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

{"title":"Conservative treatment remains the most preferred approach for proximal humeral fractures in octogenarians, nonagenarians, and centenarians: A retrospective study from Turkish national database","authors":"Yavuz Şahbat ,&nbsp;Merve Güner ,&nbsp;Naim Ata ,&nbsp;Şuayıp Birinci ,&nbsp;Rıfat Bozkuş ,&nbsp;Salih Başer ,&nbsp;Nuri Aydın ,&nbsp;Barış Kocaoğlu","doi":"10.1016/j.injury.2025.112785","DOIUrl":"10.1016/j.injury.2025.112785","url":null,"abstract":"<div><h3>Introduction</h3><div>The treatment options of orthopedic surgeons for older adults with proximal humeral fractures (PHF) may vary according to chronological age. This study aimed to present the treatment modalities, complications, and mortality rates after PHF in octogenarians, nonagenarians, and centenarians from the Turkish national database.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted using health records from the National Health Record System of Ministry of Health Turkey for individuals aged 80 and over who presented to public, private, and university hospitals from January 2016, to October 2024. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) code S42.2 (code for closed PHFs) was used to identify patients. A total of 9799 patients were included and categorized into three age groups: octogenarians (80–89 years), nonagenarians (90–99 years), and centenarians (≥100 years) and 4 groups according to treatment modalities (conservative, osteosynthesis, reverse shoulder arthroplasty (RSA), and hemiarthroplasty). Early systemic complications, revision surgery and mortality rates regarding 30-day and 90-day were recorded.</div></div><div><h3>Results</h3><div>The mean age of the study population was 85.1 ± 4.2, ranging between 80–106 years. The female ratio was 76.1 %. Octogenarians comprised 84.3 % of the entire study population, whereas 15.5 % were nonagenarians and 0.3 % were centenarians. Conservative treatment was the most preferred across all age groups (62.3 %). Among patients initially managed conservatively, 7.0 % (<em>n</em> = 425) subsequently required surgical intervention, with no statistically significant difference in surgical conversion rates across the three age groups. Only 77 patients (0.8 %) underwent RSA. No differences were observed in the ratio of early systemic complications between octogenarians, nonagenarians, and centenarians. 30-day and 90-day mortality rates were 4.9 % and 10.2 %, respectively. RSA was associated with the highest risk of 90-day mortality (HR: 2.222, 95 % CI: 1.328–3.718; <em>p</em> = 0.002), with centenarians exhibiting an even greater risk (HR: 2.879, 95 % CI: 1.193–6.949; <em>p</em> = 0.019).</div></div><div><h3>Conclusion</h3><div>Conservative treatment remains the most preferred approach for PHFs in the patient population over the age of 80. Given the significantly higher mortality rates in centenarians and in patients undergoing RSA, individualized treatment decisions should prioritize functional outcomes, patient comorbidities, and life expectancy.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 12","pages":"Article 112785"},"PeriodicalIF":2.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145270804","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":"Rising burden of upper extremity fractures in China (1990–2021): A national study linking falls, aging, and divergent global trends","authors":"Vidmi Taolam Martin,&nbsp;Shao-Yong Xu,&nbsp;Bin Yu","doi":"10.1016/j.injury.2025.112783","DOIUrl":"10.1016/j.injury.2025.112783","url":null,"abstract":"<div><h3>Background</h3><div>Upper extremity fractures (UEFs) are a growing public health concern in China, yet comprehensive epidemiological data remain limited. This study examines the burden, trends, and risk factors of UEFs in China from 1990 to 2021.</div></div><div><h3>Methods</h3><div>Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed the incidence, years lived with disability (YLDs), and causes of UEFs in China. Age-standardized rates (ASRs) were calculated, and trends were assessed using regression models. Sociodemographic index (SDI) associations and global comparisons were evaluated.</div></div><div><h3>Results</h3><div>In 2021, China recorded 11.1 million new UEF cases, a 31.92% increase since 1990. The age-standardized incidence rate (ASIR) rose by 7.97%, contrasting with a 20.92% global decline. Fractures of the radius and/or ulna had the highest ASIR (404.52 per 100,000), while shoulder fractures saw the steepest YLD increase (42.69%). UEFs were more prevalent in males, except among children (&lt;1, 10–14 years) and older adults (≥65 years), where females predominated. Falls accounted for 72.98% of UEFs, followed by road injuries (13.38%). Rehabilitation needs (YLDs) grew by 32.28%, with SDI-linked trends showing a plateau at SDI 0.59–0.72.</div></div><div><h3>Conclusions</h3><div>China's increasing burden of UEF, influenced by factors such as falls, an aging population, and urbanization, contrasts with the global downward trends. Immediate targeted actions (implementing fall prevention strategies for the elderly, enhancing road safety for young people, and broadening access to rehabilitation services) are essential to address this escalating public health issue.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 12","pages":"Article 112783"},"PeriodicalIF":2.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145270820","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":"Ketorolac use following operative clavicle fracture fixation is not associated with increased nonunion or surgical complications: A propensity-matched analysis","authors":"Tuckerman Jones ,&nbsp;Tej Joshi ,&nbsp;Akhil Katakam ,&nbsp;Daniella Ogilvie ,&nbsp;Sefy A Paulose ,&nbsp;Balazs Galdi","doi":"10.1016/j.injury.2025.112780","DOIUrl":"10.1016/j.injury.2025.112780","url":null,"abstract":"<div><h3>Objectives</h3><div><strong><em>:</em></strong> Nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are commonly used for postoperative pain management. Concerns about their potential impact on bone healing have been raised. This study investigated the relationship between ketorolac use and postoperative complications following clavicle surgery, including nonunion rates.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used the TriNetX Research Database to identify patients who underwent surgical fixation of clavicle fractures between 2002 and 2022. Two propensity-matched cohorts were created: patients who received postoperative ketorolac and those who did not. Primary outcomes included nonunion diagnosis and revision surgery; secondary outcomes included opioid use, wound disruption, surgical site infection, and infected hardware at 30 days, 90 days, 1 year, and 2 years postoperatively.</div></div><div><h3>Results</h3><div><strong>:</strong> 5,264 patients were in each cohort after matching. Nonunion diagnosis was similar between the ketorolac and no-ketorolac groups at 30 days (16 vs. 18, P=0.731), 90 days (31 vs. 40, P=0.284), 1 year (93 vs. 88, P=0.708), and 2 years (104 vs. 100, P=0.777). Similarly, revision surgery for nonunion was comparable between the two groups at all time points, 30 days (&lt;10 vs &lt;10, P=1), 90 days (&lt;10 vs &lt;10, P=1), 1 year (24 vs. 20, P=0.546), and 2 years (27 vs 26, P=0.890). Opioid prescription rates were comparable across all time points but trended lower in the ketorolac group: 30 days (1,827 vs. 1,906, P=0.108), 90 days (1,967 vs. 2,051, P=0.092), 1 year (2,340 vs. 2,428, P=0.085), and 2 year (2,574 vs 2,642, P=0.185).</div></div><div><h3>Conclusion</h3><div><strong>:</strong> Ketorolac use following clavicle surgery was not associated with increased nonunion or revision surgery rates. Although opioid prescription rates trended lower in the ketorolac group, the difference was not statistically significant.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 12","pages":"Article 112780"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236139","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":"Return to initial work and fulfillment of expectations in patients with complex proximal tibial fracture is influenced by physical workload and workers´ compensation status","authors":"L Keppler ,&nbsp;AM Keppler ,&nbsp;C Ihle ,&nbsp;F Navarre ,&nbsp;FM Stuby ,&nbsp;W Böcker ,&nbsp;T Saier","doi":"10.1016/j.injury.2025.112779","DOIUrl":"10.1016/j.injury.2025.112779","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this study was to investigate on the influence of physical workload and workers’ compensation status on fulfillment of patients’ expectations, return to initial work, and functional outcome after surgical treatment of complex proximal tibial fractures.</div></div><div><h3>Methods</h3><div>This prospective study included 114 patients with complex tibial fractures (AO/OTA type B and C). At final follow-up, an individualized questionnaire based on the Hospital For Special Surgery-Knee Surgery Expectations Survey (HFSS-KSES) was used to assess whether preoperative expectations had been met. In addition, the condition of the knee joint, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used. Physical workload was assessed using the REFA classification. Physical workload and workers’ compensation status was corelated to duration of incapacity to work (weeks), fulfillment of expectations, and functional outcome.</div></div><div><h3>Results</h3><div>Patients with higher physical workloads showed longer incapacity to work (20.1 weeks on average) and were significantly less likely to report a complete return to their initial professional activity (<em>r</em>=-0.21). Their preoperative expectations were significantly less frequently fulfilled (<em>r</em>=-0.29). Workers’ compensation status was associated with lower satisfaction and higher workload demands. Reintegration programs proved effective, enabling a high percentage of patients to return to work without restrictions (<em>p</em> = 0.04). Significant negative correlations were found between workload and functional outcomes (KOOS dimensions, residual pain, quality of life).</div></div><div><h3>Conclusion</h3><div>Individualized, job-oriented rehabilitation with realistic expectations is crucial for improving return to work, especially for high-workload patients. Future research should integrate physical and psychosocial factors in rehabilitation strategies.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 12","pages":"Article 112779"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145270819","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":"Comparing ketofol with etofen in procedural sedation analgesia for anterior shoulder dislocation reduction: A randomized trial","authors":"Mojtaba Habibi-Khorasani,&nbsp;Masoomeh Nazemi-Rafi,&nbsp;Amirhossein Mirafzal,&nbsp;Mitra Movahedi,&nbsp;Amin Honarmand","doi":"10.1016/j.injury.2025.112777","DOIUrl":"10.1016/j.injury.2025.112777","url":null,"abstract":"<div><h3>Background</h3><div>Anterior shoulder dislocations are common in emergency settings, requiring effective procedural sedation and analgesia (PSA). Ketofol (ketamine-propofol) and etofen (etomidate-fentanyl) are widely used, but their comparative efficacy remains debated.</div></div><div><h3>Objectives</h3><div>The aim of this study was to compare the efficacy and safety of ketofol versus etofen for PSA in shoulder dislocation reduction.</div></div><div><h3>Methods</h3><div>This randomized clinical trial enrolled 92 patients (46 per group). Ketofol (0.75 mg/kg) or etofen (0.15 mg/kg etomidate + 1.5 µg/kg fentanyl) was administered. Outcomes included sedation depth, hemodynamics, adverse events, and recovery times.</div></div><div><h3>Results</h3><div>Ketofol provided deeper sedation (RSS 4.5 vs. 4.1, <em>p</em> &lt; 0.001), better analgesia (VAS 1.64 vs. 2.64, <em>p</em> &lt; 0.001), and easier reduction but had more emergence reactions. Etofen showed faster onset and fewer respiratory events but caused myoclonus.</div></div><div><h3>Conclusion</h3><div>Ketofol offers superior analgesia and sedation, while etofen ensures rapid recovery and hemodynamic stability. The choice depends on clinical priorities.</div></div><div><h3>Clinical trial registration</h3><div>IRCT20220824055790N1.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112777"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226943","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":"Shark bites in New Caledonia: A retrospective study of 22 hospitalized cases and surgical management","authors":"Cerise Gosselin ,&nbsp;Claude Maillaud ,&nbsp;François Jourdel","doi":"10.1016/j.injury.2025.112775","DOIUrl":"10.1016/j.injury.2025.112775","url":null,"abstract":"<div><h3>Objective</h3><div>Although rare, shark bites can cause complex injuries requiring specialized management. This study aims to describe the surgical and medical management of shark bite injuries in New Caledonia.</div></div><div><h3>Methods</h3><div>A retrospective, descriptive, single-center study including 22 patients hospitalized between 2011 and 2023. Demographic data, attack context, injury types, surgical treatments, infectious complications, and length of hospital stay were analyzed.</div></div><div><h3>Results</h3><div>The median age was 33.5 years (IQR 15); 82 % were male. Spearfishing was the most common context (32 %). Injuries predominantly affected limbs, with musculoskeletal damage (82 %), nerve injuries (32 %), vascular injuries (27 %), and fractures (18 %). Infectious complications were rare (9 %), but identified pathogens were polymicrobial and marine-derived. The median hospital stay was 5 days (IQR 6, range 1–50 days).</div></div><div><h3>Conclusion</h3><div>Shark bites require rapid, specialized surgical care. Local organization enabled effective management. Empirical antibiotic therapy should cover marine pathogens.</div></div><div><h3>Level of Evidence</h3><div>IV</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112775"},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215009","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":"Remote monitoring of bone healing via bending with direct electromagnetic coupling sensing in an exploratory tibial fracture study","authors":"Kevin M. Labus ,&nbsp;Julie Dunn ,&nbsp;Milan Ilić ,&nbsp;Branislav M. Notaroš ,&nbsp;Kirk C. McGilvray ,&nbsp;Christian M. Puttlitz","doi":"10.1016/j.injury.2025.112771","DOIUrl":"10.1016/j.injury.2025.112771","url":null,"abstract":"<div><h3>Objectives</h3><div>The purpose of this study was to evaluate the feasibility and efficacy of longitudinal bending measurements to monitor the progression of fracture healing. Standard methods for evaluating bone healing rely on the assessment of radiographs, which is subjective in nature and intractable during the first several weeks of healing due to the delayed timeframe of radiographically visible mineralization. In contrast, bending measurements can provide a direct objective measurement of fracture stability that is sensitive to soft callus formation during the acute healing phase.</div></div><div><h3>Methods</h3><div>In this study, a direct electromagnetic coupling (DEC) sensing system, which measures bending compliance, was evaluated in an exploratory observational study of diaphyseal tibial fracture patients. Longitudinal measurements were obtained from five patients at their clinical visits and remotely from 14 patients in their homes.</div></div><div><h3>Results</h3><div>The DEC bending data satisfied repeatability criteria of less than 10 % precision error in 12 of 14 remote patients. As expected, bending compliance decreased with time for 17 of 18 fractures that resulted in union. One fracture resulted in non-union, and the corresponding bending compliance increased with time. The bending compliance rate of change, determined as early as 4 weeks post-injury, detected significant differences between patients with and without non-steroidal anti-inflammatory drug (NSAID) use and between patients with and without co-morbidities.</div></div><div><h3>Conclusions</h3><div>These results demonstrated the feasibility of remote bending measurements using DEC, which provide a precise metric of early fracture healing rate that may be invaluable for clinical patient management and as an outcome measure in clinical research.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112771"},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208359","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":"Are posterior olecranon locking plates a problem for patients after fracture healing because of prominence?","authors":"Reva Qiu ,&nbsp;Mallika Makkar ,&nbsp;Richard Buckley","doi":"10.1016/j.injury.2025.112769","DOIUrl":"10.1016/j.injury.2025.112769","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112769"},"PeriodicalIF":2.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158780","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":"TORCH: addressing the gap in training for ward based care of major trauma patients","authors":"P Ramaraj,&nbsp;KH Hancorn,&nbsp;CJ Aylwin,&nbsp;E Cole,&nbsp;SP Hettiaratchy,&nbsp;NRM Tai","doi":"10.1016/j.injury.2025.112770","DOIUrl":"10.1016/j.injury.2025.112770","url":null,"abstract":"<div><h3>Introduction</h3><div>A dedicated Major Trauma Ward (MTW) is core to the function of a Major Trauma Centre (MTC). MTCs are central to the hub-and-spoke model of an inclusive Major Trauma System (MTS). The implementation of the London Major Trauma System is heralded to have increased the in-hospital odds ratio of survival of traumatically injured patients by 19 %. There is no one universal definition of Major Trauma, but the National Institute for Health and Clinical Excellence (NICE) provides the definition, “Major trauma is defined as an injury or combination of injuries that are life-threatening and could be life changing because it may result in long-term disability”.</div><div>Major Trauma is a disease requiring multidisciplinary and multi-specialty input at every stage of the continuum of care. However, there is no formal education for staff on a MTW on the care of these complex, severely injured patients.</div><div>The Trauma ORchestration of Continuing Healthcare (TORCH) course was established in 2018 to help to address this educational void. The aims of this paper are to describe the rationale for the course, report the feedback, and identify key strengths and areas for improvement.</div></div><div><h3>Methods</h3><div>A mixed methods study was undertaken with simultaneous quantitative and qualitative analysis. Descriptive statistics of quantitative data was undertaken to describe delegate demographics. Thematic analysis of the 136 attendee responses to course feedback was performed. Course feedback was assimilated contemporaneously at the end of each course via online survey.</div></div><div><h3>Results and Discussion</h3><div>There was an 88 % (136/154) response rate to feedback. Attendees included 96 doctors, and 16 nurses and allied health professionals. The 2019 course of 24 delegates did not stratify participant demographics. The largest group of doctors (39 %) were Senior House Officer grade, with 41 % of all doctors coming from a surgical background.</div><div>Feedback themes identified as course strengths include the multidisciplinary curriculum approach. Speakers include Consultants from 12 different specialties and multiple therapists across the continuum of trauma care. Lectures based on real life case discussion was found to be an engaging and thought provoking medium of education with the focus on MTW based decision making commonly required of MTW junior staff.</div><div>Areas for future development include the continued delivery of the TORCH course outside of London and consideration of course validation for quality assurance, and a “train the trainer” model to allow for course expansion and sustainability in other MTSs of the UK and Ireland to implement formal, high quality education for staff on MTWs.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112770"},"PeriodicalIF":2.0,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226854","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":"Surgical treatment of supracondylar fractures in children: should the pins be buried or left exposed? Comparative study of functional and radiographic results of two surgical protocols","authors":"Camille Girardin ,&nbsp;Corentin Petitpas ,&nbsp;Adrien Zampieri ,&nbsp;Federico Canavese ,&nbsp;Roman Roux-Deboffle ,&nbsp;Nicolas Mainard ,&nbsp;Eric Nectoux ,&nbsp;Sebastien Pesenti","doi":"10.1016/j.injury.2025.112768","DOIUrl":"10.1016/j.injury.2025.112768","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The osteosynthesis of supracondylar fractures (SC) using pins buried under the skin (PB) or externalized (PE) is a subject of debate. The aim of this study was to compare two treatment protocols, one using PB and the other using PE, in terms of clinical and radiographic outcomes, complication rates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;The hypothesis of the study was that both protocols are equivalent in terms of clinical, radiological outcomes, and complication rates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;This was a retrospective bicentric comparative study analyzing 296 boys and 267 girls (mean age 6.2 ± 2.7 years) who underwent SC fracture surgery between 1/1/2010 and 31/12/2020 using two therapeutic protocols. The first protocol (group A; &lt;em&gt;n&lt;/em&gt; = 210) involved osteosynthesis with PB, immobilization (6–7 weeks), and pin removal in the operating room under general anesthesia. The second protocol (group B; &lt;em&gt;n&lt;/em&gt; = 353) was characterized by osteosynthesis with PE, immobilization (4–6 weeks), and pin removal in an outpatient setting. Functional outcomes were assessed using the QuickDASH questionnaire, radiographic outcomes [Baumann angle, lateral capitulum-humeral angle (LCHA), rotational disorders according to the Von Laer quotient], and postoperative complication rates (infection, recurrent fracture, stiffness, vasculo-nerve complications).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;No patients were lost to follow-up (&lt;em&gt;n&lt;/em&gt; = 563) and the mean follow-up was 6.6 ± 7.3 months (3–70). The mean immobilization duration was longer in group A (45.8 ± 7.4 vs 39.7 ± 12.0 days; &lt;em&gt;p&lt;/em&gt; &lt; 0.001). Clinical and functional outcomes were similar (&lt;em&gt;p&lt;/em&gt; = 0.316), and the pre- and postoperative complication rates were comparable between the two groups (A-&lt;em&gt;B&lt;/em&gt; = 8 %/8.6 %-6 %/7.1 %; &lt;em&gt;p&lt;/em&gt; = 0.733 and &lt;em&gt;p&lt;/em&gt; = 0.512), while the postoperative Baumann angle, LCHA, number of rotational disorders, and Von Laer quotient were significantly different [A-&lt;em&gt;B&lt;/em&gt; = 71.5°-74° (&lt;em&gt;p&lt;/em&gt; &lt; 0.001); A-&lt;em&gt;B&lt;/em&gt; = 32.8°-35.6° (&lt;em&gt;p&lt;/em&gt; &lt; 0.001); A-&lt;em&gt;B&lt;/em&gt; = 32–10 (&lt;em&gt;p&lt;/em&gt; &lt; 0.001); A-&lt;em&gt;B&lt;/em&gt; = 0.2–0.1 (&lt;em&gt;p&lt;/em&gt; = 0.020)].&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;This retrospective study compared two surgical protocols for pediatric supracondylar (SC) fractures in 563 children. Functional and clinical outcomes were similar between groups, with no significant difference in complication rates. Group B had better radiographic results and a lower rate of postoperative rotational deformities. Pin buried (Group A) increased costs and required a second general anesthesia for removal. Group B's protocol allowed outpatient pin removal under nitrous oxide, reducing risks and costs. Infection rates were no significant different between both groups. Whereas the decrease of number of rotational disorsders, the increase of Baumann angle and decrease of LCHA in this patient show that dec","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112768"},"PeriodicalIF":2.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158782","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}