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

{"title":"Concern on “Biomechanical evaluation of three different fixation methods for treating displaced tibial avulsion fracture of the posterior cruciate ligament: A finite element analysis”","authors":"Guangdong Chen , Weiguo Xu , Yibing Chen , Lee A. Tan","doi":"10.1016/j.injury.2025.112862","DOIUrl":"10.1016/j.injury.2025.112862","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112862"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490970","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":"Performance of artificial intelligence in addressing questions regarding management of clavicle fractures","authors":"John D. Milner ,&nbsp;Matthew Quinn ,&nbsp;Ashley Knebel ,&nbsp;Phillip Schmitt ,&nbsp;Patrick Morrissey ,&nbsp;Myka Dancy ,&nbsp;Jonathan Liu ,&nbsp;Simbarashe Peresuh ,&nbsp;Michel A. Arcand ,&nbsp;Andrew R. Evans ,&nbsp;Brett D. Owens ,&nbsp;E. Scott Paxton","doi":"10.1016/j.injury.2026.113053","DOIUrl":"10.1016/j.injury.2026.113053","url":null,"abstract":"<div><h3>Objectives</h3><div>Artificial intelligence (AI) has revolutionized public access to extensive information with large language model (LLM)-based chatbots allowing users to receive comprehensive, individualized responses. In this study, we aimed to evaluate the quality of LLM responses to questions about common orthopedic conditions. We hypothesized that both ChatGPT and Gemini would demonstrate high quality, evidence-based responses across evaluation criteria.</div></div><div><h3>Methods</h3><div>Responses from ChatGPT and Gemini to prompts based on the 14 AAOS Clinical Practice Guidelines for clavicle fracture management were evaluated on six criteria by seven fellowship-trained shoulder and trauma orthopedic surgeons. Statistical analyses including mean scoring, standard deviation and two-sided t-tests were calculated to compare performance between ChatGPT and Gemini. Scores were then evaluated for inter-rater reliability (IRR).</div></div><div><h3>Results</h3><div>ChatGPT and Gemini demonstrated overall mean scores greater than 3.5 for both platforms. Mean overall score for ChatGPT was highest in evidence-based (4.52 ± 0.16) and lowest in clarity (4.22 ± 0.19). Mean overall score for Gemini was highest in clarity (4.31 ± 0.17) and lowest in evidence-based (3.81 ± 0.22). ChatGPT had significantly better performance in the overall completeness category (4.50 ± 0.17 vs 4.11 ± 0.19, p &lt; 0.005) than Gemini but scores were otherwise not significantly different. Over 70 % of respondents rated the responses of ChatGPT as higher quality than Gemini.</div></div><div><h3>Conclusions</h3><div>ChatGPT and Gemini produced responses that were generally in line with the 2022 AAOS guidelines on the treatment of clavicle fractures. Scores were comparable in every overall category except completeness, with ChatGPT outperforming Gemini. These results suggest that both LLMs are capable of providing clinically relevant responses to questions related to clavicle fracture management.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113053"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079531","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":"Multiple iliosacral screws in a single osseous fixation pathway: Utility and safety","authors":"David A Zuelzer ,&nbsp;Andrew Coskey ,&nbsp;Yugant Patel ,&nbsp;Christopher Meuth ,&nbsp;Milton L “Chip” Routt ,&nbsp;Raymond D. Wright","doi":"10.1016/j.injury.2026.113023","DOIUrl":"10.1016/j.injury.2026.113023","url":null,"abstract":"<div><h3>Objectives</h3><div>1) To evaluate common characteristics for injuries treated with multiple iliosacral screws in a single sacral osseous pathway to evaluate when it may be useful and 2) to determine whether placing multiple iliosacral screws in a single sacral OFP increases risk for unsafe screws.</div></div><div><h3>Methods</h3><div>Design: Retrospective, combined case-control and cohort analyses</div><div><em>Setting:</em> Single, Level 1 regional trauma center</div><div><em>Patient Selection Criteria:</em> Treated with iliosacral screws identified by CPT code search 27,216 and 27218</div><div><em>Outcome Measures and Variables:</em> Population was divided into multiple screw (MS) and single screw (SS) groups. Outcomes of interest were factors associated with MS group and screw safety on postoperative CT scan.</div></div><div><h3>Results</h3><div>There were 133 patients with 53/133 (39.8%) in the MS group and 80/133 (60.2%) in the SS group. On logistic regression, each 2-mm increase in CT measurement was associated with higher odds of receiving multiple screws for sacroiliac style (OR = 1.34, 95% CI 1.05–1.71, <em>p</em> = 0.02) or transsacral if non-dysmorphic (OR = 1.55, 95% CI 1.25–1.93, <em>p</em> &lt; 0.001) in S1. Patients were 3.4 times more likely to be in the MS group with C-type than B-type injuries (OR = 3.40, 95%CI 1.61–7.22, <em>p</em> = 0.0014). MS was not a risk factor for juxtacortical or extraosseous screw placement (RR = 1.93, 95%CI 0.66–5.65, <em>p</em> = 0.23).</div></div><div><h3>Conclusion</h3><div>The results of this study suggest that surgeons may place multiple iliosacral screws in a single OFP in more complex or unstable injuries and/or when larger safe corridors exist on preoperative imaging and that multiple iliosacral screws may not be associated with an increase in risk for unsafe screw placement.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113023"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981569","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":"Prehospital spinal immobilization and motion restriction strategies: A scoping review of the literature","authors":"Federico Cucci ,&nbsp;Dario Marasciulo ,&nbsp;Roberto Lupo ,&nbsp;Luana Conte ,&nbsp;Giovanni Soldano ,&nbsp;Cosimo Caldararo ,&nbsp;Leonardo Zizzi ,&nbsp;Emanuele Lagazzi ,&nbsp;Michele Bonetti","doi":"10.1016/j.injury.2026.113024","DOIUrl":"10.1016/j.injury.2026.113024","url":null,"abstract":"<div><h3>Background</h3><div>Prehospital management of suspected spinal injury has long relied on routine full immobilization. In recent years, several studies have questioned its benefit and highlighted possible adverse effects. The aim of this scoping review is to describe the evidence on the management of patients with suspected spinal injury, focusing on models based on full immobilization with rigid devices and a cervical collar, and on strategies of selective spinal motion restriction (SMR).</div></div><div><h3>Methods</h3><div>A scoping review was conducted according to JBI methodology and PRISMA-ScR guidance, with a protocol registered on the Open Science Framework. The literature search was carried out in the PubMed, Scopus and Web of Science databases. Studies on adults or children with suspected traumatic spinal injury managed in the out-of-hospital setting were included when strategies of full immobilization, selective SMR or no immobilization were described or compared.</div></div><div><h3>Results</h3><div>Twenty-seven studies met the inclusion criteria, including observational cohorts, experimental studies on volunteers, simulation studies and qualitative research. Overall, no clear advantage of routine full immobilization over more selective strategies emerges. Selective SMR based on clinical assessment and decision rules appears to reduce the use of rigid devices without evidence of increased missed unstable injuries. Prolonged immobilization is instead associated with pain, discomfort, alterations in tissue perfusion and greater use of imaging examinations. The overall body of evidence is heterogeneous and largely based on observational studies, in which the influence of confounding factors cannot be fully ruled out.</div></div><div><h3>Conclusions</h3><div>The available evidence supports moving away from routine full immobilization towards selective SMR in the prehospital setting. Emergency medical services should update protocols and training accordingly and promote prospective studies focused on clinical outcomes and patient experience.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113024"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981573","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":"Outcomes of single stage treatment of chronic bone infection in adults with antibiotic impregnated calcium sulphate beads; A single centre retrospective study with a mean follow-up of 5.5 years","authors":"Panayiotis Souroullas ,&nbsp;Hemant Sharma ,&nbsp;Gavin Barlow ,&nbsp;Andy Craig ,&nbsp;Ross Muir ,&nbsp;Yvonne Hadland ,&nbsp;Elizabeth Barron ,&nbsp;Cher Bing Chuo ,&nbsp;Joanna Bates","doi":"10.1016/j.injury.2026.113052","DOIUrl":"10.1016/j.injury.2026.113052","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic bone infection is a challenging condition to treat, often requiring multiple surgeries and prolonged antibiotic therapy, which although effective, can increase patient morbidity and are resource intensive. This study was designed to evaluate midterm results of a single-stage management approach for chronic bone infection, incorporating debridement, local antibiotic delivery via calcium sulphate antibiotic loaded carrier (CALC), and soft-tissue coverage to effectively manage infection and improve patient outcomes while minimizing morbidity associated with multi-stage procedures.</div></div><div><h3>Materials and Methods</h3><div>In this retrospective observational cohort study, patients who underwent single-stage surgery with a minimum of two-year follow-up were included. Data on demographics and clinical outcomes were collected. Key objectives included assessing disease recurrence, treatment impact, and postoperative complications.</div></div><div><h3>Results</h3><div>Ninety-three patients, of which 60 were male, were included, with a mean age of 51 years. The median follow-up period was 57.5 months. The mean postoperative stay was 13 days. Thirty-nine patients were smokers, 11 were diabetics, and 10 had peripheral vascular disease. The leading cause of chronic bone infection was fracture related infection following trauma (<em>n</em> = 68), predominantly affecting the tibia (<em>n</em> = 33). Significant microbiological growth occurred in 77 patients with Staphylococcus aureus being the predominant pathogen (<em>n</em> = 42). Cierny-Mader classification revealed 31 patients with localized lesions in Class B hosts and 25 in Class A hosts. Only 24 patients required surgical stabilization at index procedure. Most patients (<em>n</em> = 70) underwent excision with primary closure, while 22 needed a soft tissue flap. Postoperative complications included wound leakage in 21 cases, with 13 recurrent infections, 10 of which needed further surgery. An infection control rate was initially achieved at 86%, and 89.2% at a 5.5-year follow-up.</div></div><div><h3>Discussion and conclusion</h3><div>Our study constitutes a large patient cohort with one of the longest available follow-up periods. Single-stage management of chronic bone infection with intralesional debridement using antibiotic impregnated CaSO₄ pellets is safe and an effective method with low recurrence rates. Our results suggest that pre-operative sampling is not essential for successful outcomes. A multidisciplinary approach following the essential basic principles of the management of CBI is essential.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113052"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038910","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":"Comment on timing of ultra-portable ultrasound (UPUS) examinations in detecting clinically concerning recurrent pneumothorax","authors":"Wenwen Zhao,&nbsp;Hong Fan,&nbsp;Ying Chen","doi":"10.1016/j.injury.2025.112865","DOIUrl":"10.1016/j.injury.2025.112865","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112865"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524857","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":"Addressing methodological gaps in finite element analysis of novel hook plates for patellar fracture fixation","authors":"Hassan Riaz ,&nbsp;Huda Faisal ,&nbsp;Hussain Ramzan","doi":"10.1016/j.injury.2025.112859","DOIUrl":"10.1016/j.injury.2025.112859","url":null,"abstract":"<div><div>This letter evaluates the methodological shortcomings in the FEA research conducted by Ma et al. (2025) that contrasts hook plates with tension-band wiring for patellar fractures. Unresolved concerns consist of: uniform bone material characteristics simplifying biomechanics; static loads neglecting dynamic physiological forces; idealized fracture spaces missing clinical variation; and unverified interfaces exaggerating stability. These gaps may exaggerate the effectiveness of the implant. We suggest personalized modeling, simulations of dynamic loading, and studies on mesh convergence to enhance clinical significance. Tackling these issues would enhance forthcoming evaluations of orthopedic devices based on FEA.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112859"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643877","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":"Attempted definitive revision amputations in emergency department vs operating room for traumatic finger injuries are associated with a high rate of revision surgery","authors":"Patrick Curtin ,&nbsp;Michael Flood ,&nbsp;Max Vaickus ,&nbsp;Matthew DeFazio ,&nbsp;Alexandra Conway ,&nbsp;Marci Jones","doi":"10.1016/j.injury.2026.113067","DOIUrl":"10.1016/j.injury.2026.113067","url":null,"abstract":"<div><h3>Background</h3><div>Revision amputation is a common treatment in the emergency department (ED) for traumatic finger injuries, yet there is limited data on outcomes for procedures completed in the emergency room versus the operating room. This study aims to assess outcome differences between ED revision amputation and delayed OR management.</div></div><div><h3>Methods</h3><div>103 consecutive patients with traumatic finger(s) amputations were identified from a single tertiary care center. Patients were evaluated by the on-call hand team and staffed with a fellowship-trained hand attending. ED revision amputations were performed with the goal of definitive care. Data was collected for injury/patient demographics, follow-up, and further revision procedures. Odds ratios were calculated to assess for predictive factors for ED management failure.</div></div><div><h3>Results</h3><div>55 patients were treated with ED revision amputation, 18 of whom (32.7 %) required further surgical management. Presence of multiple digit amputations was associated with increased initial treatment in the operating room. The most common indication for surgery was revision amputation and soft tissue coverage (88.9 %), followed by additional bony fixation for underlying fractures (44.4 %). Number of fingers amputated, fracture presence, and significant soft tissue injury were not associated with failure. Of the 48 patients with planned delayed management in the OR, 11 were treated with nonoperative wound care.</div></div><div><h3>Conclusions</h3><div>Definitive ED revision amputation was associated with a high rate of failure, need for revision surgery, and loss to follow up. Injuries with complex wound coverage or bony fixation may be better suited to OR management. Some patients may ultimately be appropriate for management without revision amputation and may be overtreated with this procedure in the ED.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113067"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079469","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":"Christopher Lewis Colton 1937–2025 – a celebration","authors":"Simon M Lambert ,&nbsp;E Paul Szypryt","doi":"10.1016/j.injury.2026.113095","DOIUrl":"10.1016/j.injury.2026.113095","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113095"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230322","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":"'Save The Haematoma': The utility of using the fracture hematoma as autograft during ORIF","authors":"Daniel Horwitz ,&nbsp;Ahmed Nageeb ,&nbsp;Tracy Watson ,&nbsp;Peter V Giannoudis","doi":"10.1016/j.injury.2026.113092","DOIUrl":"10.1016/j.injury.2026.113092","url":null,"abstract":"<div><div>The utility of using the patient’s native fracture hematoma as an autograft after performing open reduction and internal fixation (ORIF) for fractures is highlighted. The fracture hematoma may be effectively used in closed fractures as a standalone autograft for filling in or around the fracture site, or used in combination with other structural autografts, allografts, or bioceramics to potentially enhance fracture healing. We advocate surgeons to support and consider in their practice the 'Save The Haematoma Campaig'</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113092"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260239","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}