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

{"title":"Analysis of mechanical characteristics of different screw fixation methods based on digital models of acetabular quadrilateral fracture line","authors":"Jieyu Chen ,&nbsp;Huawu Liu ,&nbsp;Lei Bai ,&nbsp;Sergei V. Petrenko ,&nbsp;Jianhui Yan ,&nbsp;Chaohui Wang ,&nbsp;Bixiu Lei ,&nbsp;Shuangping He ,&nbsp;Meilan Zhai","doi":"10.1016/j.injury.2026.113029","DOIUrl":"10.1016/j.injury.2026.113029","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to hierarchically analyse the fixation effects of single and multiple screws on quadrilateral fractures in the acetabular region using finite element technology.</div></div><div><h3>Methods</h3><div>A three-dimensional finite element model of the normal pelvis was constructed based on normal adult CT data using Mimics, Geomagic, SolidWorks, ANSYS. Six transverse equidistant fracture lines were designed for the hierarchical analysis, and five simulated human body positions were considered.</div></div><div><h3>Results</h3><div>We compared the mechanical properties of single and multiple screws used for fixation under various operating conditions. The results indicated a layer-by-layer decrease in the relative displacement of the fracture lines from top to bottom under different strength conditions in the standing position and the lumbar spine. In the lateral decubitus position, fracture lines 1–5 decreased layer by layer, whereas fracture line 6 increased. Moreover, in the multiple-screw model, posterior column corridor screw experienced lower stress than in the single-screw model, while blocking screws bore significantly higher stress than posterior column corridor screw. Additionally, pronounced displacement occurred along the anterior and posterior columns sides of the quadrilateral region, while the central segment showed only minor shifting under different loading states in the standing and lumbar postures; in contrast, such behavior was not observed in the lateral decubitus position.</div></div><div><h3>Conclusion</h3><div>Multiple-screw fixation suggests better stability with smaller relative displacement than single-screw fixation under different loading conditions in the finite element analysis.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113029"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981571","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":"Gene and cellular assessment of wound healing with a novel natural cocktail gel dressing: A new method for quantitative wound closure time assessment","authors":"Reza Eshaghi-gorji ,&nbsp;Reyhaneh Nassiri Mansour ,&nbsp;Fatemeh Soleimanifar ,&nbsp;Majid Saeedi ,&nbsp;Emran Habibi ,&nbsp;Keyvan Mehdipour-chari ,&nbsp;SeyedehElnaz Enderami ,&nbsp;Fereshteh Talebpour Amiri ,&nbsp;Seyyed Mobin Rahimnia ,&nbsp;Mansoureh Mirzaei ,&nbsp;Behnaz Bageshlooyafshar ,&nbsp;Amir Melati ,&nbsp;Seyed Ehsan Enderami","doi":"10.1016/j.injury.2026.113037","DOIUrl":"10.1016/j.injury.2026.113037","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to enhance wound healing using a novel natural cocktail gel dressing composed of purslane, human amniotic membrane (hAM), and platelet-rich plasma (PRP). In addition, a new ratio-based analytical approach was applied to evaluate the healing dynamics in each treatment group, revealing correlations between the healing rate and the respective treatment compound.</div></div><div><h3>Methods</h3><div>Under aseptic conditions, specific amounts of freeze-dried decellularized hAM, PRP, and hydroalcoholic extract of purslane (HAEP) powder were prepared. The study groups included hAM gel, PRP gel, HAEP gel, a cocktail gel (HAEP + PRP + hAM), and phenytoin gel (positive control). Cytotoxicity was evaluated using the MTT assay. In vivo, seven groups were assessed on days 7, 14, and 21. Wound closure rate was analyzed via photographic imaging, and tissue samples were collected for H&amp;E staining. Wound healing dynamics were further evaluated using 14/7-day and 21/14-day ratios.</div></div><div><h3>Results</h3><div>The cocktail gel significantly enhanced wound healing compared with other groups (<em>p</em> &lt; 0.05), improving cell migration, M2 macrophage polarization, and angiogenesis. The ratio-based analysis indicated that the cocktail group exhibited the fastest healing between days 7 and 14, while purslane and hAM groups showed superior healing between days 14 and 21.</div></div><div><h3>Conclusions</h3><div>This study introduces the use of 14/7 and 21/14-day ratios for the first time as a quantitative measure of healing progression, bridging macroscopic closure rates with underlying cellular and molecular changes. The combination of purslane, PRP, and hAM significantly accelerated healing and reduced closure time, suggesting a synergistic effect. The proposed ratio-based approach provides a more accurate evaluation of wound healing phases.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113037"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127698","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":"Wiring fixation for acetabular column fractures: Mid-term outcomes and survival according to reduction quality and fracture pattern","authors":"Chan Young Lee,&nbsp;Taek-Rim Yoon,&nbsp;Kyung-Soon Park","doi":"10.1016/j.injury.2026.113016","DOIUrl":"10.1016/j.injury.2026.113016","url":null,"abstract":"<div><h3>Background</h3><div>Acetabular column fractures remain among the most complex injuries in orthopedic trauma. Conventional plating techniques require extensive soft-tissue dissection and are associated with high complication rates. The wiring technique, which achieves compression across both acetabular columns through the greater and lesser sciatic notches, was developed to minimize surgical morbidity. This study aimed to evaluate the mid-term clinical and radiologic outcomes of this technique and to analyze factors affecting hip joint preservation.</div></div><div><h3>Methods</h3><div>This retrospective study included 41 patients who underwent fixation of acetabular column fractures using the wiring technique between 1994 and 2018 at a single tertiary referral center. A dual approach combining the Kocher–Langenbeck and mini-iliofemoral incisions was used. Clinical outcomes were evaluated using the Harris Hip Score (HHS) and Visual Analog Scale (VAS), and radiologic reduction was graded according to Matta’s criteria. Survivorship was analyzed using Kaplan–Meier methods with conversion to total hip arthroplasty (THA) as the endpoint.</div></div><div><h3>Results</h3><div>The cohort included 29 men and 12 women, with a mean age of 51.2 years and a mean follow-up duration of 11.4 years. The mean operation time was 139.8 minutes. Intraoperative complications included one case each of superior gluteal artery injury, sciatic nerve palsy, and lateral femoral cutaneous nerve injury. Postoperative complications were rare. Anatomical or near-anatomical reduction was achieved in 97.5% of patients. The mean HHS and VAS at final follow-up showed satisfactory functional outcomes. Eight patients (19.5%) required conversion to THA during follow-up, resulting in an overall THA-free survival rate of 85%. Survival analysis demonstrated 100% survivorship for anatomical reductions, 75% for imperfect reductions, and 0% for poor reductions. Fracture classification did not influence clinical outcomes but significantly affected long-term survivorship, with anterior column fractures showing 100% survival and transverse with posterior wall fractures showing the lowest at 50%.</div></div><div><h3>Conclusion</h3><div>The wiring technique offers a reliable and biologically favorable method for treating acetabular column fractures. It provides stable reduction with limited soft-tissue disruption, resulting in durable mid-term hip preservation and low complication rates. These findings emphasize the importance of achieving anatomical reduction and support the wiring technique as an effective option for managing acetabular column fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113016"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981492","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":"Comparative study of the sural flap in 78 patients with a minimum follow-up of 1 year: does pedicle length matter?","authors":"Guido Carabelli ,&nbsp;Lionel Llano ,&nbsp;Gonzalo Garcia Barreiro ,&nbsp;Sebastian Gomez ,&nbsp;Danilo Taype ,&nbsp;Carlos Sancineto ,&nbsp;Jorge Barla","doi":"10.1016/j.injury.2026.113045","DOIUrl":"10.1016/j.injury.2026.113045","url":null,"abstract":"<div><h3>Purpose</h3><div>The sural flap is widely recognized as an effective method for soft tissue coverage in severe lower limb trauma or sequelae. This retrospective cohort study investigates the impact of vascular pedicle length in reverse sural fasciocutaneous flaps on vascular complications, specifically whether longer pedicles are associated with increased complications.</div></div><div><h3>Methods</h3><div>We included patients with distal third leg and foot soft tissue defects, treated between March 2008 and March 2021, with a minimum follow-up of 1 year. The cohort was divided into two groups based on the location of the flap: those with flaps above the ankle joint (short pedicle) and those below (long pedicle). Patient demographics, comorbidities (e.g., diabetes, peripheral vascular disease, smoking), and the causes of defects (including fractures, ulcers, and degloving injuries) were assessed. The occurrence of complications, including epidermolysis, partial necrosis, and total necrosis, were compared between groups using bivariate linear regression.</div></div><div><h3>Results</h3><div>A total of 44 patients received flaps above the ankle joint, while 34 had flaps below the ankle joint. Overall, 35% of patients experienced complications: 5% epidermolysis, 20% partial necrosis, and 10% total necrosis. In the short-pedicle group (flaps above the ankle), 13 complications were observed: 3 cases of epidermolysis, 5 of partial necrosis, and 5 of total necrosis. In the long-pedicle group (flaps below the ankle), 15 complications occurred: 1 case of epidermolysis, 11 of partial necrosis, and 3 of total necrosis. Although complication rates were similar between the two groups, a trend toward a higher incidence of partial necrosis was observed in the longer pedicle group. Statistical analysis using bivariate linear regression found no significant difference in complication rates based on pedicle length (p=0.407). For individual complications, there were no statistically significant differences: epidermolysis (p=0.504), total necrosis (p=0.808), and partial necrosis (p=0.098).</div></div><div><h3>Conclusion</h3><div>Flap rotation points positioned 5-6 cm above the lateral malleolus, with a wide, short pedicle, may reduce vascular complications. For defects beyond the ankle joint, careful surgical planning is crucial, to minimize the risk of partial necrosis and other complications.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113045"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981576","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":"Indications for temporizing knee-spanning external fixation in the treatment of knee dislocations: A multi-center retrospective case series","authors":"Ekrem M. Ayhan ,&nbsp;Sarah J. Levitt ,&nbsp;Hugh Medvecky ,&nbsp;Aaron J. Marcel ,&nbsp;Nancy Park ,&nbsp;Isabel Chalem ,&nbsp;Michael J. Alaia ,&nbsp;Michael J. Medvecky","doi":"10.1016/j.injury.2026.113062","DOIUrl":"10.1016/j.injury.2026.113062","url":null,"abstract":"<div><h3>Background</h3><div>The indications for temporizing knee-spanning external fixation (KSEF) in the setting of knee dislocation (KD) are poorly defined, leading to significant uncertainty and inconsistency in clinical practice. This study aimed to analyze and describe the documented indications for temporizing KSEF in a series of patients with KDs.</div></div><div><h3>Methods</h3><div>A retrospective, multi-center review was conducted at two level I trauma centers from January 2001 to May 2024, identifying patients with documented KD treated with KSEF. Data were extracted from operative records, imaging, and clinical notes, and reviewed for demographics, injury characteristics, and documented indications for KSEF. A set of KSEF indications derived from the literature was developed <em>a priori</em> to individually assess the appropriateness of each KSEF application. Knees were classified as ‘did not meet criteria’ for KSEF only when both of the following conditions were true: (1) no predefined indication was met; and (2) there was no radiographic, clinical, or documented evidence of persistent post-reduction instability.</div></div><div><h3>Results</h3><div>A total of 33 patients with 36 documented KDs treated with KSEF were identified from a cohort of 289 multiple ligament injured knees (12.5 %). Of the 36 KDs, 28 (77.8 %) met the selected criteria for KSEF. The most common primary indications for KSEF were vascular injury, tibial plateau fracture-dislocation, inability to maintain tibiofemoral reduction via non-invasive means, and morbid obesity. The remaining eight KDs (22.2 %) did not meet criteria for KSEF either as isolated injuries or in the setting of “polytrauma.” The rationale for KSEF application was cited as “polytrauma” in 6/8 (75.0 %) of these cases.</div></div><div><h3>Conclusion</h3><div>Eight of the 36 (22.2 %) KSEF applications did not meet the predefined criteria for KSEF in the setting of KD, nor showed evidence of an inability to maintain tibiofemoral reduction via non-invasive means. Polytrauma is frequently cited in the literature as a primary indication for temporizing KSEF in the setting of KD without a clear definition. Further investigation into the role of temporizing KSEF is needed, particularly in the polytraumatized patient, to determine its specific role in the management of KDs.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113062"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038912","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":"Crystalloids as an alternative to whole blood in pREBOA resuscitation for hemorrhagic shock","authors":"Mattias Renberg ,&nbsp;Jenny Gustavsson ,&nbsp;Mattias Günther","doi":"10.1016/j.injury.2026.113081","DOIUrl":"10.1016/j.injury.2026.113081","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma is a leading global health challenge, with hemorrhage being a major cause of preventable death. Resuscitative endovascular balloon occlusion of the aorta (REBOA) effectively halts hemorrhage but poses risks such as ischemic injury, especially to the kidneys. Partial REBOA (pREBOA) mitigates these effects by allowing limited distal blood flow. This study investigates crystalloid resuscitation as an alternative to whole blood during pREBOA release in a swine model, where all groups received an additional 2000 mL of Ringer’s acetate prior to balloon deflation.</div></div><div><h3>Materials and methods</h3><div>15 castrated male swine weighing 51-65 kg underwent controlled mean (SD) hemorrhage of 1200 (233) mL, followed by 60 minutes of pREBOA application and a 20-minute resuscitation phase, where the animals were randomized into three groups: low Ringer's acetate (0 mL) (n=5), high Ringer's acetate (2000 mL) (n=5), or whole blood transfusion (1000 mL)+ Ringer’s acetate (1000 mL) (n=5). Hemodynamic variables, metabolic parameters, and renal blood flow were continuously monitored. Animals were observed for 60 minutes post-REBOA deflation.</div></div><div><h3>Results</h3><div>High-volume Ringer's acetate improved stroke volume compared to low-volume crystalloids (p&lt;0.001) and reduced heart rate (p&lt;0.005) and systemic vascular resistance (p&lt;0.01) immediately post-resuscitation. Hemoglobin levels were lower in the high-volume group than in the low-volume group (p&lt;0.01), persisting for 40 minutes. Potassium remained within physiological limits.</div></div><div><h3>Conclusion</h3><div>Crystalloid resuscitation during pREBOA maintained mean arterial pressure and cardiac output comparable to whole blood, with high-volume crystalloids offering superior hemodynamic support compared to low-volume resuscitation. High-volume crystalloids improved stroke volume. Metabolic stability was preserved across groups, with no severe derangements observed. These findings highlight crystalloids as a potential alternative in resource-limited settings, although reduced renal perfusion warrants further investigation to optimize outcomes and ensure broader clinical applicability.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113081"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127640","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":"Sex-based case fatality rate of violence-related injuries among 522,939 patients: Retrospective analysis","authors":"Ayman El-Menyar ,&nbsp;Ahammed Mekkodathil ,&nbsp;Sandro Rizoli ,&nbsp;Sagar Galwnkar ,&nbsp;Peter Cameron ,&nbsp;Ibrahim Fawzy Hassan ,&nbsp;Hassan Al-Thani","doi":"10.1016/j.injury.2026.113078","DOIUrl":"10.1016/j.injury.2026.113078","url":null,"abstract":"<div><h3>Background</h3><div>Violence-related injuries (VRIs) remain a major contributor to trauma-related mortality worldwide. We evaluated the case fatality rates (CFRs) of VRIs stratified by sex. We hypothesized that sex differences affect the CRF following VRIs.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using data from the American College of Surgeons Trauma Quality Programs and ICD-10 for VRIs.</div></div><div><h3>Results</h3><div>Among 522,939 VRIs patients, males accounted for 82.8% with higher mortality than females (7.5% vs. 5.6%). Males had higher CFRs than females among firearm-related injuries (16.3% vs. 15.2%), and Self-inflicted harm (SIH) (21.9% vs. 12.1%). In Interpersonal violence, CFRs among White females and Black males were 19.7% and 15.8%, respectively. For SIH, firearm lethality was higher among older White males ≥ 65 years (64.3%) and young Black males aged 36–45 (57.8%). Firearm injury (OR 18.49) and male sex (OR 1.21) were independent predictors for mortality.</div></div><div><h3>Conclusion</h3><div>Sex-based disparities in VRIs in the United States are evident, notably in firearm injuries and SIH, underscoring the need for targeted injury prevention.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113078"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138231","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":"Application value of a novel tappable bone grafting tool with variable angle lateral window in short-segment fixation via intermuscular approach for thoracolumbar fractures","authors":"Zhenglong Liu ,&nbsp;Fei Zhang ,&nbsp;Jiaqi Li,&nbsp;Lei Guo,&nbsp;Wei Zhang,&nbsp;Yapeng Sun","doi":"10.1016/j.injury.2025.112966","DOIUrl":"10.1016/j.injury.2025.112966","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the clinical application value of a novel tappable, lateral-hole, variable-angle bone grafting tool for injured vertebra bone grafting combined with screw placement in the injured vertebra, in the context of short-segment fixation via an intermuscular approach for thoracolumbar fractures.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on 74 patients treated between January 2022 and June 2024. Patients were divided into three groups: Group A (<em>n</em> = 25) received conventional bone grafting without screw placement in the injured vertebra; Group B (<em>n</em> = 26) received conventional bone grafting with screw fixation; Group C (<em>n</em> = 23) received grafting with the novel tool plus screw fixation. Vertebral kyphosis angle (VKA), local kyphosis angle (LKA), superior endplate displacement (SED), Visual Analog Scale (VAS) scores, and complications were analyzed preoperatively, postoperatively, and at 3-month follow-up. Bone defect volume in Groups B and C was assessed using Mimics software on CT 3D reconstructions.</div></div><div><h3>Results</h3><div>There were no significant differences in sex, age, operative time, or hospital stay among the three groups (<em>P</em> &gt; 0.05). Preoperative and 1-week postoperative VAS scores were similar among the groups (<em>P</em> &gt; 0.05). At 3 months postoperatively, VAS scores in Group C were significantly lower than in Groups A and B (<em>P</em> &lt; 0.05). Groups B and C exhibited significantly less loss of vertebral kyphosis angle (VKAloss) compared to Group A (<em>p</em> = 0.011). There were no significant differences in LKA among the three groups before surgery, after surgery, or at the 3-month follow-up (<em>P</em> &gt; 0.05). Changes in SED values before and after surgery were consistent with VKA, and the SEDloss value in Group C was significantly lower than in Groups A and B at 3 months postoperatively (<em>p</em> &lt; 0.001). Compared to Group B, Group C showed a significant reduction in fracture defect volume at 3 months postoperatively (<em>p</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>The novel bone grafting tool provides effective vertebral support with high grafting efficiency, reduced pedicle damage, and improved postoperative outcomes. Its ease of use makes it a valuable addition to thoracolumbar fracture treatment via the intermuscular approach.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112966"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981495","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":"Long term outcomes in periprosthetic femoral fractures: Experience from a UK district general hospital with a weekly dedicated periprosthetic theatre list and MDT approach","authors":"Avinash Kumar Rai ,&nbsp;Shaheer Mujahid ,&nbsp;Mohammed Suhail,&nbsp;Yash Jain,&nbsp;Rachael McManus,&nbsp;Anwar Jafri,&nbsp;Manju Ramappa,&nbsp;Antoni Nargol,&nbsp;Nick Cooke,&nbsp;Raghavendra Sidaginamale","doi":"10.1016/j.injury.2026.113015","DOIUrl":"10.1016/j.injury.2026.113015","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic femoral fractures (PFFs) are increasingly common as arthroplasty rates rise, with incidence projected to double in the next two decades. Mortality approaches that of hip fractures, with 1-year rates of 22–27 % reported in multicentre datasets. While favourable outcomes are often described from high-volume centres, most PFFs present to secondary care, where resources and surgical expertise may be limited. This study evaluates whether a structured multidisciplinary team (MDT) pathway with a weekly dedicated periprosthetic theatre list can achieve outcomes comparable to national and international benchmarks in a UK district hospital.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all PFFs managed between 2013 and 2024 at a district hospital (<em>n</em> = 258) in a trauma unit with fellowship trained arthroplasty surgeons, a dedicated Orthogeriatric team and weekly periprosthetic lists. Demographics, comorbidities (Charlson Comorbidity Index, ASA), fracture type (Vancouver classification), surgical management (fixation vs revision), and outcomes were analysed. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes included discharge destination, restoration of mobility, complications, and reoperation rates. Results were compared with national and international studies.</div></div><div><h3>Results</h3><div>Mean age was 80 years (median 82) with majority (60 %) being female. 213 (82.8 %) patients were managed operatively after multidisciplinary discussions. In-hospital mortality was 1.2 % (<em>n</em> = 3), 30-day mortality 3.5 %(<em>n</em> = 9) and one year mortality rate was 19.8 %. Mean CCI was 4.8 and one-year mortality was markedly higher in patients with CCI ≥4. Length of hospital stay increased progressively with surgical delay. Among those managed operatively, 63.5 % (<em>n</em> = 87) returned to their original place of residence.</div></div><div><h3>Conclusion</h3><div>A weekly dedicated periprosthetic list with MDT involvement allowed a district hospital to achieve mortality and functional outcomes equal to, or better than, those reported from high-volume centres. These findings highlight that system-level interventions, not hospital size, are the decisive factor in PFF outcomes, and provides a scalable model for hospitals globally.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113015"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981574","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":"Injectable thermosensitive hydrogel delivering resveratrol protects articular cartilage via SIRT1/HIF1α/MMP13 signaling","authors":"Mao Xu ,&nbsp;Xin Gao ,&nbsp;Shujin Li ,&nbsp;Xuhuizi Liu ,&nbsp;Bing Li ,&nbsp;Xinxin Jin","doi":"10.1016/j.injury.2026.113040","DOIUrl":"10.1016/j.injury.2026.113040","url":null,"abstract":"<div><h3>Background</h3><div>Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, synovial inflammation and subchondral bone sclerosis. There is currently no effective drug treatments for late stage OA.</div></div><div><h3>Methods</h3><div>Here, we prepare injectable resveratrol (Res) thermosensitive hydrogels, detect its microscopic morphology and release <em>in vitro</em>. Then observing its therapeutic effect on C57BL/6 mice <em>in vivo</em> and femoral heads <em>in vitro</em> also used. Characterization of temperature-sensitive resveratrol gel, chondrosynthesis and catabolism genes, morphology of joint and femoral head from mice. Expression of sirtuin1(SIRT1) and hypoxia inducible factor-1α (HIF1α) is also detected <em>in vivo</em> and <em>in vitro</em>. IL-1β is used to imitate an <em>in vitro</em> osteoarthritis model.</div></div><div><h3>Results</h3><div>Res hydrogels show excellent strain, injectability and temperature sensitive properties, and have an apparent protective effect on the OA articular cartilage. P53 and P21 elevated in DMM mice, when HIF1α and matrix metalloproteinase 13 (MMP13) both increased similarly. While Res activates SIRT1 by suppressing HIF1α nucleus-shuttling to promote chondrocytes proliferation and reduce hypertrophy.</div></div><div><h3>Conclusion</h3><div>Taken together, injectable resveratrol thermosensitive hydrogel protects the articular cartilage from degradation and reduces the damage to joints caused by mechanical stress via SIRT1/ HIF1α/MMP13 pathway.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113040"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981623","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}