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

{"title":"Infections resulting from wild land and aquatic species injuries: A case series from Mornington Peninsula, Australia","authors":"Ishith Seth ,&nbsp;Omar Shadid ,&nbsp;Gianluca Marcaccini ,&nbsp;Roberto Cuomo ,&nbsp;Warren M. Rozen","doi":"10.1016/j.injury.2025.112715","DOIUrl":"10.1016/j.injury.2025.112715","url":null,"abstract":"<div><h3>Background</h3><div>Urban expansion into natural habitats has increased human interactions with wild terrestrial and aquatic species, leading to a rise in animal-related injuries. These incidents often result in complex infections, posing major public health challenges. This study examines the epidemiology, therapeutic interventions, and clinical outcomes of infections from non-domesticated animal injuries in the Mornington Peninsula, Australia.</div></div><div><h3>Methods</h3><div>This retrospective study (February 2021–April 2024) evaluated medical records of patients presenting with injuries from wild species who subsequently developed infections. Selection criteria included only cases with confirmed infections determined by clinical assessment or positive microbial cultures. Injuries from domestic animals, insects, or humans were excluded. The analysis assessed timing of infection onset, microbial culture results, antibiotic sensitivity profiles, and postoperative trajectories.</div></div><div><h3>Results</h3><div>A total of 52 bites from non-domesticated animals were documented, with 23 % (12/52) being infected. Most were males with an average age of 43 years. Among the 12 infected cases, Staphylococcus aureus was isolated in 3/12 (25 %), β-haemolytic streptococci in 2/12 (17 %), Enterococcus faecalis in 1/12 (8 %), Pseudomonas aeruginosa in 1/12 (8 %), Prevotella bivia in 1/12 (8 %), and Vibrio vulnificus in 1/12 (8 %); mixed coliform growth was observed in 3/12 (25 %). Compared to typical dog and cat bites, usually caused by Pasteurella multocida, streptococci, staphylococci and anaerobes, our series revealed a higher presence of marine-associated pathogens such as Vibrio species and environmental Gram-negative bacilli. Management involved wound debridement with adjunctive medical therapy (7/12), delayed primary closure (3/12), and medical management alone (3/12). All patients received empirical broad-spectrum antibiotics, which were later adjusted based on culture results. Most isolates were pan-sensitive, except for Vibrio vulnificus (ciprofloxacin-sensitive, resistant to penicillins/cephalosporins) and penicillin-resistant Staphylococcus aureus. All patients recovered without complications following comprehensive wound care and targeted antibiotic therapy. Notably, some marine-derived infections exhibited unique resistance patterns that required specific antimicrobial regimens.</div></div><div><h3>Conclusions</h3><div>The necessity for immediate comprehensive wound management and empirically guided antibiotic therapy, adjusted based on culture results, was essential for managing these complex infections. The data derived from this study provides essential insights into the microbial dynamics and clinical management of wild animal bite infections, emphasizing the need for individualized medical strategies.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112715"},"PeriodicalIF":2.0,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926515","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":"Unveiling the Severity of Pedestrian Traffic Crashes in South Australia: Age-based Insights and Safety Implications","authors":"Ali Soltani ,&nbsp;Ahmed Jaber ,&nbsp;Hamed Najafi Kashkooli ,&nbsp;Madiha Bencekri","doi":"10.1016/j.injury.2025.112716","DOIUrl":"10.1016/j.injury.2025.112716","url":null,"abstract":"<div><div>Pedestrian crashes are a global safety issue impacting all age groups, and despite extensive research, understanding the severity of crashes among different age groups has remained incomplete. Older and young pedestrians represent two distinct demographics with unique vulnerabilities. This paper examines the factors that impact the severity of pedestrian crashes resulting in Killed or Serious Injuries in South Australia over ten years (2012–2020) for two age groups, namely young pedestrians (age &lt; 18) and older pedestrians (age &gt; 65). The study employs several descriptive and analytical methods, including logistic and Classification and Regression Tree models. The findings reveal that older pedestrians are primarily involved in fatal crashes (32 %), while their young cohorts predominantly suffer from serious injuries (30 %). Young pedestrians experience more severe consequences when vehicle speeds are below 60 km/hr, but older pedestrians suffer a greater likelihood of harm at speeds beyond 60 km/hr. Age has a role in how unique elements, such as curving roadways and damp weather, affect the intensity of the impact. Young individuals are particularly drawn to motorways and one-way highways, which are prominent areas that underscore the necessity for action. Intersections, including crossroads and one-way highways, pose significant challenges for older pedestrians, underscoring the need for safety precautions. Also, there is a negative correlation between weekend crashes and log-odds of KSI compared to weekdays, which leads to lower severity for both age groups. Customizing safety protocols for distinct age cohorts is crucial for ensuring efficient crash mitigation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112716"},"PeriodicalIF":2.0,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933131","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":"Threaded K-wire vs cortical screw fixation in O’Driscoll type 2 and 3 coronoid fractures: a comparative biomechanical study","authors":"Cafer Ozgur Hancerli ,&nbsp;Ada Ozcecelik ,&nbsp;Ergun Bozdag ,&nbsp;Abdulhamit Misir","doi":"10.1016/j.injury.2025.112717","DOIUrl":"10.1016/j.injury.2025.112717","url":null,"abstract":"<div><h3>Background</h3><div>Coronoid fractures significantly impact elbow stability, yet limited biomechanical data exists comparing fixation methods for different fracture types. This study aimed to compare the biomechanical performance of threaded K-wire versus cortical screw fixation in O'Driscoll type 2 and 3 coronoid fractures.</div></div><div><h3>Methods</h3><div>Twenty-eight synthetic ulnar bones were divided into four groups (<em>n</em> = 7 each): Type 2 with K-wire fixation, Type 2 with screw fixation, Type 3 with K-wire fixation, and Type 3 with screw fixation. Fractures were created, reduced, and fixed under fluoroscopic guidance. Specimens underwent biomechanical testing using a custom-made apparatus to evaluate load to failure (N), displacement (mm), and stiffness (N/mm). Two-way ANOVA and post-hoc Tukey's tests were used for statistical analysis.</div></div><div><h3>Results</h3><div>Type 2 fractures with screw fixation demonstrated the highest load to failure (1392.59 ± 76.77 N), followed by Type 2 with K-wire fixation (1155.00 ± 200.81 N), Type 3 with K-wire fixation (1093.65 ± 248.68 N), and Type 3 with screw fixation (1058.54 ± 320.46 N), though differences were not statistically significant (<em>p</em> = 0.086). For stiffness, Type 2 fracture fixation fractures exhibited significantly higher values (∼256 N/mm) compared to Type 3 fractures (∼160 N/mm) regardless of fixation method (<em>p</em> = 0.002, Cohen's <em>d</em> = 1.55). The fixation method itself (K-wire vs. screw) did not significantly affect any biomechanical parameter (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>O'Driscoll Type 2 fracture fixation provide superior biomechanical stability compared to Type 3 fractures, primarily through enhanced stiffness. While Type 2 screw fixation demonstrated the highest load to failure values, K-wire fixation in Type 2 fractures offered comparable stiffness. These findings suggest that fracture type has a more profound impact on mechanical performance than the choice between K-wire and screw fixation, giving surgeons flexibility in fixation choice for Type 2 fractures while maintaining adequate stability for early rehabilitation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112717"},"PeriodicalIF":2.0,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921999","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 standardized fluoroscopic sequence to reveal residual MCL instability after repair of the LUCL in elbow injury","authors":"Allen A. Champagne ,&nbsp;Alexandra V. Paul ,&nbsp;George A. Puneky ,&nbsp;Matthew J. Brown ,&nbsp;Jacob S. Torrey ,&nbsp;Oke A. Anakwenze ,&nbsp;Eliana B. Saltzman ,&nbsp;Daphne M. Beingessner ,&nbsp;Jennifer Tangtiphaiboontana ,&nbsp;David S. Ruch ,&nbsp;Christopher S. Klifto ,&nbsp;Jonah Hebert-Davies ,&nbsp;Malcolm R. DeBaun","doi":"10.1016/j.injury.2025.112719","DOIUrl":"10.1016/j.injury.2025.112719","url":null,"abstract":"<div><h3>Background</h3><div>Indications for stabilization of the medial collateral ligament (MCL) after repair of the lateral ulnar collateral ligament (LUCL) remain controversial. Here, we propose a standardized fluoroscopic sequence to reveal residual medial elbow instability to facilitate intraoperative decision-making.</div></div><div><h3>Methods</h3><div>Eight matched cadaveric upper extremity pairs (<em>N</em> = 16) were mounted to simulate intraoperative positioning. Fluoroscopic images were acquired using the following: full extension, 45-degree flexion, 90-degree flexion, and full flexion with the forearm in neutral/pronation/supination. These were acquired at “baseline” and following destabilization of the LUCL/MCL. The proposed fluoroscopic sequence was then repeated following surgical fixation of the LUCL (“post-LUCL repair”) followed by MCL repair (“post-LUCL &amp; MCL repair). Blinded images were fitted using a best-fit circle to compute ulnohumeral distance (UHD, millimeters) and determine residual lateral (supination) and medial (pronation) instability defined by the presence of a drop sign (UHD&gt;4 mm). Radiocapitellar ratio (RCR) was computed to determine radiocapitellar instability (RCR&gt;10 %). Blinded images were also qualitatively evaluated against the contralateral baseline to simulate intraoperative assessment.</div></div><div><h3>Results</h3><div>Apparent instability in supination status-post destabilization resolved following LUCL repair with evident residual medial-sided instability showed in pronation, which resolved after MCL fixation. Evaluation of the drop sign at 45 and 90 degrees of flexion showed comparable quantitative sensitivity at 97 % and 98 %, unlike in full extension or full flexion (sensitivity &lt;35 %). Quantitative sensitivity was 88 % for RCR in mid-flexion. Qualitative evaluation for the drop sign and RCR resulted in sensitivity of 93 and 75 %, respectively.</div></div><div><h3>Conclusions</h3><div>The proposed fluoroscopic sequence provides reliable intraoperative assessment to evaluate for residual medial-sided instability in the setting of multi-ligamentous elbow injuries. After repair of the LUCL, medial residual instability due to MCL rupture is best revealed with the presence of a drop sign in full pronation and midflexion.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112719"},"PeriodicalIF":2.0,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144907812","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":"Rehabilitation resource planning for mass casualty incidents: A retrospective analysis of blast and ballistic injuries","authors":"C Barmatz ,&nbsp;M Crowe ,&nbsp;E Biros ,&nbsp;D Mendez ,&nbsp;I Dudkiewicz ,&nbsp;JE Reznik","doi":"10.1016/j.injury.2025.112692","DOIUrl":"10.1016/j.injury.2025.112692","url":null,"abstract":"<div><h3>Introduction</h3><div>Mass casualty incidents (MCIs) involving extensive ballistic and explosive injuries place considerable pressure on healthcare resources. This study aimed to evaluate the rehabilitation resources required for individuals who sustained blast and ballistic injuries during an MCI.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted using Electronic Medical Records (EMRs) of patients admitted to Sheba Medical Center (SMC), Israel, following an MCI on 7 October 2023. Patients diagnosed with gunshot wounds (GSW), or blast injuries (BI) were included. Data were collected over an almost 7-month period, focusing on injury patterns, rehabilitation department admissions, total hospital length of stay, and associated budgetary requirements.</div></div><div><h3>Results</h3><div>A total of 419 patients received rehabilitation at SMC: 205 with BI, 175 with GSW, 10 with both, and 9 with unknown injury causes. Two patients were under 18; the majority (76 %) of adults were aged 18–29. Military personnel comprised 90 % of the cohort, with 95 % male. Paediatric rehabilitation admitted the two minors, while adult patients were distributed across respiratory (<em>n</em> = 7), neurological (<em>n</em> = 32), head trauma (<em>n</em> = 44), and orthopaedic (<em>n</em> = 68) rehabilitation units. Additionally, 266 patients were treated in three newly established rehabilitation wards. BI patients experienced more complex, multi-trauma injuries, including traumatic brain injuries (11 %) and spinal cord injuries (11 %), underwent more surgical procedures, and had longer hospital stays. Consequently, the average rehabilitation cost per BI patient exceeded that of GSW patients.</div></div><div><h3>Conclusion</h3><div>Through strategic planning and multidisciplinary collaboration, SMC effectively managed a high volume of MCI-related injuries. BIs required significantly more rehabilitation resources than GSWs. These findings underscore the importance of preparedness, resource allocation, and interdepartmental coordination in managing rehabilitation during MCIs. SMC’s experience offers valuable insights for global healthcare systems facing similar high-demand emergency scenarios.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112692"},"PeriodicalIF":2.0,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989003","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":"Effect of ketorolac administration on the rate of nonunion of operatively treated humeral shaft fractures: A matched cohort analysis","authors":"Akhil Katakam ,&nbsp;Tej Joshi ,&nbsp;Tuckerman Jones ,&nbsp;Eitan M Kohan ,&nbsp;Francis G Alberta","doi":"10.1016/j.injury.2025.112689","DOIUrl":"10.1016/j.injury.2025.112689","url":null,"abstract":"<div><h3>Background</h3><div>Humeral shaft fractures treated surgically have a 5–10 % risk of nonunion. NSAIDs, including ketorolac, are frequently prescribed postoperatively for pain management, but concerns persist regarding their effects on bone healing. Although prior studies suggest a potential association between ketorolac and nonunion, findings remain inconclusive. This study aims to assess the impact of ketorolac on nonunion risk in adults undergoing surgical treatment for humeral shaft fractures.</div></div><div><h3>Methods</h3><div>The TriNetX Research Database was queried using ICD and CPT codes to identify patients who underwent operative fixation of humeral shaft fractures with a minimum of 2 years of follow-up. Exclusion criteria included prior humeral shaft nonunion, pathologic fractures, and age under 18. Patients were divided into two cohorts based on whether they received ketorolac within 1 month postoperatively. Outcomes included nonunion diagnosis, nonunion surgery, opioid utilization, wound complications, superficial infection, deep infection, and hardware infection. Outcomes were analyzed at 30 days, 90 days, 1 year, 2 years, and final follow-up.</div></div><div><h3>Results</h3><div>There was no significant difference in opioid utilization within 30 days postoperatively (HR 1.051, 95 % CI 0.987–1.118, <em>p</em> = 0.073; prescriptions 3.2 ± 4.9 vs. 3.2 ± 5.0, <em>p</em> = 0.721). However, at 1-year, 2-year, and overall follow-up, patients receiving ketorolac demonstrated a significantly increased risk of nonunion surgery. At final follow-up (2.9 ± 2.8 years vs. 3.4 ± 3.5 years), nonunion incidence was not significantly different (4.7 % vs. 4.2 %, <em>p</em> = 0.317), but ketorolac use was associated with a 45.1 % increased risk of nonunion surgery (95 % CI 1.050–2.006, <em>p</em> = 0.023).</div></div><div><h3>Conclusion</h3><div>Ketorolac use was associated with approximately 40 % increased risk of nonunion surgery without reducing postoperative opioid use. Further research is warranted to evaluate the perioperative administration of ketorolac and other NSAIDs in humeral shaft fractures.</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 112689"},"PeriodicalIF":2.0,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912312","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":"Fellowship recruitment: Which factors influence orthopaedic applicants to choose a combined arthroplasty/trauma fellowship program?","authors":"Nickolas L. Van Roekel ,&nbsp;Travis D. Parkulo ,&nbsp;Sandy Vang ,&nbsp;Gaonhia Y. Moua ,&nbsp;Edwin G. Rosado Hernandez ,&nbsp;Gennadiy A. Busel","doi":"10.1016/j.injury.2025.112685","DOIUrl":"10.1016/j.injury.2025.112685","url":null,"abstract":"<div><h3>Background</h3><div>To prepare junior surgeons for possible increased trauma call burden and improve young surgeons’ workplace marketability, there has been an increase in fellowship programs offering combined arthroplasty and trauma curriculums. The purpose of this study was to determine the relative importance of factors considered by applicants applying to combined programs. This information will serve program directors, who can improve applicant recruitment, along with improving the experiences of fellows.</div></div><div><h3>Methods</h3><div>Survey respondents were asked to rate 23 fellowship program factors on a 1-to-5 Likert scale with 1 being “not important at all” and 5 being “critical”. Respondents were also asked to list their top 5 factors in order of decreasing importance with 1 being the most important. A two-sample <em>t</em>-test was used to analyze subgroups. Statistical significance defined as <em>P</em>-value &lt; 0.05.</div></div><div><h3>Results</h3><div>Surveys were sent to 192 applicants, and 75 responses were received with a 39.1 % response rate. The overall highest rated factors were operative experience (mean 4.87; SD 0.34), revision total joint experience (mean 4.61; SD 0.61), periprosthetic fracture experience (mean 4.52; SD 0.60), and primary total joint experience (mean 4.17; SD 0.86). A subgroup analysis was performed by creating three groups: surgical experience, program details and history, and financial factors. Surgical experience group was ranked highest (mean 3.81; SD 1.72). Programs details and history (mean 3.12; SD 1.05) and financial factors (mean 2.35; SD 1.08) rated significantly lower than surgical experience (<em>P</em>-value &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Applicants of combined arthroplasty and trauma fellowships value similar characteristics in a program as those applying to either arthroplasty or trauma alone. Combined fellowship programs should update their websites as applicants frequently use online sources to educate themselves on existing programs.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112685"},"PeriodicalIF":2.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903173","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":"Percutaneous screw fixation of pubic symphysis disruption","authors":"Joshua J Sun,&nbsp;Peter Cannamela,&nbsp;John L Eakin,&nbsp;Ishvinder Grewal,&nbsp;Ashoke K Sathy,&nbsp;Adam J Starr","doi":"10.1016/j.injury.2025.112686","DOIUrl":"10.1016/j.injury.2025.112686","url":null,"abstract":"<div><div>Percutaneous fixation of the pubic symphysis is a relatively novel treatment strategy in the management of pelvic ring injuries with symphyseal disruption. While the current gold standard for surgical treatment of pubic symphysis diastasis is open reduction and plate fixation, high rates of implant failure and recurrent diastasis persist. Furthermore, blood loss, operative time, and postoperative infection associated with open approaches to the pelvis should be considered. Percutaneous fixation of the posterior pelvic ring has proven to be safe and effective. Percutaneous fixation of the pubic symphysis has been described in China and Spain, with promising results. We present here our surgical technique for percutaneous reduction and fixation of the pubic symphysis with emphasis on the risks to nearby anatomic structures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112686"},"PeriodicalIF":2.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921998","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":"Clinical, patient-reported, and radiographic outcomes of proximal humerus open reduction internal fixation augmented with calcium sulfate hydroxyapatite bio-composite (CERAMENT BONE VOID FILLER)","authors":"Margaret A. Sinkler,&nbsp;Tyler J. Moon,&nbsp;Jeremy M. Adelstein,&nbsp;Alexander Nighswander,&nbsp;Leah Pollifrone,&nbsp;Ashlee Gorjup,&nbsp;Elika Fanaeian,&nbsp;George Ochenjele","doi":"10.1016/j.injury.2025.112683","DOIUrl":"10.1016/j.injury.2025.112683","url":null,"abstract":"<div><h3>Introduction</h3><div>To minimize the complications associated with proximal humerus open reduction internal fixation (ORIF), various augmentation strategies have been utilized to manage humeral head bone loss. The purpose of the study is to report clinical and patient reported outcomes of calcium sulfate hydroxyapatite bio-composite bone void filler augmentation of proximal humerus ORIF.</div></div><div><h3>Methods</h3><div>A prospective cohort of patients who sustained a proximal humerus fracture (PHF) treated with ORIF were collected between 2022–2024. All patients were treated with adjunctive calcium sulfate hydroxyapatite bio-composite bone void filler (CERAMENT BONE VOID FILLER, BONESUPPORT INC, Needham, MA) after reduction and instrumentation. Peri-operative complications were recorded. PROMIS scores of physical function and pain interference were collected. Follow-up radiographs were evaluated for bone void filler resorption/remodeling and union. These patients were 1:1 propensity matched to a retrospective comparative cohort of PHF without augmentation for comparative analysis.</div></div><div><h3>Results</h3><div>24 patients were enrolled in the study. 20 patients (83 %) were female. Mean age was 68±11 years and mean BMI was 29±7 kg/m². Patients had a mean follow up of 424±123 days. All patients had radiographic evidence of bone void filler resorption and remodeling at an average of 130±77 days. Of the 24 patients, 21 had available PROMIS scores. At final follow up, patients reported an average 46.3 ± 9.9 physical function score and 63.8 ± 6.3 pain interference score at an average of 273±191 days post operative. The 24 patients augmented with CBVF were matched to 24 patients with PHF without augmentation. Twenty-two patients in the CBVF group had fracture union compared to twenty in the non-augmented group(92 % vs 83 %, <em>p</em> = 0.38). Additionally, the CBVF group had reduced rates of screw penetration(4 % vs 21 %, <em>p</em> = 0.08), progressive fracture displacement(4 % vs 17 %, <em>p</em> = 0.16), and revision surgery(4 % vs 17 %, <em>p</em> = 0.16). On multivariate analysis, the use of CBVF significantly lowered the odds of developing intra-articular screw penetration(OR = 0.007, <em>p</em> = 0.02)</div></div><div><h3>Conclusion</h3><div>This series demonstrates favorable outcomes in proximal humerus ORIF augmented using calcium sulfate hydroxyapatite bio-composite as bone void filler compared to a matched cohort of patients treated without augmentation. There is a low rate of loss of fracture fixation and high union rate with favorable patient reported outcome measures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112683"},"PeriodicalIF":2.0,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912311","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":"Comparison of the therapeutic effects of modified 15-mm incision minimally invasive approach with the conventional approach in the treatment of AO 23-B3 distal radius fractures","authors":"Jun Liu ,&nbsp;Gang Zhao ,&nbsp;Hao Liu,&nbsp;Peng Wang,&nbsp;Yuan Xue,&nbsp;Junhao Luo,&nbsp;Yongjun Rui","doi":"10.1016/j.injury.2025.112682","DOIUrl":"10.1016/j.injury.2025.112682","url":null,"abstract":"<div><h3>Background</h3><div>The classic surgical technique of the 15-mm incision minimally invasive approach is not suitable for AO 23-B3 distal radius fractures (abbreviated B3). We have modified this technique for B3. This study aimed to investigate the efficacy of the modified 15-mm incision minimally invasive approach with the conventional ORIF approach in the treatment of B3.</div></div><div><h3>Methods</h3><div>This retrospective study included 62 patients with B3 who underwent surgical treatment from January 2020 to May 2024, including 31 patients undergoing the modified 15-mm incision minimally invasive approach (M group) and 31 patients undergoing the conventional ORIF approach (C group). The two groups had similar baseline characteristics (<em>P</em> &gt; 0.05). The perioperative data, follow-up data, and imaging results of the two groups were compared. At the last follow-up, the limb function was assessed using the PRWE and DASH scores.</div></div><div><h3>Results</h3><div>In the C group, 1 patient experienced infection and 1 patient experienced complex regional pain syndrome, whereas in the M group, there were no such patients. In the M group, the incision length, intraoperative bleeding, hospital stay, hospitalization expenses, swelling, and VAS on postoperative days 2 and 7, flexion-extension, ulnar-radial deviation and pronation-supination at postoperative 3 months, and pronation-supination ROM in 12–24 months of follow-up were superior, but the surgical and fluoroscopy time was longer compared to the C group (<em>P</em> &lt; 0.05). There was no difference between the two groups in terms of fracture reduction, fracture healing time, full weight-bearing time, complications, and flexion-extension ROM, PRWE and DASH in the last follow-up (<em>P</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>Both methods were effective for treating B3. The M group was superior in terms of aesthetic appeal of the incision, surgical trauma and associated risks, hospital stay, early recovery, and final rotational function, which are consistent with the principles of MIPO and rapid recovery, but requires longer surgical and fluoroscopy time.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112682"},"PeriodicalIF":2.0,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144907811","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}