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

{"title":"Diagnostic test accuracy of CT for open globe injury: A systematic review and meta-analysis of overall impression and individual imaging signs","authors":"Mahmoud Omar ,&nbsp;Nailah Ghouse ,&nbsp;Alexander Azar ,&nbsp;Sarah Atta ,&nbsp;Wassim Malak","doi":"10.1016/j.injury.2026.113041","DOIUrl":"10.1016/j.injury.2026.113041","url":null,"abstract":"<div><h3>Introduction</h3><div>Open globe injury is a surgical emergency requiring prompt diagnosis to minimize morbidity. Orbital CT is frequently performed in trauma settings and is crucial for globe evaluation, particularly when bedside assessment is limited.</div><div>The primary objective was to evaluate the diagnostic accuracy of overall CT impression for detecting open globe injury. The secondary objective was to assess the diagnostic accuracy of CT imaging signs.</div></div><div><h3>Methods</h3><div>A systematic review protocol was prospectively registered (PROSPERO CRD42025638703). On January 16, 2025, Embase, Pubmed, Scopus, and Google Scholar were searched without date restrictions. Diagnostic accuracy meta-analyses were performed on overall CT impression and individual CT imaging signs for open globe injury. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.</div></div><div><h3>Results</h3><div>Eight studies met inclusion criteria representing 827 patients, 830 injured globes, and 339 confirmed open globe injury. The pooled sensitivity and specificity of overall CT impression was 75% (95% CI, 0.69–0.79) and 94% (95% CI, 0.91–0.96), respectively. Among individual signs, change in globe contour or scleral irregularity had the highest diagnostic odds ratio (109; 95% CI, 17–718) with sensitivity and specificity of 71% (95% CI, 0.61–0.79) and 98% (95% CI, 0.86–1.00), respectively. Change in anterior chamber depth, vitreous hemorrhage, lens abnormality, and intraocular air were insensitive but highly specific signs.</div></div><div><h3>Conclusions</h3><div>Overall CT impression and individual imaging signs demonstrate high specificity but limited sensitivity for open globe injury. Surgical exploration remains necessary when clinical suspicion persists despite inconclusive imaging.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113041"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950137","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":"Modified Masquelet technique using free vascularized fibula grafting for reconstruction of large bone defects after bone infection","authors":"Huhu Wang ,&nbsp;Hongying He ,&nbsp;Jianwen Zhao ,&nbsp;Li Han ,&nbsp;Weidong Shi ,&nbsp;Zhuo Wu ,&nbsp;Lin Yang ,&nbsp;Wenxing Han ,&nbsp;Hao Wang ,&nbsp;Shaoguang Li ,&nbsp;Xiaowei Zhang ,&nbsp;Jianzheng Zhang","doi":"10.1016/j.injury.2026.113036","DOIUrl":"10.1016/j.injury.2026.113036","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Bone infection with large bone defects presents a significant challenge for orthopedic surgeons. Free vascularized fibula grafting (FVFG) and the Masquelet technique have proven to be a practical reconstructive approach for addressing large bone defects. Although various strategies have been utilized to manage bone infection with large bone defects, there remains debate concerning the optimal treatment approach. The aim of this study was to observe the outcomes of a new surgical procedure of the modified Masquelet technique for bone infection with large bone defects.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;From October 2021 to October 2023, 10 patients of bone infection with large bone defects underwent the surgery of the modified Masquelet technique. A large bone defect was defined as bone defects &gt;6 cm. Among the 10 cases, 8 were male, and 2 were female, with a mean age of 54.7 ± 11.1 years. The median and interquartile range of the infection history was 6 (2, 66) months. The infected skeletal sites included 7 cases in the tibia and 3 in the femur. All cases underwent the modified Masquelet technique, which included two-stage surgical approaches: the first-stage surgery (FSS) involved debridement, bone cement filling, soft tissue coverage, and external fixation; the second-stage surgery (SSS) included removal of the bone cement, FVFG, iliac bone grafting, and external fixation. The bone defect sizes ranging from 9.7 to 22.4 cm (16.4 ± 4.1 cm). The median and quartile of the bone defect volume were 70.1 (52.1, 139.9) cm&lt;sup&gt;3&lt;/sup&gt;. The size of the vascularized fibula varied from 11.3 to 21.0 cm (17.2 ± 3.7 cm). Postoperatively, patients were followed for a duration ranging from 12 to 31 (19.7 ± 6.4) months. Bone graft fusion was assessed according to the radiographic union score (RUS), with scores greater than 8 indicating successful bone fusion. The pain was measured by the visual analogue scale (VAS), limb function was assessed with the lower extremity functional scale (LEFS), and anxiety levels were evaluated using the self-rating anxiety scale (SAS).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;All patients achieved complete resolution of their infections, resulting in an infection cure rate of 100%, with no recurrences observed during the follow-up period. All patients achieved osseous fusion, resulting in an overall bony union rate of 100%. The average RUS recorded was 10.6 ± 1.5, and no instances of re-fracture were observed during the follow-up period. There were no wound-related complications at the donor site of the fibula graft, nor were there any issues such as toe flexion weakness, ankle instability, or pain. Compared with the preoperative scores, the last follow-up VAS scores (0.6 ± 0.5 vs. 5.8 ± 1.0, &lt;em&gt;p&lt;/em&gt; &lt; 0.001) and SAS scores (33.3 ± 2.3 vs. 59.7 ± 4.1, &lt;em&gt;p&lt;/em&gt; &lt; 0.001) were significantly lower. Compared with the preoperative scores, the last follow-up LEFS scores (63.3 ± 7.8 vs. 20.8 ± 3.8,","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113036"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950138","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 precision of CT-guided percutaneous sacral screw placement in 114 fragility fractures of the pelvis – a retrospective study","authors":"Lorena Cogliatti ,&nbsp;Werner Vach ,&nbsp;Christoph J. Zech ,&nbsp;Henrik Eckardt","doi":"10.1016/j.injury.2026.113042","DOIUrl":"10.1016/j.injury.2026.113042","url":null,"abstract":"<div><h3>Background</h3><div>Fragility fractures of the pelvis (FFP) are increasingly common, particularly in the ageing population. Traditionally, those low-energy pelvic ring fractures have been managed conservatively, but this approach can lead to immobility and therefore complications. Surgical intervention is indicated based on various factors including type of fracture, mobility, and pain. Minimal-invasive percutaneous sacroiliac and/or transsacral screw stabilisation offers an effective treatment, enabling immediate mobilisation. There are multiple technical methods for the implantation. This study aimed to assess the precision of CT-guided percutaneous screw stabilisation and functional outcomes in elderly patients with FFP.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 114 elderly patients who underwent CT-controlled percutaneous sacroiliac screw implantation for FFP between 2010 and 2021. Data on demographics, pre-operative characteristics, surgical procedure, and postoperative outcomes were collected from routine data and analysed.</div></div><div><h3>Results</h3><div>Stabilisation using CT-guidance demonstrated favourable outcomes with low rates of screw malposition. 96% of the sacroiliac screws in S1 were placed completely intraosseous. Sacroiliac placement showed higher rates of completely intraosseous placement than transsacral placement. Placement in S1 showed higher accuracy rates than placement in S2. Operations with more radiation had a higher percentage of perfectly positioned screws and the simple fracture type had more perfectly positioned screws than the more complex type FFP4. Eighteen screws showed signs of loosening after one year, necessitating re-operation in 2 cases. Patients with 3 screws had less risk of loosening. Screws inserted from the left showed lower rates of loosening than screws from the right. Postoperative mobility assessment showed that 70% were still living at home after one year and 63% were painfree. The one-year mortality was 18%.</div></div><div><h3>Conclusion</h3><div>CT-guided implantation of 231 sacrum screws had a very high precision with no malpositioned screws. The precision of implantation is not affected by the BMI or age of the patient, but the rate of perfect position was lower in complex fractures than in simple fractures. Precision of sacroiliac screw implantation is higher than that of transsacral screws but the rate of loosening is not higher. Surgery provided freedom from pain for most patients and only few patients lost their self-dependence.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113042"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032402","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":"Impact of Psychosocial intervention on Quality of life in patients with post- traumatic limb amputation/s: a randomized controlled trial","authors":"Milandeep ,&nbsp;Rajesh Sagar ,&nbsp;Sushma Sagar ,&nbsp;Pratyusha Priyadarshini ,&nbsp;Abhinav Kumar ,&nbsp;Junaid Alam ,&nbsp;Dinesh Bagaria ,&nbsp;Narendra Chaudhary ,&nbsp;Amit Gupta ,&nbsp;Biplab Mishra ,&nbsp;Anamika Sahu ,&nbsp;Shivam Pandey ,&nbsp;Subodh Kumar","doi":"10.1016/j.injury.2026.113027","DOIUrl":"10.1016/j.injury.2026.113027","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma results in approximately 1.19 million deaths and 20–50 million disabilities globally each year. With increasing industrialization, road traffic injuries have become a leading cause of Disability Adjusted Life Years and traumatic amputations. These sudden amputations often lead to significant psychological distress. This study aims to assess the effectiveness of psychosocial interventions in enhancing the Quality of Life of post-traumatic amputees.</div></div><div><h3>Material and Methods</h3><div>This randomized controlled trial enrolled 74 post-traumatic extremity amputees aged over 18 years, who were cognitively coherent, had adequate social support, and no prior psychological illness. Following baseline psychosocial assessment, participants were randomly assigned to two groups: Group A (<em>n</em> = 39) received conventional care, while Group B (<em>n</em> = 35) received both psychosocial intervention and conventional care for seven weeks. Psychosocial outcomes were reassessed in both groups at the eighth week post-intervention.</div></div><div><h3>Results</h3><div>Quality of life showed significant improvement in both the groups. However, there was no significant difference between the groups. Level of depression, anxiety and stress significantly decreased in both the groups at 8 weeks, but the difference was not significant between the groups. However, body image showed a significant improvement in Group B as compared to Group A (<em>p</em> = 0.023).</div></div><div><h3>Conclusion</h3><div>Our study did not show any observable positive effects of psychosocial intervention over conventional care on quality of life, depression, stress, or anxiety except on body image. We hypothesize that positive results might be seen in quality of life of amputees if a larger study with longer duration of psychosocial intervention is conducted.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113027"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000146","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":"ICG-based fluorescence imaging to assess muscle perfusion for guiding surgical debridement after acute compartment syndrome","authors":"Yue Tang ,&nbsp;Shaofeng Yan ,&nbsp;Shudong Jiang ,&nbsp;Jonathan Thomas Elliott ,&nbsp;Xu Cao ,&nbsp;Lillian A. Fisher ,&nbsp;Chelsey L. Recendez ,&nbsp;Eric R. Henderson ,&nbsp;Leah Gitajn","doi":"10.1016/j.injury.2026.113039","DOIUrl":"10.1016/j.injury.2026.113039","url":null,"abstract":"<div><h3>Background</h3><div>Acute Compartment Syndrome (ACS) is a severe condition that can threaten limb viability, particularly in patients who experience prolonged immobility, such as in the found-down phenomenon. Inadequate removal of nonviable muscle after fasciotomy increases the risk of infection. While non-invasive imaging modalities have been explored for early ACS diagnosis, no tools currently exist to guide precise debridement intraoperatively. Existing technologies are limited by susceptibility to interference, lack of standardized thresholds and insufficient real-time surgical utility. This study aimed to evaluate the association between muscle perfusion, quantified by indocyanine green (ICG)-based dynamic contrast-enhanced fluorescence imaging (DCE-FI), and the degree of muscle necrosis in ACS, assessed via histopathological analysis, to explore the potential of DCE-FI to guide intraoperative muscle debridement.</div></div><div><h3>Methods</h3><div>A total of 15 adults (aged 18 years or older) undergoing ACS surgical treatment were included in this study between 2023 and 2024. DCE-FI imaging was performed and eight muscle specimens spanning the entire length of the incision were obtained for each patient. Necrosis percentage was assigned to each sample based on histopathological evaluation by a pathologist. Patients were then classified into high necrosis (HN) and low necrosis (LN) groups based on their average necrosis scores from these eight samples, using 50 % necrosis as a cutoff. Perfusion-related kinetic parameters derived from DCE-FI, including maximum fluorescence intensity (<em>I_max</em>) and blood flow (<em>BF</em>), were evaluated and compared between the two groups.</div></div><div><h3>Results</h3><div>The HN group exhibited significantly lower <em>I_max</em> (<em>p</em> &lt; 0.001) and <em>BF</em> (<em>p</em> &lt; 0.001), compared to those in the LN group, indicating substantially reduced muscle perfusion. The HN group had significantly lower median values (<em>I_max</em> 23.0 RFUs, <em>BF</em> 1.9 mL/min/100g) compared to the LN group (<em>I_max</em> 32.4 RFUs, <em>BF</em> 3.1 mL/min/100g).</div></div><div><h3>Conclusions</h3><div>ICG-based DCE-FI demonstrated strong potential for intraoperative identification of muscle damage resulting from ACS. This technique may serve as a valuable adjunct for guiding surgical debridement which may minimize complications and reduce the number of debridement procedures required, particularly in challenging cases of delayed or missed diagnosis of compartment syndrome.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113039"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000122","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":"Letter to the Editor: Exploring venous thromboembolism (VTE) risk in patients with acute spinal cord injury (SCI)","authors":"Yanbin Xue ,&nbsp;Linghui Tao","doi":"10.1016/j.injury.2025.112868","DOIUrl":"10.1016/j.injury.2025.112868","url":null,"abstract":"<div><div>We commend Bassa et al.'s study on VTE risk in acute SCI patients. We propose further exploring rehabilitation strategies, genetic polymorphisms (e.g., factor V Leiden), and inflammatory markers (e.g., CRP, IL-6) to refine personalized VTE prophylaxis and management in this population.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112868"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460928","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":"Trends in geriatric ankle fractures in the United States: An 8-year analysis","authors":"José L. Ayala-Ortiz ,&nbsp;Doriann M. Alcaide ,&nbsp;Sean Taylor ,&nbsp;Gerald McGwin ,&nbsp;Joey P. Johnson","doi":"10.1016/j.injury.2026.113066","DOIUrl":"10.1016/j.injury.2026.113066","url":null,"abstract":"<div><h3>Introduction</h3><div>Ankle fractures are among the most common fractures in older adults, associated with substantial morbidity and healthcare burden. This study aimed to evaluate recent trends in incidence and injury characteristics of ankle fractures among adults aged ≥65 years presenting to United States emergency departments.</div></div><div><h3>Methods</h3><div>The National Electronic Injury Surveillance System (NEISS) database was queried for ankle fractures in adults aged ≥65 years from 2016 to 2023. Demographics, injury mechanisms, fracture types, and hospitalization rates were analyzed. Annual incidence rates per 100,000 persons were calculated. Trends over time, as well as age- and sex-specific differences, were analyzed.</div></div><div><h3>Results</h3><div>An estimated 241,449 ankle fractures occurred among adults aged ≥65 years between 2016 and 2023, with an overall incidence rate of 55.8 per 100,000 person-years. The incidence increased from 49.1 to 63.0 per 100,000 persons during the study period (<em>P</em> &lt; 0.0001). Incidence rates increased significantly in both males (from 25.7 to 34.7 per 100,000 persons; <em>P</em> &lt; 0.0001) and females (from 67.7 to 86.4 per 100,000 persons; <em>P</em> &lt; 0.0001). Most fractures occurred in women (76.2 %), resulted from low-energy trauma (92.8 %), and were closed fractures (96.9 %). Open fracture incidence rose from 0.64 to 2.40 per 100,000 persons, representing a 275 % increase (<em>P</em> &lt; 0.0001). Hospitalization rates increased from 20.3 to 29.7 per 100,000 persons (<em>P</em> &lt; 0.0001). Women aged ≥80 years accounted for the highest fracture burden. Women were more likely to sustain low-energy injuries (<em>P</em> &lt; 0.0001), while men had a higher proportion of open fractures (<em>P</em> = 0.011). Hospitalization rates increased with age, reaching 56.6 % among patients aged ≥80 years (<em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Ankle fracture incidence among older adults in the U.S. increased significantly from 2016 to 2023, with rising rates in both males and females. Low-energy mechanisms remain the predominant cause in this population. Further studies are needed to identify optimal surgical treatments and rehabilitation strategies. Improving bone health and reducing morbidity and mortality remain key priorities in managing geriatric ankle fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113066"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079376","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":"Comparison of the effectiveness of platelet-rich plasma (PRP) injection and steroid injection in patients with bilateral moderate carpal tunnel syndrome: a prospective randomized controlled trial","authors":"Üzeyir Cansever ,&nbsp;Şebnem Koldaş Doğan ,&nbsp;İclal Erdem Toslak ,&nbsp;Meral Bilgilisoy Filiz ,&nbsp;Naciye Fusün Toraman","doi":"10.1016/j.injury.2026.113018","DOIUrl":"10.1016/j.injury.2026.113018","url":null,"abstract":"<div><h3>Background and objective</h3><div>To compare the effectiveness of platelet-rich plasma (PRP) injection, corticosteroid injection, and wrist splinting in patients with bilateral moderate carpal tunnel syndrome (CTS) using clinical, electrophysiological, and radiological parameters.</div></div><div><h3>Material and methods</h3><div>This randomized controlled study included 45 patients with bilateral moderate carpal tunnel syndrome, divided equally into three groups: PRP + splint, steroid + splint, and splint-only (control). Assessments were conducted pre-treatment and at 1 and 6 months post-treatment using VAS scores (pain and numbness), pinch and grip strength, QuickDASH questionnaire, EMG, and MRI.</div></div><div><h3>Results</h3><div>VAS scores significantly improved in all groups at both follow-ups, with greater reductions in night pain and numbness in the PRP and steroid groups versus control. All groups showed improved strength at month 1; by month 6, grip strength improved only in the PRP group, while pinch strength improved in both PRP and steroid groups. While A significant reduction in the Quick DASH symptom score was observed in the PRP and steroid groups, EMG findings improved significantly in all groups. MRI showed a significant decrease in palmar bowing in the PRP and steroid groups.</div></div><div><h3>Conclusion</h3><div>While both PRP and steroid injections were more effective than splinting alone in improving symptoms and function, PRP demonstrated some indications of more sustained benefits, particularly at the 6-month follow-up.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113018"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000086","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":"Robotic-assisted versus fluoroscopy-guided sacroiliac screw fixation: A retrospective comparative study","authors":"Maria Auron ,&nbsp;Gal Barkay ,&nbsp;Ohad Einav ,&nbsp;David Laniado ,&nbsp;Yoram Weil ,&nbsp;Josh E Schroeder","doi":"10.1016/j.injury.2026.113019","DOIUrl":"10.1016/j.injury.2026.113019","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous sacroiliac (SI) screw fixation is a widely used technique for stabilizing sacral fractures but is considered technically demanding due to complex pelvic anatomy and proximity to neurovascular structures. Conventional fluoroscopy-guided methods are associated with a relatively high risk of screw misplacement and considerable radiation exposure to patients and staff. Robotic-assisted navigation systems have been introduced to enhance screw accuracy and reduce radiation exposure. The aim of this study was to assess the efficiency, safety, and accuracy of sacroiliac screw fixation using a robot-assisted method compared with a conventional freehand technique.</div></div><div><h3>Methods</h3><div>Medical records of patients treated with sacroiliac screw fixation for sacral fractures at a single Level 1 trauma center between December 2014 and August 2025 were retrospectively analyzed. Patients were divided into robotic-assisted and freehand fluoroscopy-guided groups for comparative analysis. Primary outcomes were intraoperative radiation exposure and operative time; secondary outcomes included screw position accuracy and complications. Statistical analysis was performed with significance set at <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Twenty-five patients (mean age: 57.7 ± 22.4 years) were included; 15 in the robotic-assisted and 10 in the conventional fluoroscopy-guided groups. A total of 47 SI-screws were inserted: 29 in the robotic group and 18 in the conventional group. Operative times were comparable between groups (47.1 ± 16.3 min and. 45.1 ± 30.0 min, respectively; <em>p</em> = 0.85). Compared to conventional fluoroscopy, robotic assistance was associated with reduced fluoroscopy time (55.1 ± 23.1 vs. 181.1 ± 104.4 s, p=0.053) and higher screw placement accuracy (94 % vs. 62 %, <em>p</em> = 0.06), although these did not reach statistical significance. No major intraoperative complications occurred.</div></div><div><h3>Conclusion</h3><div>Robotic-assisted navigation in sacroiliac screw insertion can potentially lower radiation exposure and improve screw placement accuracy compared to conventional techniques, without prolonging surgical time. These findings support robotic guidance as a safe and potentially more precise alternative for sacral fracture fixation. Further prospective studies should be performed to evaluate the possible benefits of robotic assisted sacroiliac screw fixation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113019"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981570","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":"Feasibility and discriminatory properties of a simple fitness-to-drive assessment using a driving simulator placed in an orthopaedic outpatient department: a feasibility study","authors":"Jonas A Ipsen ,&nbsp;Malene B Møhring ,&nbsp;Morten Hansen ,&nbsp;Christian Wong ,&nbsp;Jens Lauritsen","doi":"10.1016/j.injury.2026.113032","DOIUrl":"10.1016/j.injury.2026.113032","url":null,"abstract":"<div><h3>Introduction</h3><div>Safe return to driving after orthopaedic injury or surgery is important, but standardised and feasible in-hospital assessments are lacking. We evaluated the feasibility of a simple simulator-based fitness-to-drive assessment in an orthopaedic outpatient department and its ability to discriminate between orthopaedic patients and professional drivers.</div></div><div><h3>Methods</h3><div>In this prospective feasibility study (January 2024–January 2025), two identical driving simulators were installed in an orthopaedic outpatient department and a vocational training centre for professional drivers. Participants were ≥18 years, held a driving licence, and had no medical driving ban. All completed a 3-lap, 6-event scenario with predefined speed progression (50/60/70 km/h). Outcomes were completion, errors, speed progression, maximum reaction time and braking length (metres) at 50 km/h, simulator sickness, perceived realism, and subgroup test–retest reliability.</div></div><div><h3>Results</h3><div>We included 57 patients and 92 drivers. Overall completion was 96.6% (144/149); 31.2% achieved speed progression. Patients were older, more often female, and more functionally impaired than drivers. Drivers had a shorter braking distance (23.3 m; 95% CI 22.1–24.5) and faster reaction time (0.5 s; 95% CI 0.5–0.6) than patients (39.4 m; 95% CI 36.7–42.1 and 1.2 s; 95% CI 1.0–1.4). Simulator sickness leading to discontinuation occurred in 3.4%. Most patients (98.2%) and 64.0% of drivers perceived simulator driving as comparable to real driving. Repeat testing showed a shorter braking distance, particularly in patients.</div></div><div><h3>Conclusion</h3><div>The simulated assessment was feasible, well tolerated, and discriminated between patients and professional drivers. Variation indicates a need for individualised assessment. Validation against on-road driving is required before clinical implementation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113032"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079375","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}