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

{"title":"Incidence of venous thromboembolism following achilles tendon rupture. Data from the UK foot and ankle thrombo-embolism (UK-FATE) audit","authors":"Matthew Solan ,&nbsp;Samuel Briggs-Price ,&nbsp;Linzy Houchen-Wolloff ,&nbsp;Karan Malhotra ,&nbsp;Lyndon Mason ,&nbsp;Jitendra Mangwani ,&nbsp;UK FATE Collaborative","doi":"10.1016/j.injury.2025.112212","DOIUrl":"10.1016/j.injury.2025.112212","url":null,"abstract":"<div><h3>Introduction</h3><div>Achilles tendon rupture (ATR) carries a high risk of venous thrombo-embolism (VTE) whether the injury is managed surgically or non-operatively. This study reports symptomatic VTE rate following ATR. The influence of patient demographics, treatment type and use of chemical thromboprophylaxis is examined.</div></div><div><h3>Materials and Methods</h3><div>Observational cohort study. The data is from a multi-centre, prospective, national audit of patients from 68 participating United Kingdom centres. Data was prospectively collected from hospital records. The study was conducted between June and November 2022, with a 3-month follow up.</div></div><div><h3>Results</h3><div>Of 11,363 participants in the National Audit, 9.5 % (<em>n</em> = 1084) had experienced an ATR. Management strategies included both non-surgical (74 %) and surgical (26 %). Following ATR, the VTE rate was 3.69 % (<em>n</em> = 40) compared to 0.57 % (<em>n</em> = 59) for other foot and ankle surgeries.</div><div>Participants who developed symptomatic VTE after ATR were older than those who did not (mean age 54 years (95 %CI 50.5 - 54.7) vs 48 years (95 %CI 47.3 - 49.1)). There was no significant difference in VTE events due to participant sex, ethnicity or number of comorbidities. Differences in treatment regimen, such as weight-bearing status and immobilisation strategy, showed no significant difference in symptomatic VTE events between groups.</div></div><div><h3>Conclusion</h3><div>After ATR, patients are 6.5-times more likely to experience symptomatic VTE than those recovering from surgery for other foot and ankle pathology. There was no significant difference in symptomatic VTE rate after ATR with specific chemical prophylaxis or early mobilisation strategies.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112212"},"PeriodicalIF":2.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143418874","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":"Classifications and treatment management of fragility fracture of the pelvis: A scoping review","authors":"Kaori Endo ,&nbsp;Norio Yamamoto ,&nbsp;Shunsuke Taito ,&nbsp;Takahiro Tsuge ,&nbsp;Yuki Nakashima ,&nbsp;Kosuke Suzuki ,&nbsp;Takao Kaneko ,&nbsp;Kae Okoshi","doi":"10.1016/j.injury.2025.112206","DOIUrl":"10.1016/j.injury.2025.112206","url":null,"abstract":"<div><h3>Background</h3><div>Fragility fractures of the pelvis (FFP) present a growing challenge in aging populations. However, standardized classifications and treatment guidelines remain scarce.</div></div><div><h3>Objective</h3><div>This scoping review examines the application of fracture classifications, treatment strategies, and outcome evaluations for FFP, identifying gaps in the literature, and suggesting directions for future research.</div></div><div><h3>Methods</h3><div>A systematic search of multiple electronic databases yielded 117 studies discussing FFP names, classifications, treatment approaches, and outcomes. Data extraction focused on study characteristics, classification systems, treatment details, outcomes, and follow-up periods. Residual analysis using the Chi-square test assessed statistical associations and underrepresentation.</div></div><div><h3>Results</h3><div>The FFP classification was the most common (51.3%), with additional treatment indicators focused on immobility (44.4%) and pain assessment (using the Visual Analog Scale [VAS] or Numeric Rating Scale [NRS], 37.6%), consistent with existing guidelines. In contrast, the sacral insufficient fractures were statistically associated with pain indications but lacked corresponding classification application. Initial management typically involved conservative or observation period. Regarding the management indications and outcomes, surgical interventions were categorized into osteosynthesis and sacroplasty. Outcome evaluations often incorporated mobility and functional status (59.0%), hospitalization length (49.6%), mortality rates (41.0%), and post-treatment living conditions (41.0%). Patient recovery was assessed through VAS scores (59.0%) and Activities of Daily Living Patient-Reported Outcomes (ADL-PROs, 34.2%). However, inconsistencies in standardized outcomes, particularly in sacroplasty studies, hinder comparative analysis.</div></div><div><h3>Conclusion</h3><div>FFP classifications, along with pain and mobility assessments, were frequently applied as management indicators for FFP. Standardizing treatment indications and establishing consistent outcome measures, including the evidenced gap treatments (sacral insufficient fracture and cement augmentation), could significantly improve comparability across studies.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112206"},"PeriodicalIF":2.2,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445384","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":"Effects of acute intermittent hypoxia on muscle strength in individuals with spinal cord injury: A systematic review of randomized trials","authors":"Anas R. Alashram","doi":"10.1016/j.injury.2025.112211","DOIUrl":"10.1016/j.injury.2025.112211","url":null,"abstract":"<div><h3>Introduction</h3><div>Muscle weakness is among the most common motor deficits in individuals with spinal cord injury (SCI). Acute intermittent hypoxia (AIH) has been used to improve motor function by facilitating neuroplasticity. The purpose of this systematic review is to explore the impacts of AIH on muscle strength in individuals with SCI, identify who would most likely respond well to the intervention, and determine the optimal therapeutic protocol.</div></div><div><h3>Methods</h3><div>Relevant literature was explored in “PubMed, MEDLINE, The Cochrane Library, Scopus, PEDro, and Web of Science” databases until October 2024. Randomized trials that involved SCI patients who underwent AIH, compared with controls, and assessed muscle strength were included in this review. The methodological quality was assessed using the “Physiotherapy Evidence Database (PEDro)” scale. The effect sizes were calculated using Cohen's d<em>.</em></div></div><div><h3>Results</h3><div>Of 502 studies, seven studies met the eligibility criteria, and the sample sizes ranged from 12 to 28 participants across the included studies. In total, 146 SCI patients (mean age 46.76 years; 88 % male) were included in this systematic review. The PEDro scores of the studies included varied between 5 and 8, with a median score of 8.</div></div><div><h3>Conclusions</h3><div>AIH is a promising therapeutic modality for enhancing muscle strength post-SCI, specifically in patients with motor-incomplete injuries. Based on good quality studies, delivering AIH independently or in combination with other treatments for 15 short (60–90 s) episodes of hypoxic exposure (Oxygen = 9 %) alternating with 15 (60–90 s) normoxic episodes (Oxygen = 21 %), across one or more sessions, could yield meaningful outcomes. Nevertheless, the evidence is limited by treatment protocol variations, small sample sizes, and a lack of standardization in combining AIH with other treatments. Therefore, further studies with larger sample sizes, more diverse populations, and standardized treatment protocols are strongly needed to verify our findings. Future studies should also address the potential bias, examine the long-term effects, and investigate underlying mechanisms to provide more generalized evidence.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112211"},"PeriodicalIF":2.2,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402422","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":"Damage control orthopedics versus early total care of femur fracture in a national cohort of pediatric patients with traumatic brain injury","authors":"Cailan L. Feingold ,&nbsp;Jose Dominguez ,&nbsp;Michael Jacoby ,&nbsp;Harshadkumar A. Patel ,&nbsp;Damon Delbello ,&nbsp;Irim Salik","doi":"10.1016/j.injury.2025.112210","DOIUrl":"10.1016/j.injury.2025.112210","url":null,"abstract":"<div><h3>Background</h3><div>Long bone fracture is one of the most common concomitant injuries in pediatric traumatic brain injury (TBI) patients, requiring surgical intervention in the form of intramedullary nailing (IMN), open reduction and internal fixation (ORIF), or temporary external fixation, otherwise known as damage control orthopedics (DCO), for transient stabilization before definitive repair. There are no definitive guidelines for femur fracture management in polytrauma TBI pediatric patients. This study investigates the outcomes of patients with TBI and femur fractures who underwent DCO versus early total care (ETC), hypothesizing that delayed fracture fixation is associated with worse outcomes.</div></div><div><h3>Methods</h3><div>Pediatric patients admitted with TBI who underwent femur fracture repair between 2016 and 2020 were investigated using the National Inpatient Sample database. Clinical outcomes, healthcare utilization data, baseline demographics, and comorbidities were collected. All Patient Refined Diagnosis Related Groups (APR-DRG) severity was defined for each case. The injury severity scale (ISS) was developed using ICD-10-CM codes for injury. High ISS was defined as greater than 75th percentile. DCO patients were compared with ETC patients. Inpatient death, prolonged LOS, and high total charges were the primary outcomes evaluated. Multivariate binary logistic regression analysis was used to evaluate for independent predictors of primary outcomes.</div></div><div><h3>Results</h3><div>A total of 6,775 pediatric TBI patients under the age of 21 who underwent repair of femur fracture were identified. The average age was 15.5 years (range: 0–21 years) and there were 2,065 (30.5 %) females. DCO to treat femur fractures was employed in 1,010 (14.9 % of patients). Patients undergoing DCO were significantly more likely to have extreme illness severity (OR = 3.049), early trauma complications (OR = 2.273), and respiratory complications (OR = 2.255). DCO was independently associated with prolonged length of stay (LOS) (OR = 1.263), high total charges (OR = 1.786), and inpatient death (OR = 2.796).</div></div><div><h3>Conclusion</h3><div>This study found that DCO is associated with worse outcomes, likely secondary to injury severity and underlying neurologic injury of patients undergoing DCO. These findings suggest it is time to definitively outline the timing and modality of femur fracture repair for the polytrauma pediatric patient with TBI.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112210"},"PeriodicalIF":2.2,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387119","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":"Operatively treated high-energy blunt pelvic ring injuries and surgical site infections – A retrospective assessment based on a prospective registry","authors":"Elvin Gurbanov ,&nbsp;Ulysse Coneys ,&nbsp;Elisabeth Andereggen ,&nbsp;Alexandre Ansorge ,&nbsp;Vanessa Morello ,&nbsp;Axel Gamulin","doi":"10.1016/j.injury.2025.112209","DOIUrl":"10.1016/j.injury.2025.112209","url":null,"abstract":"<div><h3>Introduction</h3><div>High-energy pelvic ring injuries (PRI) are severe, life-threatening trauma conditions which might require complex surgical management. One of the major complications associated with these injuries is the development of surgical site infections (SSI) which significantly impact patient outcomes. This study aimed to evaluate the rate of SSI in patients undergoing surgical fixation of high-energy blunt PRI and identify the key predisposing factors.</div></div><div><h3>Methods</h3><div>A retrospective review of patients treated for high-energy blunt PRI was conducted using the prospectively filled institutional <em>Severely Injured Patients’ Registry</em>, focusing on the rate of SSI following surgical fixation. The multifactorial nature of infection risk was analyzed, with particular attention to the type of injury, surgical technique, external fixation devices’ usage and the germs encountered.</div></div><div><h3>Results</h3><div>A SSI rate of 10,5 % (12 out of 114 patients) was encountered among the study population. The primary SSI risk factor was PRI complexity; 83.3 % of patients with SSI had an AO/OTA type C fracture and 16.7 % a type B fracture, while 43.1 % of patients without SSI had a type C fracture and 56.9 % a type B fracture (<em>p</em> = 0.008). Additionally, SSI patients had a trend to have higher extremities/pelvis AIS and higher ISS, and to have been more often treated with a transient pelvic fixation device including supra-acetabular external fixator.</div></div><div><h3>Conclusion</h3><div>These findings emphasize the need for a comprehensive infection prevention strategy in high-energy PRI patients, especially in complex cases. A multidisciplinary approach is of outmost importance and should include surgical techniques with meticulous soft tissue handling, proper implant selection and aggressive post-operative wound care. Despite external fixation devices being related to certain cases of SSI, their life-saving potential during the initial management phase should be carefully weighed against this risk.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112209"},"PeriodicalIF":2.2,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402424","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":"Risk factors for cut-throughs in intertrochanteric hip fracture fixation Tip-Apex Distance (TAD) <10 mm and Apex-to-Center <4 mm","authors":"Arielle Richey Levine,&nbsp;Trevan Klug,&nbsp;James Cross,&nbsp;Motasem Salameh,&nbsp;Matthew Riedel,&nbsp;Michael Leslie","doi":"10.1016/j.injury.2025.112205","DOIUrl":"10.1016/j.injury.2025.112205","url":null,"abstract":"<div><h3>Objectives</h3><div>TAD &gt; 25 mm is a risk factor for cut-out in intramedullary nailing. Less attention has been given to the risk factors for central cut-through and the possible outcomes of TAD &lt;10 mm. Furthermore, the risk of cut-through depending on minimum depth on either anterior-posterior (AP) or lateral views has not been explored. The goal of this study is to outline the parameters that increase risk of cut-through in intertrochanteric hip fractures.</div></div><div><h3>Methods</h3><div>A retrospective review of 2128 intertrochanteric hip fractures admitted to a single level 1 academic trauma center from 2014 – 2023 was conducted<strong>.</strong> Variables included patient and operative characteristics, fracture fixation device, fracture type based on OTA/AO 2018 classification, TAD, neck-shaft angle and radiographic and clinical outcomes.</div></div><div><h3>Results</h3><div>TAD &lt;10 millimeters carried a significantly higher risk for lag screw and blade cut-through. Cut-through risk increased significantly when either AP or lateral apex-to-center distance was &lt;4 millimeters, including when comparing fracture reduction quality for a cohort including sliding hip screws, lag screws and blades. Cut-out complications in this cohort only occurred with a TAD &gt;10 mm and was significantly more likely to occur with TAD &gt;25 mm, similar to prior studies.</div></div><div><h3>Conclusion</h3><div>TAD optimization between 10 and 25 mm reduces risk of both cut-out and cut-through and maintenance of 4 mm of distance between apex-to-center distance may help decrease the risk of cut-through complications.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112205"},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402423","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":"Patient reported outcome scores following traumatic hip dislocations","authors":"Carlo Eikani ,&nbsp;Elizabeth Cho ,&nbsp;Robert Kelly ,&nbsp;Robert Hand ,&nbsp;Joseph Cohen ,&nbsp;Hobie Summers ,&nbsp;Ashley E. Levack","doi":"10.1016/j.injury.2025.112197","DOIUrl":"10.1016/j.injury.2025.112197","url":null,"abstract":"<div><h3>Objective</h3><div>Traumatic native hip dislocations require immediate orthopaedic attention and have been associated with significant long-term morbidity. Previous studies have reported radiographic outcomes and clinical complication rates, however; evidence evaluating the effect of these injuries on patient-reported outcomes (PROs) is limited. The purpose of our study was to evaluate PRO scores among patients with native hip dislocations.</div></div><div><h3>Methods</h3><div>Adult patients with native hip dislocations between 2005 and 2020 at a single academic Level 1 trauma center were retrospectively reviewed. Radiographs and medical records were reviewed for patient demographics and comorbidities, injury characteristics, details of treatment including time to reduction, and complications. Patients were given the PROMIS Physical Function (PROMIS PF) and Short Form-36 (SF-36) via HIPAA compliant electronic data capture. Outcomes were analyzed using Student <em>t</em>-tests and Mann-Whitney U comparisons of means/medians. Floor and ceiling effects were also characterized for the various outcomes scores.</div></div><div><h3>Results</h3><div>A total of 168 patients with native hip dislocation were identified, 78 (46.4 %) of whom completed all PROs measures. Among responders, mean age was 36.2 years (SD 14.5), mean BMI was 29.2 (SD 6.7), and mean dislocation duration was 8.9 h (SD 5.1). On univariable regression, older age was associated with worse SF-36 Physical scores (<em>p</em> = 0.007). PROMIS PF showed an estimated 2.18 decrease for every one grade increase in Kellgren-Lawrence score (<em>p</em> = 0.01). There were no ceiling or floor effects seen with PROMIS PF, SF-36 Physical Summary, or SF-36 Mental Summary Scores.</div></div><div><h3>Conclusions</h3><div>Patients of older age and higher Kellgren-Lawrence score exhibited worse SF-36 Physical Function and PROMIS PF scores, respectively, highlighting the functional impact that native hip dislocations may have. PROMIS PF, SF-36 Physical and Mental Summary Scores were without floor or ceiling effects, rendering this an important tool in the evaluation of patients with traumatic native hip dislocation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112197"},"PeriodicalIF":2.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387120","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":"Enhancing pelvic fracture care: The impact of extraperitoneal pelvic packing on definitive Orthopaedic treatment","authors":"Francesco Addevico ,&nbsp;Michele Altomare ,&nbsp;Umberto Mezzadri ,&nbsp;Alberto Nicolò Bergamini ,&nbsp;Sara Gianna Salvadori ,&nbsp;Federico Bove ,&nbsp;Stefania Cimbanassi","doi":"10.1016/j.injury.2025.112207","DOIUrl":"10.1016/j.injury.2025.112207","url":null,"abstract":"<div><div>This study investigates the impact of extraperitoneal pelvic packing (EPP) on the definitive surgical treatment of pelvic fractures (PF) in trauma patients. While EPP is recognized as an effective life-saving technique for controlling non-compressible retroperitoneal bleeding, concerns persist about its potential to complicate subsequent surgical interventions.</div><div>A total of 220 trauma patients treated in a single First Level Trauma Centre from October 2016 to December 2021 were analysed. Demographic data, trauma mechanisms, hemodynamic stability, Injury Severity Scores (ISS), New ISS, PF classification (Tile), surgical timelines, and postoperative complications according to the Clavien-Dindo classification were collected. The study population was divided into two groups: those who underwent EPP (<em>n</em> = 42) and those who did not (<em>n</em> = 178). Statistical analyses included propensity score matching to balance baseline characteristics and reduce selection bias.</div><div>Key findings show that EPP effectively improved survival rates in hemodynamically unstable patients, achieving a survival rate of 71.43 %. However, EPP was associated with delays in definitive surgical treatment and a higher incidence of major postoperative complications (41.67 % vs. 17.65 %, <em>p</em> = 0.014). Despite these delays, EPP did not significantly limit the possibility of achieving definitive surgery or the choice of fixation technique. Patients who underwent both EPP and open reduction internal fixation did not show a higher rate of severe complications compared to those managed without EPP.</div><div>The study concludes that while EPP should be considered a practical emergency intervention for critically unstable PF patients, and even though it may affect the timing of definitive PF treatment, it does not prevent further surgical management.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112207"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372049","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":"Intraoperative complications in acetabular fracture management using the Stoppa approach: A retrospective cohort study","authors":"Dharmendra Kumar ,&nbsp;Shailendra Singh ,&nbsp;Balwinder Singh ,&nbsp;Arpit Singh ,&nbsp;Ankit Sriwastava ,&nbsp;Anand Kumar ,&nbsp;Ashish Kumar","doi":"10.1016/j.injury.2025.112208","DOIUrl":"10.1016/j.injury.2025.112208","url":null,"abstract":"<div><h3>Aim</h3><div>The Aim of the study is to retrospectively analyse intraoperative complications in acetabular fractures treated via the Stoppa approach, identify their frequency and nature, and define potential risk factors, in addition to evaluating clinical outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included a total of 136 acetabulum fracture cases (aged 16 to 82 years) that were managed using Stoppa approach. Records related with age, sex, mode of injury, body mass index, history and type of associated injury and time gap between injury and surgery were noted. Intraoperative records for complications, viz., vascular injury, nerve injury, peritoneum, bowel and bladder injury were retrieved. Data was analysed using SPSS 24.0 software. Chi-square and Independent samples ‘t’-tests were used for comparison.</div></div><div><h3>Results</h3><div>Mean age of patients was 40.14±14.95 years. Majority (74.3 %) of patients were males and had road traffic accident (83.8 %) as the cause of injury. Mean BMI of patients was 22.4 ± 2.43 kg/m². ACPHT (41.2 %) and ACF (27.9 %) were the most common diagnoses. A total of 16 (11.8 %) had associated injuries. Mean time gap between injury and surgery was 6.35±4.25 days. Intraoperative complication rate was 8.8 % (3.7 % peritoneum tear, 2.9 % superior iliac vein injury and 2.2 % external iliac vein injury). Intraoperative complications had a significant association with time gap between injury and surgery (<em>p</em> = 0.015).</div></div><div><h3>Conclusion</h3><div>Stoppa technique was a safe approach for management of acetabulum fractures with a low incidence of intraoperative complications. Early intervention could help to reduce rate of complications further.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112208"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387061","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":"Fracture-related infections of the lower extremity – Analysis of costs and their drivers","authors":"Ramon Nyffeler ,&nbsp;Mario Morgenstern ,&nbsp;Rik Osinga ,&nbsp;Richard Kuehl ,&nbsp;Brigitta Gahl ,&nbsp;Anna Imhof ,&nbsp;Carl-Philipp Meyer ,&nbsp;Seraina Müller ,&nbsp;Thadeus Muri ,&nbsp;Dirk Johannes Schaefer ,&nbsp;Parham Sendi ,&nbsp;Martin Clauss","doi":"10.1016/j.injury.2024.112138","DOIUrl":"10.1016/j.injury.2024.112138","url":null,"abstract":"<div><h3>Objectives</h3><div>Fracture-related infection (FRI) is a feared complication in orthopaedic trauma surgery. They are associated with multiple surgical interventions and prolonged antibiotic treatment duration, and hence, increased costs. The objective of this study was to assess the costs of FRI treatment in a Tertiary Swiss Trauma Center and to identify the variables associated with increased costs.</div></div><div><h3>Patients and methods</h3><div>In this retrospective cohort study, 116 patients with an FRI treated in a Swiss tertiary center between 01/2012 and 12/2019 were included. Clinical data and the costs of each hospital stay were evaluated. Predefined variables were categorized as modifiable and non-modifiable factors and examined for their influence on costs and hospital length of stay (LOS) in univariable and multivariable analyses.</div></div><div><h3>Results</h3><div>The median cost per patient was 39,219 [interquartile range (IQR) 22,657 to 68,588] CHF. The median LOS was 21 [IQR 14 to 36] days. Most patients were male (67%) with a median age of 58 years [40–70]. The median duration of IV antibiotic use was 16 [9–27] days. Costs related to hospitalization (nursing and physiotherapy) accounted for the highest expenses with a relative share of 49%, whereas surgical procedures had a minor impact on the total cost with a relative share of 19%. In the univariable analysis, significant drivers of both costs and LOS were the number of FRI surgeries, the use of negative pressure wound therapy, duration of IV antibiotic treatment, and cases with a change of surgical strategy. After adjustment for patient and treatment factors, duration of IV antibiotics and change of surgical strategy were associated with higher costs.</div></div><div><h3>Conclusions</h3><div>This study illustrates the financial burden of FRI in a DRG system and identifies potential drivers for these costs. Since repeated surgeries or unplanned surgical revisions are drivers of costs, optimal pre-operative planning and coordination between the involved disciplines is key to minimize costs. Management in multidisciplinary teams that are specialized in the treatment of these complex and cost-intensive patients may therefore reduce the financial burden.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112138"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916361","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}