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

{"title":"Osteosynthesis of an extra-articular distal radius fracture using a palmar locking plate with 4 epiphyseal screws (Gold Standard) versus 2 epiphyseal screws: Finite element analysis","authors":"Laure Prasil ,&nbsp;Raghid Andraos ,&nbsp;Jihad Rishmany ,&nbsp;Benoit Latelise ,&nbsp;Carlos Dos Remedios ,&nbsp;Mathieu Severyns ,&nbsp;Francois Zot ,&nbsp;Arnaud Germaneau ,&nbsp;Tanguy Vendeuvre","doi":"10.1016/j.injury.2025.112360","DOIUrl":"10.1016/j.injury.2025.112360","url":null,"abstract":"<div><div>Distal radius fractures are common injuries often requiring surgical intervention for effective management. This study compares the biomechanical stability of two osteosynthesis configurations using a palmar locking plate with either four or two epiphyseal screws for extra-articular distal radius fractures.</div><div>Finite element analysis (FEA) was performed on nine antomical radius models to evaluate displacement, axial stiffness, peri‑implant stresses, and fracture risk using the Mohr-Coulomb criterion. Results demonstrated minimal differences in displacement between the two groups, with both configurations maintaining acceptable levels of stability under a 250 N load. Assemblies with four screws exhibited slightly higher axial stiffness (average 4362 N/mm) compared to two screws (average 3080 N/mm). Peri-implant stresses were generally higher in the two-screw models, yet remained within tolerable ranges.</div><div>This study is the first to analyze a two-epiphyseal screw configuration, offering insight into the feasibility of reducing screw count without compromising stability. Potential benefits include fewer surgical complications, reduced material use, and lower costs. However, limitations such as the small sample size, simplified loading conditions, and absence of osteodensitometry warrant further experimental validation.</div><div>The findings suggest that a two-epiphyseal screw assembly could serve as an effective alternative for distal radius fracture management, supporting its potential integration into clinical practice following experimental corroboration.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 7","pages":"Article 112360"},"PeriodicalIF":2.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895583","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":"The role of the physiotherapist in the assessment and management of blunt mechanism chest wall injury: A systematic integrative review and narrative synthesis","authors":"Edward Baker ,&nbsp;Jane Barnett ,&nbsp;Timothy Driscoll ,&nbsp;Hayley Hutchings ,&nbsp;Claire O’Neill ,&nbsp;Michelle Price ,&nbsp;Hannah Toghill ,&nbsp;Rhys Whelan ,&nbsp;Ceri Battle","doi":"10.1016/j.injury.2025.112355","DOIUrl":"10.1016/j.injury.2025.112355","url":null,"abstract":"<div><h3>Background</h3><div>Blunt mechanism chest wall injury (CWI) is a common traumatic presentation to acute hospitals globally and it is associated with high levels of mortality and morbidity. The role of the physiotherapist in the management of this injured population needs clearer definition.</div></div><div><h3>Aim</h3><div>To synthesise existing evidence relating to the ‘work’ of physiotherapists in the assessment, management and evaluation of patients with blunt mechanism CWI.</div></div><div><h3>Design</h3><div>A systematic integrative review of relevant literature with a narrative synthesis.</div></div><div><h3>Data sources</h3><div>Embase (Ovid), MEDLINE (Ovid), CINAHL Plus with Full Text (EBSCO), Cochrane Central Register of Controlled Trials (Wiley), PEDro (Physiotherapy Evidence Database), AMED (Ovid). Further searches for grey literature and hand searches were applied. Databases were searched from their inception to December 2024. Analysis and data integration was undertaken through narrative synthesis following a process of thematic coding.</div></div><div><h3>Results</h3><div>From 7433 identified papers, 92 were included in the final evidence synthesis. Fifty were full published empirical studies, 14 were evidence reviews, 19 were conference abstracts, three were case presentations and six were opinion pieces. Analysis identified the broad scope of clinical care provided by physiotherapists covering (i) initial assessment and emergency care; (ii) acute care priorities and care planning; (iii) patient education and optimising patient self-management; and (iv) post-acute care and follow-up.</div></div><div><h3>Conclusion</h3><div>There is a need for a more standardised approach to the care provided to this patient group. Clinicians need to acquire and develop formal competencies and capacities and knowledge in a more structured approach.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112355"},"PeriodicalIF":2.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869666","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":"Antegrade ESIN technique via the Kocher interval reduces radiation exposure and accelerates recovery in pediatric DRDMJ fractures: A comparative study with cadaveric validation","authors":"Zhan Dong ,&nbsp;Wang Guo ,&nbsp;Zhuqing Kong ,&nbsp;Liukun Xu ,&nbsp;Zhiqun Zhang","doi":"10.1016/j.injury.2025.112348","DOIUrl":"10.1016/j.injury.2025.112348","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Distal radius diaphyseal-metaphyseal junction (DRDMJ) fractures in children often require surgical intervention due to the unique anatomical characteristics and high failure rate of nonoperative treatment. However, the choice of internal fixation remains a challenge for pediatric orthopedic surgeons. Traditional fixation methods, including plate and screw fixation, crossed Kirschner wires (K-wires), and external fixators, have drawbacks such as extensive local trauma and the risk of physeal injury. This study evaluates the clinical efficacy of antegrade elastic stable intramedullary nailing (ESIN) for DRDMJ fractures in children, comparing it with the crossed K-wire technique.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective analysis was conducted on 47 pediatric patients with DRDMJ fractures treated between June 2018 and January 2023. Patients were divided into an antegrade ESIN group (&lt;em&gt;n&lt;/em&gt; = 20) and a crossed K-wire group (&lt;em&gt;n&lt;/em&gt; = 27). Demographic data, perioperative parameters (operative time, radiation exposure), and postoperative recovery indicators (duration of internal/external fixation, radiographic healing time, wrist function recovery) were collected. All patients were followed up for at least 12 months, and complications were recorded. The Garland-Werley score was used to assess wrist function. Additionally, a cadaveric study was performed to validate the neurovascular safety of antegrade ESIN insertion via the middle third of the radial head–radial tuberosity axis within the Kocher interval.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;All patients achieved radiographic union, with no cases of dorsal interosseous nerve injury, tendon rupture, or refracture. There were no significant differences between the two groups in terms of radiographic healing time or wrist function scores at 12 months postoperatively (&lt;em&gt;P&lt;/em&gt; &gt; 0.05). However, compared to the crossed K-wire group, the antegrade ESIN group demonstrated a significantly shorter operative time by 10.71 min (&lt;em&gt;P&lt;/em&gt; = 0.002), reduced fluoroscopy use by 2.74 exposures (&lt;em&gt;P&lt;/em&gt; = 0.001), and a shorter postoperative cast immobilization duration by 9.11 days (&lt;em&gt;P&lt;/em&gt; &lt; 0.001). Additionally, the antegrade ESIN group exhibited a higher rate of excellent wrist function scores at the 3-month follow-up. The cadaveric study confirmed that needle insertion through the middle third of the Kocher interval safely avoided the dorsal interosseous nerve, with no risk of nerve injury in either pronation or supination positions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Antegrade ESIN and crossed K-wire fixation provide comparable long-term functional and radiographic outcomes for pediatric DRDMJ fractures. The antegrade ESIN technique, performed through the middle third of the radial head–radial tuberosity axis within the Kocher interval, effectively avoids dorsal interosseous nerve injury while significantly reducing operative time, minimizing intr","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112348"},"PeriodicalIF":2.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869667","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":"Comparative effectiveness of bone, cartilage and osteochondral xenograft (calf fetal) on healing of the critical bone defect in a rabbit model","authors":"Iman Farhangnia,&nbsp;Amin Bigham-Sadegh,&nbsp;Aboutorab Tabatabaei Naeini,&nbsp;Hassan Sharifi Yazdi","doi":"10.1016/j.injury.2025.112347","DOIUrl":"10.1016/j.injury.2025.112347","url":null,"abstract":"<div><div>Finding a suitable replacement tissue for bone loss in comminuted fractures and bone tumors with large bone defect or for treatment of delayed unions and non-unions is still the main challenge for orthopedic surgeons. The present study has been designed in vivo to evaluate the effects of xenogenic calf fetal bone and cartilage grafts in treatment of experimental critical bone defect in a rabbit model. 30 native male rabbits, 12 months old, weighing 3.0±0.5 kg were used in this study. Rabbits were randomly divided into five groups of six (negative control (NC), osteochondral group (OstCar), bone group (Ost), cartilage group (Car), and positive control (PC)). In the NC group the created empty space was left intact. In the OstCar group the osteochondral fragment of the same size as the expulsion was inserted into place. In the Ost group, the bone fragment of the fetal calf replaced the extracted bone fragment from the radius bone. The created defects were filled in 6 rabbits of the Car group with cartilage fragments of the fetal calf. In the PC group, after separating the fragment of radius bone midsection and removing from the site, it was re-placed at the site. This study investigated three types of replacement tissue for the missing bone and compared the results of radiology, CT scan, biomechanics and histopathology evaluations with positive and negative control groups. In conclusion, this study demonstrated that the calf’s fetal bone fragment could promote bone regeneration in the long bone defects like the autograft in the rabbit model.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112347"},"PeriodicalIF":2.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878460","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":"Assessment of the effects of core decompression on the patho-biomechanics of the femoral head in avascular necrosis: A biomechanical perspective","authors":"Ajeesh M Kurup ,&nbsp;Rajesh Kumar Bhushan ,&nbsp;Navin Kumar ,&nbsp;Naveen Kumar ,&nbsp;Ramesh Kumar Sen","doi":"10.1016/j.injury.2025.112350","DOIUrl":"10.1016/j.injury.2025.112350","url":null,"abstract":"<div><h3>Background</h3><div>Avascular necrosis (AVN) of the femur head (FH) is an incapacitating disease caused by chronic overconsumption of alcohol and corticosteroids. AVN impairs blood circulation to the FH, causing varying degrees of cell death. AVN progressively reduces the macroscopic mechanical strength of the bone's necrotic area, leading to FH collapse.</div></div><div><h3>Material and method</h3><div>This study aims to comprehend the efficacy of core decompression (CD) on biomechanical, microstructural, and compositional determinants of bone quality. In this work, 30 FH are taken of the patients who underwent total hip replacement due to AVN. These 30 samples are categorized into two groups (15 each), i.e. with CD (individuals who underwent core decompression treatment at the early stages of AVN) or without CD (individuals who did not receive any invasive therapy in the past following a hip fracture due to AVN). Bone morphometry, biomechanical, material, and nano-level properties are analyzed across necrotic and sclerotic zones of FH through micro-CT scanning, histo-pathology, Uni-axial compression, and Nano-indentation tests.</div></div><div><h3>Results</h3><div>The obtained results demonstrated a notable increment in bone volume fraction, ultimate strength, and osteocytes of the sclerotic zone of both groups compared to the necrotic region. A significant improvement was observed in the quality of trabecular bone at multiple scales of human bone tissue including higher bone volume fraction (22.87 %, <em>P</em> &lt; 0.05), increased Young’s modulus (28.80 %, <em>P</em> = 0.0183) and increment in Mineral/Matrix ratio (53.20 %, <em>P</em> = 0.0429) and reduction in % of empty lacunae (22.39 %, <em>P</em> &lt; 0.01) in the necrotic region of patients with core decompression compared to patients without any invasive treatment.</div></div><div><h3>Conclusion</h3><div>The optimum core decompression enhances the stability of the femur head by increasing the macroscopic mechanical strength of necrotic bone and decreasing the strength of sclerotic bone. This brings the strength of both bones nearly equal, further reducing the stress gradient and probability of collapse of the AVN femur head.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112350"},"PeriodicalIF":2.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143881851","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":"Is the mini-open surgical technique as good as nonoperative care for acute Achilles tendon injuries?","authors":"Mansur Halai ,&nbsp;Peter Dryden ,&nbsp;Richard Buckley","doi":"10.1016/j.injury.2025.112354","DOIUrl":"10.1016/j.injury.2025.112354","url":null,"abstract":"<div><div>History – A 38yo man was injured in a rugby match. He suffered an isolated, Achilles tendon rupture. He immediately went to his local emergency department. He was keen on the best treatment so that he could get back into playing rugby with his community team.</div><div>Past Medical History and Social History – He was a married man and lived with his wife. He was a nonsmoker. He had no medical problems that he saw a physician about. He worked as an executive with an oil company and was also involved in many sports year-round. He had had surgery for previous sports related broken bones with no complications. He had no allergies and took no medications. He was a regular beer drinker after sports matches.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112354"},"PeriodicalIF":2.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855778","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":"Rehabilitation outcomes and prognostic factors of nerve grafting combined with exercise therapy for high-level radial nerve injury: Results of a retrospective study","authors":"Yifang Cen ,&nbsp;Hongbo Zhao ,&nbsp;Liaozhang Wu","doi":"10.1016/j.injury.2025.112349","DOIUrl":"10.1016/j.injury.2025.112349","url":null,"abstract":"<div><h3>Background</h3><div>Radial nerve injury is one of the most common peripheral nerve injuries and can be effectively treated with nerve grafting. However, the efficacy of nerve grafting combined with exercise therapy for the treatment of radial nerve injury remains unclear.</div></div><div><h3>Methods</h3><div>In this study, we conducted a follow-up of at least one year in 40 patients with radial nerve injuries who received nerve grafting combined with exercise therapy, to evaluate their rehabilitation outcomes and identify the prognostic factors influencing the combined treatment.</div></div><div><h3>Results</h3><div>62.5 % (<em>n</em> = 25) patients achieved M3+ extension strength. Shorter defect length and delayed repair time and more cables of nerve graft were significantly associated with the recovery of finger extension. Moreover, multivariate analysis showed that defect length and delay in repair were the independent predictors of extensor digitorum communis reinnervation. Additionally, receiver operating characteristic (ROC) curve suggested that both delay in repair (AUC = 0.808) and cables of nerve graft (AUC = 0.837) had a high accuracy in predicting the prognosis of nerve graft combined with exercise therapy, while delay in repair+cables of nerve graft (AUC = 0.960) had the highest accuracy. The optimal time for transplantation is 6.89 months (sensitivity = 86.7 %, specificity = 58.7 %) post-injury, and the optimal number of nerve grafts is 2.5 (sensitivity = 80 %, specificity = 53.3 %).</div></div><div><h3>Conclusion</h3><div>We demonstrated that the effectiveness of nerve grafting combined with exercise therapy in treating radial nerve injury, and delay in repair and cables of nerve graft may act as the prognostic predictors of nerve graft combined with exercise therapy. These findings may provide a novel therapeutic method for radial nerve injury.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112349"},"PeriodicalIF":2.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869664","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":"The effect of trauma quality improvement programme implementation on quality of life among trauma patients in urban India","authors":"Eelika Kapitan ,&nbsp;Johanna Berg ,&nbsp;Siddarth David ,&nbsp;Mohan L N ,&nbsp;Li Felländer-Tsai ,&nbsp;Shamita Chatterjee ,&nbsp;Ulf Ekelund ,&nbsp;Nobhojit Roy ,&nbsp;Max Petzold ,&nbsp;Johan Von Schreeb ,&nbsp;Kapil Dev Soni ,&nbsp;Sendhil Rajan ,&nbsp;Monty Khajanchi ,&nbsp;Martin Gerdin Wärnberg","doi":"10.1016/j.injury.2025.112333","DOIUrl":"10.1016/j.injury.2025.112333","url":null,"abstract":"<div><div>Trauma accounts for around 4.4 million deaths annually and is among the leading causes of death, disproportionately affecting low- and middle-income countries. Trauma quality improvement programmes may reduce adverse patient outcomes but lack robust evidence. This study assessed the effect of implementing a trauma quality improvement programme using audit filters on health-related quality of life in adult trauma patients in urban India.</div><div>We conducted a controlled interrupted time series study (ClinicalTrials.gov ID <span><span>NCT03235388</span><svg><path></path></svg></span>) across four tertiary care university hospitals. Adult (≥18 years) trauma patients, who were alive at 90 days post-admission, were included. After a 14-month observation phase, two hospitals were randomized to the intervention arm and implemented the trauma quality improvement programme, while two control hospitals did not implement any interventions. The study spanned from 2017 to 2022.</div><div>Health-related quality of life was assessed 90 days post-admission using the EuroQol 5-dimensions (EQ-5D) questionnaire. The main outcome was EQ-5D health status, scaled from 0 to 100, analyzed using a difference-in-differences (DiD) approach. Descriptive analysis was performed for the five individual EQ-5D dimensions.</div><div>2307 participants were eligible for the analyses. The DiD analysis showed a statistically significant reduction in the EQ-5D health status score in the intervention arm (DiD estimate -4.07 [95 % CI:-7.00; -1.15]). For the 819 patients with major trauma, there was a more pronounced, but statistically non-significant reduction (DiD estimate -4.86 [95 % CI:-9.87; 0.15]). In the intervention arm, mobility, self-care, and pain/discomfort improved, while usual activities and anxiety/depression worsened.</div><div>Implementing trauma quality improvement programmes using audit filters may reduce the average health-related quality of life of trauma patients if more severely injured patients survive, highlighting the importance of assessing quality of life after the implementation of such programmes and ensuring adequate rehabilitation resources to support long-term recovery.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112333"},"PeriodicalIF":2.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894882","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":"Assessment of ankle fracture surgical wounds: the development and testing of the Wound after Osteosynthesis Kolding (WOK) score","authors":"Niels Martin Jensen ,&nbsp;Alice Ørts Hansen ,&nbsp;Simon Thonsgaard ,&nbsp;Ane Simony ,&nbsp;Christian Cavallius ,&nbsp;Rikke Serritslev Østergaard ,&nbsp;Lars Bo Rottwitt ,&nbsp;Charlotte Abrahamsen","doi":"10.1016/j.injury.2025.112345","DOIUrl":"10.1016/j.injury.2025.112345","url":null,"abstract":"<div><h3>Introduction</h3><div>Describing surgical wounds accurately poses challenges due to the diverse terminology used for complications. Existing evaluation methods do not cater specifically to surgical wounds from post-ankle fracture surgery with osteosynthesis. Given the unique anatomical challenges and treatment considerations (limited tissue coverage and blood supply as well as the surgical treatment with osteosynthesis), a targeted wound score is essential for ensuring consistent evaluation and high-quality care and thereby optimizing patient outcomes and satisfaction. The study aimed to develop a wound score specifically for evaluating surgical wounds following ankle fracture surgery.</div></div><div><h3>Method</h3><div>Development of the <em>Wound after Osteosynthesis Kolding</em> score (WOK) proceeded through three phases: 1) identifying WOK domains, 2) developing item and response options, and 3) pilot testing the WOK score.</div></div><div><h3>Results</h3><div>Five domains were identified: <em>erythema, swelling, dehiscence, exudate</em> and <em>warmth</em>. Response options were derived from literature and clinical insights. Content validity was assessed with an S-CVI/Ave of 0.93 for nurses and 0.82 for orthopedic surgeons. Orthopedic surgeons perceived <em>erythema</em> and <em>warmth</em> as less relevant, while nurses considered all five domains to be fairly or very relevant. High agreement between scores was found, but varying kappa scores were observed when assessing intra-rater reliability. Inter-rater reliability was acceptable across all domains (κ = 0.44 to 1.00). <em>Warmth</em> was omitted from the final WOK score due to low content validity among orthopedic surgeons and poor inter-rater reliability. Additionally, assessing <em>warmth</em> in a clinical setting was challenging because ankle brace stabilization affects overall skin humidity and warmth.</div></div><div><h3>Conclusions</h3><div>The Wound after Osteosynthesis Kolding score (WOK) has proven to be a content-valid and reliable tool for assessing minor complications in surgical wounds following ankle fracture surgery.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112345"},"PeriodicalIF":2.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860581","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":"\"Infection rates and complications following fasciotomy in mass casualty events: Lessons learned from the 2023 Turkey-Syria earthquake\"","authors":"Saygin Kamaci,&nbsp;Engin Turkay Yilmaz ,&nbsp;Ozan Tuncay,&nbsp;Ulas Can Kolac,&nbsp;Gazi Huri,&nbsp;Omur Caglar,&nbsp;Ahmet Mazhar Tokgozoglu","doi":"10.1016/j.injury.2025.112338","DOIUrl":"10.1016/j.injury.2025.112338","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate the outcomes of fasciotomy, including infection, amputation, and complications, in patients with crush injuries from the 2023 Turkey-Syria earthquake.</div></div><div><h3>Material and Methods</h3><div>Out of 210 patients presenting from the earthquake zone, 46 patients (23 male-23 female, mean age: 21 years) who underwent 52 extremity fasciotomies were included. Data collected included infection rates, need for grafts/flaps, amputation rates, creatinine, CK levels, need for dialysis, and neurologic injuries. Early fasciotomy was defined as ≤12 h and late as &gt;12 h after the earthquake. Patients were categorized by fasciotomy timing and location (earthquake-zone or university hospital). Time to first debridement was also evaluated.</div></div><div><h3>Results</h3><div>The median time to fasciotomy was 24 h (2–97 h, (IQR 12.5–65)). Fasciotomies performed in the earthquake zone had a higher infection rate (68 % vs. 25 %, <em>p</em> = 0.061), though this difference was not statistically significant, likely due to the small sample size. There was no significant difference in infection rates between patients who underwent early fasciotomy (8/13, 62 %) and those who underwent late fasciotomy (20/33, 61 %) (<em>p</em> = 1.0).Amputation was required in 7/46 patients (15 %), with 1/13 patient (8 %) in the early fasciotomy group and 6/33 patients (18 %) in the late fasciotomy group (<em>p</em> = 0.698). Skin grafting was performed for wound closure in 19 patients (42 %). In patients undergoing early fasciotomy, 75 % (9/12) required skin grafts for wound closure, whereas the rate in the late fasciotomy group was significantly lower at 30 % (10/33) (<em>p</em> = 0.019). The mean time to first debridement was significantly higher in infected patients [65.5 (SD 11.8) vs 57.8 (SD 11.4 h), <em>p</em> = 0034]. For wounds that required skin grafts, the average duration between the fasciotomy and initial debridement was significantly higher (68.5 vs 54 h), <em>p</em> = 0.001.</div></div><div><h3>Conclusion</h3><div>Fasciotomies performed in earthquake zones had higher infection rates compared to hospitals, though not statistically significant. Infections with potentially multi-drug resistant bacterias may increase the risk of complications like amputations. Timely debridement and efficient patient transfer remain essential to minimizing risks and improving outcomes.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112338"},"PeriodicalIF":2.2,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860652","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}