Injury-International Journal of the Care of the Injured最新文献

{"title":"Comparison of the RFN-advanced femoral nailing system versus locked lateral plating in the management of distal femur fractures: A matched-cohort analysis","authors":"William B. Gilbert ,&nbsp;Andres F. Moreno-Diaz ,&nbsp;Ridge Maxson ,&nbsp;Cade A. Morris ,&nbsp;Elsa Rodriguez-Baron ,&nbsp;Taylor M. Yong ,&nbsp;Nathaniel E. Schaffer ,&nbsp;William T. Obremskey ,&nbsp;Phillip M. Mitchell","doi":"10.1016/j.injury.2025.112442","DOIUrl":"10.1016/j.injury.2025.112442","url":null,"abstract":"<div><h3>Introduction</h3><div>Distal femur fractures are commonly managed with retrograde femoral nailing or locked lateral plating (LLP). As implant design has evolved, more distal and complex patterns are being treated with intramedullary implants. The aim of the present study was to compare early outcomes in distal femur fractures managed with the novel DePuy Synthes RFN-Advanced (RFNA) Retrograde Femoral Nailing System to a similar cohort treated with locked lateral plating.</div></div><div><h3>Patients and methods</h3><div>This is a retrospective cohort study of operative distal femur fractures that presented to our Level I trauma center over a 7-year period. We included patients with AO/OTA types 33A2–3, 33C1–2 fractures treated with either the RFNA or a lateral locked plate over two distinct time points. Injury radiographs were reviewed independently by three orthopedic traumatologists to include only cases deemed “nailable.” Primary outcomes included coronal and sagittal alignment. Secondary outcomes included nonunion, surgical site infection (SSI), and unplanned reoperation.</div></div><div><h3>Results</h3><div>We identified 107 patients treated with either the RFNA (<em>n</em> = 45) or LLP (<em>n</em> = 62) over the 7-year study period. No significant differences were identified in the rates of sagittal (2.2 % versus 9.7 %, <em>P</em> = 0.12) or coronal malalignment (2.2 % versus 0 %, <em>P</em> = 0.421). The nonunion rate was 8.9 % in the RFNA cohort versus 19.4 % in the LLP cohort, but this difference was not statistically significant (<em>P</em> = 0.174). We also found no difference in infection or implant failure between groups. Screw backout occurred in 8 RFNA patients (17.8 %), with 7 patients undergoing screw removal (15.6 %) either in clinic (<em>n</em> = 5) or the operating room (<em>n</em> = 2).</div></div><div><h3>Discussion and conclusions</h3><div>This matched cohort study demonstrated promising results comparing the RFNA to lateral plating of distal femur fractures. The nonunion rate of 9 % in the RFNA cohort adds to recent literature that supports improved union rates with intramedullary nailing of these fractures. Interlocking screw backout was the most common complication with RFNA treatment at a rate of 16 %, with the majority removed in clinic.</div></div><div><h3>Level of evidence</h3><div>Level III</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112442"},"PeriodicalIF":2.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Network meta-analysis of various surgical approaches for the treatment of posterolateral tibial plateau fractures","authors":"Peng Jiang ,&nbsp;Wenjie Chen ,&nbsp;Liang'en Feng","doi":"10.1016/j.injury.2025.112457","DOIUrl":"10.1016/j.injury.2025.112457","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to systematically compare the clinical efficacy and safety of different surgical approaches in the treatment of posterolateral tibial plateau fractures. Specifically, it evaluated operative time, intraoperative blood loss, fracture healing time, postoperative knee function, and complication rates, to provide evidence-based guidance for clinical surgical approach selection.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in seven major databases—CNKI, PubMed, Web of Science, Cochrane Library, Scopus, VIP, and EMBASE—from their inception to May 2025. Controlled studies comparing different surgical approaches for posterolateral tibial plateau fractures were included. Primary outcomes were operative time, intraoperative blood loss, fracture healing time, postoperative Hospital for Special Surgery (HSS) knee scores, and incidence of postoperative complications. A network meta-analysis was performed using Stata 16.0. A network diagram and league table were generated to present both direct and indirect comparisons among surgical approaches. Surface Under the Cumulative Ranking curve (SUCRA) values were used to rank the interventions. Study quality was assessed using the MINORS scale. Inconsistency testing and publication bias analysis were also conducted to ensure robustness of the results.</div></div><div><h3>Results</h3><div>A total of 26 studies involving 1864 patients and seven surgical approaches were included. The network meta-analysis showed that the Modified Extended Anterolateral Approach (MEALA) ranked highest across all primary outcomes: operative time (SUCRA: 97.8 %), intraoperative blood loss (94.9 %), fracture healing time (95.0 %), postoperative HSS score (98.2 %), and complication rate (78.5 %). Additionally, the Transfibular Head Approach (TFHA) demonstrated advantages in minimizing intraoperative blood loss and controlling complications. No significant inconsistency or publication bias was detected based on node-splitting analysis and funnel plot assessment, indicating robust results.</div></div><div><h3>Conclusion</h3><div>The Modified Extended Anterolateral Approach demonstrates superior overall performance in the treatment of posterolateral tibial plateau fractures, particularly in reducing operative time, minimizing intraoperative trauma, and enhancing postoperative functional recovery. The Transfibular Head Approach also shows potential benefits in complication management. Surgical approach selection should be individualized based on fracture morphology and surgeon experience. Further high-quality randomized controlled trials are warranted to validate these findings.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112457"},"PeriodicalIF":2.2,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144177727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisional scaphoid reconstruction for failed screw fixation of scaphoid fractures via the hand trauma plate system","authors":"Bin Li,&nbsp;Wenyao Zhong,&nbsp;Dongning Huang,&nbsp;Li Zhuo,&nbsp;Shanlin Chen,&nbsp;Yang Guo","doi":"10.1016/j.injury.2025.112455","DOIUrl":"10.1016/j.injury.2025.112455","url":null,"abstract":"<div><h3>Objective</h3><div>Surgical treatment of scaphoid nonunion after failed screw fixation is a unique challenge for hand surgeons. This retrospective study evaluated the clinical results of revisional reconstruction by a hand trauma plate system with bone grafting for this situation.</div></div><div><h3>Methods</h3><div>From 2019 to 2022, 12 patients with scaphoid nonunion after failed closed or open reduction and internal fixation surgery were treated with revisional surgery using a 1.7-mm nonlocking hand trauma plate system. Pure cancellous bone was harvested from the iliac crest or olecranon of the patient to fill the bony defect between the proximal and distal segments of the fracture. Visual analog scale scores and functional outcomes were assessed after at least 2 years of follow-up.</div></div><div><h3>Results</h3><div>We used computed tomography (CT) to assess the union, and all fractures healed. The mean interval between primary and definitive surgery was 14.4 (range, 6–36) months. The mean follow-up period was 43.4 (range, 27–72) months. The mean union time was 11 (range, 8–16) weeks. The clinical outcomes included active wrist range of motion (67.2 % ± 16.4 % vs. 82.9 % ± 12.0 %, <em>P</em> = 0.002), visual analog scale score (5.0 ± 1.3 vs. 2.3 ± 1.2, <em>P</em> &lt; 0.001), grip strength (69.4 % ± 11.3 % vs. 88.5 % ± 16.6 %, <em>P</em> &lt; 0.001), and modified Mayo wrist score (51.7 ± 16.1 vs. 71.7 ± 8.9, <em>P</em> &lt; 0.001). Three patients complained of clicking at the volar part of the wrist joint, which was resolved by plate removal.</div></div><div><h3>Conclusion</h3><div>A hand trauma plate system can be used to stabilize the scaphoid fracture nonunion in the treatment of failed screw fixation for scaphoid waist fractures. Hardware removal may be considered if impingement symptoms persist after fracture healing.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112455"},"PeriodicalIF":2.2,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144177598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for extensor pollicis longus tendon rupture following non-displaced distal radius fractures","authors":"Taichi Saito ,&nbsp;Tomoki Furutani ,&nbsp;Ryo Nakamichi ,&nbsp;Ryuichi Nakahara ,&nbsp;Hidenori Kondo ,&nbsp;Yasunori Shimamura ,&nbsp;Junya Imatani ,&nbsp;Toshifumi Ozaki","doi":"10.1016/j.injury.2025.112454","DOIUrl":"10.1016/j.injury.2025.112454","url":null,"abstract":"<div><h3>Introduction</h3><div>Distal radius fractures (DRFs) are common, with an increasing incidence, particularly among the elderly. Rupture of the extensor pollicis longus (EPL) tendon, essential for thumb extension, is a notable complication, especially in non-displaced DRFs. Several mechanisms, such as local adhesion, ischemic atrophy, and tendon laceration, are associated with EPL tendon rupture. This multicenter retrospective study aims to identify risk factors for EPL tendon rupture in non-displaced DRFs.</div></div><div><h3>Materials and methods</h3><div>The study reviewed 20 cases of EPL tendon rupture and 52 control cases from 2005 to 2022, excluding those who underwent surgery or had incomplete computed tomography (CT) data. We investigated age, sex, location of fracture line, and the morphology of Lister’s tubercle as variables. Logistic regression and decision tree analyses were employed to determine the risk factors for EPL tendon rupture based on these variables.</div></div><div><h3>Results</h3><div>Fracture lines distal to Lister’s tubercle and specific shapes of Lister’s tubercle, characterized by shallow peak height and a higher radial peak than the ulnar peak, increased the risk of EPL tendon rupture. Decision tree analysis confirmed them as major risk factors. There was a significant difference in the predicted probability rate of tendon rupture between the case with these factors and those without them (<em>P</em> &lt; 0.001). Conversely, the location and size of Lister’s tubercle did not affect the incidence of EPL tendon rupture.</div></div><div><h3>Conclusion</h3><div>The location of fracture line and the shape of Lister’s tubercle are key factors influencing EPL tendon rupture in non-displaced DRFs. Understanding these factors can help orthopedic surgeons predict and prevent EPL tendon ruptures, improving patient outcomes following these fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112454"},"PeriodicalIF":2.2,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should all unstable ankle fractures with a small posterior malleolar fracture have lateral, syndesmotic and posterior malleolar fixation?","authors":"Will Oliver,&nbsp;Joon Ha,&nbsp;Richard Buckley","doi":"10.1016/j.injury.2025.112453","DOIUrl":"10.1016/j.injury.2025.112453","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112453"},"PeriodicalIF":2.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-analysis of bone-filling mesh container versus percutaneous kyphoplasty for osteoporotic vertebral compression fractures","authors":"Bo Liu ,&nbsp;Guochao Jin ,&nbsp;Ke Zhang ,&nbsp;Zhenwei Sun ,&nbsp;Yonghong Zhang","doi":"10.1016/j.injury.2025.112451","DOIUrl":"10.1016/j.injury.2025.112451","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the pros and cons of percutaneous kyphoplasty (PKP) and bone-filling mesh containers (BFC) by means of a meta-analysis in the treatment of osteoporotic vertebral compression fractures (OVCFs).</div></div><div><h3>Materials and Methods</h3><div>A comprehensive search of Cochrane Library, PubMed, Embase, CNKI, Wanfang Database, and Chinese biomedical literature database was conducted to identify eligible clinical control studies comparing BFC versus PKP for OVCFs published until December 2022. Meta-analysis was performed utilizing Revman 5.3 to assess the effectiveness and safety of the two procedures.</div></div><div><h3>Results</h3><div>Thirteen clinical controlled trials with a total of 1025 patients were enrolled, including 487 in the BFC group and 538 in the PKP group. BFC significantly reduced operation time and bone cement leakage rates compared with PKP. No significant differences were found between the two groups in terms of VAS score, ODI score, and Cobb angle at short- and long-term follow-up.</div></div><div><h3>Conclusions</h3><div>Both BFC and PKP are effective surgical approaches for the treatment of OVCFs, with BFC having a shorter operative time and a lower incidence of cement leakage.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112451"},"PeriodicalIF":2.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-stage prosthetic dermal repair of skin defects in the donor area of the great toe nails flap","authors":"Lang-ye Liu ,&nbsp;Fan-shu Meng ,&nbsp;Song-gen Peng ,&nbsp;Cheng-ke Li ,&nbsp;Qiu-ling Lai ,&nbsp;Sheng-shan Li ,&nbsp;Min Liu ,&nbsp;Jun-ming Fu ,&nbsp;Jie-lai Yang ,&nbsp;Xiang Wu","doi":"10.1016/j.injury.2025.112450","DOIUrl":"10.1016/j.injury.2025.112450","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to evaluate the safety and efficacy of Pelnac artificial skin one-stage surgical direct repair of significant toenail flap donor area defects.</div></div><div><h3>Methods</h3><div>From March 2020 to May 2023, a total of 56 patients with traumatic finger injuries underwent reconstruction using a great toenail flap combined with iliac bone grafting, along with one-stage artificial skin repair of the great toenail flap. These patients were followed prospectively, and their clinical outcomes were systematically evaluated.</div></div><div><h3>Results</h3><div>The average follow-up was 13.4 months (3 to 30 months). The visual analog scale for pain was 0.23±0.6, and the Vancouver scar scale (VAS) was 2.82±1.06. Among 56 patients, only one case developed postoperative infections. The aesthetic satisfaction of the donor area of the patient's foot was 87.10±5.48 points (out of 100 points). Regarding the sensory recovery, the response “normal or near normal” was obtained in 44 patients (78.6 %). The maximum active mobility of the first metatarsophalangeal joint and the distal interphalangeal joint in the donor area was 66.51±7.38°and 43.21±4.62°, respectively.</div></div><div><h3>Conclusions</h3><div>Given its low donor-site morbidity and favorable cosmetic and functional outcomes, one-stage reconstruction of donor site defects using artificial dermis represents an effective and clinically viable treatment option.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112450"},"PeriodicalIF":2.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative approach to intramedullary nailing of the fibula: a technical note","authors":"Merel Visser ,&nbsp;Harm Hoekstra ,&nbsp;Leanne Blaas ,&nbsp;Robert Jan Derksen","doi":"10.1016/j.injury.2025.112445","DOIUrl":"10.1016/j.injury.2025.112445","url":null,"abstract":"<div><div>Traditionally unstable ankle fractures are surgically managed using open reduction and internal fixation (ORIF) with plate and screws. However, the operative management has gained an innovative technique. In the last decade, intramedullary (IM) nailing was introduced in local guidelines as a treatment for a selective group of elderly patients with compromised soft-tissues, as this technique is minimally invasive and less prone to wound complications including infections. Based on the authors’ experience with IM nailing of the fibula using an intramedullary locking fibula nail, common technical challenges are highlighted and tips and tricks are provided to achieve optimal anatomic reduction by optimizing the entry point of the nail. Furthermore, we introduce a flow-diagram for optimal anatomic reduction using a dorsolateral entry point for the nail.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112445"},"PeriodicalIF":2.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring venous thromboembolism (VTE) risk in patients with acute spinal cord injury (SCI)","authors":"Bibi Ayesha Bassa ,&nbsp;Valeria Lima Passos ,&nbsp;Jake McDonnell ,&nbsp;Theja Tijo ,&nbsp;Mark Breslin ,&nbsp;Fionnula Ní Ainle ,&nbsp;Joseph Butler ,&nbsp;Etimbuk Umana","doi":"10.1016/j.injury.2025.112439","DOIUrl":"10.1016/j.injury.2025.112439","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in patients with acute spinal cord injury (SCI). This study aimed to evaluate VTE incidence in patients with acute SCI and explore injury and management characteristics that may identify high-risk patients.</div></div><div><h3>Methods</h3><div>Retrospective review of consecutive patients with acute SCI ≥18 years admitted to the National Spinal Injuries Unit (NSIU) between January 2016 and December 2020 was conducted. Data were extracted from the NSIU database, internal picture archiving and communication system and hospital records. Primary outcome was VTE incidence. Latent Class Analysis (LCA) was used to identify subgroups of patients based on injury level, neurological impairment and operative management. Subgroups were linked to VTE outcomes using BCH-Adjusted Proportional Assignment correction and multiple logistic regression.</div></div><div><h3>Results</h3><div>1369 patients were included in the analysis. Mean age was 54 years (SD-20) with a male predominance (831/1369; 61 %). VTE incidence was 2.34 %(CI: 1.60 – 3.28)(32/1369). LCA identified three distinct subgroups: undifferentiated injury, multilevel injury, and thoracic-spine predominant injury. Significant differences in VTE rates were observed across the subgroups, with thoracic spine injury associated with the highest VTE risk. After adjustment, individuals with thoracic-spine injuries and severe neurological impairment had an almost 4-fold increase in the odds of developing VTE compared to those with other injury/management profiles.</div></div><div><h3>Conclusion</h3><div>This study highlights the importance of tailored VTE prevention strategies for patients with acute SCI based on injury and management characteristics. An individualized approached to VTE risk stratification and prevention is required in this group.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112439"},"PeriodicalIF":2.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed surgical fixation is associated with increased mortality in patients with distal femur fractures","authors":"Muhammad Umar Jawad ,&nbsp;Leeann M. Qubain ,&nbsp;Haroon M. Kisana ,&nbsp;J.Brock Walker ,&nbsp;Andrew P. Adamczyk ,&nbsp;Michael D. McKee ,&nbsp;Niloofar Dehghan","doi":"10.1016/j.injury.2025.112441","DOIUrl":"10.1016/j.injury.2025.112441","url":null,"abstract":"<div><h3>Objectives</h3><div>To address the conflicting evidence in the literature regarding time to surgery and its impact on outcomes for distal femoral fractures.</div></div><div><h3>Methods</h3><div>This is a retrospective review of the American College of Surgeon’s (ACS) National Surgical Quality Improvement Project (NSQIP®) database, that collects data from 680 hospitals across the United States. The database was queried from 2010–2021. Case selection was done by use of ICD-9 &amp; ICD-10 codes for native distal femoral fractures and periprosthetic distal femur fractures, along with CPT codes for surgical fixation of distal femur, total knee arthroplasty and revision knee arthroplasty. Pre-operative, operative and post-operative factors were compared for patients undergoing surgery on hospital day 0 or 1 (HD ≤ 1) to patients undergoing surgery after hospital day 1(HD &gt; 1). Primary outcome measure was 30-day mortality. Chi-square and logistic regression were used for univariable and multivariable analyses, respectively.</div></div><div><h3>Results</h3><div>A total of 6857 cases were identified (mean age of 71.5 years). 84.5 % underwent surgery on HD ≤ 1, and 15.5 % on HD &gt; 1. Rate of mortality was 1.37 % and 3.26 %, respectively. Patients who underwent surgical fixation of distal femoral fracture on HD ≤ 1 had a 40 % decrease in odds of mortality compared to fixation on HD &gt; 1 (OR 0.587; <em>p</em> = 0.031). A multi variable analysis revealed that presence of dyspnea (OR 4.338, <em>p</em> = 0.005), preoperative blood transfusion (HR 2.32, <em>p</em> = 0.001) and bleeding disorder (OR 1.727, <em>p</em> = 0.03) were associated with increased mortality at 30-days on multivariable analysis, while younger age (OR 0.216; <em>p</em> = 0.001) had a protective effect.</div></div><div><h3>Conclusions</h3><div>Delayed surgical fixation is associated with increased odds of 30-day mortality for patients with distal femoral fractures. Further studies will help determine if the increased mortality is caused by the delay itself or by other confounding variables not identified in this study that may be associated with the reason for the delay.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112441"},"PeriodicalIF":2.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}