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

{"title":"Pelvic fractures and thoracolumbar spine injury: A critical overlook in high-impact vehicular trauma management","authors":"Zachary A. Mohs ,&nbsp;Nathaniel Albrecht ,&nbsp;Anthony J. Duncan ,&nbsp;Li Cao ,&nbsp;Mentor Ahmeti","doi":"10.1016/j.injury.2024.112050","DOIUrl":"10.1016/j.injury.2024.112050","url":null,"abstract":"<div><h3>Introduction</h3><div>Pelvic fractures (PF) occur in up to 9 % of trauma cases, primarily from high-impact events, and are associated with increased morbidity and mortality due to frequent concomitant injuries. Thoracolumbar (TL) spinal fractures, particularly at the T10-L2 junction, are also common in high-energy trauma but are less frequently examined in association with PF. Missed TL fractures can lead to serious neurological deficits. Although Advanced Trauma Life Support (ATLS) recommends screening for TL fractures in trauma patients, no standardized guidelines exist. This study aims to explore the relationship between PF and TL fractures in trauma patients and to identify key variables associated with these injuries.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed data from the 2021 National Trauma Data Bank (NTDB), focusing on patients with PF resulting from high-impact blunt trauma. Patients were identified using ICD-9 codes for pelvic fractures, and those under 18 years of age or with penetrating trauma were excluded. We collected demographic data, injury grading (Injury Severity Score [ISS], Abbreviated Injury Scale [AIS]), and patient outcomes, comparing those with isolated pelvic fractures (IPF) to those with concomitant pelvic and TL fractures (PTLF).</div></div><div><h3>Results</h3><div>Of the 37,987 patients with PF, 32.4 % (n = 12,318) had concomitant TL fractures. PTLF patients were older (mean age 44.12 vs. 40.12 years, p &lt; 0.001) and exhibited higher ISS and AIS scores compared to IPF patients. The PTLF group had longer hospital stays (14.51 days vs. 9.4 days, p &lt; 0.001) and higher rates of ICU admission (41.4 % vs. 24.0 %, p &lt; 0.001) and mortality (9.5 % vs. 4.3 %, p &lt; 0.001). PTLF patients were less likely to be discharged home (29.5 % vs. 43.5 %, p &lt; 0.001) and more likely to be transferred to rehabilitation or long-term care facilities. Motor vehicle collisions were the most common mechanism of injury, but auto-pedestrian accidents were more frequent in the PTLF group (17.3 % vs. 11.1 %, p &lt; 0.001). Lumbar spine fractures accounted for 70.2 % of TL injuries.</div></div><div><h3>Conclusion</h3><div>Pelvic fractures from high-impact trauma are strongly associated with concomitant TL fractures, which lead to worse clinical outcomes. Routine TL spine screening in these patients is recommended to ensure timely diagnosis and treatment</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112050"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792565","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":"Assessing the impact of perioperative anticoagulant continuation on DVT/PE rates in trauma patients","authors":"Armarion Stegall,&nbsp;J. Tracy Watson,&nbsp;Heidi Israel","doi":"10.1016/j.injury.2025.112143","DOIUrl":"10.1016/j.injury.2025.112143","url":null,"abstract":"<div><h3>Introduction</h3><div>In the United States, deep vein thrombosis (DVT) and pulmonary embolism (PE) ranked high in terms of possibly preventable hospital deaths. Victims of trauma were at a higher risk of developing thromboembolic complications, and thus various agents were used for prophylaxis. Multiple studies recommended holding these agents in the perioperative period to decrease the potential complications of additional bleeding, wound issues, hematoma etc. However, the data regarding the timing and duration of withholding these agents was not consistent and at times surgeon specific. The aim of this study was to compare the incidence of DVT/PE in trauma patients before and after a June 2022 policy intervention to operate through prophylactic anticoagulation at an academic trauma center.</div></div><div><h3>Methods</h3><div>We compared DVT/PE rates in trauma patients requiring surgery prior to and following policy change at our institution. The query included charts from January 1, 2018, through December 31, 2023. Clinical information relating to trauma date, surgery date, injury type, anticoagulant administration, DVT/PE development, and death, if applicable, was obtained from patient charts. We conducted a chi-square post hoc analysis to evaluate the incidence of DVT or PE before and after a policy change. The analysis focused on two categories: the presence or absence of DVT/PE.</div></div><div><h3>Results</h3><div>DVT/PE development was 14.553 times more likely pre-policy change when anticoagulation was held prior to surgery compared to post-policy change when anticoagulation was administered before surgery (X² (3, N = 374) =14.553, <em>p</em>=.002). Mortality related to DVT/PE showed no significant difference between pre-policy and post-policy groups (X² (1, N = 374) = 0.130, <em>p</em> = .718). After excluding patients over age 65, analysis of MVA blunt trauma charts showed no statistical difference in blood transfusions pre policy v. post policy (X² (1, N = 174) = 0.2198, <em>p</em> = .639).</div></div><div><h3>Conclusion</h3><div>Findings suggested that DVT/PE rates have significantly decreased post policy change without a significant increase in mortality and bleeding risk.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112143"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974050","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":"Low-grade infections in nonunion of the femur and tibia without clinical suspicion of infection – Incidence, microbiology, treatment, and outcome","authors":"Katharina Trenkwalder ,&nbsp;Sandra Erichsen ,&nbsp;Ferdinand Weisemann ,&nbsp;Christian von Rüden ,&nbsp;Peter Augat ,&nbsp;SAND Research Group ,&nbsp;Simon Hackl","doi":"10.1016/j.injury.2024.112137","DOIUrl":"10.1016/j.injury.2024.112137","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Treatment algorithms for fracture nonunion depend on the presence or absence of bacterial infection. However, it is often impossible to identify infection preoperatively. While some infections may present with clinical signs of infection, low-grade infections lack infection signs and have a clinical presentation similar to aseptic nonunion. The clinical relevance of low-grade infection in nonunion is not entirely clear. Therefore, the aim of this study was to evaluate the role of low-grade infection in the development and management of lower extremity nonunion.&lt;/div&gt;&lt;div&gt;A prospective multicenter clinical study enrolled patients with femoral or tibial shaft nonunion and regular healed fractures, scheduled for nonunion revision and routine implant removal, respectively. Preoperatively, serum markers including C-reactive protein (CRP), leukocytes, and procalcitonin were determined, clinical infection signs were recorded, and a suspected septic or aseptic diagnosis was made prior to surgery and further diagnostics. Tissue samples were collected for microbiology and histopathology, and osteosynthesis material for sonication. Nonunion patients were followed for twelve months, during which the definitive diagnosis of “septic” or “aseptic” nonunion was made according to diagnostic criteria for fracture-related infection.&lt;/div&gt;&lt;div&gt;One hundred and ten patients with nonunion and 34 patients with regular healed fractures were included. Sixty-two nonunion patients were diagnosed as aseptic, 22 with expected and confirmed infection, and 23 with unexpected low-grade infection. Three patients had an unclear diagnosis. Low-grade infection was detected in 28 % of presumed aseptic nonunion patients. Sensitivity and specificity for the suspected diagnosis were 49 % and 95 %, respectively. The suspected diagnosis had a significant impact on revision strategy. All medians of the preoperative blood values were within the reference ranges except for CRP, which was slightly elevated in the expected and confirmed infected nonunion group. Expected and confirmed septic nonunion and unexpected low-grade infected nonunion demonstrated a similar bacterial spectrum. While 10 % of patients with aseptic nonunion required follow-up surgeries, re-operation rates were higher in patients with low-grade infection and expected and confirmed infection at 30 % and 64 %, respectively. Patients with low-grade infections were treated less frequently with systemic antibiotics and for a shorter duration than patients with expected and confirmed infections, with no significant difference in healing rate which was 83 % in low-grade and 62 % in expected and confirmed infections. The healing rate of aseptic nonunion was 90 %. A limitation of this study is the limited number of tissue samples for microbiological and histopathological diagnostics in the suspected aseptic nonunion cohort, which may have led to an underestimation of the low-grade infection rate.&lt;/div&gt;&lt;div&gt;Our findings sug","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112137"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974051","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":"Time to surgery and other risk factors for mortality and complication rates in patients with periprosthetic femoral fractures at the knee","authors":"Christian Wulbrand,&nbsp;Franz Müller,&nbsp;Markus Weber,&nbsp;Bernd Füchtmeier,&nbsp;Alexander Hanke","doi":"10.1016/j.injury.2024.112071","DOIUrl":"10.1016/j.injury.2024.112071","url":null,"abstract":"<div><h3>Background</h3><div>There is a high level of evidence that a short time to surgery (TTS) improves the outcome for patients with hip fractures. Accordingly, recommendations for timely treatment have been included in national guidelines. As patient characteristics appear to be similar, it seems reasonable that these guidelines are applicable to other fracture entities, such as knee periprosthetic femoral fracture (PPF). This monocentric retrospective study aimed to investigate outcome-related risk factors, particularly TTS, for knee PPF.</div></div><div><h3>Methods</h3><div>In total, 141 consecutive patients with knee PPF in a maximum-care arthroplasty and trauma centre, treated between 2006 and 2020, were retrospectively evaluated. Primary outcome variables were operative and general complications as well as mortalities within 1 year. Outcome-related risk factors were identified based on regression analysis using SPSS. For analysis of TTS, the cases were divided into two groups using a TTS of 24 h as the cutoff value.</div></div><div><h3>Results</h3><div>The 1-year mortality was 8.3 %. Associated risk factors were age (HR 1.2; <em>p</em> = 0.010) and Charlson score (HR 2.1; <em>p</em> = 0.001). Both, surgical and general complications occurred in 20.6 % of the cases. Age (OR 1.07, <em>p</em> = 0.025) and a TTS &gt; 24 h (OR 3.06, <em>p</em> = 0.020) were identified as risk factors for general complications. The TTS ≤ 24 h (<em>n</em> = 75) and TTS &gt; 24 h (<em>n</em> = 66) groups were comparable in terms of baseline characteristics. Revision arthroplasty was performed more frequently in the TTS &gt; 24 h group (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>1-year mortality after knee PPF was 8.3 %. With a high complication rate in the treatment of knee PPF, TTS was identified as a risk factor for general complications. Early treatment appears to be beneficial for patients with knee PPF.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112071"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792676","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":"Fractures complicating intraosseous access in pediatric patients – A systematic review","authors":"Megan Williams ,&nbsp;Samira Mehdi ,&nbsp;Lauren Tristani ,&nbsp;Dina El Demellawy ,&nbsp;Youssef Nasr","doi":"10.1016/j.injury.2024.112034","DOIUrl":"10.1016/j.injury.2024.112034","url":null,"abstract":"<div><h3>Introduction</h3><div>Intraosseous (IO) access is a commonly used procedure in pediatric emergencies for establishingvascular access when alternative means, such as intravenous access, cannot be obtained. Likealternative routes, IO can be administered quickly and provides a route for medications, blood products,and fluids to be infused in emergency circumstances. While the use of IO is generally considered safewith minimal risks, potential complications can include compartment syndrome, infection, thrombosis, and fracture.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, a comprehensive search was performed across various academicdatabases. Search parameters were restricted to exclude articles that where; non-English, non-full text,and not published between 1922 and 2022. Articles were included in analysis if they included patients from 0 to 18 and reported on both the patient outcomes and the procedural information.</div></div><div><h3>Results</h3><div>Following data synthesis (<em>n</em> = 27 articles [<em>n</em> = 1339 cases]), it was observed that the EZ-IO needle was thepredominant choice of access, accounting for 69.7 % of cases. The tibia emerged as the most frequentlyselected insertion site, utilized in 97 % of instances. Among the 226 cases that reported on laterality, a nearly equal distribution between left (114) and right (112) sides were observed. Most IO attempts were successful in accessing vascular access upon first attempt. There were 23 cases that required a second attempt to achieve access, and 4 cases necessitating 3 or more attempts. Within 1339 participants, a complication was reported in 105 cases, producing a complication rate of 7.8 %. Of those 105 complications, fracture occurred 7 times (6.67 %). When specifically isolating fracture as a complication resulting IO access, only 7 cases were reported, indicating an occurrence rate of 0.52 %.</div></div><div><h3>Conclusion</h3><div>This review supports the rarity of fracture as a complication following the use of an IO needle in pediatric age group, emphasizing the need for additional research to elucidate the underlying risk factors associated with fracture in these cases. Additionally, it underscores the importance of conducting further pathological investigations to gain insight into bone histology that may be indicative of IO access and/or fracture occurrence.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112034"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831516","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":"Arthroscopic lateral ligament reconstruction for isolated chronic lateral ankle instability is associated with longer recovery compared to arthroscopic Broström repair and inferior extensor retinaculum augmentation","authors":"Shi-Ming Feng ,&nbsp;Qing-Qing Sun ,&nbsp;Chong Xue ,&nbsp;Nicola Maffulli ,&nbsp;Francesco Oliva ,&nbsp;Xin Luo","doi":"10.1016/j.injury.2024.112082","DOIUrl":"10.1016/j.injury.2024.112082","url":null,"abstract":"<div><h3>Background</h3><div>Patients with chronic lateral ankle instability (CLAI) can be managed with arthroscopic Broström repair and inferior extensor retinaculum augmentation or arthroscopic assisted lateral ligament reconstruction using ipsilateral semitendinosus autograft, with good functional outcomes in patients. It is unclear whether one offers better outcome that the other. This retrospective analysis of prospectively collected data compared the outcomes of repair and reconstruction.</div></div><div><h3>Methods</h3><div>Patient treated for CLAI by arthroscopic Broström repair and inferior extensor retinaculum augmentation (Repair/augmentation Group; n=39) and lateral ligament reconstruction (Reconstruction Group; n=23) procedures with a minimum follow-up of 24 months were enrolled. The operative time, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Tegner score, Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the time of the patients return to sports activities were assessed.</div></div><div><h3>Results</h3><div>The operative time was longer in the Reconstruction Group. The patients in the Reconstruction Group experienced more pain. At 3 months after surgery, the patients in Repair/augmentation Group gained better AOFAS, KAFS, Tegner, and AJPS scores. At 6 months after surgery, better KAFS and AJPS were observed in Repair/augmentation Group. At 1 and 2 years, patients in the Reconstruction Group recorded better functional outcomes (AOFAS and KAFS) compared to the Repair/augmentation Group. The mean time of the patients return to sports activities was 10.42 ± 7.77 weeks (range, 8-56 weeks) in the Repair/augmentation Group, compared to 14.18± 5.34 weeks (range, 8-24 weeks) in the Reconstruction Group (<em>p</em> = 0.049).</div></div><div><h3>Conclusion</h3><div>In CLAI patients, arthroscopic reconstruction yields better outcomes in terms of ATT, AOFAS, and KAFS in the mid-term; however, it is associated with a longer intraoperative time, delayed return to sports, and an extended duration to resume normal ankle function compared to the arthroscopic Broström repair and inferior extensor retinaculum augmentation procedure.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112082"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866824","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":"Role of trauma center level in the outcome of severely injured geriatric patients","authors":"Samantha Scharringa ,&nbsp;Pieta Krijnen ,&nbsp;Pieter van de Linde ,&nbsp;Willem Stigter ,&nbsp;Guido Stollenwerck ,&nbsp;Jan Siert Reinders ,&nbsp;Klaas Hartholt ,&nbsp;Jochem Maarten Hoogendoorn ,&nbsp;Inger B. Schipper","doi":"10.1016/j.injury.2025.112201","DOIUrl":"10.1016/j.injury.2025.112201","url":null,"abstract":"<div><h3>Background</h3><div>According to the nationally imposed standard of care in the Netherlands, severely injured patients should be brought to a Level-1 trauma center for primary treatment. If not, they are considered to be undertriaged. This study aimed to determine the incidence of undertriage among severely injured geriatric patients and to evaluate the relation between hospital-undertriage and patient outcomes in elderly.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used anonymized data from the regional trauma registry of 1,431 patients aged ≥70 years with an Injury Severity Score ≥16 that were admitted to hospitals within the Trauma Region West-Netherlands between 2015 and 2022. Poor patient outcome was defined as in-hospital mortality or as a Glasgow Outcome Scale (GOS) score ≤3 at hospital discharge. The association between hospital level and poor outcomes was analyzed using multivariable logistic regression analysis with adjustment for confounders after multiple imputation of missing values.</div></div><div><h3>Results</h3><div>Seventeen percent of the severely injured geriatric patients were primarily transported to a Level-2/3 hospital. Female patients, older patients, and patients that had suffered a low-energy fall were most likely to be undertriaged. The adjusted odds ratio's for in-hospital mortality and GOS score ≤3 in Level-1 versus Level-2/3 hospitals were 1.26 (95 % confidence interval, 0.83–1.93; <em>p</em> = 0.28) and 0.81 (95 % confidence interval, 0.57–1.15; <em>p</em> = 0.24), respectively.</div></div><div><h3>Conclusion</h3><div>Undertriaged severely injured geriatric patients did not have a higher risk for poor outcomes. Level-2/3 hospitals seem to present a safe alternative for the treatment of these patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112201"},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174578","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":"Modified posterolateral approach to the ankle: A novel approach to minimise soft tissue dissection","authors":"S.M. Timoko-Barnes,&nbsp;C. Zhang","doi":"10.1016/j.injury.2025.112198","DOIUrl":"10.1016/j.injury.2025.112198","url":null,"abstract":"<div><div>Unstable ankle injuries often comprise multiple fracture lines; including a posterior malleolus fracture in up to 40% of cases. Surgical fixation of such injuries often requires multiple incisions. The configuration of the posterior malleolus fracture can also vary greatly, and the presence of this fracture is known to poorly affect patient outcomes. In this paper, the authors describe a modified posterolateral approach to the ankle which provides three windows for fixation of complex ankle fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112198"},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143208346","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 10-year experience of paediatric lower limb free flap surgery an evolution over time","authors":"Riyam Mistry ,&nbsp;Umraz Khan","doi":"10.1016/j.injury.2025.112196","DOIUrl":"10.1016/j.injury.2025.112196","url":null,"abstract":"<div><h3>Introduction</h3><div>Open lower limb fractures can carry significant morbidity and are typically managed with a well-defined care pathway. Thankfully such injuries are less frequent in paediatric populations. Management for children is the same as it is for adults. The aim of this study was to analyse paediatric patients undergoing treatment for open lower limb fractures at a UK major trauma centre over a ten-year period.</div></div><div><h3>Method</h3><div>A retrospective analysis was performed on all paediatric patients with an open lower limb fracture that required soft tissue coverage, presenting to a major trauma centre with orthoplastic services from December 2011 to February 2023. Patient data was analysed according to demographics, co-morbidities, injury classification, time to wound excision, time to definitive surgery, soft-tissue reconstruction type and size, types of anastomoses used, grades of operators, peri‑operative use of inotropes and blood products, return to theatre in 24 h, flap survival and long-term complications.</div></div><div><h3>Results</h3><div>We treated 94 patients with a mean age of 11 years old and mean weight of 46 .21kg The majority were ASA Grade I (80 %), additional co-morbidities included asthma, obesity and ADHD. Open tibial fractures were most common (61 %) followed by open foot fractures (18 %). Admission was within 24 h for 84 of the 86 patients for whom there was data, with 71 % having definitive fixation within 72 h of injury. The scapular or scapular/parscapular flap was most used (52 %) followed by an anterolateral thigh flap (29 %). A consultant was main operator in 70 % and a microsurgical fellow in 15 % of the cases recorded.</div><div>Five cases out of 78 we had data for returned to theatre within the first 24 h of definitive surgery. with a mean of 18.5 h. In long term follow up there was 1 total flap failure and 1 flap that survived 60 % out of 53 patients there was data for. There were no deep bone infections.</div></div><div><h3>Conclusion</h3><div>Paediatric patients should be treated as aggressively as adults with an open lower limb fracture. Scapular and scapular/parascapular flaps offer a more cosmetically and functionally appealing option. Prompt IV antibiotics, combined specialist orthopaedics and plastics experience help to reduce deep bone infections.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112196"},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143175578","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":"Evaluating brain injury outcomes in female subjects: A computational approach to accident reconstruction of fatal and non-fatal cases","authors":"Carlos G.S. Cardoso,&nbsp;André A. Salgado,&nbsp;Fábio A.O. Fernandes,&nbsp;Ricardo J. Alves de Sousa","doi":"10.1016/j.injury.2025.112164","DOIUrl":"10.1016/j.injury.2025.112164","url":null,"abstract":"<div><div>Traumatic brain injury remains a significant concern in public health, affecting millions of individuals globally and leading to long-term cognitive and physical impairments. Historically, research in this field has primarily focused on male subjects, often neglecting to consider the substantial biomechanical and anatomical differences between genders and individuals of varying ages. The present study investigates sex-specific biomechanical responses to head impacts in real-world accidents, employing an advanced female finite element head model, with a particular focus on critical brain structures such as the corpus callosum and pituitary gland.</div><div>Two real-world accident scenarios were simulated: a non-fatal e-scooter collision and a fatal work-related incident involving a falling prop. A finite element analysis was conducted to determine the strain and stress distributions within the brain in response to impact conditions, assessing the potential for injury considering established failure criteria.</div><div>The analysis revealed notable discrepancies in strain and stress distributions between anthropometric models. The smallest percentiles exhibited a higher risk of strain-related injury, while larger individuals demonstrated higher strain levels in key brain regions under similar impact conditions. Additionally, it was evaluated the efficacy of a safety helmet in a work-related scenario.</div><div>These findings highlight the importance of subject-specific analyses in understanding TBIs and emphasise the need for continued refinement of FEHMs to improve the accuracy of injury prediction.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112164"},"PeriodicalIF":2.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082450","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}