuration, by finite element analysis for Pauwels type III fracture neck of femur.</div></div><div><h3>Methods</h3><div>DICOM format images of saw-bone were used to build the 3-D geometric models, which were hypermeshed to create models of Pauwels type III FNF with an angle of 65°. CAD models of three configurations were created as per AO specifications and analysed for stress distribution of bone &amp; implant, relative displacement between fracture planes &amp; stiffness.</div></div><div><h3>Results</h3><div>The peak stress at the fracture surface was found to be low in 4-CCS, which promotes fracture healing. 4-CCS had a decreased chance of failure due to lower implant stress and fracture surface displacement, indicating improved length stability. Overall, 4-CCS had the maximum construct stiffness, indicating a stable and rigid fixation.</div></div><div><h3>Conclusion</h3><div>The static configuration of 4-CCS showed superior biomechanical properties in terms of low stress of bone &amp; implant, and lower relative displacement of the fracture surface with high construct stiffness over other configurations. So, 4-CCS (Alpha configuration) should be the preferred configuration for the Pauwels type III FNF.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103024"},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868633","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 management for distal phalanx osteomyelitis: A narrative review","authors":"J. Terrence Jose Jerome ,&nbsp;Arun Kumar ,&nbsp;Dr Mauli Chandar","doi":"10.1016/j.jcot.2025.103021","DOIUrl":"10.1016/j.jcot.2025.103021","url":null,"abstract":"<div><div>Distal phalanx osteomyelitis, although rare, represents a challenging infection that can have devastating functional and cosmetic consequences if inadequately managed. In patients with comorbidities—most notably diabetes mellitus—the infection may progress rapidly, causing bone destruction, soft tissue involvement, and ultimately, joint destruction. This review discusses the pathophysiology, diagnosis, and surgical management of distal phalanx osteomyelitis. It also highlights key gaps in the current literature, particularly the lack of standardized treatment protocols and limited long-term outcome data, aiming to provide a more consolidated approach to this complex condition. Drawing on current literature and our clinical experience, we outline indications and contraindications for surgery, evaluate imaging modalities and diagnostic criteria, describe detailed surgical techniques (including debridement, dead space management, and reconstruction), and examine the role of antibiotic therapy. We also propose a surgical algorithm based on the extent of infection and review potential complications and outcomes. The article emphasizes that early recognition and aggressive surgical management—coupled with culture-directed antibiotics—are key to optimizing hand function and preventing recurrence.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103021"},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864375","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":"Influence of femoral component downsizing on knee extension and resultant extension gap in TKA","authors":"Anoop Jhurani,&nbsp;Piyush Agarwal,&nbsp;Gaurav Ardawatia,&nbsp;Hardik Sahni,&nbsp;Mudit Srivastava","doi":"10.1016/j.jcot.2025.103023","DOIUrl":"10.1016/j.jcot.2025.103023","url":null,"abstract":"<div><h3>Background</h3><div>Downsizing of femur is often considered during TKA to increase the flexion space or to reduce the mediolateral overhang of the femoral component. This leads to an obvious opening up of flexion space by 2–3 mm. However, the effect of downsizing of the femur component on knee extension and final sagittal correction are unknown. This CAS based prospective study aims to find out change in knee extension caused as a result of downsizing the femur component through objective data from computer navigation.</div></div><div><h3>Methods</h3><div>Out of a total 1811 CAS knees operated between 2020 and 2022. 152 knees required downsizing of which 112 knees were included after applying exclusion criteria. The patients had average BMI of 28.2 ± 4.6 kg/m and average age of 62.5 ± 8 years.</div></div><div><h3>Results</h3><div>The average preoperative deformity was fixed flexion of 7.7 ± 4.3 (0.5–14) and varus of 8.6 ± 2.7 (3–13). The average difference of deformity in sagittal plane in extension between larger and downsized femur trial was 5.8° which was statistically significant (p = 0.001). Knee achieves more extension after downsizing possibly because of decrease in metallic volume in the joint capsule and soft tissue envelope. There was significant correction in coronal plane alignment (1°) on downsizing as the soft tissue envelope on the medial side relaxed due to decreased impingement (p = 0.001).</div></div><div><h3>Conclusion</h3><div>Surgeons should be aware that downsizing of the femur may increase the knee extension by 5.8° and this can be a strategy to increase both gaps specially when there is significant mediolateral overhang of the femoral component.</div></div><div><h3>Level of evidence</h3><div>Type IV.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"65 ","pages":"Article 103023"},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912990","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":"Hemi-capitate arthroplasty for chronic unstable dorsal fracture-dislocations of the proximal interphalangeal joint: A retrospective analysis of functional and radiological outcomes","authors":"J. Terrence Jose Jerome","doi":"10.1016/j.jcot.2025.103020","DOIUrl":"10.1016/j.jcot.2025.103020","url":null,"abstract":"<div><h3>Background</h3><div>This retrospective study examined the clinical and radiological outcomes of hemi-capitate arthroplasty in treating chronic unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint.</div></div><div><h3>Methods</h3><div>Fifteen patients, aged 22–36 years, who underwent hemi-capitate arthroplasty for chronic unstable dorsal PIP joint fracture-dislocations between 2020 and 2022, were included in this review. Thirteen patients had nondominant hand involvement. Clinical outcomes were evaluated by assessing PIP joint range of motion (ROM), grip strength, pain using the Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. Radiographic evaluations focused on posttraumatic arthritis, graft integrity, and joint stability.</div></div><div><h3>Results</h3><div>The average time from injury to surgery was 79 days (range: 45–125 days), with a mean follow-up of 23 months (range: 18–36 months). At the final follow-up, the mean PIP joint ROM significantly improved from 3° preoperatively to 95° postoperatively (p &lt; 0.05), with a motion arc between 85° and 105°. The mean extension lag was 2° (range: 0°–10°). Postoperative grip strength reached 92 % (range: 78 %–100 %) of the contralateral hand. The QuickDASH score improved to a mean of 5.5 (range: 0–13.3), and mean pain score was low (mean VAS: 0.2, range: 0–4). Based on the Ishida and Ikuta scoring system, 13 patients had excellent outcomes. No patients developed postoperative osteoarthritis, graft collapse, donor-site problems, or wrist pain. Three patients had a mild extensor lag (approximately 10°), but all patients had returned to their previous activities by an average of 13 weeks (range: 11–16 weeks) after surgery.</div></div><div><h3>Conclusions</h3><div>Hemi-capitate arthroplasty consistently yielded positive functional and radiological outcomes in chronic unstable dorsal PIP joint fracture-dislocations. This technique effectively restores joint stability and a substantial range of motion, allowing patients to resume daily activities with few complications.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103020"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852119","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":"Characteristics of pelvic injuries in a health region of New Zealand","authors":"Anna Sayers ,&nbsp;Sheena Moosa ,&nbsp;Ishani Soysa ,&nbsp;Grant Christey","doi":"10.1016/j.jcot.2025.103022","DOIUrl":"10.1016/j.jcot.2025.103022","url":null,"abstract":"<div><h3>Background</h3><div>Pelvic fractures involve a high volume of patients with low injury severity yet they are rarely described in the literature despite placing a considerable burden on hospital resources. This study aims to describe the demographics, mechanisms of injury, management and outcomes in patients who sustained pelvic trauma of all severities in a health region in New Zealand.</div></div><div><h3>Methods</h3><div>A retrospective analysis of Te Manawa Taki Trauma Registry data between January 1, 2014 and December 31, 2023 was conducted. Included are patients admitted to hospital with injuries to the pelvic ring and/or acetabula classified with the Abbreviated Injury Scale.</div></div><div><h3>Results</h3><div>A total of 3163 events were recorded and 53.5 % sustained severe pelvic injuries. The mean age was 45.9 years, 52 % male and 83.2 % non-Māori. The incidence throughout the study period averaged 33.7 per 100,000; however, in the final 3 years, the average incidence decreased to 25.9. Incidents most commonly occurred on streets/highways (46.5 %) and in the home (24.6 %). The mechanism of injury was blunt in 99.5 % of cases. Of the total, 76 % involved the pelvic ring, while 23.8 % were acetabular injuries. Additionally, 2.1 % of injuries were open. Posterior arch disruption was seen in 54 % of pelvic ring fractures, with 6.1 % showing complete disruption. The overall mortality rate for trauma admissions was 1.1 %, and 53.6 % of these patients had concurrent pelvic injuries. The case fatality rate of patients with pelvic injuries was 4.96 %. The mean length of stay was 12.1 days.</div></div><div><h3>Conclusion</h3><div>Pelvic fractures of different severities are frequently associated with high energy mechanisms of injury and represent a significant burden on patients, their families/whānau and healthcare services. Clear preventative measures and care pathways are needed to reduce incidence and minimise morbidity and mortality.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103022"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924710","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":"Anatomic MPFL reconstruction with Gracillis autograft using all suture anchors","authors":"Rahul Grover,&nbsp;Jaskaran Singh,&nbsp;Skand Sinha","doi":"10.1016/j.jcot.2025.103016","DOIUrl":"10.1016/j.jcot.2025.103016","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103016"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854899","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":"Management and clinical outcomes of Dubberley type A capitellar fractures","authors":"Prateek A. Saxena ,&nbsp;Abhinandan Kotian ,&nbsp;Faris Ali ,&nbsp;Tamara Mertz ,&nbsp;Andrew P. Dekker ,&nbsp;Neil Ashwood","doi":"10.1016/j.jcot.2025.102926","DOIUrl":"10.1016/j.jcot.2025.102926","url":null,"abstract":"<div><h3>Aims</h3><div>Capitellar fractures are uncommon, accounting for 0.5–1 % of all elbow fractures. These fractures are best managed surgically to restore articular congruity. Dubberley type A fractures treated with anterolateral or lateral surgical approaches have been associated with high complication rates. The ‘Global’ approach to elbow has been conceptualised in order to comprehensively approach elbow injuries. The aim of this study was to evaluate the clinical outcomes of fractures of the capitellum treated using global surgical approach.</div></div><div><h3>Methods</h3><div>Data was prospectively collected for all patients presenting between 1998 and 2020.Patient's demographics, mechanism of injury, Mayo Elbow Performance Index MEPI, Grip Strength and radiographs were retrospectively collected and analysed.</div></div><div><h3>Results</h3><div>31 patients met the inclusion criteria with a mean age of 47yrs (IQR 12–81yrs) years, 18 males: 13 female patients. According to Dubberley classification, 24 were type I, 5 were type II and 2 were type III. 4 patients sustained associated collateral ligament injuries and 2 patients had radial head fractures. Global approach with an inside Kaplan approach was used in 26 patients, others were treated with an inside Kocher or anterior approaches. Almost all fractures were fixed using headless screws alone (n = 25),6 patients had fixation augmented with bioabsorbable rods or a posterior buttress plate. Mean follow up was 46 months. Mean MEPI was 89 (SD8), Extension 9.35 ± 5.32, Flexion 130.29 ± 8.7, Pronation 59.16 ± 7.034, Supination 63.97 ± 7.1. Mean Grip strength was 22.94 ± 4.5. These were significantly better following surgery (p &lt; 0.001). Further surgery was only required in 1 case for stiffness. Overall complication rate was 9.6 %. There were no infections or cases of instability following fixation.</div></div><div><h3>Conclusion</h3><div>This study is one of the largest case series reporting good functional outcomes in Dubberley type A fractures treated with headless screws using global surgical approach. We report lowest complication rate,100 % fracture union rate and good MEPI scores.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 102926"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900023","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":"Advancing spinal care excellence: A specialized training series for trauma nurse practitioners","authors":"Sari Wathiq Al Hajaj ,&nbsp;Karthic Swaminathan ,&nbsp;K.C. Mohan ,&nbsp;Hameed Malik ,&nbsp;Girish Swamy ,&nbsp;Sriram Harish Srinivasan","doi":"10.1016/j.jcot.2025.103019","DOIUrl":"10.1016/j.jcot.2025.103019","url":null,"abstract":"<div><h3>Background</h3><div>Trauma nurse practitioners (TNPs) play an essential role in trauma and orthopaedic care domains. Their contributions extend beyond the mere provision of patient care; they also serve to mitigate physician shortages. TNPs deliver comprehensive post- and pre-operative care and assist patients in their healing process, from the initial stages following fractures through to the various stages of treatment. This study focuses on developing a teaching series to improve their knowledge and skills in managing spine trauma. <strong>Materials and methods</strong>: We developed a structured educational program integrating theoretical instruction, interactive workshops, and practical sessions. The curriculum encompasses spinal anatomy, injury assessment, radiological imaging, and management strategies. Following these sessions, we gathered feedback through surveys to evaluate participants' confidence, knowledge enhancement, and overall satisfaction.</div></div><div><h3>Results</h3><div>A thorough statistical analysis of the collected surveys revealed a significant enhancement in TNP confidence, as indicated by a P value of 7.45 × 10⁻⁹, thus confirming the effectiveness of the training program. Approximately 82 % of respondents reported a considerable increase in their knowledge, while 85 % indicated that the outcomes of these sessions met their expectations. Furthermore, a substantial majority of participants, 96 %, expressed a desire for additional education and training.</div></div><div><h3>Conclusion</h3><div>The educational series has enhanced the confidence and expertise of Trauma Nurse Practitioners (TNPs) in managing spinal trauma. Our findings underscore the importance of implementing structured training programs to maximise TNPs' contributions, improve patient care, and reduce the burden on orthopaedic surgeons. Future research may investigate the long-term impacts, broaden training, and incorporate additional topics. Ultimately, this underscores the significance of continuous education for orthopaedic nursing.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103019"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852118","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":"Time-related predictors for adverse events in polytrauma patients undergoing stand-alone definitive surgery","authors":"Philipp Vetter,&nbsp;Cédric Niggli,&nbsp;Jan Hambrecht,&nbsp;Hans-Christoph Pape,&nbsp;Ladislav Mica","doi":"10.1016/j.jcot.2025.103017","DOIUrl":"10.1016/j.jcot.2025.103017","url":null,"abstract":"<div><h3>Background</h3><div>Timely triage is crucial for polytrauma patients. Those with lower injury severity and physiological stress typically undergo isolated definitive surgery, but predictors for adverse events (AEs) in this group remain unclear. This study aims to identify time-related predictors of AEs in polytrauma patients undergoing stand-alone definitive surgery, excluding damage control interventions.</div></div><div><h3>Methods</h3><div>We analyzed a trauma database spanning from 1996 to 2022, including 3653 patients. The focus was on individuals aged ≥16 years with an Injury Severity Score (ISS) ≥16 who underwent definitive orthopedic surgery. Injury and physiological parameters were recorded at admission and on the first and second days post-admission. Documented AEs included systemic inflammatory response syndrome (SIRS), sepsis, and mortality.</div></div><div><h3>Results</h3><div>Among the 276 patients (mean age: 45.0 years with confidence interval, CI, 42.7–47.2 years; 71.7 % male; median ISS: 27 with interquartile range: 20–34), the incidence of SIRS was 79 % (n = 218), sepsis 13.8 % (n = 38), and mortality 4 % (n = 11). Upon admission, severe head and facial injuries and elevated leucocyte count (LC) predicted SIRS. Predictors for sepsis included ISS, heart rate, pH, and prothrombin time (PT), while non-survivors were older, with more severe head injuries and lower base excess (BE). On day one, elevated lactate levels were noted in both septic patients and non-survivors; LC predicted sepsis. By day two, higher lactate persisted in both groups, with non-survivors also showing reduced BE and PT. Primary (admission day) and multiple surgeries correlated with SIRS, whereas delayed surgeries were associated with sepsis. No surgical factors were correlated with mortality.</div></div><div><h3>Conclusion</h3><div>Injury severity, physiological and surgical factors are associated with AEs in polytrauma patients undergoing definitive surgery. These findings with re-evaluation may help guide decision-making to minimize the risk of AEs.</div></div><div><h3>Level of evidence</h3><div>Cohort-study, Level of Evidence = III.</div></div><div><h3>Trial registration</h3><div>No. StV: 1-2008.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103017"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859660","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}