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

{"title":"Follow-up and complications rates in orthopedic trauma patients with substance use disorders","authors":"Paul Toogood","doi":"10.1016/j.injury.2025.112730","DOIUrl":"10.1016/j.injury.2025.112730","url":null,"abstract":"<div><h3>Background</h3><div>Substance use disorders (SUD) are common and associated with trauma [1–5]. Despite the high frequency of patients with SUDs presenting with trauma and the ubiquitous concerns about compliance, follow-up, and complications amongst providers caring for these patients there has been little attempt to quantify outcomes in this everyday group of patients. The purpose of the current study was thus to document basic demographics, follow-up rates, and surgical outcomes in orthopedic trauma patients presenting with substance use disorders.</div></div><div><h3>Methods</h3><div>A retrospective review of an observational cohort was performed. All skeletally mature patients younger than 70 and with insurance that allowed long term follow-up and surgically treated for orthopedic trauma by a single author at an urban level-1 trauma center between November 2019 and December 2024 were enrolled. 202 patients did not have a pre-existing substance use disorder (NO-SUD), 96 patients did (SUD). Basic demographic information, injury characteristics, follow-up rates, and surgical complication rates over the first post-operative year were compared.</div></div><div><h3>Results</h3><div>Mean age and percentage of male/female did not differ between SUD and NO-SUD cohorts. There were more white and fewer Asian/Pacific Islanders in the SUD cohort. Of the 10 most common comorbidities, there was only a significantly higher rate of congestive heart failure (CHF) in the SUD cohort. Injury location did not differ between cohorts. Those in the SUD cohort more often had high grade open fractures. Follow-up rates in both groups were poor, but worse at all time points for those in the SUD cohort. The SUD cohort also had significantly longer lengths of stay and a higher mortality rate at 1 year. Infection, construct failure, and amputations rates were all higher in the SUD cohort.</div></div><div><h3>Conclusions</h3><div>Demographics between the SUD and NO-SUD populations were similar. Injury severity, follow-up rates, and complication rates were all significantly worse in the SUD cohort. Such data can be used by surgeons to council patients on prognosis and when discussing the risks and benefits of surgical intervention in the SUD population.</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 11","pages":"Article 112730"},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926516","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":"Cost-effectiveness of operative versus nonoperative treatment of lateral compression type 1 pelvic fractures","authors":"Soham Ghoshal ,&nbsp;Tynan Friend ,&nbsp;Michael Gustin ,&nbsp;Alexander R. Farid ,&nbsp;Derek S. Stenquist ,&nbsp;Nishant Suneja ,&nbsp;Michael J. Weaver ,&nbsp;Arvind G. Von Keudell","doi":"10.1016/j.injury.2025.112723","DOIUrl":"10.1016/j.injury.2025.112723","url":null,"abstract":"<div><h3>Background</h3><div>Lateral compression type 1 (LC1) pelvic fractures are common injuries with ongoing debate regarding the cost-effectiveness of operative versus non-operative treatment. The goal of this study is to evaluate the cost-effectiveness of operative versus non-operative management for lateral compression type 1 (LC1) pelvic fractures, using pain (Brief Pain Inventory, BPI) and functional recovery (Majeed Pelvic Score, MPS) as outcome measures across early follow-up intervals.</div></div><div><h3>Methods</h3><div>A decision tree model was developed to analyze the costs and outcomes of operative and non-operative management for LC1 fractures. Costs were derived from Medicare reimbursement rates, and probabilities were informed by clinical data and expert opinion. BPI and MPS scores were used as proxies for utility, with incremental cost-effectiveness ratios (ICERs) calculated at 2, 6, and 12-week follow-ups. An ICER exceeding the willingness-to-pay (WTP) threshold of $50,000 indicated that non-operative management was the more cost-effective option. Sensitivity analyses explored the utility improvements required for operative treatment to meet the WTP threshold of $50,000 per meaningful change in BPI or MPS.</div></div><div><h3>Results</h3><div>Operative management was cost-effective for early pain relief, with an ICER of $33,466.08 per meaningful change in BPI at 2 weeks. However, it exceeded the WTP threshold at 6 weeks ($68,632.04) and only approached cost-effectiveness again at 12 weeks ($50,828.58). Using MPS, operative management was found to be cost-effective at 12 weeks ($44,992.90), but not at 2 or 6 weeks. Sensitivity analyses demonstrated that small utility gains could make operative management cost-effective at intermediate follow-up intervals.</div></div><div><h3>Conclusion</h3><div>Operative management of LC1 fractures may offer early cost-effective pain relief and possible delayed cost-effective functional recovery, particularly by 12 weeks. These findings may support surgical intervention for patients prioritizing rapid recovery by 12 weeks, but careful patient selection remains critical.</div></div><div><h3>Level of evidence</h3><div>Level 3.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112723"},"PeriodicalIF":2.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912314","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":"What is the impact of the fracture location on patient-reported functional outcomes in patients with lateral tibial plateau fractures?","authors":"Lotte R. van der Linden ,&nbsp;Thijs P. Vaartjes ,&nbsp;Christiaan J.S.A. Kramer ,&nbsp;Harm Hoekstra ,&nbsp;Job N. Doornberg ,&nbsp;Nick Assink ,&nbsp;Frank F.A. IJpma","doi":"10.1016/j.injury.2025.112720","DOIUrl":"10.1016/j.injury.2025.112720","url":null,"abstract":"<div><h3>Background</h3><div>Lateral-sided tibial plateau fractures are most common and can range from minor to very extensive injuries of the lateral plateau. The impact of fracture location and extent on functional outcomes remains unclear. This study aimed to investigate this relationship.</div></div><div><h3>Methods</h3><div>A retrospective cross-sectional study was performed in 529 patients treated for a lateral tibial plateau fracture within 6 hospitals between 2003–2018. Patients were approached by posted mail and completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire after a median follow-up of six years (IQR: 4–9 years). Fractures were classified according to the Krause 'Ten segment method'. The seven most prevalent fracture patterns were identified and compared using descriptive statistics. Multivariate regression analysis, adjusted for age, sex, Schatzker classification, treatment, and residual incongruity, was performed to assess the association between fracture location, number of affected segments, and patient-reported outcome.</div></div><div><h3>Results</h3><div>The most frequent lateral tibial plateau fracture patterns were: pattern 1 – two posterior segments (KOOS = 82, IQR:66–93); pattern 2 – four lateral segments (KOOS = 74, IQR:53–94); pattern 3 – two anterolateral and one posterior segment (KOOS = 82, IQR:62–93); pattern 4 – anterolateral involvement (KOOS = 87, IQR:59–97); pattern 5 – involvement of the entire lateral plateau (KOOS = 60, IQR:40–71); pattern 6 – two posterior and one anterolateral segment (KOOS = 81, IQR:67–93); and pattern 7 – isolated lateral involvement (KOOS = 60, IQR:46–84). Patterns 5 and 7 showed the lowest KOOS scores (<em>p</em> = 0.008). Overall KOOS declined by 2.59 points per additional segment involved (<em>p</em> = 0.010), with similar trends observed in the ADL, sport, and QoL subscales (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Surgeons should be aware during management of lateral tibial plateau fractures that all regions of the plateau—anterior, medial, lateral, and posterior—are crucial in preserving function. Fractures involving the entire lateral plateau (pattern 5) and isolated lateral segments (pattern 7) result in worse functional outcomes, likely due to the severity of the injury and associated soft tissue involvement, especially in the meniscal area. Greater fracture extent, as indicated by increased segment involvement, correlates with worse patient-reported outcomes.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112720"},"PeriodicalIF":2.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997210","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":"Impact of prehospital delay on postoperative complications and 5-year mortality in older adults with hip fractures","authors":"Yu Jiang ,&nbsp;Shuhuai Tan ,&nbsp;Kaihua Qin ,&nbsp;Sizheng Steven Zhao ,&nbsp;Tianjunke Zhou ,&nbsp;Dingfa Liang ,&nbsp;Tingjie Zhao ,&nbsp;Wen Ju ,&nbsp;Zhi Wen ,&nbsp;Hui Guo ,&nbsp;Yong Xie ,&nbsp;Xiang Cui ,&nbsp;Peifu Tang ,&nbsp;Houchen Lyu ,&nbsp;Licheng Zhang","doi":"10.1016/j.injury.2025.112727","DOIUrl":"10.1016/j.injury.2025.112727","url":null,"abstract":"<div><h3>Purpose</h3><div>Guidelines recommended early surgery for hip fracture to improve outcomes, yet it is often hindered by prehospital delays. However, it remains unclear whether prehospital delay independently leads to poor outcomes of the well-recognized impact of in-hospital delay for hip fracture surgery.</div></div><div><h3>Methods</h3><div>We included patients aged over 60 years old who underwent surgery for their first acute hip fracture between 2000 and 2022 at a national trauma center in Beijing, China. Patients were categorized into short prehospital delay (time from injury to hospital admission ≤ 48 h) or long prehospital delay (&gt; 48 h) groups. The primary outcome was a composite endpoint of postoperative complications, and the secondary outcome was 5-year all-cause mortality. Multivariate logistic and Cox regression models were used to assess the association between exposure and outcomes.</div></div><div><h3>Results</h3><div>Among 3103 included patients (mean age, 78.1 ± 8.3 years; 69.1 % female), 1152 (37.1 %) experienced a long prehospital delay. Patients with long prehospital delay had a higher risk of postoperative complications (28.8 % vs. 16.8 %; adjusted odds ratio = 1.41, 95 % CI, 1.12–1.76, <em>P</em> &lt; 0.01) and 5-year all-cause mortality (63.9 vs. 43.3 per 1000 person–years; adjusted hazard ratio = 1.25, 95 % CI, 1.01–1.57, <em>P</em> &lt; 0.05) compared to those with short prehospital delay after adjusting for potential confounders including in-hospital delay.</div></div><div><h3>Conclusion</h3><div>Prehospital delays is associated with higher risk of postoperative complications and 5-year mortality in older adults with hip fractures, highlighting the need for public health policies to minimize such delays.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112727"},"PeriodicalIF":2.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932398","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":"Modified serrated-tip cannulated screwdriver as a sleeve for anterior column screw insertion in percutaneous acetabular fixation: A technical note and a report of two cases","authors":"Ali Fergany ,&nbsp;Bahaaeldin Ibrahim ,&nbsp;Ahmed A. Khalifa ,&nbsp;Osama Farouk","doi":"10.1016/j.injury.2025.112722","DOIUrl":"10.1016/j.injury.2025.112722","url":null,"abstract":"<div><div>Percutaneous fixation of certain types of acetabular fractures is a valid, minimally invasive, and successful procedure. However, the technique for proper insertion of such screws is sensitive and requires adequate understanding of radiographic images. Furthermore, an optimum entry point and trajectory of the screws should be guaranteed to avoid hip joint penetration and screws misplacement. Various tools and techniques were described; we provide a technical note describing a modification on the tip of the cannulated screwdriver where serrations were added, which helped in better stability over the bone while inserting the guidewires for screws insertion, besides protecting the soft tissue envelope, especially in obese patients. We presented two early cases, one with a pure anterior column fracture and the other with a combined anterior column fracture and disruption of the sacroiliac joint on the same side, where we used the technique we described to ease percutaneous insertion of an anterior column screw for acetabular fracture fixation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112722"},"PeriodicalIF":2.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912315","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":"Incidence, risk factors, and machine learning prediction models of rib fractures in patients with traumatic thoracic vertebral fractures","authors":"Bingchuan Liu ,&nbsp;Zhengguang Wang ,&nbsp;Fang Zhou ,&nbsp;Zhishan Zhang ,&nbsp;Guojin Hou ,&nbsp;Zhongwei Yang ,&nbsp;Yun Tian","doi":"10.1016/j.injury.2025.112728","DOIUrl":"10.1016/j.injury.2025.112728","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to comprehensively describe the clinical characteristics of rib fractures in patients with traumatic thoracic vertebral fractures (TVFs), and to develop machine learning (ML) models for predicting the risk of rib fractures.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients diagnosed with TVFs at a single hospital between January 2007 and November 2024, enrolling 1420 patients and 20 variables. Chest CT scans were used to confirm the presence of rib fractures and to examine their distribution characteristics. Several ML models, including Support Vector Machine (SVM), XGBoost, Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Gradient Boosting Decision Tree (GBDT), Naive Bayes (NB), Neural Network (NN), and Ensemble Learning (EL), were applied. Model performance was evaluated using indicators such as area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, density, discrimination slope, and a scoring system. Additionally, the prediction performance of the ML models was compared with that of three experienced clinicians.</div></div><div><h3>Results</h3><div>Rib fractures were identified in 222 patients (15.6 %), with a total of 1035 rib fractures recorded. Only 22.5 % were single rib fractures, and the distribution of unilateral and bilateral fractures was comparable (54.5 % vs. 45.5 %). Multivariate logistic regression revealed four significant predictors of rib fractures: gender (<em>P</em> = 0.004), cardiovascular disease (<em>P</em> = 0.003), trauma mechanism (<em>P</em> &lt; 0.001), and the number of thoracic fractures (<em>P</em> &lt; 0.001). Among all models, the EL model demonstrated the best predictive performance, achieving an accuracy of 0.920, F1 score of 0.767, sensitivity of 0.683, specificity of 0.977, PPV of 0.875, NPV of 0.928, and the highest overall score (48). Notably, its performance surpassed that of all three clinicians.</div></div><div><h3>Conclusions</h3><div>Rib fractures are relatively common in patients with TVFs and may be underdiagnosed, especially in the absence of clear symptoms. The EL model developed in this study offers strong predictive capability and may serve as a valuable clinical decision-support tool to identify high-risk patients and reduce the likelihood of missed diagnoses.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112728"},"PeriodicalIF":2.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997209","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":"Proximal humerus fractures: national treatment trends with associated 30- and 90-day readmission rates","authors":"Tej Joshi ,&nbsp;Daniel Calem ,&nbsp;Daniella Ogilvie ,&nbsp;Tuckerman Jones ,&nbsp;Akhil Katakam ,&nbsp;Suleiman Y Sudah ,&nbsp;Eitan M Kohan ,&nbsp;Frank G Alberta","doi":"10.1016/j.injury.2025.112690","DOIUrl":"10.1016/j.injury.2025.112690","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of proximal humerus fractures is rising, with increasing use of reverse total shoulder arthroplasty (rTSA). This study analyzed treatment trends, readmission rates, and causes of readmission.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database (NRD) was queried for admissions with a primary diagnosis of proximal humerus fracture in the U.S. (2016–2021) using ICD-10 codes. Patient demographics, comorbidities, facility characteristics, and 30-/90-day readmission rates were analyzed. Treatments included non-operative (Non-Op), hemiarthroplasty (HA), anatomic total shoulder arthroplasty (aTSA), rTSA, open reduction internal fixation (ORIF), and intramedullary nailing (IMN).</div></div><div><h3>Results</h3><div>Among 218,425 admissions, rTSA use increased (20.27 % to 22.30 %), while ORIF decreased (20.77 % to 14.86 %). Non-Op had the highest readmission rates at 30- and 31–90 days (10.5 % and 8.9 %), even after adjusting for age/comorbidities. rTSA had the lowest readmission rates (5.9 % and 4.6 %), with instability being the most common cause.</div></div><div><h3>Conclusion</h3><div>There is a trend towards increased rTSA utilization for treating proximal humerus fractures. The readmission rate following rTSA was the lowest of all treatment modalities, including non-operative management.</div></div><div><h3>Level of evidence</h3><div>Level III Retrospective Cohort Comparison Using Large Database Prognosis Study</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112690"},"PeriodicalIF":2.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921997","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":"Is postoperative ketorolac administration associated with nonunion in adults after proximal humerus open reduction and internal fixation? a propensity-matched retrospective cohort study","authors":"Anthony N. Baumann ,&nbsp;Robert J. Trager ,&nbsp;Shahabeddin Yazdanpanah ,&nbsp;Albert T. Anastasio ,&nbsp;Tyler Sanda ,&nbsp;Michael Makowski","doi":"10.1016/j.injury.2025.112693","DOIUrl":"10.1016/j.injury.2025.112693","url":null,"abstract":"<div><h3>Introduction</h3><div>Although ketorolac's association with poor bone healing remains debated, no study has examined the impact of ketorolac administration in adults with proximal humerus fractures (PHFs) after open reduction and internal fixation (ORIF), limiting surgeon decision-making. Therefore, the primary aim of this study was to examine the association between short-term ketorolac administration within the first three days after ORIF for PHF and the incidence and risk of nonunion or malunion through one year.</div></div><div><h3>Methods</h3><div>A pre-registered retrospective propensity-matched cohort study was performed using a large United States health records-based database (TriNetX, LLC). Patients included adults (≥18 years old) who underwent first-time proximal humerus ORIF and received either acute (≤3 days) postoperative ketorolac (ketorolac cohort) or acetaminophen (control cohort). The primary outcome was the risk ratio (RR) of nonunion through one year. Secondary outcomes explored the incidence and risk of reoperation by surgery type, other relevant postoperative adverse events (such as malunion), and RR and mean count of postoperative oral opioid prescription. Over fifteen risk factors associated with bone union were used for propensity matching.</div></div><div><h3>Results</h3><div>There were 2143 patients per cohort (<em>n</em> = 4286 total) with a mean age of 55 years. Comparing the ketorolac cohort to the control cohort, there was a statistically significant increase in risk of nonunion (<em>p</em> = 0.040; RR: 1.46 [1.02, 2.10]; 3.3% versus 2.2%; 70 patients versus 48 patients). Individual outcomes demonstrated no statistically significant difference in risk of malunion (<em>p</em> = 0.288; RR: 1.28; 1.9% versus 1.5%), revision ORIF (<em>p</em> = 0.493), total shoulder arthroplasty (<em>p</em> = 0.354), or acute kidney injury (<em>p</em> = 0.423). There was a statistically significant decrease in risk (<em>p</em> = 0.015) and mean count (<em>p</em> = 0.033) of oral opioid prescription.</div></div><div><h3>Conclusion</h3><div>Acute postoperative ketorolac after ORIF for PHF is associated with a modest increase in risk of nonunion and reduction in opioid prescriptions, with no significant differences in malunion, reoperation, or acute kidney injury. These findings support the need for individualized decision-making to weigh risks and benefits in postoperative pain management, with future research needed on dosages.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112693"},"PeriodicalIF":2.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144907813","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 novel acetabular injury pattern: Posterior osteochondral impaction without cortical involvement","authors":"Mahmoud Fahmy,&nbsp;Mostafa Ahmed Shawky","doi":"10.1016/j.injury.2025.112724","DOIUrl":"10.1016/j.injury.2025.112724","url":null,"abstract":"<div><h3>Introduction</h3><div>Acetabular fractures typically involve disruption of cortical columns or walls and are well-classified by Judet, Letournel, and AO/OTA systems. However, some injuries involve pure osteochondral impaction of the articular surface without cortical involvement, making them difficult to detect and unclassified by current systems. This study identifies and evaluates a rare, previously undescribed acetabular injury pattern—posterior dome osteochondral impaction without cortical fracture.</div></div><div><h3>Aim</h3><div>To characterize this unique injury pattern and assess clinical and radiological outcomes following two surgical techniques aimed at anatomical restoration.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on eight patients (six males, two females; mean age 34 years) treated at a tertiary referral center between 2008 and 2023. Inclusion criteria included isolated posterior dome osteochondral impaction confirmed by computed tomography, absence of cortical disruption, and minimum six months follow-up. Patients underwent surgical management via either posterior wall osteotomy or a cortical window technique, with subchondral support provided by autologous bone graft or rafting screws. Functional outcomes were measured using the Modified Merle d’Aubigné and Postel score. Radiological results were assessed according to Matta criteria.</div></div><div><h3>Results</h3><div>All injuries followed high-energy trauma, predominantly motor vehicle collisions. Posterior wall osteotomy was performed in five patients: cortical window technique in three. Anatomical reduction was achieved and confirmed radiologically in all cases. At a mean follow-up of 12 months, no evidence of secondary collapse, hardware failure, or early osteoarthritis was noted. Functional outcomes were excellent in five patients and good in three (mean Merle d’Aubigné score 16.4).</div></div><div><h3>Conclusion</h3><div>Isolated osteochondral impaction of the posterior acetabular dome without cortical fracture is a distinct injury not encompassed by current classification systems. Surgical intervention using posterior wall osteotomy or cortical window elevation facilitates anatomical reduction and yields excellent mid-term outcomes. Recognition of this lesion and its inclusion in future acetabular fracture classifications are essential for accurate diagnosis and optimal treatment.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112724"},"PeriodicalIF":2.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917395","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":"Factors affecting time to surgery and mobilization following hip fracture","authors":"Jack T. Bragg ,&nbsp;Matthew Feldman ,&nbsp;Dikran R. Balian ,&nbsp;Catherine M. Call ,&nbsp;Scott P. Ryan","doi":"10.1016/j.injury.2025.112726","DOIUrl":"10.1016/j.injury.2025.112726","url":null,"abstract":"<div><h3>Introduction</h3><div>Faster time to operative fixation and mobilization decreases morbidity and mortality for hip fracture patients. Many hospitals are working at or above their capacity and beds in surgical floors for surgical patients may not be available. The purpose of this study was to determine if the floor of admission after a hip fracture impacts time to surgical fixation and time to mobilization after surgery.</div></div><div><h3>Methods</h3><div>781 patients over the age of 50 who underwent hip fracture surgery between January 2011 and January 2021 were included in this analysis. Patient demographics, injury characteristics and floor of admission were collected and analyzed. Time of diagnosis was defined as the time of the initial presenting radiograph, and time of mobilization was defined as the time the patient stood at edge of bed with physical therapy. Floor of admission is determined based on admitting service (medicine, orthopaedics, trauma surgery) as well as bed availability. Floors were considered surgical or non-surgical based on standard patient populations.</div></div><div><h3>Results</h3><div>Time to surgery from diagnosis was significantly longer on nonsurgical floors (28 vs. 22 hours p = 0.003). Time from surgery to mobilization out of bed was significantly shorter for patients on surgical floors (53 vs. 63 hours, p = 0.01). There was no difference in time to evaluation by physical therapy (p = 0.8). Time from diagnosis to surgery and time from surgery to injury was not different across patient races or language spoken.</div></div><div><h3>Conclusions</h3><div>Patients admitted to non-surgical floors had a significantly longer time to surgery as well as longer time to mobilization compared to patients who were admitted to surgical floors. Time to physical therapy evaluation following surgery was the same, suggesting different factors such as medical comorbidities, staff training, and resource availability likely contribute to the significant difference in time to mobilization. Race and language did not play a role in delaying time to the operating room or mobilization with physical therapy.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112726"},"PeriodicalIF":2.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912313","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}