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

{"title":"Minimally invasive plate osteosynthesis for humeral shaft fractures with the far cortical locking system: A matched comparison with the standard locked plating construct","authors":"Joon-Woo Kim,&nbsp;Chang-Wug Oh,&nbsp;Sang-Roc Han,&nbsp;Hee-June Kim","doi":"10.1016/j.injury.2025.112635","DOIUrl":"10.1016/j.injury.2025.112635","url":null,"abstract":"<div><h3>Introduction</h3><div>The far cortical locking (FCL) system reduces axial stiffness in locked plating constructs while maintaining construct strength, thereby promoting secondary bone healing following fracture fixation. However, studies evaluating its efficacy compared with standard locked plating (LP) systems for upper extremity fractures remain limited. This study compared humeral shaft fractures treated with minimally invasive plate osteosynthesis (MIPO) using either the FCL or LP system.</div></div><div><h3>Materials and Methods</h3><div>We analyzed 40 patients with diaphyseal humeral fractures treated with MIPO using either FCL or LP and conducted a matched-pair comparative analysis. Prospective data were collected from 20 consecutive patients who underwent MIPO with FCL. A matched case-control cohort was constructed by pairing MIPO cases using LP with the most closely matched FCL cases. The primary outcome was a comparison of radiographic and clinical fracture healing, as well as complications, between the two groups using statistical analysis. Statistical significance was set at <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Union was achieved in 18 of 20 cases (90 %) in the FCL group at a mean of 13.6 weeks. All 20 cases in the LP group achieved union after a mean of 20.1 weeks. Time to union was significantly shorter in the FCL group (<em>p</em> &lt; 0.05), though the union rate did not differ significantly (<em>p</em> = 0.49). Near cortex healing occurred at a mean of 11.2 weeks in the FCL group and 18.8 weeks in the LP group (<em>p</em> &lt; 0.01). Two FCL cases required revision surgery due to screw breakage or pull-out at the proximal fracture segment. Mean coronal and sagittal angulations were 2.9° and 4.8° in the FCL group, and 2.4° and 3.3° in the LP group, with no significant differences (<em>p</em> = 0.60 and 0.24). No significant differences in functional outcomes were observed between the groups.</div></div><div><h3>Conclusions</h3><div>The FCL group showed significantly faster union compared to the LP group, but no significant differences in union rate, alignment, or functional outcomes. Although not statistically significant, a 10 % complication rate was observed in the FCL group. Caution is warranted, as FCL screws may fail at the proximal fracture segment, either by breakage due to mechanical overload or by pull-out.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112635"},"PeriodicalIF":2.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757778","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":"Acute reverse total shoulder arthroplasty versus internal fixation for 3- and 4- part proximal humerus fractures: A propensity matched analysis of 5466 elderly patients","authors":"Margaret A. Sinkler,&nbsp;Andrew J. Moyal,&nbsp;Jeremy M. Adelstein,&nbsp;Robert J. Burkhart,&nbsp;Raymond Chen,&nbsp;Robert J. Wetzel,&nbsp;George Ochenjele,&nbsp;John K. Sontich,&nbsp;Jacob G. Calcei,&nbsp;Joshua K. Napora","doi":"10.1016/j.injury.2025.112624","DOIUrl":"10.1016/j.injury.2025.112624","url":null,"abstract":"<div><h3>Introduction</h3><div>The purpose of this study was to utilize a large national database to evaluate short- and long-term outcomes of acute management of proximal humerus fractures (PHF) with reverse total shoulder arthroplasty (RSA) compared to open reduction internal fixation (ORIF).</div></div><div><h3>Methods</h3><div>The TriNetX platform was utilized to perform a retrospective review of patients who sustained PHFs treated within three weeks of injury. Patients were identified using Current Procedural Terminology codes and the International Classification of Disease diagnosis codes. The cohorts were 1:1 propensity matched. Patients who received RSA were propensity matched to patients who underwent ORIF. Short-term and long-term outcomes were compared across the cohorts across various post operative periods. Kaplan Meier survival analysis was used to analyze implant survival rate and Cox hazard ratio was used to identify risk factors of re-operation.</div></div><div><h3>Results</h3><div>Following propensity matching, each cohort included 2733 patients with an average age of 71±9.5. Patients treated with ORIF were more likely to have a re-operation or hospital admission than patients who underwent RSA at both 1 and 2 year follow up (5.5 % vs 2.1 %; <em>p</em> &lt; 0.001; 6.9 % vs 2.6 %, <em>p</em> &lt; 0.001 and 13.7 % vs 11.3 %, <em>p</em> = 0.01; 19.6 % vs 16.4 %, <em>p</em> = 0.003). At two year follow up, 173 patients treated with ORIF had a re-operation of which 60 (35 %) were converted to arthroplasty. On Kaplan Meier survival analysis for re-operation, both implants had satisfactory survival rates at both one and two year time point with survival rates over 90 %. However, there was a difference between survival rates at both one and two years between the ORIF and RSA groups (94 % vs 98 %, <em>p</em> &lt; 0.0001; 91 % vs 97 %, <em>p</em> &lt; 0.0001). For ORIF, patients with four part PHF and osteoporosis had a 39 % and 19 % increased risk of re-operation (<em>p</em> &lt; 0.001; <em>p</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>While both ORIF and RSA have been shown to be acceptable techniques for managing PHFs in the elderly, ORIF had a significantly higher re-operation and hospital readmission rate at mid- and long-term follow up. Additionally, a large portion of patients undergoing re-operation following ORIF were converted to shoulder arthroplasty although acute RSA has superior outcomes compared to delayed RSA. Therefore, for operative elderly candidates we advocate for the use of RSA in three- and four-part PHFs.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112624"},"PeriodicalIF":2.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766948","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":"Psychosocial concerns in burn survivors and their families: A narrative review","authors":"Beylin Dmitry ,&nbsp;Rachel Kornhaber ,&nbsp;Michelle Cleary","doi":"10.1016/j.injury.2025.112626","DOIUrl":"10.1016/j.injury.2025.112626","url":null,"abstract":"<div><div>Burn injuries result in profound and enduring consequences that extend well beyond the initial physical trauma. Although survival rates have significantly improved in recent decades, particularly in high-income countries, many survivors continue to experience complex psychological and social challenges that persist long after discharge from hospital care. This review outlines the current understanding of the psychological and social impacts of burn injuries and highlights key strategies to support survivors and their families through each stage of recovery. Common psychological concerns include post-traumatic stress, anxiety, depression, and disruptions to self-perception. These issues frequently emerge early in the recovery process and may endure for several years, influencing daily functioning, interpersonal relationships, and the ability to return to work. Caregivers are also affected, often experiencing emotional fatigue and psychological strain, particularly when access to support services is limited. Reintegration into everyday life is frequently marked by social stigma and exclusion, with children and adolescents being especially vulnerable due to ongoing identity development. Holistic recovery requires more than physical rehabilitation; it requires a coordinated, multidisciplinary approach that incorporates psychological support, social reintegration, and long-term follow-up. Interventions such as cognitive-behavioural therapy, peer and family support programs, and digital health platforms have shown promise in addressing these needs. While some individuals report personal growth following burn trauma, outcomes are influenced by various factors, including mental health history, community context and available support. Psychosocial care must be responsive to cultural and developmental differences and accessible across diverse settings. Innovations such as virtual reality and telehealth are increasingly valuable in bridging service gaps, particularly for individuals in rural or underserved areas.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112626"},"PeriodicalIF":2.0,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757777","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":"Amputation trends in military personnel during the israel-hamas war in 2023-24","authors":"Yigal Chechik ,&nbsp;Ofer Almog ,&nbsp;Yoav Jordan Gutterman ,&nbsp;Shlomi Abuhasira","doi":"10.1016/j.injury.2025.112611","DOIUrl":"10.1016/j.injury.2025.112611","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the mechanisms, distribution, and outcomes of traumatic limb amputations among military casualties during the Israel-Hamas War, and to evaluate the association between life-saving interventions and survival.</div></div><div><h3>Design, Setting, and Participants</h3><div>This retrospective observational study analyzed data from the Israel Defense Forces Trauma Registry. The cohort included 3253 urgent battlefield casualties who sustained limb injuries and were treated by IDF medical forces between October 27th, 2023 and October 31st, 2024.</div></div><div><h3>Main Outcomes and Measures</h3><div>The primary outcomes were anatomical distribution of amputations, mechanism of injury, application of life-saving interventions (tourniquet, whole blood, freeze-dried plasma), and survival on the way to hospital admission and during hospitalization.</div></div><div><h3>Results</h3><div>Of 3253 casualties, 135 (4.2 %) were initially recorded as having amputations. After review, 112 cases were confirmed to involve at least one amputated limb. Explosive devices were the leading cause of injury among amputees (88.9 %). Among the 112 confirmed cases, 50 (44.6 %) survived until hospital admission, and 62 (55.4 %) were pronounced dead prior to hospital arrival; 4 of the survivors died during hospitalization. Tourniquets were applied in 90 % of survivors compared to 24.2 % of deceased (<em>p</em> &lt; 0.001). Whole blood and FDP were administered more frequently in survivors (60 % and 40 %, respectively) than in deceased casualties (9.7 % and 4.8 %, respectively; <em>p</em> &lt; 0.001 for both). Above-knee amputations were the most common anatomical level in both groups.</div></div><div><h3>Conclusion and Relevance</h3><div>Combat-related limb amputations during the Israel-Hamas War were primarily caused by explosions and were associated with high mortality. Prompt application of life-saving interventions, particularly tourniquets and early blood resuscitation, was strongly associated with survival. These findings emphasize the critical need for rapid hemorrhage control and trauma care readiness in modern military conflict settings.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112611"},"PeriodicalIF":2.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722921","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 study on the efficacy of femoral neck system, FNS with anti-rotation screws, and multiple cancellous screws in treating femoral neck fractures in young and middle-aged patients","authors":"Yixin Huang ,&nbsp;Dongze Lin ,&nbsp;Jiaqi Lan ,&nbsp;Rongxin Zeng ,&nbsp;Fengfei Lin","doi":"10.1016/j.injury.2025.112621","DOIUrl":"10.1016/j.injury.2025.112621","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate and compare the medium- to long-term outcomes of the Femoral Neck System (FNS), FNS combined with the Anti-Rotation Screw (ARS), and Multiple Cancellous Screws (MCS) in the treatment of femoral neck fractures in young and middle-aged patients.</div></div><div><h3>Methods</h3><div>A retrospective, multi-group comparative cohort study was conducted on 731 young and middle-aged patients with femoral neck fractures treated at Level I Trauma Center between September 2019 and January 2024. Patients were divided into three groups based on the surgical method: FNS group (327 cases), FNS+ARS group (120 cases), and MCS group (284 cases). Postoperative follow-up assessments included fracture healing time, functional scores (Harris Hip Score [HHS], Oxford Hip Score [OHS], Hip Outcome Score [HOS]), and complication rates (femoral neck shortening, femoral head necrosis, nonunion, and implant-related complications).</div></div><div><h3>Results</h3><div>Key findings demonstrated the FNS+ARS group achieved significantly faster fracture healing (10.21 ± 1.33 weeks) versus FNS (12.52 ± 1.91) and MCS (13.57 ± 2.13 weeks; <em>P</em> = 0.036). Functional outcomes consistently favored FNS+ARS across all timepoints:3 months: HHS (61.54 ± 2.98 vs 58.15 ± 2.34 vs 54.43 ± 2.79, <em>P</em> &lt; 0.001), OHS (37.19 ± 2.35 vs 43.20 ± 2.91 vs 42.89 ± 3.00, <em>P</em> &lt; 0.001), HOS (33.59 ± 2.39 vs 32.21 ± 2.32 vs 30.39 ± 2.72, <em>P</em> &lt; 0.001);6 months: HHS (87.35 ± 5.58 vs 81.95 ± 5.99 vs 76.54 ± 5.45, <em>P</em> &lt; 0.001), OHS (22.66 ± 2.78 vs 25.96 ± 3.64 vs 27.66 ± 4.81, <em>P</em> &lt; 0.001), HOS (76.02 ± 5.47 vs 75.42 ± 7.63 vs 73.38 ± 6.75, <em>P</em> &lt; 0.001);Final follow-up: HHS (91.95 ± 9.06 vs 90.38 ± 11.21 vs 87.67 ± 11.71, <em>P</em> &lt; 0.001), OHS (21.04 ± 8.71 vs 20.41 ± 7.88 vs 23.40 ± 10.18, <em>P</em> &lt; 0.001), HOS (87.51 ± 12.93 vs 85.84 ± 16.22 vs 85.98 ± 15.00, <em>P</em> &lt; 0.001);Complication rates were significantly lower with FNS+ARS, particularly for femoral neck shortening (2.50 % vs 8.87 % vs 5.28 %; <em>P</em> = 0.031) and avascular necrosis (6.67 % vs 10.92 %; <em>P</em> = 0.040).</div></div><div><h3>Conclusion</h3><div>FNS combined with ARS outperformed FNS and MCS in promoting fracture healing, reducing postoperative complication rates, and accelerating functional recovery.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112621"},"PeriodicalIF":2.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750583","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":"Mortality following fragility fractures of the pelvis: Systematic review and meta-analysis","authors":"Norio Yamamoto ,&nbsp;Hidehiro Someko ,&nbsp;Yuki Nakashima ,&nbsp;Shuri Nakao ,&nbsp;Takao Kaneko ,&nbsp;Takahiro Tsuge","doi":"10.1016/j.injury.2025.112618","DOIUrl":"10.1016/j.injury.2025.112618","url":null,"abstract":"<div><h3>Background</h3><div>Fragility fractures of the pelvis (FFPs) in older adults are increasingly recognized as serious injuries with substantial morbidity. However, mortality after FFP has not been comprehensively quantified across timepoints or patient subgroups, limiting the ability to inform prognosis and guide clinical strategies. This systematic review and meta-analysis aimed to assess the 1-year mortality following FFP in patients aged ≥60 years. We also assessed the mortality at 30 days, 3 months, 6 months, 2 years, and 5 years after FFP, and the differences in mortality by geographic region, sex, fracture classification, or treatment modality.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of studies published from inception to May 2024 in MEDLINE, Embase, and CENTRAL databases. Eligible studies reported mortality outcomes in patients aged ≥60 years with FFP. A random-effects model was used to estimate pooled mortality at prespecified time points. We assessed the risk of bias using the Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool. Subgroup analyses were conducted to assess differences by region, sex, fracture classification, and treatment modality. We conducted a sensitivity analysis including only the high-quality studies according to the JBI assessment. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.</div></div><div><h3>Results</h3><div>The pooled 1-year mortality was 17 % (95 % confidence interval, 14 %–19 %). The certainty of this evidence was rated as low because of publication bias and heterogeneity. The mortality at 30 days, 3 months, 6 months, 2 years, and 5 years were 5 %, 10 %, 14 %, 26 %, and 46 %, respectively. Mortality was lower in studies from Asia than in those from Europe or North America. Male sex, lower-grade FFPs, and nonoperative management showed numerically higher mortality, though not statistically significant.</div></div><div><h3>Conclusion</h3><div>FFPs are associated with substantial short- and long-term mortality, warranting their recognition as high-risk injuries in older adults. Regional and treatment-related variation highlights the need for individualized management. Future research should clarify causal mechanisms and assess targeted interventions to reduce mortality risk.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112618"},"PeriodicalIF":2.2,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704029","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":"Expeditious femoral nailing prior to vascular repair in fractures associated with vascular injury: A series of four cases","authors":"Austin M. Cronen ,&nbsp;Richard L. Auran ,&nbsp;Jeromy S. Brink ,&nbsp;Michael D. McKee","doi":"10.1016/j.injury.2025.112613","DOIUrl":"10.1016/j.injury.2025.112613","url":null,"abstract":"<div><h3>Case</h3><div>Femoral shaft fractures with concomitant vascular injury requiring limb revascularization, although rare, are a limb-threatening condition. Historically, emergent external fixation of the femur fracture followed by vascular repair has been considered the standard of care. We discuss four cases of femoral fracture with an associated vascular injury amenable to nail fixation stabilized by expeditious intramedullary nailing (IMN), followed by limb revascularization. We discuss the timeline and duration of the procedure for this technique.</div></div><div><h3>Conclusion</h3><div>Expeditious femoral IMN prior to limb revascularization has multiple clinical advantages and has become our standard protocol for these injuries.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112613"},"PeriodicalIF":2.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656878","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":"Corrigendum to “Magnitude and factors associated with road traffic injuries in Brazil: results from the National Health Survey, 2019” [Injury, volume 54 (2023) p.1492–1502/Issue 6]","authors":"Rafael Alves Guimarães ,&nbsp;Kamylla Guedes de Sena ,&nbsp;OtalibaLibânio de Morais Neto ,&nbsp;Deborah Carvalho Malta","doi":"10.1016/j.injury.2025.112588","DOIUrl":"10.1016/j.injury.2025.112588","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112588"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632495","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 economic burden of hip fractures in the geriatric population by mental health illness and substance Use Status: National estimates 2016 to 2020","authors":"Anuja L. Sarode ,&nbsp;Emily Su ,&nbsp;Jennifer Drost ,&nbsp;Madeline Evan ,&nbsp;Lyn Haselton ,&nbsp;Nathan Blecker","doi":"10.1016/j.injury.2025.112615","DOIUrl":"10.1016/j.injury.2025.112615","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the economic burden of hip fracture hospitalizations associated with mental health and substance use (MHSU) disorder.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the National Inpatient Sample 2016–2020. Patients 65 years and older with hip fracture-related ICD-10 diagnosis and discharge codes were selected. Pre-defined by Clinical Classification Software (CCS), we identified 34 MHSU groups. We analyzed MHSU disorders in two ways: first, we looked at patients with at least one MHSU disorder to compare demographic and clinical characteristics; and second, we examined individual MHSU categories separately to assess their prevalence and compare costs. The dependent variable was the hospitalization cost adjusted for 2024 inflation. Multiple regression analysis with a log transformation of costs was used to assess hospitalization costs by individual MHSU categories, adjusting for confounding factors.</div></div><div><h3>Results</h3><div>Of 274,784 inpatient hip fracture admissions, 35 % had at least one diagnosis related to MHSU. Among the 34 MHSU categories, only five had a prevalence greater than 1 %: depression (15 %), anxiety or fear-related disorders (14 %), alcohol use (3 %), opioid use (3 %), and tobacco use (9 %). Patients with MHSU were younger and had longer hospital length of stay (LOS) than patients with no MHSU (NoMHSU) (median age 80 vs. 84 years, <em>p</em> &lt; 0.001; median LOS 5 days vs. 4 days, <em>p</em> &lt; 0.001). The total estimated cost of hospitalization for the cohort was $30.5 billion during the study period. Patients with MHSU incurred higher mean hospitalization costs compared to NoMHSU ($22,634 vs. $22,000, <em>p</em> &lt; 0.001). After adjusting for demographic, regional, and clinical factors, costs were 4 % (<em>p</em> &lt; 0.001) and 6 % higher (<em>p</em> &lt; 0.001) for patients with alcohol-related and opioid-related disorders, respectively, compared to those without these conditions.</div></div><div><h3>Conclusions</h3><div>The economic burden of hip fractures in older adults is significant and exacerbated by the presence of substance use disorders, particularly alcohol- and opioid-related, underscoring the need for targeted policies and clinical interventions to optimize care and resource allocation for this population.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112615"},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750582","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":"Clinical outcome in tibial plateau fractures improves over time: Insights from a collaborative data network","authors":"Clemens Lang ,&nbsp;Christina Hörmandinger ,&nbsp;Michelle Klaut ,&nbsp;Claas Neidlein ,&nbsp;Julius Watrinet ,&nbsp;Jörg Arnholdt ,&nbsp;Wolfgang Böcker ,&nbsp;Fabian M. Stuby ,&nbsp;Markus Bormann ,&nbsp;Julian Fürmetz ,&nbsp;Robert Pätzold","doi":"10.1016/j.injury.2025.112607","DOIUrl":"10.1016/j.injury.2025.112607","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a strong demand for research on the long-term outcomes of tibial plateau fractures (TPFs) in large cohorts. Stringent data protection regulations and high ethical standards are essential for safeguarding participants' rights, but they can increase the logistical complexity of conducting multicentre studies. This study aims to evaluate clinical outcome data collected over more than a decade through a collaborative data network in surgically treated TPFs.</div></div><div><h3>Patients and Methods</h3><div>This retrospective cohort study was conducted at two level-I trauma centers and included 364 adult patients with operatively TPFs, classified according to the Schatzker system. Eligible patients were treated between January 2010 and September 2022, were ≥18 years of age at the time of injury, resided in Germany, and had a minimum follow-up of 1.25 years with completed patient-reported outcome measures. Patients with cognitive or physical impairments preventing survey participation were excluded. Data collection occurred between September 2022 and January 2023. Outcome measures included the International Knee Documentation Committee (IKDC) form, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm Score. Multiple linear regression was used to assess associations between outcome scores, follow-up duration, and Schatzker classification.</div></div><div><h3>Results</h3><div>Longer follow-up times were associated with significantly higher scores for IKDC (<em>p</em> &lt; 0.05), KOOS Pain (<em>p</em> &lt; 0.05), Activities of Daily Living (ADL) (<em>p</em> &lt; 0.05), Sports (<em>p</em> &lt; 0.05), and Quality of Life (QoL) (<em>p</em> &lt; 0.00001). Complex fractures (Schatzker IV–VI) were consistently linked to worse outcomes, particularly in the KOOS Sports (<em>p</em> &lt; 0.001) and Quality of Life (<em>p</em> &lt; 0.00001) subscores. Adjusted R-squared values ranged from 2 % to 10 %, with the highest values observed in KOOS QoL scores.</div></div><div><h3>Conclusions</h3><div>Patient-reported outcomes (PROMs) were found to be positively associated with longer follow-up durations, up to 12 years postoperatively emphasizing the need for prolonged aftercare in TPFs. Complex fractures, in particular, might benefit from tailored, long-term follow-up. Given the severity of TPFs, it is crucial to manage patient expectations and address psychosocial factors to optimize the outcome. Collaborative data networks, like the one used here, hold promise for expanding research and improving treatment strategies across multiple centers.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112607"},"PeriodicalIF":2.2,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657279","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}