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

{"title":"Trends and determinants of falls: A generalized estimating equations modelling approach using serial data from the geelong osteoporosis study","authors":"Tewodros Yosef ,&nbsp;Julie A Pasco ,&nbsp;Monica C Tembo ,&nbsp;Lana J Williams ,&nbsp;Kara L Holloway-Kew","doi":"10.1016/j.injury.2025.112298","DOIUrl":"10.1016/j.injury.2025.112298","url":null,"abstract":"<div><h3>Background</h3><div>With Australia's aging population, the incidence of falls is expected to rise. The proportion of adults aged ≥65 years is projected to increase from 15 % in 2017 to 22 % by 2057, highlighting the growing need for effective fall prevention measures. Therefore, this study aimed to assess fall trends and determinants using repeated follow-up data from a population-based study.</div></div><div><h3>Methods</h3><div>This study utilized data from the Geelong Osteoporosis Study (GOS) to analyse fall trends in men and women. Men's data were collected at baseline (2001–2006; <em>n</em> = 1533), 5 years (2006–2011; <em>n</em> = 968), and 15 years (2016–2021; <em>n</em> = 627), while women's data were from 6 years (2001–2003; <em>n</em> = 1014), 10 years (2004–2008; <em>n</em> = 1098), and 15 years (2011–2014; <em>n</em> = 844). Falls data, self-reported for the past 12 months, were age-standardised to the Australian population. Data included self-reported prior fractures, medications, comorbidities, alcohol use, and smoking, along with measured anthropometrics, muscle strength, biochemical tests, and imaging. A multivariable Generalised Estimating Equation model identified fall determinants, reporting adjusted odds ratios (AORs) and 95 % confidence intervals.</div></div><div><h3>Results</h3><div>In men, the age-adjusted prevalence of falls declined over time, while in women, it initially dropped by 4.2 % before a slight 0.6 % increase. After adjusting for confounders, each additional year of age raised the fall risk by 1 % (AOR = 1.01, 95 % CI: 1.00–1.02). Women had a 52 % higher likelihood of falling than men (AOR = 1.52, 95 % CI: 1.22–1.88). Diabetes increased the risk by 69 % (AOR = 1.69, 95 % CI: 1.23–2.31), while a 1 N/kg increase in hip flexion strength lowered the risk by 3 % (AOR = 0.97, 95 % CI: 0.95–0.99).</div></div><div><h3>Conclusion</h3><div>Men experienced a steady decrease in fall prevalence over time, whereas women displayed a more intricate trend, with falls initially declining before subsequently rising, following a polynomial pattern. The key predictors of falls included age, sex, diabetes and hip flexion strength. Policies should prioritize tailored fall prevention, strength training, and diabetes care integration.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112298"},"PeriodicalIF":2.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attributable risk factors and trends in global burden of falls from 1990 to 2021: A comprehensive analysis based on Global Burden Of Disease Study 2021","authors":"Jiahui Li ,&nbsp;Yafen Yang ,&nbsp;Zhuolin Huang ,&nbsp;Yalin Yuan ,&nbsp;Zhaoyu Ren ,&nbsp;Bin Liang","doi":"10.1016/j.injury.2025.112296","DOIUrl":"10.1016/j.injury.2025.112296","url":null,"abstract":"<div><h3>Background</h3><div>Falls are a leading cause of disability-adjusted life years (DALYs) and mobility difficulties. Previous estimates have relied on restricted regional scope and lack a thorough global study. This study, for the first time, examines the evolving trends in the global burden of falls from 1990 to 2021, focusing on geographic variation in disease burden and risk factors, predicting the development of burden of falls. Our aim was to provide information for allocating medical resources, taking health policies into action, and making patient management systems operate better.</div></div><div><h3>Method</h3><div>Data on incident cases, deaths, and DALYs were collected for countries, regions, ages, and sexes worldwide from the Global Burden Disease (GBD) 2021 database. Using R (version 4.3.2), we calculated estimated annual percent changes (EAPCs) for assessing trends in age-standardized rates, visualized risk factors, and predicted the global burden of falls. Joinpoint regression (version 4.9.1.0) was used to identify significant temporal trends and change points.</div></div><div><h3>Results</h3><div>In 2021, 548.8 million people were affected by falls. There were 215 million incidence, 43.8 million DALYs, and 800,000 deaths caused by falls. The incidence rate of falls increases with age, and sex inequalities exist. Compared with 1990, the age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate (ASDALYsR) declined despite an increase in absolute numbers. The ASDR and ASDALYsR of falls are expected to decline in the future, whereas the ASIR is expected to rise. The fall burden varied significantly according to region and its sociodemographic index (SDI). Both ASIR (<em>R</em> = 0.510, <em>p</em> &lt; 0.001) and ASDALYsR (<em>R</em> = 0.2762, <em>p</em> &lt; 0.001) were positively correlated with SDI. In contrast, ASDR (<em>R</em>=-0.536, <em>p</em> &lt; 0.001) showed a consistently negative association with SDI. Low bone mineral density, occupational injuries, alcohol use, and smoking emerged as the top factors associated with fall-related DALYs and deaths.</div></div><div><h3>Conclusions</h3><div>The overall burden of falls declined between 1990 and 2021, but the future incidence is expected to increase. The global burden of falls remains unchanged and shows significant regional and sex-based differences. Effective prevention and strategies against risk factors are imperative for reducing the future burden.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112296"},"PeriodicalIF":2.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738346","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":"Does the timing of debridement of an upper extremity open fracture really matter?","authors":"Gareth Ryan,&nbsp;Jared Topham,&nbsp;Richard Buckley","doi":"10.1016/j.injury.2025.112300","DOIUrl":"10.1016/j.injury.2025.112300","url":null,"abstract":"<div><h3>History</h3><div>– A 49yo woman was involved in a car crash. She suffered an isolated, open, left both bones forearm mid-diaphyseal fracture. She had a sling applied at the scene but had a 16-hour transport time from an isolated rural location. She was found to have no other injuries upon her careful work-up at the Level 1 emergency department. The injury had not compromised the distal neurovascular status of the limb. The ER staff admitted the patient to the orthopedic team. The patient had an evaluation by a senior resident and their assessment was that this was a grade 3A open fracture of the dorsum of the mid forearm (Figure 1 and Figure 2). By the time surgery could be initiated at the Trauma center, fully 36 hours had passed. Most of the delay at the Trauma center was due to other very significant injuries in the Trauma room that day.</div></div><div><h3>Past Medical History and Social History</h3><div>– She is a married woman and lives with her husband and a university aged teenager. She has been a nonsmoker. She has no medical problems that she sees a physician about. She works as a secretary but presently is unemployed. She has only had obstetrical surgery, has no allergies and takes no medications. She is a regular wine drinker.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112300"},"PeriodicalIF":2.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725306","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":"Health behavior, health, and socioeconomic background in adolescence as risk factors for traumatic brain injuries: A longitudinal study","authors":"Alisa Teuho ,&nbsp;Matias Vaajala ,&nbsp;Ville Ponkilainen ,&nbsp;Leena Koivusilta ,&nbsp;Arja Rimpelä ,&nbsp;Ville M. Mattila","doi":"10.1016/j.injury.2025.112293","DOIUrl":"10.1016/j.injury.2025.112293","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic brain injuries (TBI) are a considerable health burden on adolescents and young adults. This study aims to assess the influence of health compromising behavior, poor perceived health, poor school success, and low family socioeconomic background during adolescence on subsequent TBI in a large cohort of Finnish adolescents with an average 25-year follow-up.</div></div><div><h3>Materials and methods</h3><div>Baseline Finnish Adolescent Health and Lifestyle survey data gathered biennially (1981–1997) was linked with the diagnosis of subsequent TBI from the Finnish Care Register for Health Care. A structural equation modeling (SEM) was used to analyze the associations between health behavior, poor perceived health, poor school success, and low family socioeconomic background during adolescence on subsequent TBI.</div></div><div><h3>Results</h3><div>Total of 41 336 persons were included in the analyses. During the follow-up, 1 459 (3.5 %) TBIs occurred. Men were more likely to suffer a TBI. The mean follow-up time was 25.3 years (SD 4.0) and the mean age at the time of TBI was 32.1 years (SD 7.7). Health compromising behavior and not living with both parents in adolescence were associated with the increased risk of TBI. Also, poor perceived health and stress symptoms increased the risk of TBI. Low family socioeconomic status (SES) was only indirectly associated with TBI trough health compromising behavior.</div></div><div><h3>Conclusion</h3><div>The main finding was that health compromising behavior was associated with TBI, and low family SES was associated with TBI through health compromising behavior in later life. Poor perceived health, stress symptoms, and not living with both parents in adolescence increased the risk of TBI, too. Our findings suggest that adolescents who are at risk of drifting into health compromising behavior and report stress symptoms have an increased risk of TBI in later life.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112293"},"PeriodicalIF":2.2,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FDA regulatory considerations for innovative orthopedic devices: A review","authors":"Connor Huxman","doi":"10.1016/j.injury.2025.112291","DOIUrl":"10.1016/j.injury.2025.112291","url":null,"abstract":"<div><div>Novel and innovative orthopedic devices are needed to address clinical challenges in orthopedic practice. Obtaining regulatory authorization for such devices, however, can prove challenging. An inherent dilemma exists between innovation to address unmet needs and imitation to demonstrate substantial equivalence to a predicate device, which is required for the less burdensome 510(k) pathway. This article provides both an overview of highly innovative orthopedic devices over the last 10 years as well as considerations for FDA regulatory pathways and programs available to manufacturers of such devices. A review of 20 innovative orthopedic devices receiving Breakthrough Device Designation and/or a De Novo classification found that devices had diverse features and applications, but did possess shared technological trends including bioresorption, flexible components, and new substance/material use. A review of all new orthopedic devices authorized through the three major regulatory pathways in the last 10 years was also conducted. Spinal devices represented the largest share of recent orthopedic devices (38 % of 510(k) clearances and 25 % of De Novo classifications). Across all three pathways, decision time was on average around 30 % shorter for orthopedic devices with a Breakthrough Device Designation versus those without, though differences were not significant. New orthopedic devices authorized in the last 10 years were found to be highly reliant on the 510(k) pathway, with a 99 % utilization rate. However, the FDA Breakthrough Devices Program and De Novo pathway offer opportunities specific to innovative technologies, such as expedited review and potential market competition protection, as demonstrated through specific case studies in this review. As these FDA initiatives continue to evolve and manufacturers continue to take advantage of these opportunities, orthopedic device development, which has primarily prioritized incremental innovation, may too evolve to produce more breakthrough innovations.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112291"},"PeriodicalIF":2.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714881","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":"Artificial intelligence versus orthopedic surgeons as an orthopedic consultant in the emergency department","authors":"Jonathan Liu ,&nbsp;Kathryn Segal ,&nbsp;Mohammad Daher ,&nbsp;Jordan Ozolin ,&nbsp;William D Binder ,&nbsp;Michael Bergen ,&nbsp;Christopher L. McDonald ,&nbsp;Brett D Owens ,&nbsp;Valentin Antoci","doi":"10.1016/j.injury.2025.112297","DOIUrl":"10.1016/j.injury.2025.112297","url":null,"abstract":"<div><h3>Introduction</h3><div>ChatGPT, a widely accessible AI program, has demonstrated potential in various healthcare applications, including emergency department (ED) triage, differential diagnosis, and patient education. However, its potential in providing recommendations to emergency department providers with orthopedic consultations has not been evaluated yet.</div></div><div><h3>Methods</h3><div>This study compared the performance of four board certified orthopedic surgeons, two attendings and two trauma fellows who take independent call at the same institution and ChatGPT-4 in responding to clinical scenarios commonly encountered in emergency departments. Five common orthopedic ED scenarios were developed (lateral malleolar ankle fractures, distal radius fractures, septic arthritis of the knee, shoulder dislocations, and Achilles tendon ruptures), each with four questions related to diagnosis, management, surgical indication, and patient counseling, totaling 20 questions. Responses were anonymized, coded, and evaluated by independent reviewers including emergency medicine physicians using a five-point Likert scale across five criteria: accuracy, completeness, helpfulness, specificity, and overall quality.</div></div><div><h3>Results</h3><div>When comparing the ratings of AI answers to non-AI responders, the AI answers were shown to be superior in completeness, helpfulness, specificity, and overall quality with no difference in regards to accuracy (<em>p</em> &lt; 0.05). When considering question subtypes including diagnosis, management, treatment, and patient counseling, AI was shown to have superior scores in helpfulness, and specificity in diagnostic questions(<em>p</em> &lt; 0.05). In addition, AI responses were superior in all the assessed categories when looking at the patient counseling questions (<em>p</em> &lt; 0.05). When considering different clinical scenarios, AI outperformed non-AI groups in completeness in the distal radius fracture scenario. Furthermore, AI outperformed non-AI groups in helpfulness in the lateral malleolus fracture scenario. In the shoulder dislocation scenario, AI responses were more complete, helpful, and had a better overall quality. AI responses were non-inferior in the remaining categories of the different scenarios.</div></div><div><h3>Conclusion</h3><div>Artificial intelligence exhibited non-inferior and often superior performance in common orthopedic-ED consultations compared to board certified orthopedic surgeons While current AI models are limited in their ability to integrate specific images and patient scenarios, our findings suggest AI can provide high quality recommendations for generic orthopedic consultations and with further development, will likely have an increasing role in the future.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112297"},"PeriodicalIF":2.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143706053","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":"Decrease in pediatric farm-related injuries presenting to United States emergency departments: A national study from 2014-2023","authors":"Charu Jain,&nbsp;Uma Balachandran,&nbsp;Luca M. Valdivia,&nbsp;Niklas H. Koehne,&nbsp;Avanish Yendluri,&nbsp;Nikan K. Namiri,&nbsp;Sheena C. Ranade","doi":"10.1016/j.injury.2025.112299","DOIUrl":"10.1016/j.injury.2025.112299","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric farm-related injuries, while less common than other pediatric injuries, are often more severe. Agricultural youth injuries can require costly treatment and have higher hospitalization rates, often resulting from industrial hazards, unsafe worksites, or agricultural recreational activities. Injuries in rural areas often necessitate travel to larger hospitals for specialized treatment, delaying care.</div></div><div><h3>Objective</h3><div>This study aims to evaluate trends in farm-related injuries among youth presenting to emergency departments (EDs) in the United States (US).</div></div><div><h3>Methods</h3><div>The National Electronic Injury Surveillance System (NEISS), a publicly available database representing approximately 100 US EDs, was queried for all injuries among individuals aged 0–18 occurring in farms (land, pasture, farm, barn, outbuildings). Queries were restricted to injuries from 2014 to 2023.</div></div><div><h3>Results</h3><div>From 2014 to 2023, a total of 750 ED visits from farm-related injuries were identified, resulting in a national estimate (NE) of 33,664 cases. Injury rates decreased significantly across the study period <em>(P=0.012)</em>. The most common diagnosis was fracture (NE 7337, 21.8 % of all injuries), with males accounting for 52.1 % and females for 47.9 %. In an age-specific analysis, 12-year-olds experienced more farm-related injuries than any other age group (NE 3185, 9.5 %), followed by 11-year-olds (NE 2769, 8.2 %), who also sustained the highest number of head injuries (NE 711, 13.2 % of all head injuries). The most commonly affected body part across ages was the head (NE 5384, 16 % of all injuries). The most common mechanism of injury was horseback riding (NE 10,691, 31.8 % of all injuries). The overall rate of hospitalization was 13.5 %.</div></div><div><h3>Conclusion</h3><div>The incidence of farm-related injuries in young people has decreased over time. Most injuries are caused by horseback riding, with a majority involving the head and relatively high hospitalization rates. 11–12-year-olds are the most affected, highlighting the importance of continued targeted prevention efforts. Although occupational hazards are a concern, this study demonstrates that younger patients are also frequently affected by farm injuries, emphasizing the need for increased focus on child access and safety in agricultural recreational activities.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112299"},"PeriodicalIF":2.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685712","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":"Prediction of psychological continuing health problems based on types of injury and manner of accident in Mozambique: A population-based analysis of burns, fractures, internal injuries, and wound injuries","authors":"Shrouq Shaher Al-Sabaileh ,&nbsp;Laith Ashour ,&nbsp;Khalaf Alnowaishiri ,&nbsp;Ghada Alzoubi ,&nbsp;Zaid Alhabashneh ,&nbsp;Mutaz Ashour ,&nbsp;Samar Hamdan ,&nbsp;Nour Al Qurneh","doi":"10.1016/j.injury.2025.112274","DOIUrl":"10.1016/j.injury.2025.112274","url":null,"abstract":"<div><div>The long-term effects of injuries have significant implications for forensic practice. There is a dearth of research highlighting long-term psychological problems resulting from various injuries in under-researched populations like Mozambique. This study employed multiple logistic regression analyses on the 2022–2023 Mozambique Demographic and Health Survey (DHS) data to determine injury types predictive of emotional trauma, limb function loss, and chronic pain as continuing health problems. The data from the Accidents and Injury module was used for all participants. The injuries analyzed included broken bones, wounds, internal injuries, and burns. Additionally, we investigated the predictive capacity of unintentional and violent injuries on emotional trauma as a continuing health problem. The total number of injured people (whether due to traffic or non-traffic accidents) was 419. The proportion of unintentional injuries was much higher than violent injuries (86.4% vs 7.7%). Our results indicated that burn injuries were strongly associated with emotional trauma (Odds Ratio (OR) = 4.15, 95% CI: [1.24-13.84], P = 0.021), broken-bone injuries predicted both limb function loss (OR = 2.67, 95% CI: [1.17- 6.09], P = 0.02) and emotional trauma (OR = 3.73, 95% CI: [1.51-9.22], P = 0.005), internal injuries predicted chronic pain (OR = 2.52, 95% CI: [1.18-5.38], P = 0.018), and violent injuries predicted emotional trauma (OR = 4.41, 95% CI: [1.16-16.67], P = 0.03). These findings enhance comprehension of how injury types predict long-term psychological complications in Mozambique and provide valuable insights regarding the enduring consequences of various injuries in similar populations.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112274"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725307","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":"Biomechanical evaluation of novel 3D-printed magnesium alloy scaffolds for treating proximal humerus fractures with medial column instability","authors":"Yiyuan Yang ,&nbsp;Zhuo Chen ,&nbsp;Yuanyu Hu ,&nbsp;Yun Tian","doi":"10.1016/j.injury.2025.112266","DOIUrl":"10.1016/j.injury.2025.112266","url":null,"abstract":"<div><h3>Background</h3><div>Patients with complex proximal humerus fractures (PHFs) have a higher complication rate when treated with locking compression plate (LCP) alone. This increased complication rate may be due to humeral head collapse and insufficient medial column support in the proximal humerus. In response, we proposed the use of bionic porous 3D-printed magnesium alloy scaffolds (MAS) in combination with LCP for the treatment of PHFs. The aim of this study is to compare the biomechanical characteristics of the LCP alone versus LCP-MAS fixation constructs in treating PHFs with medial column instability.</div></div><div><h3>Methods</h3><div>A three-dimensional model of a PHF with medial column instability was developed using computed tomography, and fixation was applied using LCP and LCP-MAS. Finite element analysis was employed to evaluate the biomechanical characteristics of these two fixation models, focusing on construct stiffness, von Mises stress distribution, and fracture displacements.</div></div><div><h3>Results</h3><div>The construct stiffness of the LCP-MAS fixation construct was approximately 3.50 to 7.30 times greater than that of the LCP fixation construct under normal bone conditions, and 2.60 to 4.90 times greater under osteoporotic bone conditions. The LCP-MAS fixation reduced the maximum von Mises stress on the implants by at least 70 %-80 %. Furthermore, the LCP-MAS fixation significantly minimized fracture displacement compared to LCP alone.</div></div><div><h3>Conclusions</h3><div>The findings of this study suggest that the additional use of MAS can significantly enhance both the overall and local stability of PHFs. Thus, the LCP-MAS fixation approach presents a viable alternative for the treatment of PHFs.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112266"},"PeriodicalIF":2.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reexamining the need for antibiotic prophylaxis in pediatric upper extremity surgery","authors":"Nathan Khabyeh-Hasbani ,&nbsp;Yufan Yan ,&nbsp;Yossef Rubinov ,&nbsp;Elliot Bareket ,&nbsp;Seven M. Koehler","doi":"10.1016/j.injury.2025.112271","DOIUrl":"10.1016/j.injury.2025.112271","url":null,"abstract":"<div><h3>Aims</h3><div>The literature has recently questioned the routine use of prophylactic antibiotics in adults undergoing clean, upper extremities surgeries. Moreover, consensus remains elusive if antibiotic prophylaxis in upper extremity (UE) and hand pediatric procedures are necessary. Therefore, we aim to investigate whether antibiotic prophylaxis has no effect on reducing postoperative surgical site infection (SSI) rates in pediatric upper extremity (UE) procedures.</div></div><div><h3>Methods</h3><div>A retrospective review of all pediatric patients undergoing clean UE surgery between November 2021 and November 2023 at a single institution was performed. Primary outcome measures were diagnosis of SSI by 14-days and 30-days. Secondary outcomes included the type of management employed to treat infection, including the use of antibiotics only, operative washout and hardware removal. Chi-square and Fisher's exact tests were performed for categorical variables, and Wilcoxon rank-sum tests were performed for continuous variables. A <em>p</em>-value of &lt; 0.05 for all analyses was considered statistically significant.</div></div><div><h3>Results</h3><div>396 patients (150 female and 246 male) were included for analysis- 217 received preoperative antibiotics and 179 did not. Among those who received preoperative antibiotics, only two patients were diagnosed with an SSI, with an infection rate of 0.9 %. Similarly, in those who did not receive preoperative antibiotics, two patients were diagnosed with an SSI, with an infection rate of 1.1 %. Infection rates were not statistically different (<em>p</em> = 0.846). The odds ratio (OR) of having an SSI when not receiving preoperative antibiotics is 1.21 (95 % CI: 0.16 – 8.71).</div></div><div><h3>Conclusion</h3><div>The study challenges the historical dogma of the necessity of preoperative antibiotics in pediatric upper extremity surgeries. The findings suggest that there is no statistical difference in postoperative SSI rates whether antibiotic prophylaxis is administered. To reassess the necessity of preoperative antibiotics in upper extremity cases, further randomized controlled studies with larger patient populations should be advocated for.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112271"},"PeriodicalIF":2.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685811","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}