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

{"title":"Biomechanical evaluation of fixation methods used in the treatment of fifth metatarsal fractures and the development of a novel biodegradable screw design","authors":"Talip Çelik ,&nbsp;Hamid Asadi Dereshgi ,&nbsp;Dilan Demir","doi":"10.1016/j.injury.2025.112756","DOIUrl":"10.1016/j.injury.2025.112756","url":null,"abstract":"<div><div>The fifth metatarsal is essential for balance control during gait and remains susceptible to proximal fractures such as the Jones fracture due to its limited vascularity, making the choice of fixation method of critical importance. The study was conducted to biomechanically compare conventional fixation techniques and identify the most effective strategy for Jones fracture management, culminating in the design and rigorous evaluation of a novel biodegradable implant. A volumetric model of the fifth metatarsal with fixation constructs was developed using medical imaging and digital design tools, and its mechanical performance was assessed by finite element analysis. The proximal end of the metatarsal bone was immobilized, and a 60 N—according to literature—was applied to the distal end; frictional interaction was incorporated at the fracture interface to simulate realistic mechanical conditions. The mechanical properties of Ti6Al4V and CrNiMo alloys were used for the implant models. The intramedullary screw model registered the lowest stress values for both materials, prompting subsequent material and design modifications. A magnesium-based biodegradable material was adopted, and mechanical analyses were conducted again following the implementation of requisite design refinements. The modified biodegradable implant was verified to provide adequate structural performance, indicating its suitability for Jones fracture fixation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112756"},"PeriodicalIF":2.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088714","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":"Bariatric surgery and distal radius fractures, a population-based study","authors":"Tal Frenkel Rutenberg ,&nbsp;Ran Rutenberg ,&nbsp;Assaf Kadar ,&nbsp;Yona Kosashvili ,&nbsp;Sorin Daniel Iordache","doi":"10.1016/j.injury.2025.112755","DOIUrl":"10.1016/j.injury.2025.112755","url":null,"abstract":"<div><h3>Introduction</h3><div>Obesity is a growing global concern. Bariatric surgery (BS) is the only intervention which leads to significant and long-lasting weight reduction. However, it has been associated with an increased risk of fracture. We aimed to investigate the association between BS and distal radius fractures (DRF).</div></div><div><h3>Methods</h3><div>A retrospective cohort study of patients with obesity who underwent BS was conducted. The incidence of DRF and the non-osteoporotic scaphoid fracture in the six-years pre-and post-BS was compared. Sub-analysis for surgical type, weight loss, nutritional supplements, and treatment modality was conducted.</div></div><div><h3>Results</h3><div>Seventeen-thousand, nine-hundred and four patients, aged 40 (SD 2.7) were included in the study, most of whom were females (71.2%). Most underwent restrictive gastric surgery (82.6%). The incidence of both fractures increased following BS (OR 2.091, 95% CI [1.524,2.896], p&lt;0.001 for DRF and OR 6.013, 95% CI [2.819,14.720], p&lt;0.001 for scaphoid fracturs). Women were affected more. DRFs were less common following restrictive surgery (0.6% versus 1.15% for gastric bypass surgery, OR 0.52 95% CI [0.35,0.79], p.=0.002), and their incidence was not associated with the time elapsed from BS. A greater weight reduction was not related with increased fracture risk, regardless of the fracture type, as was nutritional supplements consumption. DRF surgery rates were not affected by BS.</div></div><div><h3>Conclusions</h3><div>BS was found to relate with increased risk for DRFs. The risk was greater for gastric bypass patients and independent of the increasing cohort age, the amount of weight lost, the time elapsed from surgery, and the intake of nutritional supplements.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112755"},"PeriodicalIF":2.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048893","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":"Severe periarticular lower extremity injuries: Do all first need an external fixator to prepare soft tissues before definitive ORIF?","authors":"Andrew Caines ,&nbsp;Scott Willms ,&nbsp;Richard Buckley","doi":"10.1016/j.injury.2025.112751","DOIUrl":"10.1016/j.injury.2025.112751","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112751"},"PeriodicalIF":2.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088759","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":"Associations between neighborhood-level gun violence and child general health status: An ECHO cohort analysis","authors":"Nandita Somayaji ,&nbsp;Emily A. Knapp ,&nbsp;Marie L. Churchill ,&nbsp;Kelly A. Hirko ,&nbsp;Courtney K. Blackwell ,&nbsp;Alison E Hipwell ,&nbsp;Nicholas Cragoe ,&nbsp;Judy L. Aschner ,&nbsp;Lisa A Croen ,&nbsp;Theresa M. Bastain ,&nbsp;Amy J. Elliott ,&nbsp;Christina A. Porucznik ,&nbsp;Kristen Lyall ,&nbsp;Carlos A. Camargo Jr. ,&nbsp;Hooman Mirzakhani ,&nbsp;T.Michael O’Shea ,&nbsp;Zoe B. Kaplan ,&nbsp;Thomas G O’Connor ,&nbsp;Margaret R. Karagas ,&nbsp;Traci A. Bekelman ,&nbsp;Aruna Chandran","doi":"10.1016/j.injury.2025.112752","DOIUrl":"10.1016/j.injury.2025.112752","url":null,"abstract":"<div><div>The impact of gun violence on the well-being of children in the United States is a vital public health issue. Gaps remain in characterizing the population health burden, exacerbated by gun violence data limitations and research policy restrictions. This study explores the association between neighborhood-level gun violence and the general health status of children nationwide in the Environmental influences on Child Health Outcomes (ECHO) study. 13,450 children ages 0–17 and parents reported general health status. Gun violence incidents, defined as any death or injury caused by a gun, were extracted from the publicly available Gun Violence Archive by census tract between 2020 and 2023. Census tracts were categorized as low gun violence (&lt; 2 incidents between 2020–2023) and high gun violence (≥ 2 incidents). A generalized estimating equation logistic model with robust variance was used to estimate the association between binary general health status (Good/Fair/Poor vs. Excellent/Very good) and neighborhood-level gun violence events adjusting for individual and census tract-level sociodemographic covariates. 11,329 (84 %) reported Excellent/Very Good general health and 2121 (16 %) reported Good/Fair/Poor general health. The adjusted odds of Excellent/Very Good general health were 20 % lower among children living in census tracts with high gun violence compared to low gun violence (OR 0.804; 95 % CI: 0.721, 0.897). When stratified by age group, the odds of Excellent/Very Good general health among younger children (ages 0 – 7) were 17.3 % lower (OR 0.827; 95 % CI: 0.687, 0.997) and 19.7 % lower among older children (ages 8 – 17) among those living in census tracts with high gun violence compared to those with low gun violence (OR 0.803; 95 % CI: 0.702, 0.919). Among children living in high socioeconomic vulnerability census tracts, the odds of Excellent/Very Good general health were 23 % lower in children living in census tracts with high gun violence compared to those with low gun violence (OR 0.767, 95 % CI 0.669, 0.880). Findings underscore the importance of community violence prevention efforts and the need to strengthen our understanding of community risk factors such as gun violence that hinder optimal child growth and development.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112752"},"PeriodicalIF":2.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048895","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 DAIR for early fracture related infection: Clinical remission, recurrence, and bone healing in a retrospective cohort","authors":"Gabriel Chartuni Teixeira Cury,&nbsp;Patrick Bolzan Guidoni,&nbsp;Leonardo Hideki Ikeda,&nbsp;Caio César Ummen de Almeida Cardoso Ferreira,&nbsp;Maria Adelaide de Miranda Gonçalves,&nbsp;Marcos de Camargo Leonhardt,&nbsp;Ana Lucia Munhoz Lima,&nbsp;Jorge dos Santos Silva,&nbsp;Kodi Edson Kojima","doi":"10.1016/j.injury.2025.112749","DOIUrl":"10.1016/j.injury.2025.112749","url":null,"abstract":"<div><h3>Background</h3><div>Fracture related infection (FRI) is a serious complication of orthopedic trauma. The DAIR (Debridement, Antibiotics, and Implant Retention) approach has been used as a limb- and implant-sparing strategy in selected early infections, but the factors associated with clinical success and bone healing remain incompletely defined.</div></div><div><h3>Objective</h3><div>To evaluate the effectiveness of DAIR in treating early FRI and to identify clinical, surgical, and microbiological factors associated with infection remission, recurrence and fracture consolidation.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adult patients diagnosed with early FRI and treated with DAIR between 2017 and 2023. Clinical remission was defined as infection resolution without further surgery or suppressive antibiotic therapy at 12-month follow-up. Recurrence was defined as clinical or microbiological evidence of infection reappearance. Fracture consolidation was evaluated radiographically. Univariate analyses were performed using logistic regression, Fischer’s exact text, chi-square, and <em>t</em>-test where appropriate.</div></div><div><h3>Results</h3><div>A total of 59 patients were included. Clinical remission was achieved in 86.4 % of cases, while recurrence occurred in 32.2 %. All patients with recurrence had failed clinical remission (<em>p</em> &lt; 0.001). Remission was significantly lower in patients with prior external fixation (72.7 % vs. 94.6 %; <em>p</em> = 0.031) and lower extremity infections (77.1 % vs. 100 % for pelvis and upper limb; <em>p</em> = 0.002). Fracture consolidation was observed in 86.4 % of patients. Although not statistically significant, trends indicated better consolidation in those with remission (90.2 % vs. 62.5 %) and lower healing in patients with comorbidities, or polymicrobial infections.</div></div><div><h3>Conclusions</h3><div>DAIR is effective treatment for early FRI, achieving high clinical remission and consolidation rates. Remission is a strong predictor of both infection control and bone healing. Prior external fixation and lower limb involvement were associated with reduced treatment success.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112749"},"PeriodicalIF":2.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048894","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":"Nail dynamization for delayed union and nonunion in femur and tibia fractures following intramedullary nailing: A systematic review and meta-analysis","authors":"Pengzheng Yu ,&nbsp;Ligang Huang ,&nbsp;Longjian Wang ,&nbsp;Lijun Cai ,&nbsp;Dongpeng Tu","doi":"10.1016/j.injury.2025.112748","DOIUrl":"10.1016/j.injury.2025.112748","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the efficacy of nail dynamization in patients with delayed union and nonunion of femur and tibia shaft fractures following intramedullary nailing, and systematically analyze the associated factors to guide surgeons.</div></div><div><h3>Methods</h3><div>A comprehensive search of PubMed, EMBASE, and Cochrane Library databases was conducted to identify relevant studies. We screened the literature based on the eligibility criteria, extracted relevant data, and assessed the quality of the included studies. A single-arm meta-analysis using a random-effects model was conducted to estimate overall union rates, while meta-regression and subgroup analyses explored sources of heterogeneity and contributing factors. Sensitivity analyses were used to assess result stability.</div></div><div><h3>Results</h3><div>11 studies consisting of 318 patients met the inclusion criteria. The pooled union rate after nail dynamization was 77.2 % with significant heterogeneity. Meta-regression identified the time of dynamization, the method of dynamization, and Fracture Healing Index (FHI) as critical factors affecting union rates. Subgroup analysis revealed that dynamization within 6 months, preserving the dynamic locking screw, and an FHI &gt;1.17 were significantly associated with higher union rates.</div></div><div><h3>Conclusion</h3><div>Nail dynamization is an effective treatment for delayed union and nonunion of femur and tibia shaft fractures following intramedullary nailing. Early dynamization (within 6 months), preserving the dynamic locking screw, and ensuring an FHI &gt;1.17 are crucial strategies for maximizing union rates.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112748"},"PeriodicalIF":2.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020105","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":"Surgical treatment of reversed oblique trochanteric femur fractures: Clinical outcome and introduction of a novel surgical classification","authors":"Robert Breuer ,&nbsp;Nikolaus Wilhelm Lang ,&nbsp;Cornelia Zeitler ,&nbsp;Matthias Hanzal ,&nbsp;Rainer Fiala ,&nbsp;Maximilian Florian Kasparek ,&nbsp;Harald Kurt Widhalm","doi":"10.1016/j.injury.2025.112725","DOIUrl":"10.1016/j.injury.2025.112725","url":null,"abstract":"<div><h3>Introduction</h3><div>The reverse oblique fracture patterns accounts for about 5–10 % of all intertrochanteric fractures. This type of fracture is regarded as highly unstable and is still associated with high complication and failure rates. Cut-off values for the use of short or long implants are not yet defined. An easy-to-use and comprehensive classification system is still lacking.</div></div><div><h3>Materials and Methods</h3><div>This study was performed as a single center retrospective data analysis. Between 2008 and 2018, 4003 patients with per/subtrochanteric fractures, were screened. A total of 286 (7 %) patients with a reverse-oblique fracture pattern were included. Fracture patterns were analyzed and classified according to a new classification system with 4 main types (I-IV), which are subdivided in to subtypes a and b. The choice of implants, complication rates, revision surgery and time of surgery were raised. Radiological outcome parameters (TAD, calTAD, Parker‘s Ratio) and loss of reduction were measured.</div></div><div><h3>Results</h3><div>The distribution between the various subgroups was IIa and IVa (21 %), IIb (20 %), Ia (12 %), IVb (9 %), IIIa (8 %), Ib (6 %) and IIIb (3 %). A rate of 39 (14 %) complications, which needed revision surgery were recorded. Open reduction significantly increased the complication rate (<em>p</em>= 0.0356) as well as an increase in time of surgery (<em>p</em> = 0.0107). The additional use of cerclage wires had no additional influence. There was a trend to more complications after the use of a long implant in patients with type-a fractures (<em>p</em>= 0.056). Radiological parameters did not have any predictive value. Loss of reduction of the medial or lateral cortex shows a trend to a higher complication rate. After a primary complication, the necessity of repeating revision surgery is likely to happen.</div></div><div><h3>Conclusion</h3><div>The novel classification system depicts all relevant fracture patterns. Open reduction and prolonged time of surgery increase the complication rate. In type-a fractures, the use of short implants is recommended. Additional use of cerclage wires does not have a negative impact on outcome.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112725"},"PeriodicalIF":2.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103254","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":"Perioperative glucagon-like Peptide-1 receptor agonist use and clinical outcomes following lower extremity fracture fixation: A large retrospective cohort study with two year follow up","authors":"Daniel E. Pereira ,&nbsp;Sri Tummala ,&nbsp;Mehul M. Mittal ,&nbsp;Mitchel Obey ,&nbsp;Marschall B. Berkes ,&nbsp;Christopher M. McAndrew ,&nbsp;Jenna L. Wilson","doi":"10.1016/j.injury.2025.112746","DOIUrl":"10.1016/j.injury.2025.112746","url":null,"abstract":"<div><h3>Introduction</h3><div>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for Type 2 diabetes and obesity due to their cardiometabolic benefits. However, their effects on fracture healing remain controversial. This study investigates perioperative GLP-1 RA use and outcomes following surgical treatment of lower extremity (LE) fractures.</div></div><div><h3>Methods</h3><div>A retrospective analysis utilizing a large multicenter database compared patients on GLP-1 RAs within one year prior to and after lower extremity index surgery (+GLP) with those not on GLP-1 RAs (–GLP). Propensity score matching was performed on 275,970 included patients, matching 1:1 on age, sex, tobacco use, diabetes mellitus, primary hypertension, hyperlipidemia, chronic ischemic heart disease, chronic lower respiratory disease, and body mass index (BMI), resulting in 6125 “best-matched” patients per group. This was conducted utilizing multivariate logistic regression with a 0.1 caliper. Outcomes were assessed at 1 month, 3 months, and 1 year.</div></div><div><h3>Results</h3><div>At 1-year follow-up, GLP-1 RA users demonstrated a significantly higher rate of nonunion compared to matched controls (5.4% vs 4.4%, Risk Ratio 1.2, 95% CI 1.0–1.4, <em>P</em> &lt; 0.05) when assessing patients who also continued GLP-1 RAs postoperatively. There were no significant differences in wound dehiscence, deep or superficial surgical site infections, or hematoma. Importantly, the +GLP group experienced significantly lower rates of cardiac arrest (0.8% vs 1.6%, RR 0.5, 95% CI 0.3–0.7, <em>P</em> &lt; 0.01) and all-cause mortality (4.4% vs 8.0%, RR 0.5, 95% CI 0.4–0.6, <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Perioperative GLP-1 RA use was associated with a higher risk of nonunion following lower extremity fracture surgery, though without increased wound complication rates. Importantly, GLP-1 RA use was linked to reduced cardiac arrest and mortality within one year. These findings suggest that while the increased rate of nonunion is statistically significant, its clinically significance is limited. Thus, the mortality reduction may be more clinically meaningful for patient counseling and perioperative management. Further study is required to clarify the balance between systemic benefits and surgical outcomes of GLP-1 RAs in orthopedic trauma.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112746"},"PeriodicalIF":2.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007563","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 dermal-fibroblast-derived ECM and dextran sulfate supplementation on osteoblast differentiation – results of a preliminary in vitro study","authors":"V. Wlach ,&nbsp;L. Furrer ,&nbsp;K. Arnke","doi":"10.1016/j.injury.2025.112718","DOIUrl":"10.1016/j.injury.2025.112718","url":null,"abstract":"<div><h3>Background</h3><div>Critical size bone defects represent a clinical challenge, associated with considerable morbidity, and frequently trigger the requirement of secondary procedure. To fill osseous gaps, multiple steps are required, such as proliferation and differentiation on the cellular level and the building of extracellular matrix. In addition, the osteogenic potential of cell-derived extracellular matrices (CD-ECM) is known to enhance bone healing. We therefore examined the osteogenic potential of fibroblast-derived ECM (Fibro-ECM) and assessed the influence of Dextran-sulfate (Dx-S) addition regarding the production of extracellular matrix (ECM).</div></div><div><h3>Methods</h3><div>ECMs were generated by culturing human dermal fibroblasts, adipose-derived stromal cells (ASCs), and osteoblasts derived from ASCs (Osteo-ECM) for four days, with or without Dx-S supplementation. After decellularization, skeletal stem cells (SSCs) isolated from femoral head aspirations were seeded onto the ECMs and differentiated under osteogenic conditions for 17 days. Osteogenesis was assessed by Alizarin Red S staining for calcium deposition and RT-qPCR analysis of osteogenic marker genes.</div></div><div><h3>Results</h3><div>SSCs cultured on Fibro-ECM exhibited enhanced osteogenesis compared to Osteo-ECM and ASC-derived ECM, as evidenced by increased calcium deposition. Notably, Dx-S supplementation further improved the osteoinductive capacity of Fibro-ECM, leading to an upregulation of osteocalcin (OCN) and bone morphogenetic protein 2 (BMP2). In contrast, Dx-S had no significant effect on Osteo-ECM.</div></div><div><h3>Conclusion</h3><div>The addition of Dx-S in autologous fibroblast-derived ECM induces an improvement in osteoinductivity. Addition of Dx-S may therefore be a useful adjunct in the <em>in vitro</em> bone generation models. Whether these results may represent a piece in the puzzle for difficult healing situations in patients with nonunions and bone defects should be subject to further study.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112718"},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004867","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 multidisciplinary emergency protocol reduces revascularization time in major upper and lower limb replantations","authors":"Qianheng Jin ,&nbsp;Lei Xu ,&nbsp;Lei Li ,&nbsp;Jihui Ju ,&nbsp;Ruixing Hou ,&nbsp;Yuefei Liu","doi":"10.1016/j.injury.2025.112729","DOIUrl":"10.1016/j.injury.2025.112729","url":null,"abstract":"<div><h3>Background</h3><div>Major limb amputation salvage procedures exhibit an increased risk of failure when revascularization is delayed beyond 360 min. Institutional delays persist as critical barriers, even with advancements in surgical techniques.</div></div><div><h3>Methods</h3><div>Retrospective cohort study (November 2022- December 2024) at Level I Trauma Center. We implemented a systematized emergency protocol featuring: Prehospital activation → Green channel → OR-direct transport Parallel processing → revascularization. Primary outcome: Revascularization time (limb arrival → arterial flow).</div></div><div><h3>Results</h3><div>30 consecutive amputees (M: <em>F</em> = 21:9; mean age 43.6 ± 14.35 yrs). Included 21 upper limbs (6 wrist, 9 forearm, 6 upper arm) and 9 lower limbs (6 ankle, 3 calf). Revascularization achieved in 142.0 ± 21.17 mins. All cases (100 %) met the ≤180-min golden window. Key timings: Door-to-OR: 19.7 ± 3.2 mins, OR preparation: 20 ± 3.45 mins, Surgery start to revascularization: 102.3 ± 19.8 mins. Limb survival rate reached 96.7 % (29/30). Vascular bridging reconstruction was performed in 17 cases (including 5 cases with emergent anterolateral thigh (ALT) flap arteriovenous bridging). Vascular crisis occurred in 2 cases and was relieved after surgical exploration. The final limb amputation salvage rate was 96.7 % (29/30). One case of ankle-level salvage resulted in postoperative infection and necrosis. At 12-month follow-up, 80 % of upper limbs achieved grasp function (S2-S4 sensibility), and 89 % of lower limbs regained ambulation without prosthesis.</div></div><div><h3>Conclusion</h3><div>The multidisciplinary emergency protocol significantly reduced ischemia time, with rapid revascularization serving as the critical determinant of high limb amputation salvage rates. The protocol achieved functional limb salvage in 83 % of cases, demonstrating that rapid revascularization correlates with both viability and functional recovery.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112729"},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921996","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}