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

{"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}

{"title":"Typical dose values for intra-operative fluoroscopy during orthopaedic trauma surgery at Larnaca general hospital in cyprus: A five-year retrospective study","authors":"Vasileios I. Metaxas ,&nbsp;Stavros Savvakis ,&nbsp;Eleni Skouridi ,&nbsp;Demetris Kaolis ,&nbsp;Georgios Gkaras ,&nbsp;Constantinos Hadjilampi ,&nbsp;Eleftherios Stamatakis ,&nbsp;Efstratios A. Papadelis ,&nbsp;Constantinos Pistevos ,&nbsp;Petros Prodromou","doi":"10.1016/j.injury.2024.112089","DOIUrl":"10.1016/j.injury.2024.112089","url":null,"abstract":"<div><div>The purpose of this study was to establish typical dose values at orthopaedic operating rooms of the Larnaca General Hospital (LGH). Kerma area product (KAP), fluoroscopy time (FT) and cumulative air-kerma (K_a,r) measurements were collected for 821 patients who underwent common and reproducible trauma surgery over a five-year period, with three mobile C-arm systems; two equipped with an image-intensifier and one with a flat-panel detector. Dose indices were automatically extracted from radiation dose structured reports or DICOM meta-data files archived in the PACS, using custom-made software. The procedures were categorised based on the anatomical area and included foot/ankle, tibia/fibula, knee (distal femur, tibia plateau), femur/trochanter, hip, hand, radius/ulna, elbow, and humerus. The medians of KAP, FT and K_a,r were defined as typical dose values. Variations in dose values among the C-arm systems or different surgical operations involving femur/hip, tibia/fibula, and humerus were analysed as secondary outcomes. For the procedures on upper extremities, the typical dose values ranged between 20.1–197 mGycm² for KAP, 4.50–14.5 s for FT and 0.07–0.71 mGy for K_a,r, whilst for the procedures on lower extremities ranged between 46.6–202 mGycm² for KAP, 4.86–24.0 s for FT and 0.16–0.74 mGy for K_a,r. The largest values were reported for dynamic hip screw (889 mGycm², 14.3 s, 3.10 mGy), and femur/trochanter intramedullary (long/short nail: 2007/1326 mGycm², 52.3/36.0 s, 6.53/4.05 mGy) nailing, respectively. A decrease of up to 65 %, and 74 % was found in median KAP, and K_a,r, and an increase of up to 119 % (except knee's) in median FT values for the procedures performed with the flat-panel systems. Additionally, when comparing surgical operations, only femur/trochanter long/short and tibia intramedullary nailing demonstrated a significant increase in median KAP, FT and K_a,r values compared to dynamic hip screw and fixation with a locking plate, respectively. The typical dose values reported could be used as a guide to appropriate levels of intra-operative fluoroscopy in orthopaedic trauma surgery at LGH, and to encourage further optimisation by providing a baseline for audit of local practice in the absence of national reference doses. These values could also contribute to the establishment of the first national DRLs for orthopaedic trauma surgery.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112089"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901365","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":"Medial buttress plate use in neck of femur fracture fixations: A systematic review","authors":"Luke McGarry ,&nbsp;Jessica Rotaru ,&nbsp;Rajitha Gunaratne ,&nbsp;Ian Hickey","doi":"10.1016/j.injury.2025.112160","DOIUrl":"10.1016/j.injury.2025.112160","url":null,"abstract":"<div><h3>Background</h3><div>Femoral neck fractures, particularly Pauwels type II and III, pose significant challenges due to their vertical instability and susceptibility to complications such as non-union and avascular necrosis (AVN). Medial buttress plates (MBPs) have emerged as a promising adjunct in fixation, offering biomechanical advantages by neutralizing shearing forces and enhancing stability. However, the clinical efficacy of MBPs across different fixation techniques, plate configurations, and positioning remains unclear.</div></div><div><h3>Purpose</h3><div>This study aimed to (1) analyse outcomes of femoral neck fracture fixations augmented with MBPs, focusing on Pauwels type 2 and 3 fractures, and (2) analyse the impact of plate size, positioning, and the use of MBPs in different fixation techniques.</div></div><div><h3>Study design</h3><div>Systematic review; Level of evidence, 4.</div></div><div><h3>Methods</h3><div>Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using PubMed, MEDLINE, EMBASE, and Cochrane databases. Studies published from 2010 onwards, focusing on MBPs in Pauwels type II and III femoral neck fractures, were included. Clinical outcomes and plate details were recorded.</div></div><div><h3>Results</h3><div>Data from 21 studies, including 11 derived from meta-analyses, encompassing 642 patients were analysed. MBP-augmented fixations demonstrated a non-union rate of 6 %, an AVN rate of 4 %, and an overall failure rate of 17.3 %. The mean time to union was 3.9 ± 1.2 months, and the average HHS was 89.5 ± 5.5 at the final follow-up. Multiple cannulated screws (MCS) combined with a MBP showed a lower failure rate (14.6 %) compared to dynamic hip screw combined with a MBP (26.8 %), though not statistically significant (<em>p</em> = 0.164). Medial or anteromedial plate positioning yielded better outcomes, while anterior placement was associated with high failure rates. No studies examined the outcomes of femoral neck system fixation combined with a MBP.</div></div><div><h3>Conclusion</h3><div>MBPs are a valuable adjunct in managing Pauwels type II and III femoral neck fractures, providing favourable outcomes with low rates of failure and complications. The combination of MBPs with various fixation techniques has shown promising results, highlighting the potential for improved stability and outcomes. Further research is needed to optimize plate size, screw type, positioning, and the role of MBPs in augmenting fixation techniques for these challenging fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112160"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018784","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":"Ballistic femoral neck fractures: Associated injuries and outcomes","authors":"Noah J. Harrison ,&nbsp;Sally Jo ,&nbsp;Marschall B. Berkes ,&nbsp;Christopher M. McAndrew ,&nbsp;Mitchel R. Obey ,&nbsp;Anna N. Miller","doi":"10.1016/j.injury.2025.112148","DOIUrl":"10.1016/j.injury.2025.112148","url":null,"abstract":"<div><div><strong>Background:</strong> Ballistic fractures of the femoral neck, rare injuries that overwhelmingly affect younger adults, pose significant challenges to the treating surgeon. However, there is limited literature that the treating surgeon can leverage to guide their treatment decisions. The goal of this study is to describe the demographics, associated injuries, outcomes, and complications associated with ballistic femoral neck fractures.</div><div><strong>Patients and methods:</strong> This retrospective case series, performed at a single, academic, urban, level-one trauma center, evaluated patients with a ballistic fracture of the femoral neck (AO/OTA 31B) between 2003 and 2022. International Classification of Disease codes were utilized to identify patients in the electronic medical record. Chart review was performed to assess patient demographics, associated injuries, success rate of operative and nonoperative intervention, and post-operative complication rate and types.</div><div><strong>Results:</strong> Seventeen patients were included (94 % male; median age 22.5 years). Median follow up was 12.2 months (range 1–84 months). Five patients (29 %) sustained a concomitant vascular injury. Eight patients (47 %) sustained an additional osseous injury. The median injury severity score was 9 (interquartile range 4–17). Thirteen patients were treated with operative reduction and fixation, 3 patients with incomplete fractures were treated nonoperatively, and one was treated with acute total hip arthroplasty (THA). Overall, 12 of 17 patients (71 %) healed their fracture or had an uncomplicated recovery after acute THA. Of the 13 patients treated with operative reduction and fixation, 8 (62 %) healed their fracture and 5 (38 %) developed one or more post-operative complications.</div><div><strong>Conclusions:</strong> Nearly 1 in 3 patients with ballistic femoral neck fractures sustain concomitant vascular injury and almost half sustain another osseous injury. In this series, only 62 % of patients who underwent operative reduction and fixation healed their fractures, and nearly 40 % of patients treated with operative reduction and fixation developed a post-operative complication. Given the poor outcomes and high complication rates associated with these injuries, surgeons should counsel patients with ballistic femoral neck fractures accordingly. Further research into the optimal treatment of ballistic femoral neck fractures is needed.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112148"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018836","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":"Short-term clinical outcomes of subway-related amputations","authors":"Garrett Ruff ,&nbsp;Nina Fisher ,&nbsp;Danielle Markus ,&nbsp;Toni M. McLaurin ,&nbsp;Philipp Leucht","doi":"10.1016/j.injury.2024.112135","DOIUrl":"10.1016/j.injury.2024.112135","url":null,"abstract":"<div><h3>Introduction</h3><div>In city hospitals, subway-related traumatic amputations are a frequent pattern of injury, however there is a paucity of literature on this specific injury pattern. The purpose of this study was to describe the epidemiology of subway-related traumatic amputations, as well as compare them to non-subway traumatic amputations.</div></div><div><h3>Patients and Methods</h3><div>Retrospective review was performed at a single Level-1 trauma center in a metropolitan area. All patients who sustained a traumatic lower-extremity amputation over a seven-year period were included. Demographics, injury, treatment-related information, and complications were collected. Subway and non-subway traumatic amputations were statistically compared. Cohorts were further subdivided into above-knee amputations (AKAs) and below-knee amputations (BKAs) for statistical comparison.</div></div><div><h3>Results</h3><div>Fifty-seven patients sustained 72 traumatic lower-extremity amputations, including 64 subway-related amputations. Fifteen patients with bilateral lower-extremity amputations all had subway-related injuries. Patients with subway-related injuries were more likely to have a history of alcohol use disorder (58.1 % vs. 0 %; <em>P</em> = 0.002), and experienced longer stays in the intensive care unit (ICU) (8.9 vs. 3.6 days; <em>P</em> = 0.006). Twenty-four amputations (33.3 %) were complicated by wound infection during the initial hospitalization, with wound cultures growing a variety of organisms, most frequently <em>Enterococcus</em> species and <em>Enterobacter cloacae</em>. When subway injuries were separated by AKAs and BKAs, patients with AKAs underwent more irrigation and debridement procedures on average (10.3 vs. 5.8; <em>P</em> = 0.006), had a higher rate of wound infections (58.8 % vs. 25.0 %; <em>P</em> = 0.018), and had longer hospital stays (50.4 vs. 32.2 days; <em>P</em> = 0.047).</div></div><div><h3>Conclusion</h3><div>Subway-related amputations are associated with longer ICU stays and a history of alcohol use disorder compared to non-subway traumatic amputations. Approximately 1/3 of these patients are expected to develop a wound infection, with <em>Enterococcus</em> and <em>Enterobacter</em> species being the most commonly identified organisms. Further research into high-energy, traumatic amputations, including subway injuries, may help improve prognostication of patient outcomes, identify potential in-hospital complications, and proactively direct differences in care compared to the standard for non-subway-related amputations.</div></div><div><h3>Level of Evidence</h3><div>Prognostic Level III.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112135"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928913","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 best surgical approach for open operative reduction of a mid-humerus fracture – anterior or posterior?","authors":"Meredith Stadnyk,&nbsp;Stephanie Gibbon,&nbsp;Richard Buckley","doi":"10.1016/j.injury.2025.112142","DOIUrl":"10.1016/j.injury.2025.112142","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112142"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960504","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":"Management of post-injury anticoagulation in the traumatic brain injury patient: A scoping review","authors":"Michael Keirsey,&nbsp;Grace M Niziolek","doi":"10.1016/j.injury.2025.112159","DOIUrl":"10.1016/j.injury.2025.112159","url":null,"abstract":"<div><div>Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality among trauma patients. The care of these patients continues to be a complex endeavor with prevention of associated complications, often requiring as much attention as that of the treatment of the primary injury. Paramount among these are venous thromboembolic events (VTE) due to their high incidence, additive effect on the risk of morbidity and mortality, and the careful balance that must be utilized in their diagnosis and treatment to prevent progression of the brain injury itself.</div><div>In this review, we have synthesized the most recent major studies detailing the ideal choice of chemoprophylactic agent, the timing of initiation, and continued monitoring and management strategies through the hospital course and beyond. Additional discussion is provided for subpopulations in which management can vary significantly, including the elderly, critically ill, and obese. Ultimately, current literature supports the use and safety of low molecular weight heparin over unfractionated heparin, especially when dosed using newer assays including anti-Xa levels. The timing of prophylaxis remains important, as the risk of VTE increases with each day that prophylaxis is held. Consensus findings favor initiation within 24–72 h, in the absence of documented progression, life threatening bleeding, or need for major surgical intervention. Despite available data, there continues to be significant variability in practice patterns which we hope to address with this review.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112159"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974052","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":"Treatment and outcome after hip fracture for patients on oral anticoagulation","authors":"Alexander Wilton,&nbsp;Ayman Sorial,&nbsp;Tanzeelah Jamadar,&nbsp;Martyn Parker","doi":"10.1016/j.injury.2024.112072","DOIUrl":"10.1016/j.injury.2024.112072","url":null,"abstract":"<div><h3>Aims</h3><div>An increasing number of patients with hip fracture are taking oral anticoagulation medication including direct oral anticoagulants (DOAC). The management of these patients regarding the timing of surgery and occurrence of complications remains contentious. The aim of this study was to compare treatment and outcomes for hip fracture patients taking anticoagulation.</div></div><div><h3>Methods</h3><div>Data from a consecutive series of 3,707 hip fracture patients admitted to a single centre was collected over a seven-year period.</div></div><div><h3>Results</h3><div>The proportion of patients taking warfarin fell slightly over the study period (6.1 % to 4.7 %) whilst the proportion taking DOAC increased greatly (1.4 % to 11.4 %). Patients on oral anticoagulation were slight older (mean age 83 years for warfarin, 85 years for DOAC versus 80 years for those not on anticoagulation), more likely to have atrial fibrillation, less likely to take anti-platelet medication and less likely to have spinal anaesthesia. Patients taking oral anticoagulant had an increased delay to theatre (mean hours admission to theatre 37.9 for warfarin, 39.5 for DOAC, 31.1 for no anticoagulation). There was no difference in the number of patients transfused, wound complications, post-operative haemoglobin or 30 -day mortality between groups.</div></div><div><h3>Conclusion</h3><div>Current policies on the timing of surgery and anticoagulation are safe.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112072"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792677","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}