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

{"title":"Effect of age on major trauma profile and characterisation: Analysis from the national major trauma audit in Ireland","authors":"Olga Brych ,&nbsp;Seif El Hadidi ,&nbsp;Pamela Hickey ,&nbsp;Rachael Doyle ,&nbsp;Conor Deasy ,&nbsp;Louise Brent","doi":"10.1016/j.injury.2025.112343","DOIUrl":"10.1016/j.injury.2025.112343","url":null,"abstract":"<div><h3>Background</h3><div>Major trauma (MT) is a significant cause of morbidity and mortality worldwide, with older adult patients facing unique challenges due to age-related vulnerabilities and higher risks of falls. This study aimed to investigate differences in trauma characteristics, injury mechanisms, and outcomes of older adults compared to all younger patients with MT on a national level.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analysed the national Major Trauma Audit data from 23,765 eligible patients with MT in Ireland of all ages and stratified into two age groups: those under 65 years (<em>n</em> = 12,620) and those aged 65 years or older (<em>n</em> = 11,145). The Major Trauma Audit follows the methodology of National Major Trauma Registry in the UK. Variables assessed included injury severity, comorbidities, length of stay (LOS), and mortality rates. Statistical comparisons were made between the two age groups.</div></div><div><h3>Results</h3><div>Older adults represent 47 % of the total Irish patient population with MT, with a significantly higher proportion of females (56 %) compared to younger patients (31 %) (<em>P</em> <em>&lt;</em> <em>0.001</em>)<em>.</em> Falls of less than two meters were the leading mechanism of injury for older adults (82 %), while road traffic accidents (RTA) were more common among younger patients (25 %). Severe injuries were observed in 34 % of both age groups, but &lt;10 % of older adults were received by a trauma team. Comorbidities were significantly more prevalent in older adults (75 %) compared to 39 % in younger patients, (<em>P</em> <em>&lt;</em> <em>0.001</em>). Median hospital LOS was twelve days for older adults, compared to seven days for younger patients. Mortality rates were significantly higher among the older patient population, who were also more likely to be discharged to long-term care, (<em>P</em> <em>&lt;</em> <em>0.001)</em>.</div></div><div><h3>Conclusion</h3><div>In comparison to younger patients, the present study highlights that older adults who experience major trauma are frequently under-triaged as suspected MT, leading to delays in care, inadequate treatment, or worse clinical outcomes.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112343"},"PeriodicalIF":2.2,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860580","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":"Functional outcomes and complication rates of the SPAIRE approach compared to the direct lateral approach in hemiarthroplasty for displaced femoral neck fractures","authors":"Maren Paus ,&nbsp;Ulf Sundin ,&nbsp;Kristian Sydnes ,&nbsp;Mette Martinsen ,&nbsp;Haldor Valland ,&nbsp;Sylvia Sunde ,&nbsp;Joseph Sexton ,&nbsp;Siri Lillegraven ,&nbsp;Mads Sundet","doi":"10.1016/j.injury.2025.112339","DOIUrl":"10.1016/j.injury.2025.112339","url":null,"abstract":"<div><h3>Aims</h3><div>A soft-tissue sparing posterior surgical approach (SPAIRE) for hip hemiarthroplasty after femoral neck fractures is hypothesized to provide better functional results than the standard direct lateral approach, while maintaining a low dislocation rate. The aim of this study was to compare rate of complications and functional results between these approaches in a clinical cohort.</div></div><div><h3>Methods</h3><div>Prospectively collected registry data on all femoral neck fracture cases treated with hemiarthroplasty between September 2018 and November 2022 in a single Norwegian hospital were analyzed grouped by SPAIRE versus direct lateral approach. Outcomes were prosthesis dislocation, surgical site infection, 30-day mortality, and tests of function three months postoperatively. Linear regression was used for continuous outcomes, and dichotomous outcomes were analyzed by logistic regression and contingency tables.</div></div><div><h3>Results</h3><div>Of 858 cases, 430 were operated using SPAIRE, and 428 using direct lateral approach. There were no group differences in prosthesis dislocation rate (SPAIRE 0.7 % vs direct lateral 0.9 %, <em>p</em> = 0.725), and no differences in surgical site infections or 30-day mortality. In the patients with three months follow-up (total <em>n</em> = 372; SPAIRE <em>n</em> = 192; direct lateral <em>n</em> = 180) the SPAIRE group had better functional outcomes; New Mobility Score: 6.1 vs 5.0 (difference 1.1, <em>p</em> &lt; 0.001), New Mobility Score change from preoperative: −1.3 vs −1.8 (difference 0.5, <em>p</em> = 0.024), Short Physical Performance Battery: 7.3 vs. 5.9 (difference 1.4, <em>p</em> &lt; 0.001), Walking speed: 0.8 vs 0.7 m/s (difference 0.1, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>We found no differences in the rate of prosthesis dislocations, infections, or mortality between the SPAIRE and the direct lateral approach. Functional outcomes were better in patients operated with the SPAIRE approach.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112339"},"PeriodicalIF":2.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869665","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":"Employment outcomes following thoracic and lumbar fractures in wales: Long term follow up greater than 5 years","authors":"Elliot J. Kimber ,&nbsp;Jacob J. Allman ,&nbsp;Davor Dasic ,&nbsp;Fabian Wong ,&nbsp;Michael J H. McCarthy","doi":"10.1016/j.injury.2025.112326","DOIUrl":"10.1016/j.injury.2025.112326","url":null,"abstract":"<div><h3>Study design</h3><div>Retrospective study.</div></div><div><h3>Objectives</h3><div>To identify outcomes, in particular employment, &gt;5 years following traumatic thoracic and/or lumbar fracture/s.</div></div><div><h3>Methods</h3><div>235 patients between the ages of 18 and 65 were identified from hospital radiology databases having sustained a traumatic thoracic and/or lumbar fracture on CT and/or MRI between 01/01/2013 and 31/12/2017. Questionnaires were sent via post and available emails, with a reminder letter and phone calls. Retrospective data was gathered about employment status pre-fracture and &gt; 5 years post-injury.</div></div><div><h3>Results</h3><div>26 (11 %) patients died before follow-up, leaving 209 patients. 108 (52 %) were treated surgically and 101 (48 %) conservatively. 106 replies were received, with 85 (80 %) opting in and 21 (20 %) out. 68 (80 %) patients completed full questionnaires, and 17 (20 %) filled out a shortened questionnaire via phone conversation. Of the 85 enrolled patients, 52 (61 %) had undergone surgery, and 33 (39 %) had been treated conservatively. The mean follow-up time was 7.9 years (range 5–11 years). Prior to injury, 66 patients (78 %) were employed and 19 (22 %) unemployed (6 were full-time students, 8 retired). 49 (74 %) previously employed patients had returned to work at follow-up, with 35 (53 %) working the same or increased hours. Regarding employment, there was no significant difference between the treatment groups (<em>p</em> = 0.355) or the fracture classification (<em>p</em> = 0.303). 16 (19 %) patients reported back pain before their injury, whilst 69 (81 %) did not. There were 58 (68 %) cases of new pain, with the most affected area being the lumbar region in 43 (51 %) patients. 32 (38 %) patients reported neurological deficit post-injury: 19 with subjective symptoms, 9 objective symptoms and 4 suffered paralysis.</div></div><div><h3>Conclusion</h3><div>After 5 years or more following a traumatic thoracic and/or lumbar fracture, most individuals return to employment. There was no significant difference between the severity of the fracture or treatment on their employment outcomes.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112326"},"PeriodicalIF":2.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847902","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":"Injury caseload, pattern and time of presentation to emergency services in Mozambique: A pragmatic, multicentre, observational study","authors":"Naisa Manafe ,&nbsp;Simon Stewart ,&nbsp;Olimpio Durão ,&nbsp;Bonifacio Cebola ,&nbsp;Maria Helena Anibal ,&nbsp;Frederico Sebastião ,&nbsp;Nerolie Stickland ,&nbsp;Yhi-Khi Chan ,&nbsp;Ashley Kimberley Keates ,&nbsp;Mário Jacob ,&nbsp;Nino Paichadze ,&nbsp;Ana Olga Mocumbi","doi":"10.1016/j.injury.2025.112332","DOIUrl":"10.1016/j.injury.2025.112332","url":null,"abstract":"<div><h3>Background</h3><div>Rapid population growth and urbanisation raise a critical need to better understand the burden of injuries in sub-Saharan Africa. We assessed the pattern of service demand for injuries at emergency department (ED) in urban areas of Mozambique.</div></div><div><h3>Methods</h3><div>This prospective, multi-centric, observational study was conducted in EDs in southern (Maputo), central (Beira) and northern (Nampula) of Mozambique. We randomly selected 7809 cases (age ≥1 years) during the seasonally distinct months of April/2016–2017 and October/2017. Data on patients’ demographics, nature of injury and clinical outcomes were collected.</div></div><div><h3>Results</h3><div>Overall, 1881/7809 (26.2 %) emergency cases comprising 518 children (58.5 % male, aged 4.6 ± 2.5 years), 324 adolescents (64.8 % male, 14.7 ± 3.0 years) and 10,39 adults (60.8 % male, 34.5 ± 13.0 years) presented with injury. The arms, legs and head were most affected in both children (518 with 795 injuries) and adults (1039 with 1496 injuries). The diversity of injuries increased with older age. Injury cases predominantly presented during daylight hours (from 0900 to 1900) with age-differentials evident. There were proportionately more injury presentations in the hotter and wetter October than in colder and drier April<span>.</span> The most common mechanisms of injury were falls, physical violence and road traffic injuries. Overall, 9.1 % of injury cases were admitted to hospital and 0.2 % died.</div></div><div><h3>Conclusions</h3><div>Injuries corresponded to around one-quarter of all emergency admissions in urban Mozambique, and were predominantly caused by falls, physical violence, and road traffic injuries. Understanding distinctive variations in the pattern and timing of these presentations according to the age, location and season will assist in future planning for more efficient injury prevention and health care services in Mozambique.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112332"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863807","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":"Simultaneous “fix and replace” has non inferior survivorship compared to staged arthroplasty in acetabular fracture management at two year follow up","authors":"MJ Kennedy ,&nbsp;IW Kennedy ,&nbsp;TR Williamson ,&nbsp;B Wheelwright ,&nbsp;A Marsh ,&nbsp;SL Gill","doi":"10.1016/j.injury.2025.112315","DOIUrl":"10.1016/j.injury.2025.112315","url":null,"abstract":"<div><h3>Aims</h3><div>In an increasingly frail population, simultaneous “fix and replace” surgery (fixation of the acetabulum to accommodate a press fit cup and total hip arthroplasty (THA)) is a novel alternative to open reduction and internal fixation (ORIF) alone in the management of acetabular fractures. We aimed to determine whether patients managed with “fix and replace” have comparable survivorship to those undergoing staged THA following previous open reduction and internal fixation for acetabular fracture.</div></div><div><h3>Methods</h3><div>All Patients with acetabular fractures surgically managed within our Tertiary centre over a five year period (01/01/2018–30/05/2023) were identified. Thirty-four patients underwent simultaneous “fix and replace” surgery and 133 underwent acetabular ORIF alone. Twenty-one of these patients required staged THA (6 %).</div></div><div><h3>Results</h3><div>Follow up mean was 2.7 years (SD ±1.7) for 'fix and replace' versus 3.3 years (SD ± 1.5) for staged THA. There was no statistically significant difference between the two groups with regards to BMI or sex. The fix and replace group were older (<em>p</em> = 0.001), had higher American Society of Anesthesiologists (ASA) grade (<em>p</em> = 0.006) and Charlson Comorbidity Index (CCI) (<em>p</em> = 0.027), respectively. High energy mechanism of injury accounted for 56 % of the \"fix and replace\" group compared to 48 % in the ORIF to THA. 74 % of 'fix and replace' were associated/complex fractures (LeTournel) compared to 53 % of staged THA. Mean wait to surgery was 3 days in the 'fix and replace' group compared to 186 days from listing to operation in the staged THA group. Survival analysis demonstrated acceptable results for both groups with greater than 85 % survival at 2 years and no statistical significantly worse survivorship in the 'fix and replace' group (<em>p</em> = 0.13). Complications were comparable in both groups (41 % versus 43 %, <em>p</em> = 0.58).</div></div><div><h3>Conclusions</h3><div>'Fix and replace' is a good option for the elderly, co-morbid patient. It enables early weight bearing and has acceptable survivorship compared to staged THA following acetabular ORIF.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112315"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851458","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 different minimally invasive screw osteosyntheses methods for the stabilization of the sacral fractures","authors":"Martin Naisan ,&nbsp;Andreas Kramer ,&nbsp;Stefan Kindel ,&nbsp;Marcus Richter ,&nbsp;Florian Ringel ,&nbsp;Philipp Hartung","doi":"10.1016/j.injury.2025.112317","DOIUrl":"10.1016/j.injury.2025.112317","url":null,"abstract":"<div><h3>Background Context</h3><div>Percutaneous screw osteosynthesis is the gold standard for managing sacral fragility fractures in geriatric patients with immobilizing pain. However, comparative evidence regarding the optimal type, length, or insertion position of sacroiliac screws remains limited.</div></div><div><h3>Purpose</h3><div>This study aimed to compare outcomes between long transsacral screws bridging both sacroiliac joints and short sacroiliac screws.</div></div><div><h3>Study Design/Setting</h3><div>Retrospective cohort single-center study.</div></div><div><h3>Patient Sample</h3><div>Geriatric patients treated with percutaneous sacroiliac screws for sacral fragility fractures.</div></div><div><h3>Outcome Measures</h3><div>Primary outcome: screw loosening at 3-, 6-, and 12-month follow-ups. Secondary outcomes: surgical duration, postoperative pain, mobility improvement, and hospital stay length.</div></div><div><h3>Methods</h3><div>Data from 122 patients (median age 81, 84 % female) treated between 2018 and 2021 were analyzed. Patients were categorized into three groups [<span><span>1</span></span>]: two long transsacral screws [<span><span>2</span></span>], a combination of one long and two short screws, and[<span><span>3</span></span>] four short sacroiliac screws. Fracture characteristics, FFP classification, and risk factors for screw loosening were evaluated.</div></div><div><h3>Results</h3><div>Fractures were bilateral in 73 %, with FFP classifications of type 2 (48 %), type 3 (12 %), and type 4 (40 %). Anterior pelvic fractures were present in 63 %, comminuted fractures in 34 %, and H-type fractures in 29 %. Loosening rates were 17 % in the long-screw group, 6 % in the combination group, and 4 % in the short-screw group. Surgical duration was shortest for long screws (mean 52.6 min) compared to the combination (61.8 min) and short-screw (83.4 min) groups. Pain scores decreased below 5 in 88 % of patients at 3 months and 92 % at 12 months. Screw length was a significant risk factor for loosening (<em>p</em> = 0.04).</div></div><div><h3>Conclusions</h3><div>Long transsacral screws offer minimally invasive fixation with reduced surgical duration but higher loosening rates. Osteosynthesis with four short sacroiliac screws demonstrates superior long-term stability, making it a promising option for sacral fragility fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112317"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839645","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":"Prophylactic antibiotics in gunshot fractures with concomitant bowel injury to prevent fracture-related infections and other infectious complications","authors":"Dylan Kahler ,&nbsp;Natalie DeWitte ,&nbsp;Megan Thompson ,&nbsp;Saqib Rehman ,&nbsp;Jeffrey Anderson","doi":"10.1016/j.injury.2025.112304","DOIUrl":"10.1016/j.injury.2025.112304","url":null,"abstract":"<div><h3>Background</h3><div>Standard antibiotic therapy for abdominal gunshot wounds (GSWs) with hollow viscus injury involves up to 24 h of prophylactic broad-spectrum antibiotics. However, antibiotic management strategies are poorly defined in treating gunshot wounds with bowel-to-bone trajectories. These injuries threaten fracture-related infection as missiles can carry contaminating material along their intracorporeal trajectory. This study seeks to determine whether the duration of prophylactic antibiotic therapy used in bowel-to-bone injuries is associated with fracture-related infection prevention or overall infectious sequelae.</div></div><div><h3>Methods</h3><div>This six-year retrospective review identified all patients experiencing abdominal GSWs with a trajectory causing bowel injury and simultaneous fracture. Patient demographics, duration of antibiotic therapy, and subsequent infectious complications were compared with nonparametric tests as indicated.</div></div><div><h3>Results</h3><div>140 patients experienced GSWs with bowel-to-bone trajectory; the median duration of prophylactic antibiotic therapy was four days (IQR 2 – 5 days); two patients were diagnosed with fracture-related infection and 65 patients experienced an infectious complication during their index hospitalization. Duration of prophylactic antibiotic therapy was not associated with the development of overall infection (<em>p</em> = 0.31). Comparing three days of prophylactic antibiotic therapy to more than three days of therapy, no difference occurred in overall infection (<em>p</em> = 1.0).</div></div><div><h3>Conclusion</h3><div>The development of fracture-related infections in bowel-to-bone gunshot wounds is rare. The duration of prophylactic antibiotic therapy in bowel-to-bone injuries did not correlate with an increase in overall infectious complications. Notably, three days of prophylactic antibiotic therapy was not inferior compared to longer-duration therapy in the development of infectious sequelae. Thus, patients with a bowel-to-bone gunshot trajectory likely do not require extended antibiotic coverage for prevention of fracture-related infections.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112304"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863808","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":"A meta-analysis of the incidence of intra-abdominal injuries associated with thoracic or lumbar flexion-distraction injuries","authors":"Ibrahim Serag ,&nbsp;Julian Scherer ,&nbsp;Eugen Cezar Popescu ,&nbsp;Bogdan Costachescu ,&nbsp;Martin Holas ,&nbsp;Abdullah salah Alahmadi ,&nbsp;Mohamed M. Aly","doi":"10.1016/j.injury.2025.112337","DOIUrl":"10.1016/j.injury.2025.112337","url":null,"abstract":"<div><h3>Background</h3><div>Intra-abdominal injuries (IAIs) are often associated with thoracic or lumbar flexion distraction injuries (TLFDIs) or Chance fractures. The incidence ranges from 10 to 50 % in previous literature.</div></div><div><h3>Aim</h3><div>To synthesize data about the incidence of IAIs associated with TLFDIs.</div></div><div><h3>Methods</h3><div>We searched PubMed, WOS, and Cochrane databases for all studies reporting the incidence of IAIs associated with TL FDIs. The primary outcome was the overall pooled incidence of IAIs, surgical intervention, and specific organ injuries. A subgroup analysis was done for studies that included adults, pediatrics, and mixed populations. We assessed the methodological quality of the included studies using the Newcastle-Ottawa Scale. We used A random effects model to calculate pooled incidence rates and heterogeneity. This systematic analysis followed PRISMA guidelines.</div></div><div><h3>Results</h3><div>A total of eight retrospective studies with 652 patients met the inclusion criteria. The pooled incidence of overall IAIs associated with TLFDIs was 36.2 % (95 % CI: 32.2 % %–57.2 %), with high heterogeneity (I² = 90.71 %, <em>p</em> = 0.0001). The incidence of surgical interventions was 29.03 % (95 % CI: 22.0 %–48.3 %), with high heterogeneity (I² = 92.3 %, <em>p</em> &lt; 0.0001). Small bowel injuries occurred in 19.17 % of cases, large bowel injuries in 10.92 %, liver injuries in 7.6 %, splenic injuries in 7.2 %, kidney injuries in 5.36 %, and pancreatic injuries in 3.7 %. Pediatric populations showed significantly higher rates of IAAs (55.8 % vs. 23.03 %) and surgical intervention (45.5 % vs.10.6 %) than adults.</div></div><div><h3>Conclusion</h3><div>The pooled incidence of IAAs associated with TL FDIs is 36.2 %, and surgical intervention is 29.03 %. Small bowels, large bowels, liver, and splenic injuries were the most frequent injuries. These rates are probably overestimated due to the retrospective design of studies and the variability in the definition of TLFDIs. Therefore, prospective, well-designed studies are needed to estimate the true incidence of IAAs associated with TLFDIs accurately.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112337"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863809","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":"Efficacy of intranasal ketamine in controlling pain caused by bone fractures: A single-center double blind randomized controlled trial","authors":"Morteza Zavvar ,&nbsp;Mahboub Pouraghaei ,&nbsp;Saeid Safiri ,&nbsp;Gholamreza Faridaalaee","doi":"10.1016/j.injury.2025.112328","DOIUrl":"10.1016/j.injury.2025.112328","url":null,"abstract":"<div><h3>Introduction</h3><div>Bone fractures are recognized as the second most prevalent cause of pain for patients seeking treatment in medical facilities. This study aims to evaluate the efficacy of intranasal and intravenous ketamine in comparison to intravenous morphine in alleviating severe pain in patients presenting to emergency departments with various bone fractures.</div></div><div><h3>Method &amp; material</h3><div>The clinical trial was conducted on patients over the age of 18 who presented at the emergency department of Imam Reza Educational and Medical Center with bone fractures. These patients were divided into three groups for treatment: intranasal ketamine at a dose of 1 mg/kg body weight, intravenous ketamine at a dose of 0.5 mg/kg body weight, and intravenous morphine at a dose of 0.1 mg/kg body weight. The severity of pain experienced by patients was documented using the numerical pain rating scale at the time of admission, and then at 15 min, 30 min, and 60 min after drug administration.</div></div><div><h3>Results</h3><div>The results of the study revealed that there was no statistically significant difference in the efficacy of pain relief among the three study groups (<em>p</em>=0.77). The interaction of (time*type of drug) had no significant effect on pain intensity (<em>p</em>=0.58). There was no statistically significant difference in side effects reported by patients between the three study groups, with the intranasal ketamine group reporting only minor side effects.</div></div><div><h3>Conclusion</h3><div>The results of this study showed significant effects of intranasal ketamine and intravenous ketamine in reducing pain in patients with bone fractures. The findings further suggest that the analgesic effect of intranasal ketamine is comparable to that of intravenous ketamine and morphine, with no significant adverse effects observed.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112328"},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850473","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 the effects of curvilinear position and micromovement on prevention of intraoperative acquired pressure injuries among patients undergoing surgery in the supine position: A randomized controlled trial","authors":"Nasim Jamshid Malekara ,&nbsp;Negin Larti ,&nbsp;Alireza Shirzadi ,&nbsp;Ramin Bozorgmehr","doi":"10.1016/j.injury.2025.112327","DOIUrl":"10.1016/j.injury.2025.112327","url":null,"abstract":"<div><h3>Background</h3><div>Patients undergoing surgery are at significant risk of developing pressure injuries due to immobility and fixed positioning on the operating table, particularly during lengthy procedures. Therefore, implementing effective prevention strategies for pressure injuries should begin as early as the surgical phase. This study aims to compare the two methods of curvilinear position and micromovement in preventing pressure injuries among patients undergoing general surgery in the supine position.</div></div><div><h3>Method</h3><div>This was a double-blind, prospective, randomized, controlled trial conducted from October 2024 to January 2025. The study included a sample size of 120 patients randomly divided into three groups: control (<em>n</em> = 40), micromovement (<em>n</em> = 40), and curvilinear (<em>n</em> = 40). Skin assessments were conducted using the National Pressure Ulcer Scale immediately after surgery and again one day later.</div></div><div><h3>Results</h3><div>A total of 114 patients were included in the analysis: 39 in the control group, 38 in the micromovement group, and 37 in the curvilinear group. A significant difference was found between the three groups regarding the incidence of pressure injuries (<em>p</em> &lt; 0.05). However, there was no considerable difference regarding the location and stage of the pressure injury between groups (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>Micromovement and curvilinear supine position can significantly reduce the incidence of intraoperative acquired pressure injuries. Therefore, it is recommended that these methods be utilized as an effective intervention by the surgical team, especially for high-risk patients and those undergoing prolonged surgeries.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 6","pages":"Article 112327"},"PeriodicalIF":2.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785593","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}