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

{"title":"3D printed scaffolds for reconstruction of segmental long bone defects: A mini narrative review","authors":"Maud J.V. Gilissen,&nbsp;Anna J.L. Lodewijks,&nbsp;Lotte C.A. Vissers - Van der Broeck,&nbsp;Taco J. Blokhuis,&nbsp;Martijn van Griensven,&nbsp;Martijn Poeze","doi":"10.1016/j.injury.2026.113758","DOIUrl":"10.1016/j.injury.2026.113758","url":null,"abstract":"<div><div>Large segmental bone defects remain a major challenge in orthopedic reconstruction because successful healing requires both mechanical stability and coordinated biological regeneration. Although autologous bone grafting remains the clinical gold standard due to its osteogenic, osteoinductive, and osteoconductive properties, its application is limited by donor site morbidity, restricted graft availability, and increased operative burden. These limitations have stimulated the development of scaffold-based regenerative strategies aimed at restoring structural integrity while promoting bone regeneration. Recent advances in additive manufacturing have enabled the fabrication of patient-specific three-dimensional (3D) scaffolds with controlled architecture, porosity, and mechanical properties that approximate native bone structure. This mini-review summarizes recent developments in 3D-printed scaffolds for the reconstruction of long bone defects, with particular emphasis on differences between non-biodegradable metallic constructs and biodegradable polymeric, ceramic, and composite materials. Porous titanium scaffolds demonstrate high mechanical stability and early osteointegration, making them promising for extensive load-bearing defects, although concerns remain regarding long-term stress shielding and permanent implant retention. Biodegradable ceramics and polymer-based scaffolds offer improved biological integration and controlled degradation, but often require further optimization of mechanical stability and biological augmentation. Composite constructs combining polymers, ceramics, or bioactive metals aim to integrate structural support with enhanced osteogenic and angiogenic responses. Despite encouraging preclinical results and emerging early clinical applications, current evidence remains limited by small patient cohorts, heterogeneous scaffold designs, and insufficient long-term outcome data. Future studies should focus on standardized scaffold designs, comparative clinical trials, and long-term evaluation to clarify the optimal role of 3D-printed biomaterials in the treatment of large segmental bone defects.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 ","pages":"Article 113758"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278843","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":"Innovative intramedullary nail system with internally locking: A safe alternative fixation technique for humerus shaft fracture that reduces the risk of the iatrogenic radial nerve injury and surgical time","authors":"Yilmaz Onder,&nbsp;Mahmut Tuncez,&nbsp;Tolgacan Kurtulus,&nbsp;Tugrul Bulut","doi":"10.1016/j.injury.2026.113639","DOIUrl":"10.1016/j.injury.2026.113639","url":null,"abstract":"<div><h3>Purpose</h3><div>Humeral shaft fractures may be managed conservatively or operatively; however, increasing non-union and complications after non-operative treatment have renewed interest in intramedullary fixation. Innovative intramedullary nails with distal internally locking, requiring neither fluoroscopy nor external guidance, aim to reduce surgical time, simplify the procedure, and minimise the risk of iatrogenic radial nerve injury. This study evaluates the clinical and radiological outcomes of a humeral nail utilising distal internally locking.</div></div><div><h3>Material and method</h3><div>A retrospective review included 75 patients treated with antegrade intramedullary nailing for humeral shaft fractures between 2020 and 2025. Patients with pathological fractures, preoperative radial nerve palsy, concomitant upper-limb injuries, or insufficient follow-up were excluded. Operative parameters, complications, union time, hospital stay, and return to activity were recorded. Functional outcomes were assessed at final follow-up using the Constant-Murley score, QDASH, VAS, and shoulder range of motion.</div></div><div><h3>Results</h3><div>Operative time was 46.4 ± 11.1 min, and hospital stay was 3.2 ± 0.8 days. Radiological union occurred at 13.0 ± 2.9 weeks, and patients returned to daily activities at 12.6 ± 2.5 weeks. No postoperative radial nerve palsy or infections were observed. One non-union required exchange nailing, and three cases of proximal screw irritation resolved after screw removal. Functional outcomes were excellent overall, with a Constant score of 93.4 ± 9.4, QDASH of 2.9 ± 6.0, VAS of 0.8 ± 1.3, and near-complete restoration of shoulder mobility.</div></div><div><h3>Conclusion</h3><div>Intramedullary nailing with an internally distal locking mechanism, without the need for fluoroscopy and an external guidance system, offers a safe and efficient treatment option for humeral shaft fractures. This technique significantly reduces surgical time and the risk of iatrogenic radial nerve injury, while maintaining excellent union rates and functional outcomes. This system represents a reliable alternative to traditional interlocking nails and plate fixation, particularly in clinical settings where minimising surgical time is essential.</div></div><div><h3>Clinical trial registration</h3><div>Not applicable</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 10","pages":"Article 113639"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876994","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 operative intervention in blunt cerebral vascular injury","authors":"Branson D. Taheri,&nbsp;Devan V. Girish,&nbsp;Olumide D. Fajolu,&nbsp;Rafael D. Malgor,&nbsp;Julie A. Rizzo,&nbsp;Bradley A. Dengler,&nbsp;Vikhyat S. Bebarta,&nbsp;Steven G. Schauer","doi":"10.1016/j.injury.2026.113690","DOIUrl":"10.1016/j.injury.2026.113690","url":null,"abstract":"<div><h3>Introduction</h3><div>Blunt cerebrovascular injury (BCVI) occurs in 3–7% of patients with blunt trauma and has the potential to lead to stroke. The effectiveness of surgical intervention for BCVI remains uncertain due to a lack of comprehensive data on current techniques.</div></div><div><h3>Methods</h3><div>We analyzed data from the American College of Surgeons National Trauma Databank (NTDB). Patients with BCVI were divided into two cohorts with and without surgical management for comparison. We hypothesized that those managed operative for BCVI would have worse injury profiles and outcomes than non-operative patients.</div></div><div><h3>Results</h3><div>From 2017–2024, there were a total of 9369,340 encounters in the NTDB database, of which 65,171 (0.7%) had a BCVI. Those in the non-operative management group had lower composite injury severity scores (20 vs. 24, p &lt; 0.001). Of those with a BCVI, 1394 (2.1%) received an endovascular intervention, 248 (&lt;1.0%) received an open vascular intervention, and 25 (&lt;1.0%) received both. Overall, 2062 were diagnosed with a stroke (3%). Among those undergoing endovascular intervention, 201 (14%) were diagnosed with a stroke. Among those undergoing open vascular intervention, 26 (10%) were diagnosed with a stroke. There was no difference in survival to discharge between the two cohorts (non-surgical 87% vs. surgical 86%, p = 0.062). The proportion undergoing interventions for BCVI decreased over the study period.</div></div><div><h3>Conclusion</h3><div>These data show that patients undergoing operative management of BCVI are generally more severely injured with higher stroke rates. Despite this, there was no significance difference in survival to discharge between operative and non-operative cohorts.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 10","pages":"Article 113690"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946375","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":"Alternate non-metallic implants in fracture care – A review","authors":"Tobias Fritz,&nbsp;David Osche,&nbsp;Emmanouil Liodakis,&nbsp;Marcel Orth","doi":"10.1016/j.injury.2026.113663","DOIUrl":"10.1016/j.injury.2026.113663","url":null,"abstract":"<div><div>The use of implants in the treatment of fractures evolved over the last decades. Until today, most implant designs are based on metallic alloys such as Titanium or stainless steel. However, the global ageing population with increasing numbers of fragility and pathological fractures challenges current implant designs regarding stress shielding, fragile soft tissue and advanced demands like reduced imaging artefacts for radiotherapy planning. Therefore, alternative non-metallic implants that more closely resemble the mechanical properties of bone or provide additional stability as intramedullary augmentation have become available. This narrative-review summarizes the current available (2026) technology, biomechanical properties, clinical applications, outcomes and complications of CFR-PEEK implants and photodynamic bone stabilization implants in fracture management. In total n = 100 publications were taken into consideration for this narrative-review. Non-metallic-implants for fracture care are still a niche product in the treatment of fractures. However, with the ageing population and the increasing number of impaired bone quality and stability, these methods could help reduce stress shielding and force distribution comparable to physiological bone (CFR-PEEK implants) or allow additional augmentation (photodynamic bone stabilization) in reduced bone quality.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 ","pages":"Article 113663"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149257849","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":"Modernizing preoperative planning in orthopaedic trauma surgery","authors":"Christopher R. Leland,&nbsp;Alexander R. Farid,&nbsp;Derek S. Stenquist,&nbsp;Nishant Suneja,&nbsp;Arvind G. von Keudell","doi":"10.1016/j.injury.2026.113640","DOIUrl":"10.1016/j.injury.2026.113640","url":null,"abstract":"<div><div>Preoperative planning in orthopaedic trauma remains largely experience-driven despite advances in imaging and predictive modeling. Although three-dimensional (3D) reconstructions improve fracture visualization, they do not routinely predict biomechanical stability across competing fixation strategies. Automated segmentation and finite element analysis (FEA) offer the potential to transition trauma planning from primarily anatomic to a method by which constructs may be optimized. This narrative review summarizes the current state of 3D planning and segmentation, describes the principles and established applications of FEA, delineates the workflow of finite element modeling in clinical practice, and integrates representative clinical cases to illustrate how plate positioning and screw configuration affect construct stability and works alongside the surgeon to help inform decisions. Broader implications for hospital systems, patients, and industry are discussed, along with future integration into navigation, robotics, and intraoperative 3D imaging workflows.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 ","pages":"Article 113640"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149257840","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":"Review of a \"Bone Glue Fixation\" development","authors":"Philip Procter","doi":"10.1016/j.injury.2026.113707","DOIUrl":"10.1016/j.injury.2026.113707","url":null,"abstract":"<div><div>The paper presents some of the background to the development of bone glues. Whilst there have been many attempts over the last 100 years to find a safe and effective biomimetic adhesive biomaterial it is only recently that promising and feasible candidates have been developed. In particular a formulation based on a combination of an amino acid, phosphoserine (PSer), together with calcium salts and water, has demonstrated the potential to meet clinically defined requirements for a bone adhesive (Osstic®). This bone glue has achieved first in human use after having demonstrated consistent preclinical performance.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 ","pages":"Article 113707"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149257996","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":"Success rate variation between trauma video review and chart review of trauma intubations at a Level 1 trauma center","authors":"Avi Ruderman,&nbsp;Carolyn Shanks,&nbsp;Rebecca Kernen,&nbsp;Bhaskar Thakur,&nbsp;Samuel McDonald,&nbsp;Bahaa Succar,&nbsp;Ryan Dumas,&nbsp;Nathaniel Bonfanti","doi":"10.1016/j.injury.2026.113681","DOIUrl":"10.1016/j.injury.2026.113681","url":null,"abstract":"<div><h3>Background</h3><div>First pass success (FPS) is an important quality metric for endotracheal intubations. FPS rates for trauma patients in the emergency department (ED) have been reported to be between 80% and 90% and are often based on self-reported data. We evaluated the number of intubation attempts seen on trauma video review (TVR) and compared them against charted attempts.</div></div><div><h3>Methods</h3><div>We used TVR to review a consecutive cohort of adult trauma intubations in the ED at a level 1 trauma center over 10 months. Four reviewing physicians with specialization in emergency medicine participated in video and chart reviews and each case was reviewed by a minimum of two reviewers. We calculated FPS rates for the cohort and for each category of intubating physician. We evaluated interrater reliability using intraclass correlation coefficients (ICC).</div></div><div><h3>Results</h3><div>50 patient cases were evaluated. The overall TVR FPS rate was 78% compared to a charted FPS rate of 92%. ICCs for chart reviews were 0.9 (CI 0.85–0.94) for a single rater and 0.97 (CI 0.96–0.98) for the average of multiple raters. ICCs for TVR were 0.55 (CI 0.4–0.68) between individual reviewers and 0.83 (CI 0.74–0.89) for the average across raters.</div></div><div><h3>Conclusions</h3><div>TVR demonstrated lower FPS rates compared to self-reported data. TVR may offer a more accurate method of FPS estimation than retrospective chart reviews.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 10","pages":"Article 113681"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914834","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":"CT-based three-dimensional fracture mapping reveals characteristic patterns in pelvic insufficiency fractures","authors":"Katharina Jäckle,&nbsp;Yvonne Radke,&nbsp;Niklas Lehmann,&nbsp;Marc-Pascal Meier,&nbsp;Thelonius Hawellek,&nbsp;Paul-Jonathan Roch,&nbsp;Friederike Eva Roch,&nbsp;Lukas Weiser,&nbsp;Wolfgang Lehmann,&nbsp;Arndt F. Schilling","doi":"10.1016/j.injury.2026.113697","DOIUrl":"10.1016/j.injury.2026.113697","url":null,"abstract":"<div><h3>Background</h3><div>Pelvic insufficiency fractures are increasingly common in older adults and frequently involve the posterior pelvic ring. However, their population-based three-dimensional distribution has not yet been systematically characterized across the complete Fragility Fractures of the Pelvis (FFP) classification. This study aimed to generate a standardized CT-based three-dimensional fracture map, identify reproducible anatomical hotspots, and visualize fracture distribution across FFP types I–IV.</div></div><div><h3>Methods</h3><div>CT datasets from 67 geriatric patients with pelvic insufficiency fractures (mean age 82.78 ± 6.84 years; 77.6% women) were retrospectively analyzed. Fractures were classified according to the FFP classification of Rommens and Hofmann, segmented in 3D Slicer, registered to a standardized pelvic template, and visualized as frequency-based three-dimensional heatmaps in Blender.</div></div><div><h3>Results</h3><div>A total of 184 fracture lines were mapped. Fracture clustering was most pronounced in the sacral alae, accounting for 54% of all mapped fracture locations, followed by the parasymphyseal region (22%) and the remaining anterior pelvic ring (15%). Iliac wing and acetabular involvement was less frequent, accounting for 6% and 3%, respectively. FFP-specific heatmaps demonstrated a transition from isolated anterior fractures in FFP type I to progressively broader posterior and bilateral involvement in FFP types II–IV.</div></div><div><h3>Conclusion</h3><div>Standardized CT-based three-dimensional fracture mapping identified the sacral alae as the principal hotspot of pelvic insufficiency fractures and visualized characteristic spatial patterns across the FFP classification. This approach provides an anatomical framework for improved CT interpretation and future biomechanical, diagnostic, and surgical-planning studies.</div></div><div><h3>Mini abstract</h3><div>Pelvic insufficiency fractures are an increasing consequence of osteoporosis, but their three-dimensional distribution remains poorly understood. CT-based heatmapping identified the sacral alae as the principal fracture hotspot and visualized progressive posterior extension across the FFP classification. These findings improve the anatomical understanding of osteoporotic pelvic fragility fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 10","pages":"Article 113697"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979182","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":"Generation Z and engagement in orthopaedic trauma: A multigenerational qualitative study","authors":"Taco J. Blokhuis,&nbsp;Micha Holla,&nbsp;Jesus Gomez Vallejo,&nbsp;Sithombo Maqungo,&nbsp;Robert P. Dunbar","doi":"10.1016/j.injury.2026.113538","DOIUrl":"10.1016/j.injury.2026.113538","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare systems face increasing demand due to population ageing and workforce shortages. At the same time, Generation Z is entering surgical training. Their work values may differ from those of previous generations, potentially affecting engagement in demanding specialties such as orthopaedic trauma surgery. This study explores multigenerational perspectives on professional identity, work intensity, academic engagement, and work–life integration within orthopaedic trauma.</div></div><div><h3>Methods</h3><div>Prior to the 2024 Leadership Forum of the Osteosynthesis and Trauma Care Foundation (OTCF), a standardized questionnaire consisting of declarative statements rated on a five-point Likert scale was distributed to orthopaedic trauma residents and senior consultants from international chapters. During the Forum, a moderated multigenerational discussion was conducted. The session was recorded, transcribed verbatim, and analyzed using thematic qualitative analysis.</div></div><div><h3>Results</h3><div>Eight residents and fifteen consultants from Europe, North America, South America, Africa, and Asia participated. Across generations, intensive training was considered essential for achieving surgical mastery. However, younger participants emphasized work–life boundaries, institutional recognition of non-clinical work, and psychological safety. Senior surgeons more frequently described their profession as central to their identity and viewed unpaid academic engagement as intrinsic to surgical responsibility.</div></div><div><h3>Conclusion</h3><div>Generation Z trainees demonstrate strong commitment to orthopaedic trauma but differ from senior surgeons in expectations regarding professional identity, uncompensated academic work, and work–life integration. Recognition of evolving professional values is critical for workforce sustainability and intergenerational collaboration in trauma surgery.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 ","pages":"Article 113538"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149257850","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":"Femur Diaphysis Fractures: Mechanics Sorted but Biology Needs More Proactive Approach and Solutions","authors":"Zsolt J. Balogh,&nbsp;Seth M. Tarrant,&nbsp;Matthew D. Farrow,&nbsp;Gabrielle D Briggs","doi":"10.1016/j.injury.2026.113693","DOIUrl":"10.1016/j.injury.2026.113693","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 10","pages":"Article 113693"},"PeriodicalIF":2.4,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946381","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}