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

{"title":"Open versus percutaneous fibular graft harvesting in long bone nonunion surgery: A comparative cohort study","authors":"Laith Al Hseinat,&nbsp;Majdala Al-Bataineh,&nbsp;Ahmad Al Migdad,&nbsp;Moha’dKheir Aolymate,&nbsp;Mahmoud Sbaihat,&nbsp;Ashraf Ahmad Al Badaineh,&nbsp;Laith Abdel Aziz Alzyadat,&nbsp;Hidar Al Soudi","doi":"10.1016/j.injury.2026.113676","DOIUrl":"10.1016/j.injury.2026.113676","url":null,"abstract":"<div><h3>Aims</h3><div>The traditional open harvesting method used in fibular grafting is a well-established reconstructive technique, but it is associated with donor-site morbidity. However, percutaneous harvesting has been introduced as a minimally invasive method to reduce trauma while preserving graft adequacy.</div></div><div><h3>Methods</h3><div>A retrospective comparative analysis was conducted to measure the outcomes of percutaneous versus open fibular graft harvesting. Studied variables included patient demographics, intraoperative parameters (harvest time, estimated blood loss, incision length), and postoperative outcomes (pain scores, analgesia requirements, donor-site complications, and functional recovery).</div></div><div><h3>Results</h3><div>Among 34 patients undergoing non-vascularized fibular grafting for long-bone non-unions, 16 (47%) underwent graft harvest using an open approach, and 18 (53%) using a percutaneous technique. Baseline demographic and surgical characteristics were generally similar between the groups. The percutaneous approach was associated with significantly lower postoperative pain scores at 1 week (VAS 7.39 ± 0.61 vs. 8.19 ± 0.66, <em>p</em> = 0.0008), 1 month (4.56 ± 0.78 vs. 6.13 ± 0.66, <em>p</em> &lt; 0.0001), and 3 months, shorter graft harvest time, reduced intraoperative blood loss, and smaller incision length. Sensory deficits of the peroneal nerve were observed exclusively in the open group (37.5% vs. 0%, <em>p</em> = 0.004). Both techniques achieved comparable union rates (100% vs. 88.9%, <em>p</em> = 0.169), graft incorporation during follow-up (100% vs. 83.3%, <em>p</em> = 0.087), overall complication rates, and reoperation rates, with no mortality reported at one-year follow-up.</div></div><div><h3>Conclusion</h3><div>Percutaneous fibular graft harvesting offers a safe and effective alternative to the conventional open approach. It is associated with lower intraoperative morbidity and improved early postoperative recovery, without compromising graft utility or increasing complication rates. These findings support the wider adoption of minimally invasive techniques in fibular graft harvesting.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 10","pages":"Article 113676"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922415","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":"Pectoralis major reference technique improves humeral height restoration and tuberosity healing after hemiarthroplasty for complex proximal humeral fractures: A comparative study","authors":"Bum-Soon Park,&nbsp;Du-Han Kim,&nbsp;Hyuk-Joon Sohn,&nbsp;Chul-Hyun Cho","doi":"10.1016/j.injury.2026.113651","DOIUrl":"10.1016/j.injury.2026.113651","url":null,"abstract":"<div><h3>Background</h3><div>Accurate humeral stem positioning is critical for achieving favorable outcomes after hemiarthroplasty for complex proximal humeral fractures. This study aimed to compare the clinical and radiological outcomes of hemiarthroplasty performed using the pectoralis major reference technique (PMRT) with those performed using a conventional technique (CT)</div></div><div><h3>Methods</h3><div>Thirty-nine patients who underwent hemiarthroplasty for complex proximal humeral fractures were included in this study. The conventional technique was used in the first 24 cases (CT group) and PMRT was applied in the subsequent 15 cases (PMRT group). The mean follow-up period was 54.5 months (range, 12–96 months) in the PMRT group and 56.1 months (range, 24–132 months) in the CT group. Radiographic outcomes included postoperative head–tuberosity distance and tuberosity healing status, assessed using serial plain radiographs. Clinical outcomes were evaluated using the visual analog scale (VAS) pain score, the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, the subjective shoulder value (SSV), and active range of motions.</div></div><div><h3>Results</h3><div>The rate of complete tuberosity healing was significantly higher in the PMRT group than in the CT group (80.0% vs 58.3%). The mean postoperative head–tuberosity distance was significantly shorter in the PMRT group compared with the CT group (5.9 mm vs 11.8 mm). In the PMRT group, total humeral height did not differ significantly between the operated and contralateral sides (294.4 mm vs 293.4 mm). The PMRT group demonstrated significantly greater external and internal rotation than the CT group; however, no significant differences were observed in clinical scores, forward flexion, or abduction. The overall complication rates did not differ significantly between the two groups (26.6% vs 45.8%, p = 0.231). At the final follow-up, rotator cuff insufficiency was observed in 4 patients (26.7%) in the PMRT group and 9 patients (37.5%) in the CT group.</div></div><div><h3>Conclusion</h3><div>Compared with the conventional technique, PMRT was associated with more favorable restoration of proximal humeral anatomy, improved tuberosity healing, and better postoperative rotational function following HA for complex proximal humeral fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 10","pages":"Article 113651"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889841","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":"Hemorrhage control in hemodynamically unstable pelvic fractures using external fixation, angioembolization, or combined treatment: Outcomes from a level 1 trauma center","authors":"Stijn De Bondt,&nbsp;Anmol Kaur,&nbsp;Mattias Gilleir,&nbsp;Willem-Jan Metsemakers,&nbsp;Harm Hoekstra,&nbsp;Dominique Misselyn,&nbsp;Laurens Aerden,&nbsp;Femke De Haes,&nbsp;Lawrence Bonne,&nbsp;Eveline Claus,&nbsp;Jo Peluso,&nbsp;Geert Maleux,&nbsp;Michiel Herteleer","doi":"10.1016/j.injury.2026.113715","DOIUrl":"10.1016/j.injury.2026.113715","url":null,"abstract":"<div><h3>Introduction</h3><div>Multiple hemorrhage control methods for hemodynamically unstable pelvic fractures are used in clinical practice; however, the optimal treatment algorithm remains unclear. The aim of this study was to evaluate outcomes of our level 1 trauma center protocol and to compare characteristics and outcomes between patients treated with pelvic external fixation (EF), transcatheter arterial embolization (TAE), or a combination of both (EF+TAE).</div></div><div><h3>Materials and methods</h3><div>A retrospective observational study including patients with hemodynamically unstable pelvic fractures presenting at our institution between January 2011 and December 2024 was conducted. Demographics, trauma characteristics, treatment characteristics, and clinical outcomes were evaluated for the total study population and compared across the treatment groups (EF, TAE, and EF+TAE) using a univariate analysis. Statistical significance was defined as <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Out of 2921 patients presenting with pelvic fractures at our institution, seventy-nine patients were included in the final analysis. The mean age was 53.6 ± 20.7, fifty patients were male (63%) and mean Injury Severity Score (ISS) was 30.9 ± 11.7. Fifty patients (63%) were initially managed with external fixation, twelve patients (15%) received TAE without external fixation and seventeen patients (22%) received both. Patients undergoing TAE were significantly older than those treated with external fixation alone or combined external fixation and TAE (<em>p</em> &lt; 0.01) and received more units of packed red blood cells (median 10.0 for TAE, 8.0 for EF+TAE and 2.0 for EF (<em>p</em> &lt; 0.001)). Acetabular fracture involvement was present in 5 of 12 patients treated with TAE, representing a significantly higher proportion than in the other treatment groups (<em>p</em> = 0.01). The median time-to-embolization in the TAE group was 197.5 min, compared to 206.0 min in the EF + TAE group (<em>p</em> = 0.64). Overall, 1-year mortality rate was 22%. No significant differences in mortality rates were found across the treatment groups.</div></div><div><h3>Conclusion</h3><div>Overall, 1-year mortality rate of patients presenting with hemodynamically unstable pelvic fractures was 22%, mainly caused by traumatic brain injury. Patients treated with angioembolization were older and presented more frequently with acetabular fractures. External fixation before TAE did not prolong time-to-embolization.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 10","pages":"Article 113715"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984443","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":"Cerclage wiring: Innovations and applications","authors":"S. Förch,&nbsp;S. Sandriesser,&nbsp;A. Fenwick,&nbsp;P. Augat,&nbsp;E. Mayr","doi":"10.1016/j.injury.2026.113722","DOIUrl":"10.1016/j.injury.2026.113722","url":null,"abstract":"<div><div>Immediate full weight-bearing of osteosynthesis constructs is gaining increasing importance in modern trauma surgery. Many geriatric patients cannot reliably adhere to partial weight-bearing instructions, and younger patients may benefit from accelerated rehabilitation enabled by early full weight-bearing. In this context, an older technique of minimally invasive cerclage fixation of the tibia is receiving renewed attention. The surgical technique has been adapted to contemporary cerclage systems and biomechanically evaluated for the first time. Several studies using synthetic and cadaveric bone models have demonstrated that modern cable cerclages, particularly in spiral fractures, are capable of significantly increasing the stiffness of both locking plate and intramedullary nail osteosyntheses, provided that anatomical reduction is achieved through the cerclage. From a biomechanical standpoint, the additive cerclage thus enables immediate postoperative full weight-bearing. Early clinical studies suggest, that minimally invasive tibial cerclage can be applied without an increased complication rate and is associated with faster rehabilitation and higher patient satisfaction in the early postoperative phase. Although evidence is limited, the principle of additive cerclage appears to be transferable to humeral shaft spiral fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 ","pages":"Article 113722"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149257998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherent antimicrobial coatings for orthopaedic implants – A narrative review","authors":"Andrea Montali,&nbsp;Matteo D’Este,&nbsp;T. Fintan Moriarty,&nbsp;Volker Alt","doi":"10.1016/j.injury.2026.113485","DOIUrl":"10.1016/j.injury.2026.113485","url":null,"abstract":"<div><div>There is a broad consensus among orthopaedic and trauma surgeons, as well as infection specialists, that antibacterial coatings represent an important tool for both the prevention and management of fracture-related infections. Nonetheless, the choice of commercially available implants fitted with an antibacterial coating remains limited. Intramedullary nails with resorbable, antibiotic eluting coatings have been commercially available for over a decade. Although multiple case series have shown evidence of efficacy of antimicrobial orthopaedic implants, randomized controlled trials are still lacking and their uptake in everyday clinical practice has been slow. More recently, nails with galvanic noble metal coatings were introduced, with encouraging clinical results. The most widely used coatings with the longest clinical track record are silver coated joint replacement endoprostheses, which have been successfully employed in revision surgeries and in patients undergoing tumor-related procedures. Silver coated plates are on the verge of market introduction and will represent the first of their kind to be broadly available. Overall, adherent antibacterial coatings are showing beneficial outcomes in terms of safety and efficacy. Health-technology assessments show cost effectiveness, demonstrating that in higher risk patient populations, the additional cost of using a coated implant is significantly less than the cost of treating an infection. Regulatory hurdles remain high, especially in the USA, where, to be best of our knowledge, coated implants have not been approved yet. Driven by the clear clinical need, we anticipate a dynamic near future in this field, with progress moving toward establishing coated implants as the standard of care for appropriate patient populations and expanding the range of available coating solutions. Such developments will ultimately benefit patients, surgeons, and the overall healthcare system.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 ","pages":"Article 113485"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond surviving: The mental and physical impairment of health-related quality of life after polytrauma emphasizes the need for interprofessional long-term aftercare","authors":"C. Spering,&nbsp;F. Bator,&nbsp;N. von Steinbüchel,&nbsp;A. Neubert,&nbsp;H. Awan Malik,&nbsp;W. Lehmann","doi":"10.1016/j.injury.2026.113644","DOIUrl":"10.1016/j.injury.2026.113644","url":null,"abstract":"<div><h3>Background</h3><div>Major trauma, particularly from road traffic accidents, is a leading cause of death and long-term disability in young adults worldwide. Advances in trauma center management, especially in Germany, have substantially improved survival rates to approximately 90%, which can be considered excellent. They often experience a reduced health-related quality of life (HrQoL) due to persistent physical, emotional, and mental challenges, underscoring the need for comprehensive long-term aftercare. This study focuses on the traumatic aftermath two years after polytrauma beyond the individual pattern of injury.</div></div><div><h3>Methods</h3><div>This single-center cohort study was performed at the polytrauma outpatient center of the Department of Trauma Surgery, Orthopaedics, and Plastic Surgery of the University Medical Center Göttingen (UMG), Germany. Patients were retrospectively identified from hospital and trauma registry records, and data collection (questionnaires and interviews) was performed prospectively. Seventy patients aged 18 years or older with multiple trauma (ICD-10: T07 or related combinations) participated in the study 24 months after the initial trauma. Data on general HrQoL, depressive and anxiety symptoms, and socioeconomic consequences were collected using validated questionnaires (validated trauma-specific questionnaire, SF-36, PHQ-9 &amp; GAD-7), trauma-specific surveys, and patient records. Statistical analyses were used to assess differences and correlations between patient factors and outcomes.</div></div><div><h3>Results</h3><div>Participants displayed significantly lower HrQoL scores across all SF-36 dimensions compared to the general population (p &lt; 0.005), with pronounced deficits in physical functioning, pain, and emotional role functioning. Nearly half of the participants exhibited mild depressive symptoms, and approximately 40% showed mild to severe anxiety symptoms. Pain, particularly in the lower extremities, and difficulties in daily activities were strongly associated with reduced physical and mental health sum scores. Socioeconomic impacts included changes in social relationships and employment status, with only 51% returning to full-time work and nearly 30% losing their jobs post-injury. Rehabilitation was rated positively, but access remained limited.</div></div><div><h3>Conclusions</h3><div>Polytrauma should be conceptualized as a chronic disease with complex physical, psychological, and socioeconomic sequelae that significantly impair long-term HrQoL. Effective management requires individualized interdisciplinary aftercare programs focusing on physical rehabilitation, mental health support, and socioeconomic reintegration. Coordinated care models, such as specialized outpatient centers, are essential for addressing these multifaceted needs and improving long-term outcomes for polytrauma survivors.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 10","pages":"Article 113644"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major trauma centre clinicians: who cares? A comprehensive study of major trauma centre clinicians: are they prone to increased levels of stress, burnout and secondary trauma symptoms?","authors":"Louise Johnson,&nbsp;S. Loonat,&nbsp;P.J. Harwood,&nbsp;S.R. Vollans","doi":"10.1016/j.injury.2026.113655","DOIUrl":"10.1016/j.injury.2026.113655","url":null,"abstract":"<div><h3>Objectives</h3><div>Major Trauma Centres (MTCs) treat the most severely injured patients. Clinicals working in MTCs and with trauma victims are regularly exposed to the most severe and tragic cases, which can result in burnout, compassion fatigue and secondary traumatic stress (STS). These can negatively impact on work performances, social relations, physical and psychological health. The present study aimed to investigate whether MTC consultants are at an increased risk of burnout, compassion fatigue, stress and STS compared to non-MTC consultants. It also sought to identify the contributing factors to stress and ways to manage stress at work and home.</div></div><div><h3>Methods</h3><div>MTC orthopaedic and vascular consultants and non-MTC ‘general’ orthopaedic consultants completed questionnaires about their burnout, compassion fatigue, stress and STS. MTC consultants then took part in an interview asking what contributes to their stress and how they manage stress at work and at home.</div></div><div><h3>Results</h3><div>20 consultants responded to the questionnaire, 11 MTC orthopaedic consultants, 4 MTC vascular consultants and 5 “general” orthopaedic consultants. 19 were male and 1 was female. MTC/ vascular consultants had higher median scores in perceived stress, burnout, compassion satisfaction and STS compared to non-MTC consultants. MTC/ vascular consultants identified their main cause of stress to be aspects relating to ‘Time’ and ‘Personal factors’. To cope with stress, participants wanted to feel ‘supported at work’ and found ‘distractions’ at home, such as hobbies and exercise, to be beneficial.</div></div><div><h3>Conclusions</h3><div>MTC/ vascular consultants are more likely to experience the negative consequences of working with trauma patients, such as burnout and STS, compared to non-MTC consultants. To cope with stress, they sought support from colleagues, peers and family and engaged in distracting activities at home. This study indicates that consultants working in MTCs are more likely to experience the adverse consequences, but more research is needed to examine the psychological impact and interventions.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 10","pages":"Article 113655"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957197","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":"Tight rope fixation in fracture management","authors":"J.F. Keating","doi":"10.1016/j.injury.2026.113530","DOIUrl":"10.1016/j.injury.2026.113530","url":null,"abstract":"<div><div>The use of tightrope fixation using metal buttons linked by suture material was first reported in 2005 when their use was suggested as an alternative to syndesmosis screws in ankle fractures associated with a diastasis. These implants are now used widely as a component of fixation in ankle fractures with a diastasis. The published results of their use in these injuries have shown that they are an effective method of treating diastasis of the ankle tibio-fibular syndesmosis with some evidence to suggest that they have a lower rate of malunion, fewer implant related complications, a reduced need for implant removal and in some trials better functional outcomes than screw fixation. Variations of these devices have also been used for fixation of lateral third clavicular fractures and acromioclavicular dislocations. Their use alone or in combination with plate fixation has been shown to be an effective method of fixation of lateral third clavicle fractures with a low rate of malunion and implant related problems. They have also shown to be an effective method of treatment for acromioclavicular dislocation, although there is still debate about the role of surgical treatment for these injuries. There are miscellaneous reports of their use for other fractures and dislocations in other anatomic locations notably for Lisfranc injuries in the foot. Better quality prospective clinical studies are still needed to define their exact role in fracture management.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 ","pages":"Article 113530"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149257847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovation in external fixation: Emerging hardware, software and automation technologies","authors":"Siddarth Raj,&nbsp;Massimiliano Fornasiero,&nbsp;Shao-Ting Jerry Tsang","doi":"10.1016/j.injury.2026.113661","DOIUrl":"10.1016/j.injury.2026.113661","url":null,"abstract":"<div><div>External fixation remains a cornerstone of contemporary orthopaedic trauma and limb reconstruction surgery. While the biological principles for bone healing and regeneration established by Ilizarov continue to underpin modern practice, significant technological innovation has occurred over the past two decades. These developments have focused on improving construct stability, enhancing deformity correction accuracy, reducing technical complexity and improving the patient experience. Advances in hardware design have expanded fixation options and increased the adaptability of circular frames in complex trauma and reconstructive settings. Parallel developments in software have transformed deformity analysis, preoperative planning and correction execution through improved registration systems, virtual frame construction and cloud-based treatment platforms. More recently, remote patient support systems and automated strut technologies have sought to reduce the treatment burden associated with prolonged frame use. This review examines contemporary innovations in external fixation, focusing on developments in hardware, software, patient engagement technologies and automation. The available evidence is critically appraised and future directions explored. While many innovations demonstrate clear theoretical and practical advantages, robust clinical evidence remains limited for several emerging technologies. Nevertheless, the convergence of advanced engineering, digital health technologies and artificial intelligence is likely to fundamentally reshape the future of external fixation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 ","pages":"Article 113661"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149257841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal femur plate-nail constructs. Belt and suspenders?","authors":"Francisco Chana-Rodríguez,&nbsp;José Manuel Rojo-Manaute,&nbsp;Girgis Saad Latif,&nbsp;Habib Mohammed Al Ismaily,&nbsp;Robert Dunbar","doi":"10.1016/j.injury.2026.113469","DOIUrl":"10.1016/j.injury.2026.113469","url":null,"abstract":"<div><div>Given the inherent complexity of distal femoral fractures and non-unions, management should be directed by an experienced orthopaedic trauma surgeon to ensure optimal reduction and stable fixation. This report describes the surgical technique of three cases managed with dual nail-plate fixation, supplemented by a review of contemporary literature regarding this hybrid construct. Evidence from meta-analyses suggests that combined fixation significantly minimizes total complications and reoperations compared to single-construct fixation in distal femur fractures. Notably, these clinical benefits are achieved without a significant increase in operative duration, blood loss, or hospital stay. However, the current literature is restricted to retrospective studies, underscoring the imperative for prospective randomized controlled trials to validate these clinical benefits.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 ","pages":"Article 113469"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149257844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}