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

{"title":"Comparison of clinical, radiological and functional outcome between the supra-patellar and infra-patellar techniques of Tibial nailing in Indian population: A prospective, randomized controlled trial","authors":"Aditya Chaubey,&nbsp;Buddhadev Chowdhury,&nbsp;Vivek Trikha,&nbsp;Vijay Sharma,&nbsp;Nishank Mehta,&nbsp;Apoorva Kabra,&nbsp;Pon Aravindhan A Sugukumar,&nbsp;Tejaswin Jha,&nbsp;Samarth Mittal","doi":"10.1016/j.injury.2025.112471","DOIUrl":"10.1016/j.injury.2025.112471","url":null,"abstract":"<div><h3>Introduction</h3><div>Tibial shaft fractures are common injuries seen particularly because of high velocity trauma. Considerable debate exists between the suprapatellar and infrapatellar approach for nailing of tibial shaft fractures. The aim of this study was to compare the clinical, radiological and functional outcomes and intra-operative fluoroscopy time, total blood loss and operative time between supra-patellar and infra-patellar insertion techniques in the treatment of extra-articular tibial shaft fractures.</div></div><div><h3>Methods</h3><div>Sixty patients aged between 18–45 years who presented to our Level I trauma-centre with AO/OTA type 42 fractures were randomized into Suprapatellar (SP) and Infrapatellar (IP) groups. Operative time, intra-operative blood loss and radiation exposure was recorded. Severity of knee pain by VAS score and knee range of motion were documented at 2 weeks, 6 weeks, 3 months, 6 months, 12 months, 18 months and 24 months follow-up. Functional outcomes were measured using Knee Society Score, Lysholm Knee Score and KOOS-PF score and radiological union assessed with radiograph done at 6 weeks, 3 months, 6 months, 12 months, 18 months and 24 months post-operatively.</div></div><div><h3>Results</h3><div>Thirty patients each underwent nailing by suprapatellar and infrapatellar approach. A statistically significant difference favouring the suprapatellar group was noted in the operative time (p-value 0.003) and mean intra-operative blood loss (p-value 0.027). There was no difference between the two groups in terms of knee pain or knee range of motion and the mean functional scores.</div></div><div><h3>Conclusion</h3><div>Suprapatellar nailing of tibial shaft fractures may help to reduce operative time and intra-operative blood loss with similar intra-operative radiation exposure, clinical and functional outcomes compared to infrapatellar nailing.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112471"},"PeriodicalIF":2.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298450","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":"Diagnosis and treatment of fracture-related infection in children and adolescents: A retrospective study","authors":"Michaela Doležalová Hrubá ,&nbsp;Tomáš Zídek ,&nbsp;Martin Kloub ,&nbsp;Jiří Urban","doi":"10.1016/j.injury.2025.112519","DOIUrl":"10.1016/j.injury.2025.112519","url":null,"abstract":"<div><h3>Introduction</h3><div>A Fracture-related infection (FRI) is a rare but serious complication of surgical fracture treatment in children and adolescents. Exact data on the incidence of FRI in children and adolescents are not available in the literature. In adults, criteria for the diagnosis and treatment of FRI were published in 2018 by an expert group and divided into suggestive and confirmatory categories. However, there is no recommended approach for diagnosing and treating FRI in children or adolescents.</div></div><div><h3>Purpose of the study</h3><div>This study aimed to determine the incidence of FRI in children and adolescents who underwent operative fracture treatment at a Level I trauma center between 2019 and 2023, to evaluate age distribution, anatomical sites and bacterial spectrum of FRI in children and adolescents, to evaluate risk anatomical locations and initial fracture treatment methods in relation to the development of FRI and to assess the applicability of FRI diagnostic criteria in the pediatric patients.</div></div><div><h3>Materials and methods</h3><div>It is a retrospective monocentric study conducted by reviewing hospital database. The study included all patients under 18 years of age with present growth plates who underwent surgical fracture treatment between 2019 and 2023.</div></div><div><h3>Results</h3><div>The incidence of FRI in children was 0,95 % among 1156 osteosynthesis procedures performed between 2019 and 2023. The average age of pediatric patients with FRI was 11,18 years. The most common anatomical site of FRI in out cohort was the forearm (36,36 %). High-risk locations in terms of developing FRI relative to the number of osteosyntheses performed included the proximal femur (20 %) and the diaphysis of the humerus (7.69 %). The most common pathogen causing FRI in children was <em>S. aureus</em> (63,6 %). On average, 2.1 additional surgical procedures were required to eradicate the infection.</div></div><div><h3>Conclusion</h3><div>FRI in children is a rare but serious complication, which most commonly occurs in the upper extremity, specifically in the forearm area. However, some anatomical sites with a lower incidence of fractures demonstrate a significantly higher relative risk for the development of FRI. The recommended guidelines developed in 2018, including diagnostic criteria for FRI, can be successfully applied to the pediatric population.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112519"},"PeriodicalIF":2.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262514","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":"Combined surgical management of periprosthetic acetabular fractures: a retrospective study","authors":"Mikolaj Bartosik ,&nbsp;Eckart Mayr ,&nbsp;Ulf Culemann","doi":"10.1016/j.injury.2025.112461","DOIUrl":"10.1016/j.injury.2025.112461","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic acetabular fractures (PPAF) are a rare and serious complication in hip arthroplasty. The increase in the number of hip arthroplasty patients and the long service life of implants are leading to a rise in periprosthetic fractures.</div></div><div><h3>Purpose</h3><div>We hypothesized (1) that modified Stoppa approach in Combination with direct anterior approach of PPAF leads to good patient outcomes in both patients with and without acetabular cup instability; (2) the complication rate of our combined surgical procedures is lower than reported in the literature; (3) that combined surgical procedures for PPAF have a low 1-year mortality.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed from January 2013 to February 2024. Patients were treated with osteosynthesis using the modified Stoppa approach and revision of the cup using the direct anterior approach (DAA). Mobility before and after surgical treatment, modified Harris Hip Score (mHHS), complications, revision rates, and 1-year mortality were recorded using a questionnaire.</div></div><div><h3>Results</h3><div>A total of 24 PPAF were identified, of which 18 patients were included in this study. Of 18 PPAF that were treated interdisciplinary by the trauma and orthopedic department, 13 cases showed cup instability. Fifty percent of the patients achieved a satisfactory result after mHHS, however, with a mean mHHS of 57±30, showing a wide range between good and poor outcomes. 13 (61.1 %) patients reported the same mobility postoperatively as prior to fracture. The complication and revision rates were 16.6 % and 5.6 %, respectively, which is below the rates reported in the literature. The 1-year mortality rate was 33.3 %.</div></div><div><h3>Conclusion</h3><div>Combined surgery showed low perioperative complication and revision rates. However, a 1/3 mortality rate at 1 year is quite high, which is likely a reflection of these patients’ fragility and co-morbidities. Furthermore, there is no advantage for the functional outcome according to the mHHS.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112461"},"PeriodicalIF":2.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195851","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":"Can early postoperative radiographs predict fracture union? A case-control study of femoral shaft nails","authors":"Meghan Hughes,&nbsp;Jordan Brand,&nbsp;Tyler Edmond,&nbsp;Tina Zhang,&nbsp;Michael Raffetto,&nbsp;Kristin E. Turner,&nbsp;Joshua E. Lawrence,&nbsp;Murali Kovvur,&nbsp;Mark J. Gage,&nbsp;Jason W. Nascone,&nbsp;Marcus F. Sciadini,&nbsp;Nathan N. O’Hara,&nbsp;Robert V. O’Toole","doi":"10.1016/j.injury.2025.112512","DOIUrl":"10.1016/j.injury.2025.112512","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if 4–8-week radiographs are useful for predicting nonunions in patients with femoral shaft fractures treated with an intramedullary nail (IMN).</div></div><div><h3>Methods</h3><div>A retrospective case-control study; 1:2 ratio was conducted at a level I trauma center. Adult patients with a femoral shaft fracture (OTA/AO 32) treated with IMN between 2016 and 2022 were identified via Current Procedural Terminology code. The included cases underwent nonunion surgery a minimum of 3 months after the index procedure. The controls were randomly selected from the cohort and had a minimum of 6 months postoperative follow-up and evidence of radiographic union. The modified Radiographic Union Score of the Tibia (mRUST) applied to femur fractures was determined on radiographs obtained 4–8 weeks after the index surgery.</div></div><div><h3>Results</h3><div>One hundred forty-eight patients (mean age, 35 [SD, 15] years) were included. A significant difference was found between cases and controls relating to the distribution of mRUST scores at 4–8 weeks postoperatively (median, 6 versus 9; <em>p</em> &lt; 0.0001). Logistic regression analysis demonstrated that the mRUST score at 4–8 weeks is a strong predictor of union with an area under the curve of 0.85 (95 % CI: 0.78–0.92). If the mRUST score at 4–8 weeks postoperatively is 9 or above, the probability of eventual union is 99 % (95 % CI: 94–100 %).</div></div><div><h3>Conclusion</h3><div>The results suggest that healing on 4–8-week radiographs after IMN fixation for femoral shaft fractures may help identify patients at elevated risk of nonunion. Patients with mRUST scores 9 or above on the 4–8-week postoperative radiographs have a low likelihood of nonunion and less frequent radiographic follow-up may be needed.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112512"},"PeriodicalIF":2.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262515","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":"Increased wound complications in glabrous skin with absorbable sutures following carpal tunnel and trigger finger release","authors":"Evan Moon ,&nbsp;Phillip Ross","doi":"10.1016/j.injury.2025.112511","DOIUrl":"10.1016/j.injury.2025.112511","url":null,"abstract":"<div><h3>Purpose</h3><div>With no clear consensus on absorbable verses non-absorbable suture-usage for glabrous skin closures, the purpose of this study was to investigate whether incisions closed with Monocryl sutures displayed higher wound complication rates than nylon sutures following carpal tunnel and trigger finger release surgery.</div></div><div><h3>Methods</h3><div>A total of 155 carpal tunnel or trigger finger release surgeries in 138 patients performed in an outpatient academic medical center were analyzed. Patients with pre-operative trauma or infection, or who received concurrent surgeries were excluded. Incisions were closed using either 4–0 poliglecaprone 25 (Monocryl) or 4–0 nylon (Ethilon). Suture choice was determined via a pseudo-randomized method: Monocryl sutures were utilized in surgeries performed on even dates (e.g. 4/10/2024) and nylon sutures on odd dates (e.g. 4/11/2024). The medical records were reviewed for demographics and wound-related complications occurring within 90 days post-surgery. Criteria including additional medical encounters, co-morbidities, and assisting resident level-of-training between Monocryl and nylon cohorts were also evaluated for differences in complication rates.</div></div><div><h3>Results</h3><div>There were 86 carpal tunnel release (55.5 %) and 69 trigger finger release (44.5 %) surgeries. The average age at surgery was 62.4 ± 11.6 years, with Monocryl used in 73 (47.1 %) and nylon in 82 (52.9 %) procedures. The rates of infection requiring antibiotics were similar between Monocryl (4.1 %, <em>n</em> = 3) and nylon cohorts (2.4 %, <em>n</em> = 2). However, higher rates of dehiscence were observed with Monocryl (11.0 %, <em>n</em> = 8) compared to nylon (2.4 %, <em>n</em> = 2). Multivariable logistic regression showed that inflammatory arthritis, immunosuppressant drug use, and junior resident assistance were independent predictors of wound complications.</div></div><div><h3>Conclusion</h3><div>In conclusion, we found usage of Monocryl sutures following carpal tunnel and trigger finger release associated with higher a dehiscence rate within 90 days post-operation. Additionally, factors including resident training level, immunosuppression, and inflammatory arthritis were associated with increased complications.</div></div><div><h3>Type of Study/Level of Evidence</h3><div>Therapeutic IV</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112511"},"PeriodicalIF":2.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231474","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":"Exploring the patterns and outcomes of accidental and assaultive facial soft tissue injuries: A one-year medicolegal study in the emergency department of Alexandria main university hospital","authors":"Mohamed H Abouarab ,&nbsp;Zahraa Khalifa Sobh ,&nbsp;Helmy Elwakeel ,&nbsp;Magda Hassan Mabrouk Soffar ,&nbsp;Mohamed Yassin ,&nbsp;Manal Ibrahim Fathy Balah","doi":"10.1016/j.injury.2025.112470","DOIUrl":"10.1016/j.injury.2025.112470","url":null,"abstract":"<div><h3>Background</h3><div>Plastic surgeons must document initial facial injuries before surgery for medicolegal purposes. Distinguishing between accidental and assaultive injuries poses a challenging issue. Therefore, this study explored the features that differentiate assaultive facial soft tissue injuries from accidental injuries.</div></div><div><h3>Methods</h3><div>This prospective cross-sectional study included 179 patients with facial soft tissue injuries. We recorded sex, age, occupation, marital status, residence, and history of drug abuse. Additionally, the traumatic events were analyzed, and injuries were assessed. All patients received standard medical care.</div></div><div><h3>Results</h3><div>Males constituted 82.7 % of patients. 62.57 % of patients had accidental facial injuries, while the rest of the patients attributed their injuries to assaults. A significantly higher percentage of assaultive injuries were located on the left side of the face, with <em>p</em> &lt; 0.001 (OR = 5.966, 95 % CI=3.013- 11.813). Whereas a significantly higher percentage of accidental injuries were located on the midface, with <em>p</em> &lt; 0.001. A multivariate binary logistic regression analysis that identified strong predictors of assaultive facial injuries, including a history of drug abuse (OR = 44.998, 95 % CI: 3.049–661.107), injury with sharp instruments (OR = 638.601, 95 % CI: 20.296–20,093), and a cutting/piercing mechanism of injury (OR = 89,298.81, 95 % CI: 196.963–404,861). Regarding the characteristics of soft tissue facial injuries, the probability of assaultive trauma increases with the presence of injuries on the left side of the face (OR = 27.309, 95 % CI: 1.653–451.157), involvement of the mandibular zone (OR = 40.780, 95 % CI: 1.147–1449.419), neurovascular or duct injury (OR = 121.806, 95 % CI: 1.110–13,369.2), and the presence of multiple associated injuries (OR = 1.005, 95 % CI: 1.001–1.254).</div></div><div><h3>Conclusions</h3><div>Accidental facial injuries are more common than assaultive injuries, and males are particularly vulnerable to both traumas. This study helps differentiate between assault-related and accidental facial injuries. A history of drug abuse, injuries caused by sharp instruments, and mechanisms involving cutting or piercing are strong indicators of assaults. Clinical signs that strongly suggest assault-related injuries include injuries on the left side of the face, involvement of the mandibular area, damage to neurovascular structures or ducts, and the presence of multiple associated injuries.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112470"},"PeriodicalIF":2.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239624","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":"Randomized trial of surgery vs. non-surgical management for pelvic fragility fractures","authors":"Steven F. Shannon ,&nbsp;John David Black ,&nbsp;Richard S. Yoon ,&nbsp;Ryan Michels ,&nbsp;Michael Hadeed ,&nbsp;Gillian Soles ,&nbsp;Edward Westrick ,&nbsp;Kristoff Reid ,&nbsp;Daniel Cher ,&nbsp;Robyn Capobianco ,&nbsp;Douglas Dirschl","doi":"10.1016/j.injury.2025.112462","DOIUrl":"10.1016/j.injury.2025.112462","url":null,"abstract":"<div><h3>Objectives</h3><div>Non-surgical management (NSM) of posterior pelvic fragility fractures (PFF) can lead to prolonged disability, morbidity, and death. Surgical management (SM) also has risks but has been reported to rapidly restore mobility. This study sought to compare improvement in mobility between NSM and SM in a prospective cohort of patients with PFF.</div></div><div><h3>Methods</h3><div><em>Design:</em> Prospective, randomized controlled trial of SM vs NSM</div></div><div><h3>Setting</h3><div>Academic and community trauma centers</div></div><div><h3>Patient Selection Criteria</h3><div>PFF patients without significant cognitive impairment who are bedbound</div></div><div><h3>Outcome measures and comparisons</h3><div>The primary endpoint was time to regain two points on a modified functional mobility scale (MFMS). Secondary endpoints included PROMIS physical function and pain interference, Oswestry Disability Index (ODI), and numeric rating scale (NRS) pain score. A 12-month CT scan was performed in the SM group only.</div></div><div><h3>Results</h3><div>Enrollment was challenging despite modifying the study to include an observational cohort. 28 subjects were enrolled (age 78±9.8); 16 underwent SM and 12 received NSM. The primary endpoint occurred at a median of 10 days in the SM group and 16 days in the NSM group (<em>p</em> = .1). 100 % of SM and 83 % of NSM subjects achieved the primary endpoint by 6 weeks. Five subjects who received SM could be considered NSM failures; including these failed subjects in the NSM group widened the difference in primary endpoint success rates (100 % in SM vs. 48 % in NSM, <em>p</em> &lt; 0001). Some trends in secondary outcome measures favored SM, but they did not reach statistical significance. There were no device- or procedure-related serious adverse events.</div></div><div><h3>Conclusion</h3><div>Despite enrollment challenges, consistent trends were observed to suggest that SM may be superior to NSM in patients with painful PFF. Key challenges in enrollment in geriatric fracture trials comparing NSM to SM were identified. It is conceivable that studies such as this may represent the most robust investigations possible in comparing SM to NSM in PFF.</div></div><div><h3>Level of Evidence</h3><div>II.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112462"},"PeriodicalIF":2.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231479","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":"Platelet dysfunction in trauma: a sub study of the FEISTY pilot trial analysing whole blood aggregometry data","authors":"Zachary J Durkin ,&nbsp;Stephen F Whebell ,&nbsp;Martin Wullschleger ,&nbsp;James McCullough ,&nbsp;Sarah Czuchwicki ,&nbsp;Elizabeth Wake ,&nbsp;Michael C Reade ,&nbsp;James Winearls","doi":"10.1016/j.injury.2025.112468","DOIUrl":"10.1016/j.injury.2025.112468","url":null,"abstract":"<div><h3>Objective</h3><div>To identify platelet hypofunction and its associations in severely injured trauma patients presenting with haemorrhage.</div></div><div><h3>Design</h3><div>Planned sub-study of data collected from the FEISTY trial; an Australian multicentre, randomised controlled pilot trial investigating early fibrinogen replacement in severely injured trauma patients.</div></div><div><h3>Setting</h3><div>Four major trauma centres in Queensland, Australia.</div></div><div><h3>Participants</h3><div>Adult trauma patients (age ≥18 years) presenting with clinically significant haemorrhage or potential for significant transfusion requirements.</div></div><div><h3>Main outcome measures</h3><div>Platelet function parameters arachidonic acid (ASPI), adenosine diphosphate (ADP), and thrombin receptor-activating peptide (TRAP) assessed via Multiplate® analysis, rotational thromboelastometry (ROTEM®) parameters EXTEM, FIBTEM, and PLTEM (EXTEM – FIBTEM), transfusion requirements, and clinical outcomes.</div></div><div><h3>Results</h3><div>Significant platelet hypofunction was detected in this cohort of severely injured trauma patients at time of presentation, with 70 % of patients having hypofunction in at least one Multiplate® channel. The median ASPI area under the curve and 95 % confidence interval were below the lower reference range, indicating this population had reduced platelet function. In patients with deranged platelet function, significantly lower platelet count (<em>p</em> ≤ 0.001), EXTEM amplitude at five minutes (A5) and maximum clot firmness (MCF) (<em>p</em> = 0.001, <em>p</em> ≤ 0.001), and PLTEM A5 and MCF (<em>p</em> = 0.005, <em>p</em> = 0.003) were identified compared to patients with normal platelet function. A significant improvement in platelet function parameters was not observed following platelet transfusion.</div></div><div><h3>Conclusion</h3><div>Platelet hypofunction is common in severely injured trauma patients. This was true both before and after platelet transfusion, suggesting trauma precipitates alteration of the vascular circulating milieu in a way that impairs platelet function. Characterisation of this change might lead to targeted interventions to improve haemostasis.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112468"},"PeriodicalIF":2.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221727","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 RFN-advanced femoral nailing system versus locked lateral plating in the management of distal femur fractures: A matched-cohort analysis","authors":"William B. Gilbert ,&nbsp;Andres F. Moreno-Diaz ,&nbsp;Ridge Maxson ,&nbsp;Cade A. Morris ,&nbsp;Elsa Rodriguez-Baron ,&nbsp;Taylor M. Yong ,&nbsp;Nathaniel E. Schaffer ,&nbsp;William T. Obremskey ,&nbsp;Phillip M. Mitchell","doi":"10.1016/j.injury.2025.112442","DOIUrl":"10.1016/j.injury.2025.112442","url":null,"abstract":"<div><h3>Introduction</h3><div>Distal femur fractures are commonly managed with retrograde femoral nailing or locked lateral plating (LLP). As implant design has evolved, more distal and complex patterns are being treated with intramedullary implants. The aim of the present study was to compare early outcomes in distal femur fractures managed with the novel DePuy Synthes RFN-Advanced (RFNA) Retrograde Femoral Nailing System to a similar cohort treated with locked lateral plating.</div></div><div><h3>Patients and methods</h3><div>This is a retrospective cohort study of operative distal femur fractures that presented to our Level I trauma center over a 7-year period. We included patients with AO/OTA types 33A2–3, 33C1–2 fractures treated with either the RFNA or a lateral locked plate over two distinct time points. Injury radiographs were reviewed independently by three orthopedic traumatologists to include only cases deemed “nailable.” Primary outcomes included coronal and sagittal alignment. Secondary outcomes included nonunion, surgical site infection (SSI), and unplanned reoperation.</div></div><div><h3>Results</h3><div>We identified 107 patients treated with either the RFNA (<em>n</em> = 45) or LLP (<em>n</em> = 62) over the 7-year study period. No significant differences were identified in the rates of sagittal (2.2 % versus 9.7 %, <em>P</em> = 0.12) or coronal malalignment (2.2 % versus 0 %, <em>P</em> = 0.421). The nonunion rate was 8.9 % in the RFNA cohort versus 19.4 % in the LLP cohort, but this difference was not statistically significant (<em>P</em> = 0.174). We also found no difference in infection or implant failure between groups. Screw backout occurred in 8 RFNA patients (17.8 %), with 7 patients undergoing screw removal (15.6 %) either in clinic (<em>n</em> = 5) or the operating room (<em>n</em> = 2).</div></div><div><h3>Discussion and conclusions</h3><div>This matched cohort study demonstrated promising results comparing the RFNA to lateral plating of distal femur fractures. The nonunion rate of 9 % in the RFNA cohort adds to recent literature that supports improved union rates with intramedullary nailing of these fractures. Interlocking screw backout was the most common complication with RFNA treatment at a rate of 16 %, with the majority removed in clinic.</div></div><div><h3>Level of evidence</h3><div>Level III</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112442"},"PeriodicalIF":2.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169483","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 COVID-19 on trauma care in trauma and non-trauma centers in New York State: a SPARCS 2016–2022 analysis","authors":"Gabriela Santos-Revilla ,&nbsp;Nwe Oo Mon ,&nbsp;Pooja Patel ,&nbsp;Elizabeth Swezey ,&nbsp;Sara Cardozo-Stolberg ,&nbsp;Karen Li ,&nbsp;L.D.George Angus","doi":"10.1016/j.injury.2025.112469","DOIUrl":"10.1016/j.injury.2025.112469","url":null,"abstract":"<div><h3>Introduction</h3><div>There were concerns about depleting trauma care capabilities due to the significant strain on healthcare services and resources during the COVID-19 pandemic. We aimed to describe the epidemiology of trauma care in New York State (NYS) during this period to elucidate how a healthcare crisis, such as a pandemic, can alter trauma care delivery.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective review of trauma and non-trauma hospital discharges in New York State from 2016 to 2022 using the Statewide Planning and Research Cooperative System (SPARCS) database. The years 2016–2019 served as the baseline, March 2020 to December 2021 as the COVID period, and 2022 as the post-COVID recovery period. Changes in case volumes were analyzed by trauma center levels and non-trauma centers, presenting demographic characteristics, injury mechanisms, health services areas, illness severity, and in-hospital fatalities.</div></div><div><h3>Results</h3><div>Level 1 trauma centers accounted for the highest percentage of trauma admissions, making up 44 % of the total, and also had the majority of non-trauma cases. During this period, pediatric trauma admissions decreased in these centers. However, trauma admissions for individuals categorized as Black or African American, Multi-racial, and Other increased. There was a notable rise in motorcycle-related injuries, other land transport injuries, and assaults involving firearms during the COVID period, which increased by up to 53 %, 49 %, and 48 %, respectively. Severity of illness scores revealed a significant increase in extreme cases. Additionally, trauma-related fatalities rose in trauma centers during the COVID period, whereas they decreased in most non-trauma centers during the same time frame.</div></div><div><h3>Discussion</h3><div>During the COVID-19 pandemic, trauma centers in NYS continued to treat critically injured patients despite increased healthcare strain. There was a disproportionate impact across age groups and racial backgrounds, with a rise in violent injuries observed in both trauma and non-trauma centers. Higher fatality rates in trauma centers may be due to the admission of more severely injured patients. We recommend that regional and local trauma stakeholders tailor trauma care services preparedness to the vulnerability of their served communities to anticipate the accommodation of resources in the face of future healthcare crises.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 8","pages":"Article 112469"},"PeriodicalIF":2.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231473","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}