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

{"title":"MRI manifestations and associated injuries in adolescent tibial tuberosity fractures: A retrospective study","authors":"Xinwei Li ,&nbsp;Lu Zhang ,&nbsp;Taotao Hui ,&nbsp;Zhongli Zhang ,&nbsp;Weifeng Lin","doi":"10.1016/j.injury.2025.112765","DOIUrl":"10.1016/j.injury.2025.112765","url":null,"abstract":"<div><h3>Purpose</h3><div>Tibial tuberosity fractures are rare physeal injuries in adolescents and are frequently overlooked on radiographs, despite a high risk of associated soft tissue injury. This study analyzed magnetic resonance imaging (MRI) findings and concurrent injuries in 63 cases to improve diagnostic accuracy and guide clinical management. This study aimed to investigate the MRI features and associated injury patterns of tibial tuberosity fractures in adolescents.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on 63 adolescent patients with tibial tuberosity fractures admitted to our hospital between June 2017 and January 2025. The cohort comprised 62 males and 1 female, with ages ranging from 11 to 16 years (mean: 13.9 years). Fractures occurred on the right side in 22 cases, the left side in 40 cases, and bilaterally in 1 case. Body mass index (BMI) ranged from 20.8 to 33.3 kg/m², with a mean of 26.8 kg/m². Upon admission, all patients underwent MRI examinations within 48 h (3.0 T, including T1-, T2-, and STIR-weighted sequences). Fracture types were classified according to the Ogden classification, and associated injuries involving ligaments and the meniscus were simultaneously documented.</div></div><div><h3>Results</h3><div>MRI revealed patellar tendon injuries in all patients (patellar tendon rupture in 6 cases). Associated injuries included anterior cruciate ligament (ACL) injuries in 28 cases (44.4 %) and posterior cruciate ligament (PCL) injuries in 3 cases (4.8 %). Meniscal injuries were observed in 25 cases (39.7 %), comprising 9 cases of grade I, 12 cases of grade II, and 4 cases of grade III. Peripatellar retinacular injuries were present in 28 cases (44.4 %), and medial or lateral collateral ligament injuries of the knee were identified in 13 cases (20.6 %). Additional associated injuries included 1 case (1.6 %) of fibular fracture, 10 cases (15.9 %) of patellar fracture, and 5 cases (7.9 %) of patellar subluxation.</div></div><div><h3>Conclusion</h3><div>Plain radiography is the preferred imaging modality for diagnosing tibial tuberosity fractures in adolescents, while computed tomography (CT) can be useful for further classification of fracture types. In cases where concomitant soft tissue injuries—such as those involving the patellar ligament or meniscus—are suspected, MRI provides significant diagnostic value and plays a crucial role in surgical planning and complication prevention.</div></div><div><h3>Level of Evidence</h3><div>Level III.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112765"},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109522","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":"Traumatic meniscus tears requiring repair at the time of surgery are a marker of poorer outcome following Tibial plateau fracture at medium term follow up","authors":"Amaya M.Contractor BS ,&nbsp;Steven Rivero ,&nbsp;Philipp Leucht ,&nbsp;Abhishek Ganta ,&nbsp;Sanjit R. Konda ,&nbsp;Kenneth A. Egol","doi":"10.1016/j.injury.2025.112763","DOIUrl":"10.1016/j.injury.2025.112763","url":null,"abstract":"<div><div><em>Introduction</em>: The purpose of this study was to assess the effect of an acute traumatic meniscus tear that required repair in association with a tibial plateau fracture repair on outcomes.</div><div><em>Methods</em>: Over a 17-year period, 843 patients presented with a tibial plateau fracture and were followed prospectively. 721 patients with Schatzker I-VI fractures were treated operatively via a standardized algorithm. 161 tibial plateau fractures (22.3 %) had an associated meniscus tear that underwent acute repair at the time of bony fixation. These patients were compared to operatively repaired tibial plateau fracture patients with no meniscus injury (NMR). Demographics were collected and outcomes including: radiographic healing, knee range of motion (ROM), and complication rates, were recorded. In addition, re-operation rates were compared and any reoperation for meniscus repair failure identified. All patients had a minimum of 1 year follow up.</div><div><em>Results</em>: A total of 524 patients with a mean of 21.4 (range: 12–120) months follow up met inclusion criteria. Patients in the meniscus repair (MR) cohort had poorer knee extension (1.01 degrees, range: 0–30 degrees) compared to the NMR cohort (0.07 degrees, range: 0–10 degrees) (<em>p</em> &lt; 0.001), in addition to poorer knee flexion (123 degrees, range: 0–145 degrees, <em>p</em> = 0.024). Additionally, MR patients reported higher pain scores (mean: 3 and range: 0–8, <em>p</em> = 0.005) at latest follow up. Finally, MR patients had higher rates of infection (8.1 % vs. 3.3 %, <em>p</em> = 0.025) and lateral collapse of the joint (<em>p</em> = 0.032).</div><div><em>Conclusion</em>: Patients who had a meniscus repair at the time of tibial plateau fracture repair were found to have poorer knee ROM, more patient reported pain at minimum 12 (mean 24) months post-operation. Additionally, these patients developed more post-operative complications than those patients who did not undergo a meniscus repair.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112763"},"PeriodicalIF":2.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158779","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":"PROCESS guided case series of primary targeted muscle reinnervation and regenerative peripheral nerve interfaces in the prevention of post amputation and phantom limb pain","authors":"C. L. Nightingale ,&nbsp;K. C. Lee ,&nbsp;D. L. Wallace","doi":"10.1016/j.injury.2025.112767","DOIUrl":"10.1016/j.injury.2025.112767","url":null,"abstract":"<div><div>Lower limb amputations have a prevalence of about 26 per 100,000 in the United Kingdom. A significant proportion of these patients suffer from chronic pain and/or phantom limb pain. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) have been found to help improve these symptoms, however these are usually used as a treatment as opposed to prevention. These techniques work on the principle of giving the nerves somewhere to go and something to do, but it is not yet standard practice. Central neural reorganisation and adaptation to chronic/phantom limb pain suggest that preventing the symptom in the first place could yield a superior result to treatment after the problem has arisen. We present a series of 24 cases of where TMR and/or RPNI were performed primarily at the time of initial amputation. Patients were followed up approximately one year after procedure and assessed their pain scores according to a numerical rating scale (NRS) and the PROMIS Pain Interference Short form 6b Significant improvements of pain scores were found for these patients when compared to patients without previous TMR or RPNI. PLP is a debilitating, life limiting and an economic burden on patients who have undergone limb amputations, and with no clear medical or surgical intervention yet widely accepted to offer a definitive management option for this problem, TMR and RPNI may be able to fill a void. This is a good proof of principle showing promising results, and suggests that further investigations with randomised control studies are warranted.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112767"},"PeriodicalIF":2.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109521","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":"Roles of a nonvascularized fibular graft with and without fixation in the treatment of segmental tibial bone loss: A finite element analysis","authors":"Surasak Jitprapaikulsarn ,&nbsp;Nattapon Chantarapanich ,&nbsp;Theerachai Apivatthakakul ,&nbsp;Chantawat Ruchawapol ,&nbsp;Arthit Gromprasit ,&nbsp;Pasit Sengpanich ,&nbsp;Chantas Mahaisavariya ,&nbsp;Ravisara Sukhan","doi":"10.1016/j.injury.2025.112764","DOIUrl":"10.1016/j.injury.2025.112764","url":null,"abstract":"<div><h3>Background</h3><div>A nonvascularized fibular graft (NVFG) is considered to be an alternative option in managing segmental bone loss of the tibia. Nevertheless, there has been no consensus on optimal graft position and graft fixation technique. The purposes of the present study were to mechanically test the influences of various NVFG fixation techniques on the overall stability of the fixation construct by use of finite element analysis.</div></div><div><h3>Methods</h3><div>Seven FE models of tibias with segmental bone loss stabilized with various fixation techniques were developed including medial and lateral plate-screw, medial and lateral plate-screw with a NVGF on the opposite cortex, medial and lateral plate-screw with an additional locking screw inserting into a NVGF, and intramedullary nail. Single-legged loading with 388 N applying on the tibial plateau was under consideration.</div></div><div><h3>Results</h3><div>A NVGF placed on opposite cortex to the plate played an important role in withstanding bending moment which could reduce implant stress. An additional locking screw inserted into the NVGF helped to keep the NVGF in position and was essential for maintaining fracture gap width.</div></div><div><h3>Conclusion</h3><div>A NVFG with locking screw fixation could be an effective modality in managing segmental bone loss of the tibia. A construct of lateral LCP with a NVFG stabilized by a locking screw was mechanically superior to the others.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112764"},"PeriodicalIF":2.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158781","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":"Delayed posterior sternoclavicular joint dislocation in a young adult managed with plate fixation and cardiothoracic collaboration","authors":"Germain Craddock,&nbsp;Amber Park,&nbsp;Blake Campbell,&nbsp;Wayne Ngo,&nbsp;Amy Iloani,&nbsp;Edgar Araiza","doi":"10.1016/j.injury.2025.112760","DOIUrl":"10.1016/j.injury.2025.112760","url":null,"abstract":"<div><h3>Introduction</h3><div><strong>:</strong> Posterior sternoclavicular joint (SCJ) dislocations are rare, accounting for &lt;1 % of all joint dislocations. Despite their rarity, these injuries warrant urgent recognition due to the SCJ’s proximity to mediastinal structures, including the trachea, esophagus, and great vessels. While not always surgical emergencies, delayed or unstable cases can result in life-threatening complications if not managed in an appropriately equipped hospital setting.</div></div><div><h3>Case Presentation</h3><div><strong>:</strong> A 28-year-old male presented two weeks after sustaining a right SCJ injury while sliding during a softball game. He reported persistent pain, difficulty breathing, and limited shoulder function. Initial radiographs were unremarkable; however, CT imaging revealed a posterior dislocation of the medial clavicle. Given the delayed presentation and potential mediastinal involvement, the patient underwent open reduction and internal fixation (ORIF) with cardiothoracic surgical assistance. Fixation was achieved using unicortical screws in the sternum and bicortical screws in the clavicle. He recovered without complications and returned to full activity</div></div><div><h3>Conclusion</h3><div><strong>:</strong> Posterior SCJ dislocations are challenging to diagnose on radiographs and often require CT for accurate assessment. Although closed reduction is an option in acute cases, delayed presentations typically necessitate surgical stabilization. Plate fixation offers reliable alignment and secure fixation. This case underscores the importance of timely diagnosis, hospital-based care, and multidisciplinary surgical planning when managing posterior SCJ dislocations.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112760"},"PeriodicalIF":2.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105780","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":"Predicting spontaneous tendon rupture in dialysis: a parsimonious clinical model on the frailty and CKD–MBD axis","authors":"Basri Pür ,&nbsp;Mehmet Demir ,&nbsp;Salih Kaya ,&nbsp;Eyüp Şenocak ,&nbsp;Nurdan Pür ,&nbsp;Mustafa Toker","doi":"10.1016/j.injury.2025.112762","DOIUrl":"10.1016/j.injury.2025.112762","url":null,"abstract":"<div><h3>Objective</h3><div>To predict the risk of spontaneous tendon rupture (STR) in dialysis patients using a low-variable, clinically implementable model and to perform internal validation.</div></div><div><h3>Materials and Methods</h3><div>In a single-centre case–control study, 102 individuals were analysed (34 STR cases, 68 controls). Pre-specified candidate predictors comprised four clinical variables: frailty (Clinical Frailty Scale, CFS), dialysis vintage, calcium–phosphate (Ca–P) product, and quinolone exposure within the past 6 months. Group comparisons were conducted; multivariable analysis used logistic regression. Discrimination and calibration were assessed with an L2-penalised approach, 5-fold cross-validation, and bootstrap optimism correction; decision curve analysis (DCA) was undertaken.</div></div><div><h3>Results</h3><div>Compared with controls, cases had higher CFS, longer dialysis vintage, higher Ca–P product and intact parathyroid hormone (iPTH), and lower albumin; C-reactive protein did not differ materially. In the multivariable model, CFS and dialysis vintage were independently and positively associated with STR; Ca–P and quinolone coefficients were positive but did not cross conventional significance thresholds. Discrimination was good: apparent AUC 0.806 and optimism-corrected AUC 0.786; Brier score 0.247. Calibration was visually acceptable, with greater uncertainty at higher predicted probabilities. On DCA, across a 15 %–25 % risk threshold range, the model provided higher net benefit than a treat-none strategy and a net benefit comparable to a treat-all strategy. Among cases, the operative rate was 100 %, complications 11.8 %, recurrence 8.8 %, 12-month mortality 6.3 %, and median length of stay 3.7 days. Rupture sites were quadriceps in 44.1 % and patellar tendon in 32.3 %.</div></div><div><h3>Conclusions</h3><div>In dialysis patients, STR risk appears predictably estimable using readily obtainable indicators such as CFS and dialysis vintage. The Ca–P/iPTH axis may contribute directionally to risk, while the effect of quinolone exposure warrants confirmation in larger cohorts. The model has potential to inform clinical decision-making; further calibration refinement and external validation are recommended before routine implementation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112762"},"PeriodicalIF":2.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105712","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":"Evaluation of union rate of scaphoid non-union fracture in adults by Herbert screw versus volar buttress plate","authors":"Mohammed Hassan Hashem ,&nbsp;Khaled Karam Abed El-Aleem Mohammed ,&nbsp;Mohammed Osama Hegazi ,&nbsp;Ahmed Naeem Atiyya","doi":"10.1016/j.injury.2025.112759","DOIUrl":"10.1016/j.injury.2025.112759","url":null,"abstract":"<div><h3>Purpose</h3><div>The disability and pain after a neglected scaphoid non-union fracture are well recorded in the literature. We aimed to compare and detect the short-term results of non-united scaphoid waist fracture treated by internal fixation and bone graft with the volar buttress plate utilization versus the Herbert screw.</div></div><div><h3>Methods</h3><div>This is a therapeutic study. This randomized, prospective comparative an intervention study was carried out on 30 cases with non-union scaphoid waist fractures. They were randomly categorized into two equal groups, group (A) treated by volar buttress plate fixation with bone graft, and group (B) managed by Herbert screw fixation along with bone graft. Bone graft in both groups was taken from the distal radius. All cases underwent clinical examination and radiological evaluation.</div></div><div><h3>Results</h3><div>With an average of 18 months, thirty cases were followed up. Both groups had similar baseline characteristics. The union rate and time were insignificant difference between both groups. Insignificant differences were determined across either intervention groups in terms of grip strength, the visual analogue pain scale (VAS), the Mayo wrist score, and the quick disabilities of arm, shoulder and hand score (quick DASH score) during the early interval of follow-up postoperatively (at 3, 6, 9 and 12 months). Group (A) demonstrated shorter operative time and lower numbers of image intensifier intraoperatively in contrast to group (B). Hardware removal after union was needed in 3 patients of group (A) in variance to group (B), in which no cases need implant removal. The Radio-scaphoid (RS) impingement and flexor carpi radialis (FCR) tenosynovitis exhibited a significant elevation in group (A) in contrast to group (B). Among the patients with scaphoid fracture non-union who underwent surgery, some cases did not achieve union after the initial procedure. We had to employ an alternative fixation method for these cases, and we followed them until union was achieved, and their function was restored. Specifically, three patients from group (A) (20%) [one case was fixed with a miniplate 2 mm, and two cases were fixed with a microplate 1.5 mm] and two patients from group (B) (13.3 %) required this approach.</div></div><div><h3>Conclusions</h3><div>The functional and radiological outcomes are comparable between volar buttress plate and Herbert screw in the treatment of non-united waist scaphoid fracture. The rate of removal of the implant is higher in the volar buttress plate.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112759"},"PeriodicalIF":2.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109523","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":"Staged hand-foot flap reciprocity: A microsurgical protocol utilizing great toenail flap for finger defect reconstruction","authors":"Wei Zhao ,&nbsp;Guohui Yin ,&nbsp;Linfeng Liu ,&nbsp;Jianwen Zhao","doi":"10.1016/j.injury.2025.112745","DOIUrl":"10.1016/j.injury.2025.112745","url":null,"abstract":"<div><h3>Background</h3><div>Finger defect reconstruction requires functional and aesthetic restoration. The great toenail flap demands advanced microsurgical skills. We propose a staged approach: initial pedicled flap coverage, followed by second-stage exchange of the great toenail flap with the finger flap, enhancing donor site repair while reducing complexity and expanding access in resource-limited settings.</div></div><div><h3>Method</h3><div>Sixteen patients (2017–2024) underwent staged reconstruction: primary pedicled flap followed by great toenail flap-finger flap exchange. Outcomes included complications, functional metrics (Semmes-Weinstein monofilament test, Michigan Hand Outcomes Questionnaire [MHQ], static two-point discrimination [2-PD]), and donor foot pain (Visual Analog Scale [VAS]). Healthy sides served as controls.</div></div><div><h3>Results</h3><div>At mean 12-month follow-up, reconstructed fingers showed mean static 2-PD of 5 mm and Semmes-Weinstein result of 3.67 g; MHQ averaged 89.6. Foot donor sites demonstrated mean 2-PD of 5.5 mm and VAS of 1. Complications included partial flap necrosis (1 case) and significant donor foot pain (1 case). Interphalangeal joint motion, 2-PD, and MHQ scores differed significantly from healthy sides (<em>p</em> &lt; 0.001)..</div></div><div><h3>Conclusion</h3><div>This staged protocol provides a safe, practical solution for finger reconstruction, particularly in settings with limited microsurgical resources. It reduces primary hospital treatment thresholds and addresses suboptimal aesthetic/functional outcomes.</div></div><div><h3>Therapeutic</h3><div>Level III.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112745"},"PeriodicalIF":2.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of osteochondral fragment loss on maximal tibiotalar articular stress in posterior malleolus fractures: A finite element study","authors":"Gregory R. Roytman ,&nbsp;Sarah E. Rizzo ,&nbsp;Anshu Jonnalagadda ,&nbsp;Steven M. Tommasini ,&nbsp;Daniel H. Wiznia ,&nbsp;Brad J. Yoo","doi":"10.1016/j.injury.2025.112754","DOIUrl":"10.1016/j.injury.2025.112754","url":null,"abstract":"<div><h3>Introduction</h3><div>Posterior malleolus fractures are frequently associated with varying degrees of comminution. This comminution often leads to osteochondral fragment loss from the posterior articular surface of the tibial plafond. The purpose of this study is to use finite element modeling to determine whether osteochondral defects at the posterior malleolus fracture interface significantly influence tibiotalar contact stress.</div></div><div><h3>Methods</h3><div>3D models of 10 randomly selected patients were created of the tibia and talus from CT scans. A layer of cartilage was added to simulate contact at the tibiotalar joint. Different circular osteochondral defects were modeled at the fracture interface 3 mm, 5 mm, 10 mm in diameter. Two sizes of fractures were modelled (5 mm and 10 mm), from the posterior-most point on the articular tibial surface. Models with fractures and without osteochondral defects, were tested as controls. Models were loaded in finite element software under single-leg-stance at average body weight. Scenarios were repeated for maximal dorsiflexion and plantarflexion. Differences between the sizes of osteochondral defects across different fracture sizes for each ankle range of motion scenario were determined.</div></div><div><h3>Results</h3><div>No significant differences in maximum articular contact stresses were observed between different sized osteochondral defect sizes in the 5 mm fracture size and ankle range of motion scenarios. However, significant differences in maximum articular contact stresses were observed between different sized osteochondral defect sizes with 10 mm fracture sizes. These differences were observed in neutral and dorsiflexion, but not in plantarflexion.</div></div><div><h3>Conclusion</h3><div>Larger posterior malleolus fractures with osteochondral defects, when loaded with the ankle in neutral and dorsiflexion, resulted in larger tibiotalar articular stresses.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112754"},"PeriodicalIF":2.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092861","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":"Epidemiology, complications and patient-reported outcomes for surgically treated traumatic foot injuries","authors":"Thirza A. Berk ,&nbsp;Quirine M.J. van der Vliet ,&nbsp;Adele Usai ,&nbsp;D.P.J. Smeeing ,&nbsp;Jan Siert Reinders ,&nbsp;Detlef van der Velde ,&nbsp;Egbert Jan M.M. Verleisdonk ,&nbsp;Jort Keizer ,&nbsp;Mark C.P.M. van Baal ,&nbsp;Loek P.H. Leenen ,&nbsp;Falco Hietbrink ,&nbsp;Roderick M. Houwert","doi":"10.1016/j.injury.2025.112757","DOIUrl":"10.1016/j.injury.2025.112757","url":null,"abstract":"<div><h3>Background</h3><div>Literature on quality of life and functionality following various types of surgically treated foot injuries is limited, despite the significant impact on patients’ daily lives. As a result, managing patient expectations becomes challenging. The current objective is to prospectively evaluate long-term patient-reported and clinical outcomes of surgically treated foot injuries.</div></div><div><h3>Methods</h3><div>A multicentre prospective cohort study was conducted. Adult patients undergoing operative treatment for traumatic foot fractures and/or dislocations were eligible for inclusion. Data on patient demographics, treatment, patient-reported outcomes (health-related quality of life assessed using the EuroQol questionnaires, functionality evaluated by the American Orthopaedic Foot and Ankle Society scales, satisfaction, and return to work/sports), complications, and reoperations were collected. Follow-up lasted two years. Statistically significant and clinically relevant changes in outcomes were determined using the Friedman test and minimally important differences.</div></div><div><h3>Results</h3><div>The follow-up response rate was 92%. Patients showed significant and relevant differences in EuroQol scores during follow-up compared to pre-trauma, not returning to their baseline levels. The EQ-VAS™ showed clinically relevant improvement between 1 and 2 years postoperatively. Patients with forefoot injuries had better EuroQol and sports function scores, but lower satisfaction compared to those with midfoot and hindfoot injuries. The EuroQol pain domain exhibited the largest increase in reported problems, followed by usual activities, mobility, anxiety, and self-care. In the forefoot, midfoot, and hindfoot subgroups, the complication rates were 50%, 19%, and 44% respectively. Most complications were related to posttraumatic arthrosis (26%) and infections (24%). Over half of the patients (52%) underwent implant removal. The majority of reoperations involved secondary arthrodesis (37%) or revision surgery (32%).</div></div><div><h3>Discussion and conclusion</h3><div>Strengths of this study include the prospective multicentre setting, the high response and follow-up rates, its epidemiological nature, and the inclusion of various injury types with stratified data presentation. Limitations include recall bias, suboptimal minimal important differences, group heterogeneity, and the use of the suboptimal AOFAS scales.</div><div>The overview of patient-reported and clinical outcomes for patients treated surgically for acute foot injuries presented in this study show persisting impairment in functionality at the two-year follow-up. The data will help manage patient expectations effectively.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112757"},"PeriodicalIF":2.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088743","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}