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

{"title":"Which screw corridors can be used for bilateral fragility fractures of the pelvis with a transverse fracture component (FFP IVb)?","authors":"Sarah Hoppler,&nbsp;Dmitry Notov,&nbsp;Suzanne Zeidler,&nbsp;Philipp Pieroh,&nbsp;Stephanie Einhorn,&nbsp;Christian Kleber,&nbsp;Andreas Höch ,&nbsp;Georg Osterhoff","doi":"10.1016/j.injury.2025.112171","DOIUrl":"10.1016/j.injury.2025.112171","url":null,"abstract":"<div><h3>Background</h3><div>Fragility fractures of the pelvis are becoming increasingly important in an ageing society. However, they are under-represented in the current research literature. In particular, unstable bilateral fragility fractures of the sacrum (FFP IVb) benefit from surgical treatment, but individual fracture patterns need to be considered in the surgical decision. This study describes the sacral anatomy in patients with FFP IVb pelvic fractures, with particular emphasis on the identification and evaluation of possible trans-sacral screw corridors, with particular emphasis on the transverse fracture components.</div></div><div><h3>Methods</h3><div><strong>Design:</strong> Retrospective clinical study. <strong>Setting:</strong> Level 1 trauma center. <strong>Patient Selection Criteria:</strong> The study reviewed 100 patients admitted for bilateral FFP with a transverse fracture between 01 / 2013 and 11 / 2023 that had a preoperative computed tomography (CT) of the pelvis including the fifth vertebra, treated with FFP IVb using preoperative multiplanar CT scans to analyze sacral anatomy. <strong>Outcome Measures and Comparisons:</strong> Sacral types and transitional abnormalities were classified, and corridor dimensions for S1 and S2 were measured, including estimated bone density using Hounsfield units. Bone corridors ≥ 8 mm were considered adequate. In addition, possible trans-sacral screw corridors were evaluated, taking into account the transverse fracture component.</div></div><div><h3>Results</h3><div>While large trans-sacral screw corridors (≥ 8 mm) for S1 and S2 were identifiable in most cases, the actual feasibility for screw placement was limited due to the transverse fracture component's location, resulting in meaningful corridors in only 80 % for S1 and 47 % for S2. Additionally, in 4 % of patients without an S1 corridor, trans-sacral screw fixation was deemed inadequate due to the fracture line passing through S2.</div></div><div><h3>Conclusions</h3><div>These results indicate that not all FFP IVb fractures can be effectively stabilized using trans-sacral screw or bar fixation, necessitating alternative techniques for some cases. Furthermore, precise preoperative planning is essential for the management of these fractures due to complexity of anatomy. To identify the most suitable treatment approaches, further clinical studies are required.</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 2","pages":"Article 112171"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018825","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":"Buried or exposed kirschner wires in paediatric upper extremity fracture fixation: A systematic review and meta-analysis of infection rates and complications","authors":"Jack Pullan ,&nbsp;Olusegun Ayeko ,&nbsp;James Metcalfe","doi":"10.1016/j.injury.2025.112155","DOIUrl":"10.1016/j.injury.2025.112155","url":null,"abstract":"<div><h3>Background</h3><div>Paediatric upper limb fractures are commonly treated with Kirschner (K) wire fixation, which can be buried or left exposed. Although both techniques are widely used, controversy remains regarding infection risk, complications, and other clinical outcomes between buried and exposed K-wires. This systematic review and meta-analysis aimed to compare infection rates and secondary outcomes between buried and exposed K-wires in paediatric upper limb fractures located distal to and including the elbow, and proximal to the carpus.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was conducted according to PRISMA guidelines, with searches performed across Medline, EMBASE, and the Cochrane Library up to July 2023. Studies were included if they directly compared buried and exposed K-wires in paediatric patients (under 18 years old) and reported on infection rates. Meta-analysis was conducted to compare overall infection rates. Pooled means were used to compare secondary outcomes. Bias was assessed using the ROBINS-I and RoB2 tools.</div></div><div><h3>Results</h3><div>Fifteen studies involving 1,854 participants were included. The meta-analysis showed that buried K-wires were associated with a significantly lower risk of overall postoperative infection compared to exposed K-wires (RR 0.33; 95 % CI 0.22 to 0.50; <em>p</em>&lt; 0.001). The risk of deep infection requiring further surgery was 1.74 % in buried K-wires (95 % CI: 0.72 % to 2.75 %) and 2.07 % in exposed K-wires (95 % CI: 0.55 % to 3.59 %). Skin erosion was a common complication of buried K-wires, with a pooled mean rate of 13.0 %. Buried K-wires were associated with a higher likelihood of requiring removal in theatre (84.4 % vs. 4.2 %). Time to K-wire removal was longer in the buried group (10.9 weeks vs. 5.3 weeks). Re-operation and bone union failure rates were similar between groups.</div></div><div><h3>Conclusion</h3><div>Our systematic review and meta-analysis suggest that, while buried K-wires are associated with lower overall infection rates, the risk of deep infection is comparable between buried and exposed K-wires. Buried K-wires show higher rates of skin erosion and increased need for removal in theatre. Given these findings, exposed K-wires offer a safe and more cost-effective option for paediatric upper limb fracture fixation. Further studies are needed to assess patient-reported outcomes and environmental impacts.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112155"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985537","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":"Psychological health status after major trauma across different levels of trauma care: A multicentre secondary analysis","authors":"J.C. Van Ditshuizen ,&nbsp;M.A.C. De Jongh ,&nbsp;D. Den Hartog ,&nbsp;K.W.W. Lansink ,&nbsp;M.H.J. Verhofstad ,&nbsp;E.M.M. Van Lieshout","doi":"10.1016/j.injury.2025.112152","DOIUrl":"10.1016/j.injury.2025.112152","url":null,"abstract":"<div><h3>Introduction</h3><div>Concentration of trauma care in trauma network has resulted in different trauma populations across designated levels of trauma care.</div></div><div><h3>Objective</h3><div>Describing psychological health status, by means of the impact event scale (IES) and the hospital anxiety and depression scale (HADS), of major trauma patients one and two years post-trauma across different levels of trauma care in trauma networks.</div></div><div><h3>Methods</h3><div>A multicentre retrospective cohort study was conducted. Inclusion criteria: aged ≥ 18 and an Injury Severity Score (ISS) &gt; 15, surviving their injuries one year after trauma. Psychological health status was self-reported with HADS and IES. Subgroup analysis, univariate, and multivariable analysis were done on level of trauma care and trauma region for HADS and IES as outcome measures.</div></div><div><h3>Results</h3><div>Psychological health issues were frequently reported (likely depressed n = 31, 14.7 %); likely anxious n = 32, 15.2 %; indication of a post-traumatic stress disorder n = 46, 18.0 %). Respondents admitted to a level I trauma centre reported more symptoms of anxiety (3, P₂₅-P₇₅ 1–6 vs. 5, P₂₅-P₇₅ 2–9, p = 0.002), depression (2, P₂₅-P₇₅ 1–5 vs. 5, P₂₅-P₇₅ 2–9, p &lt; 0.001), and post-traumatic stress (6, P₂₅-P₇₅ 0–15 vs. 13, P₂₅-P₇₅ 3–33, p = 0.001), than patients admitted to a non-level I trauma centre. Differences across trauma regions were reported for depression (3, P₂₅-P₇₅ 1–6 vs. 4, P₂₅-P₇₅ 2–10, p = 0.030) and post-traumatic stress (7, P₂₅-P₇₅ 0–18 vs. 15, P₂₅-P₇₅ 4–34, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Major trauma patients admitted to a level I trauma centre have more depressive, anxious, and post-traumatic stress symptoms than when admitted to a non-level I trauma centre. These symptoms differed across trauma regions, indicating populations differences. Level of trauma care and trauma region are important when analysing psychological health status.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112152"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018807","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":"Bone regeneration: The influence of composite HA/TCP scaffolds and electrical stimulation on TGF/BMP and RANK/RANKL/OPG pathways","authors":"Júlia Venturini Helaehil ,&nbsp;Boyang Huang ,&nbsp;Paulo Bartolo ,&nbsp;Milton Santamaria-JR ,&nbsp;Guilherme Ferreira Caetano","doi":"10.1016/j.injury.2025.112158","DOIUrl":"10.1016/j.injury.2025.112158","url":null,"abstract":"<div><div>The repair of critical-sized bone defects represents significant clinical challenge. An alternative approach is the use of 3D composite scaffolds to support bone regeneration. Hydroxyapatite (HA) and tri-calcium phosphate (β-TCP), combined with polycaprolactone (PCL), offer promising mechanical resistance and biocompatibility. Bioelectrical stimulation (ES) at physiological levels is proposed to reestablishes tissue bioeletrocity and modulates cell signaling communication, such as the BMP/TGF-β and the RANK/RANK-L/OPG pathways. This study aimed to evaluate the use HA/TCP scaffolds and ES therapy for bone regeneration and their impact on the TGF-β/BMP pathway, alongside their relationship with the RANK/RANKL/OPG pathway in critical bone defects. The scaffolds were implanted at the bone defect in animal model (calvarial bone) and the area was subjected to ES application twice a week at 10 µA intensity of current for 5 min each session. Samples were collected for histomorphometry, immunohistochemistry, and molecular analysis. The TGF-β/BMP pathway study showed the HA/TCP+ES group increased BMP-7 gene expression at 30 and 60 days, and also greater endothelial vascular formation. Moreover, the HA/TCP and HA/TCP+ES groups exhibited a bone remodeling profile, indicated by RANKL/OPG ratio. HA/TCP scaffolds with ES enhanced vascular formation and mineralization initially, while modulation of the BMP/TGF pathway maintained bone homeostasis, controlling resorption via ES with HA/TCP.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112158"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018841","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":"Bigger is not necessarily better – 2-ring circular frames associated with shorter duration of treatment in the management of complex tibial fractures – a retrospective cohort study","authors":"Thomas Hodkinson ,&nbsp;William Groom ,&nbsp;Panos Souroullas ,&nbsp;Elizabeth Moulder ,&nbsp;Ross Muir ,&nbsp;Hemant Sharma","doi":"10.1016/j.injury.2024.112045","DOIUrl":"10.1016/j.injury.2024.112045","url":null,"abstract":"<div><div>Frame configuration for the management of complex tibial fractures is highly variable and is dependent upon both fracture pattern and surgeon preference. The optimal number of rings to use when designing a frame remains uncertain. Traditionally larger, multi-ring-per-segment constructs have been assumed to offer optimal stability and therefore favourable conditions for fracture healing but there is little in-vivo evidence for this and the recent concept of reverse dynamisation challenges this approach.</div><div>We compared the clinical outcomes in 302 consecutive patients with tibial fractures treated in our unit with either a stable two-ring circular frame or a three-or-more-ring (3+) frame. The primary outcome measure was time spent in frame. Secondary outcomes were the incidence of malunion and the need for further surgical procedures to achieve bone union.</div><div>The mean time in frame was 168 days for the 2-ring group and 202 days for the 3+ rings group (<em>p</em> = 0.003). No significant differences were found in the rate of malunion or the requirement for secondary surgical intervention to achieve union. The groups were evenly matched for age, co-morbidities, energy of injury mechanism, post-treatment alignment and presence of an open fracture.</div><div>This study finds that 2-ring frame constructs are a reliable option associated with shorter duration of treatment and no increase in rates of adverse outcomes compared with larger, more complex frame configurations.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112045"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054616","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 and outcomes of severe injury patients related to suicide attempt or self-harm in Korea: Nationwide community-based study, 2016–2020","authors":"Sun Young Lee ,&nbsp;Kyoung Jun Song ,&nbsp;Ki Jeong Hong ,&nbsp;Jeong Ho Park ,&nbsp;Tae Han Kim ,&nbsp;Joo Jeong ,&nbsp;Seul Ki Choi ,&nbsp;Young Ho Choi","doi":"10.1016/j.injury.2024.112032","DOIUrl":"10.1016/j.injury.2024.112032","url":null,"abstract":"<div><h3>Introduction</h3><div>Suicide is a major social issue in Korea. Suicide attempt or self-harm (SA/SH)—a risk factor for suicides—is in itself a major public health problem. Investigating vulnerable populations is the first step for designing an effective prevention program. This study aimed to investigate the epidemiology and outcomes of patients with severe injuries related to suicide attempts or self-harm (SA/SH) by age groups, using a nationwide database.</div></div><div><h3>Materials and Methods</h3><div>This retrospective observational study was conducted in Korea between 2016 and 2020. Its participants were patients with severe injuries, who were treated by emergency medical service (EMS). From among injured patients who met the criteria for a field-based injury triage scheme or had a prehospital physiological abnormality, those with SA/SH were included. Exposure was based on age groups: adolescents (10–18 years), adults (19–64 years), and older adults (≥65 years). The study's outcomes were in-hospital mortality. Patients’ characteristics and outcomes were compared by age groups and SA/SH mechanisms. Predictors of mortality were investigated using multivariable logistic regression analysis.</div></div><div><h3>Results</h3><div>Among the 204,211 patients with severe injuries transferred by EMS, 43,945 (21.5 %) were SA/SH-related. Their median (interquartile) age was 48 (35–61) years, and 52.9 % were female patients. The common SA/SH mechanisms were: poisoning (67.6 %), hanging (16.3 %), and jumping (8.1 %). Overall, the mortality was 21.9 %, but it was higher for hanging (69.2 %) and jumping (62.0 %), than for common poisoning (6.5 %). Among adolescents, poisoning (46.1 %), followed by jumping (34.0 %) was common, and the mortality was 23.3 %. In the older adults, poisoning (68.6 %), followed by hanging (20.2 %) was common, and the mortality was 34.9 %. Older adults compared to adults, males compared to females, and hanging and jumping compared to poisoning, were associated with higher mortality.</div></div><div><h3>Conclusions</h3><div>More than 20 % of EMS treated patients with severe injury were SA/SH-related, and the mortality was over 20 %. Although poisoning was the most common mechanism, the high proportions of jumping and hanging with high mortality, resulted in adolescents and the older adults groups having high mortality. Therefore, designing target-specific SA/SH prevention programs based on age, sex, and common SA/SH mechanisms are necessary.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112032"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792240","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":"Nanosphere hydrogel-mediated delivery of miR-34a-5p improves achilles tendon function in rat model","authors":"Jin Liang ,&nbsp;Cong He ,&nbsp;Qianqian Yang ,&nbsp;Haoran Chen ,&nbsp;Youlang Zhou ,&nbsp;Aidong Deng ,&nbsp;Gu Heng Wang","doi":"10.1016/j.injury.2024.112038","DOIUrl":"10.1016/j.injury.2024.112038","url":null,"abstract":"<div><div>Restoring motor function and preventing re-rupture and adhesion during Achilles tendon healing remain significant clinical challenges. Increasing evidence suggests that miRNA plays a crucial role in tendon healing and regeneration. The previously designed nanosphere hydrogel sustained-release system enables targeted, controlled release of drugs. In this study, we developed a version of this system loaded with miR-34a-5p for localized delivery to an acute Achilles tendon injury model. The results of the Achilles functional index and Catwalk behavior analysis in rats indicated that miR-34a-5p mimic promoted early recovery of motor function following Achilles tendon injury. Although gross observation suggested that the miR-34a-5p mimic group had a minimal inhibitory effect on the adhesion of Achilles tendon tissue, tension analysis demonstrated that it effectively increased the maximum tensile strength. Additionally, in vitro experiments showed that miR-34a-5p mimic could increase tendon cells proliferation and improve tendon cells viability. This study confirmed the efficacy of the miR-34a-5p nanosphere hydrogel sustained-release system in tendon injury repair, presenting it as a promising treatment strategy for clinical practice.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112038"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792467","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":"Emergency centre thoracotomy for penetrating trauma: Insights from 2 South African district-level emergency centres","authors":"Johann Christian Sittmann ,&nbsp;Ferhana Gool ,&nbsp;Candice Van Koningsbruggen ,&nbsp;Katya Evans","doi":"10.1016/j.injury.2024.112083","DOIUrl":"10.1016/j.injury.2024.112083","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma is a major contributor to global disease burden, disproportionally affecting low- and middle-income countries, especially in the African Region. Emergency centre thoracotomy (ECT) is a potentially life-saving procedure for a sub-group of trauma patients in extremis. Most literature regarding ECT originated in high-income countries. This study aimed to describe patient, procedure and outcome characteristics of ECTs performed at two facilities in a resource-limited setting in South Africa.</div></div><div><h3>Patients and methods</h3><div>A retrospective chart review was performed at two district-level facilities in Cape Town from 1 April 2017 to 31 March 2021. All patients who underwent post-trauma thoracotomy in the emergency centre (EC) were eligible for inclusion. Cases were excluded if patients did not undergo thoracotomy in the EC, or if medical records were missing. Patients were identified using an electronic EC attendance register, and theatre records, which were screened using documented diagnoses and dispositions. Clinical notes were interrogated for information regarding patient demographics, mechanism of injury, clinical presentation, procedural characteristics (such as level of clinician, injury found, use of ultrasound). Outcomes measured were survival to specified endpoints, and neurological or functional outcomes.</div></div><div><h3>Results</h3><div>Over 4 years, 67 ECTs were performed (50 stabs, 17 gunshots). No ECTs were performed for blunt trauma. Most patients were male, with a median age of 25 years (IQR 21–33). More than two-thirds of patients presented with their own transport, and more than 80 % presented with signs of life. Most ECTs were performed by non-specialists. Survival to hospital discharge was 24 % (32 % for stabs, 0 % for gunshots). Neurological outcome was difficult to analyse, however seemed to be good in all but one survivor.</div></div><div><h3>Conclusion</h3><div>The performance of ECT in this resource-limited district-level setting, followed by stabilisation and transfer of patients to tertiary hospitals seems to result in comparable or better survival rates than reported in international literature. Further research is needed to better describe the performance and outcomes of EC thoracotomies in a resource-limited setting. This study setting, with high incidence of trauma and ECT performed, provides an excellent opportunity for further research. Prospective studies may demonstrate correlations between specific patient and procedural characteristics and outcomes and may guide the development of local guidelines.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112083"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901165","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":"Trauma surgeons: Have we achieved gender equality?","authors":"Alessandro Aprato ,&nbsp;Andrea Audisio ,&nbsp;Virginia Masoni ,&nbsp;Chiara Guidetti ,&nbsp;Stefano Artiaco ,&nbsp;Alessandro Massè","doi":"10.1016/j.injury.2024.112087","DOIUrl":"10.1016/j.injury.2024.112087","url":null,"abstract":"<div><h3>Purpose</h3><div>Several concerns regarding gender equality in orthopedic surgery do exists. The aim of this study was to (1) compare operative times, (2) compare mortality rates, (3) investigate gender disparities in hip fracture surgeries, and (4) analyze gender distribution among attending and resident surgeons performing Closed Reduction Internal Fixation (CRIF) and Hemiarthroplasty (HA)</div></div><div><h3>Methods</h3><div>All patients &gt;75 years old treated for proximal femur fractures in a level-one trauma center in a four-year timeframe were retrospectively enrolled. Exclusion criteria were follow-up &lt;3 years, incomplete data, active patients treated with total hip arthroplasty (THA) and other surgeries performed during the same anesthesia. Patients were grouped according to procedure: 1) Closed Reduction Internal Fixation (CRIF) and 2) Hemiarthroplasty (HA). Gender and level of expertise (residents or attending surgeon) of leading surgeons (male (M), female (F) and non-binary (NB)) was extracted from medical records. Operative time, mortality rates, and the likelihood of performing either CRIF or HA were compared across genders.</div></div><div><h3>Results</h3><div>A total of 172 leading surgeons (M: 141 (82%); F: 31 (18%); NB: 0 (0%)) performed 1916 surgical procedures (CRIF: 1425 (74.4%); HA: 491 (25.6%)). 14.7% were performed by female surgeons (group 1: 15.5%; group 2: 12.2%; <em>p</em> = 0.076). No gender disparities were observed in the mean operating times for either group 1 (<em>p</em> = 0.759) or group 2 (<em>p</em> = 0.981). Similarly, there were no significant differences in mortality rates between genders in group 1 (<em>p</em> = 0.5779) or group 2 (<em>p</em> = 0.069). Additionally, no significant gender disparities were found in the performance of CRIF (<em>p</em> = 0.636) or HA (<em>p</em> = 0.141). Finally, analysis of gender distribution among attending and resident surgeons across various procedures, including CRIF and HA, revealed no significant differences in gender distribution (CRIF: <em>p</em> = 0.133, HA: <em>p</em> = 0.468, all procedures: <em>p</em> = 0.122).</div></div><div><h3>Conclusions</h3><div>Despite orthopedics still being a male-dominated field, gender does not affect surgical outcomes or the likelihood of performing CRIF or HA. However, the focus should shift towards improving inclusivity in surgical education and practice by providing equal opportunities and removing social and educational barriers based on gender.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112087"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934278","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":"How wide of a distal metaphyseal femoral fracture gap is a high risk of varus collapse and fixation failure? A finite element study","authors":"Surasak Jitprapaikulsarn ,&nbsp;Nattapon Chantarapanich ,&nbsp;Theerachai Apivatthakakul ,&nbsp;Pasin Lertvilai ,&nbsp;Sujin Wanchat ,&nbsp;Arthit Gromprasit ,&nbsp;Pasit Sengpanich ,&nbsp;Chantas Mahaisavariya","doi":"10.1016/j.injury.2024.112091","DOIUrl":"10.1016/j.injury.2024.112091","url":null,"abstract":"<div><h3>Background</h3><div>Severe metaphyseal comminution and sizable bone defect of the distal femur are high risks of fixation failure. To date, no exact magnitude of comminution and bone loss is determined as an indication for augmentation of fixation construct. The present study aimed to investigate the influence of metaphyseal gap width, working length, and screw distribution on the stability of the fixation construct.</div></div><div><h3>Methods</h3><div>A finite element model of a fractured femur with 0–80 mm metaphyseal gap width stabilized by an 11-hole distal femur locking compression plate (LCP-DF) was generated. The different working length and screw distribution were created by three different screw configurations: 9–10–11 (long working length, cluster screw), 8–10–11, and 7–9–11 (short working length, spreading screw). Physiological loading conditions were applied to evaluate biomechanical performance including equivalent von Mises (EQV) stress, bone stress, and fracture strain.</div></div><div><h3>Results</h3><div>The EQV stress increased accordingly to a metaphyseal gap width of 0–20 mm. The EQV stress values were at the same levels for 30-mm metaphyseal gap width and higher, particularly in screw configuration 9–10–11. Screw configuration 7–9–11 produced the lowest elastic strain. A 0-mm metaphyseal gap width presented the lowest bone stress. Bone stress values were in a similar magnitude across a 10–80 mm metaphyseal gap.</div></div><div><h3>Conclusion</h3><div>The 30-mm and wider metaphyseal gap width with a long working length presented a risk of varus collapse and fixation failure. Short working length with spreading screw provided low EQV stress, low bone stress, and high fracture stability.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112091"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960498","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}