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

{"title":"Antegrade insertion of full-length ramus screws for the treatment of pelvic and/or acetabular fracture","authors":"Libin Zheng ,&nbsp;Jiangtao Hao ,&nbsp;Chia-Jui Hu ,&nbsp;Xionghai Shen ,&nbsp;Guangming Yang ,&nbsp;Guanfei Zeng ,&nbsp;Lai Yu ,&nbsp;Yongwei Pan","doi":"10.1016/j.injury.2025.112669","DOIUrl":"10.1016/j.injury.2025.112669","url":null,"abstract":"<div><h3>Introduction</h3><div>The success rate of antegrade insertion of a full-length ramus osseous fixation pathway (OFP) screw remains unreported. The objective of this study was to assess the safety, feasibility, and effectiveness of a novel antegrade technique for inserting full-length ramus screws, as well as to determine the parameters of the ramus OFP based on screw placement.</div></div><div><h3>Patients and Methods</h3><div>From January 2022 to September 2024, patients with fractures of the superior pubic ramus or the anterior acetabular column treated with a novel technique of an antegrade insertion of a superior ramus OFP screw were recruited into this study. Peri- and postoperative complications were documented. Parameters of the OFP were measured based on the position of the inserted full-length screws on postoperative CT scans.</div></div><div><h3>Results</h3><div>Thirty-eight fully threaded, large-diameter (7 mm) antegrade full-length screws were successfully inserted in 32 patients with no intraoperative screw insertion failures occurring. The procedure was performed without any noted wound infections or associated neurological, urological, and visceral complications. Postoperative CT images confirmed that all 38 ramus screws were correctly positioned within the bony corridors, with no evidence of screw breaching the hip joint. The OFP measures 118.9 ± 5.6 mm in length, with an angle projection of 38.7 ± 3.8 degrees to the horizontal plane and 15.8 ± 4.9 degrees to the coronal plane. All patients were followed for an average duration of 16.1 months (range, 6.2–31 months). Bone union was achieved in all cases with a union time of 3 months (range, 2.5 to 5 months), and no complications such as loss of reduction, screw loosening, breakage, or bone delayed union were noted.</div></div><div><h3>Conclusions</h3><div>Our novel antegrade technique for inserting a full-length large ramus screw has been validated for its safety, feasibility, and effectiveness. The parameters obtained through the insertion of a full-length screw in this study accurately represent those of our new ramus OFP and serve as a guide for the placement of full-length screws.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112669"},"PeriodicalIF":2.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829468","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":"The effect of acetabular retroversion on ipsilateral injuries during traumatic hip dislocation","authors":"Jessica L. Koshinski ,&nbsp;Carly J. Deter ,&nbsp;C. Logan SanCraint ,&nbsp;Taikhoom Dahodwala ,&nbsp;James E. Murphy","doi":"10.1016/j.injury.2025.112654","DOIUrl":"10.1016/j.injury.2025.112654","url":null,"abstract":"<div><h3>Background</h3><div>Determine whether native acetabular anteversion angle increased the risk of ipsilateral limb injuries in patients with traumatic hip dislocations.</div></div><div><h3>Methods</h3><div>Retrospective clinical series completed at a large, tertiary health care system between February 2016-November 2021. Patients with a native traumatic hip dislocation requiring a closed reduction in the operating room or open reduction internal fixation (ORIF) of an associated fracture were included, identified using current provider terminology (CPT) codes 27,250 and 27,252. Standard acetabular version angles were measured on CT images.</div></div><div><h3>Results</h3><div>121 cases were included in the analysis. The average age of our population was 37.5 years and 72 % were male. The median acetabular version was 14.7° (2–27°). Of the 121 cases of dislocations, 28 experienced a knee injury (23 %, <em>p</em> = 0.89) and 40 had a femoral head injury (33 %, <em>p</em> = 0.88). The most common knee injuries were patellar fractures (29 %, <em>n</em> = 8), tibial plateau fractures (29 %, <em>n</em> = 8), meniscal injuries (25 %, <em>n</em> = 7) and ligamentous knee injuries 21 %, <em>n</em> = 6). Median version angle was not associated with an increase in predisposition to femoral head injury or knee injury for patients with a native hip dislocation (<em>p</em> = 0.13).</div></div><div><h3>Conclusion</h3><div>These findings demonstrate that native acetabular anteversion does not predispose, nor protect, patients from experiencing an ipsilateral limb injury in the setting of a traumatic hip dislocation. Future studies should investigate other factors that may influence the occurrence of ipsilateral limb injuries in these settings.</div></div><div><h3>Level of evidence</h3><div>Level IV – Therapeutic (Retrospective Clinical Series).</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112654"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144865820","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":"Caregiver experience of at-home softcast removal following paediatric trauma","authors":"Jingjing Wang ,&nbsp;Katie Patterson Hughes ,&nbsp;Joanna Marilyn Stewart Aithie ,&nbsp;Neil Ranjan Wickramasinghe ,&nbsp;Emily Jane Baird","doi":"10.1016/j.injury.2025.112663","DOIUrl":"10.1016/j.injury.2025.112663","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to explore safety and feasibility of at-home softcast removal in children with displaced injuries undergoing manipulation; understand caregiver experience; and determine its impact on service at our tertiary centre.</div></div><div><h3>Methods</h3><div>Paediatric patients (&lt;16 years) with any fracture requiring application of a circumferential softcast, later removed at home without planned routine follow-up, were retrospectively analysed from two time-points: July–September 2022; February–April 2023. Demographic data including age, fracture location, angulation, whether manipulation was undertaken, and unplanned re-attendances were recorded. Caregivers completed a telephone Likert questionnaire (1=extremely positive, 5=extremely negative) reviewing cast removal time and qualitative descriptors of experience. Cost analysis was performed based on use of consumables, staff and clinical areas.</div></div><div><h3>Results</h3><div>77 caregivers completed the questionnaire at mean 93.4 days post-injury. Mean patient age was 7.6 years at time of injury. 41 (53.2 %) were distal radius, 20 (26.0 %) forearm and 16 (20.8 %) were elbow, hand or tibia fractures. Mean sagittal angulation was 24.7 degrees and 40 (52.0 %) injuries underwent manipulation under sedation. 13 (16.9 %) patients re-attended with cast problems. Caregivers estimated a mean 13.3 min to remove the cast. 83.1 % found it ‘extremely’ or ‘somewhat’ easy. 75.3 % were ‘extremely’ or ‘somewhat’ satisfied. 71.4 % were ‘extremely’ or ‘somewhat’ likely to recommend it. Qualitative descriptors ranged from “traumatic” to “easy”. Since introduction of this practice, subsequent clinic attendances for children diagnosed with a fracture in the Emergency Department has reduced by &gt;50 %, equating to savings of approximately £22,600 per annum.</div></div><div><h3>Conclusion</h3><div>Our experience confirms at-home softcast removal without further orthopaedic follow-up is safe and feasible, even in displaced injuries undergoing manipulation. The majority of families reported positive experiences. However, this was not universal and adequate patient education was integral to this.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112663"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889626","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":"Development of an assessment tool for open reduction and internal fixation of midshaft ulnar fractures: A global delphi consensus study","authors":"Jacob Faurholdt ,&nbsp;Mads Emil Jacobsen ,&nbsp;Leizl Joy Nayahangan ,&nbsp;Monica Ghidinelli ,&nbsp;Chitra Subramaniam ,&nbsp;Kristoffer Borbjerg Hare ,&nbsp;Lars Konge ,&nbsp;Amandus Gustafsson","doi":"10.1016/j.injury.2025.112650","DOIUrl":"10.1016/j.injury.2025.112650","url":null,"abstract":"<div><h3>Objectives</h3><div>In acknowledgement of the ongoing transition of surgical education from a time-based approach to competency-based curricula, this study aimed to identify key parameters for assessing the performance of surgical trainees in open reduction and internal fixation (ORIF) of a simple ulnar shaft fracture (AO/OTA classification 2U2A3.B).</div></div><div><h3>Methods</h3><div><u>:</u> A 4-round Delphi process regarding seven different orthopedic osteosynthesis surgeries was conducted with an international panel of orthopedic surgeons involved in surgical education. This manuscript focuses on compression plating of isolated ulna fractures. Round 1 focused on item generation, round 2 on importance rating, round 3 on defining optimal intervals and borderline error values for a specific fracture model (not reported in this manuscript), and round 4 on assigning weights to each parameter. Data collection was carried out online.</div></div><div><h3>Results</h3><div><u>:</u> Ninety-eight surgeons agreed to participate in the study. Round 1 generated 30 assessment parameters. In round 2 and 3, these were reduced to 26 parameters. In round 4, parameters received an overall mean weight of 8.27 out of 10 (SD 0.66) with a range of individual parameter mean weights from 6.7 to 9.4. The assessment parameters that achieved the highest weights were anatomical fracture reduction and assessment of forearm range of motion after fixation. In the final list of parameters, five were related to fracture reduction, three to hardware choice, five to plate placement, nine to screw placement, and four to concluding the procedure.</div></div><div><h3>Conclusions</h3><div><u>:</u> Utilizing a Delphi process, expert consensus was reached generating a comprehensive list of 26 assessment parameters that can be used to assess surgeon performance in open reduction and internal fixation of an isolated adult ulnar shaft fracture. This will allow educators to provide standardized feedback (formative assessment) to trainees and use a mastery-learning training approach (summative assessment).</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112650"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878872","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 electroacupuncture intervention before and after operation on perioperative neurocognitive disorders in elderly patients with hip fractures: A randomized controlled trial","authors":"Jiaqi Long ,&nbsp;Xiaoming Zhang ,&nbsp;Jialing Zhang ,&nbsp;Tao Zhou ,&nbsp;Wei Chen ,&nbsp;Yuebing Li","doi":"10.1016/j.injury.2025.112660","DOIUrl":"10.1016/j.injury.2025.112660","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of postoperative neurocognitive disorder (PND) in elderly patients with hip fractures poses a significant clinical challenge, with current management strategies offering limited efficacy in prevention or resolution. This prospective study evaluated the effectiveness of pre-and postoperative electroacupuncture (EA) intervention in mitigating PND in this patient cohort.</div></div><div><h3>Methods</h3><div>A double-masked, randomized controlled trial was conducted involving 60 elderly patients (≥65 years) with fragility hip fractures scheduled for surgical repair. Participants were randomly assigned to either the EA intervention group (Group A) or a non-stimulated control group (Group C). Mini-Mental State Examination (MMSE) scores were recorded at baseline and 1, 3, and 7 days postoperatively, while ELISA was used to assess IL-1β, IL-6, and S-100β levels. Time-varying MAP, SpO2, and HR were measured. Adverse cardiovascular events, extubation duration, recovery room stay, VAS scores, analgesia pump use, postoperative adverse responses, and hospitalization length were recorded.</div></div><div><h3>Results</h3><div>Among 60 randomized patients (mean age 74.02 years; 54.7 % male), 53 were analyzed for primary outcomes. Postoperative day 1 PND incidence was significantly lower in Group A (25.0 %) than Group C (56.0 %; <em>P</em> &lt; 0.05), persisting on day 3 (Group A: 14.3 %, Group C: 48.0 %; <em>P</em> &lt; 0.05). By day 7, PND incidence was similar in both groups. Time-group interactions were significant for IL-1β, IL-6, and blood pressure (<em>P</em> &lt; 0.05). Group A exhibited a lower VAS score at 24 h postoperatively (2.65 ± 0.94 vs. 3.96 ± 0.96; <em>P</em> &lt; 0.05). Adverse events were reported in 26 Group A and 32 Group C cases. Postoperative nausea and vomiting (PONV) significantly differed (Group A: 3.7 %, Group C: 30.8 %).</div></div><div><h3>Conclusions</h3><div>The findings suggest that pre- and postoperative EA stimulation may significantly reduce the risk of PND, modulate inflammatory responses, and lower blood pressure. Furthermore, EA intervention was associated with reduced postoperative pain and a marked decrease in the incidence of PONV in elderly patients with hip fractures. These results highlight the potential therapeutic benefits of EA in managing PND in this vulnerable patient population and warrant further investigation.</div></div><div><h3>Subject words</h3><div>electroacupuncture, transcutaneous electrical acupoint stimulation, hip surgery, perioperative neurocognitive disorders, pain, postoperative nausea and vomiting</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112660"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889662","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 quantitative analysis of bone defects in displaced proximal humeral fractures using virtual reduction technique","authors":"Xueliang Cui ,&nbsp;Xiangxu Chen ,&nbsp;Wenjun Xie ,&nbsp;Sheng Zhang ,&nbsp;Hui Chen","doi":"10.1016/j.injury.2025.112671","DOIUrl":"10.1016/j.injury.2025.112671","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Medial column disruption in proximal humeral fractures (PHFs) is associated with poor outcomes following reduction and internal fixation. Current assessments of unstable medial columns rely on qualitative descriptors such as disrupted hinges and insufficient osseous contact, often overlooking the quantification of bone defects. This study aims to quantitatively analyze bone defect characteristics in varus PHFs using advanced computer image processing techniques.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on 202 patients diagnosed with varus proximal humeral fractures who received treatment at two tertiary hospitals between January 2017 and December 2022. Three-dimensional (3D) fracture models were reconstructed using Mimics software based on preoperative computed tomography (CT) scans, followed by virtual reduction procedures performed in 3-matic software. Comprehensive demographic and morphological data were collected, including patient age, gender distribution, fracture classification, and quantitative parameters of bone defects the volume of bone defect (VBD), extent of bone defect area (EBDA), main defect region (MDR), and maximal defect height (MDH).</div></div><div><h3>Results</h3><div>Quantile regression demonstrated that age exhibited strong positive associations with VBD across all quantiles (<em>P</em> &lt; 0.001). EBDA and MDH showed consistently significant positive associations with VBD at every quantile level (all <em>P</em> &lt; 0.001). For Sex, males showed no statistically significant differences compared to females (all <em>P</em> &gt; 0.05). Among fracture classifications, 2-part fracture and 3-part fracture had comparable VBD values to 4-part fracture in most quantiles (all <em>P</em> &gt; 0.05), except for 2-part fracture at Q90 (<em>P</em> = 0.017).</div></div><div><h3>Conclusion</h3><div>This study demonstrates that all varus PHFs with significant displacement are associated with bone defects. Age, EBDA, and MDH are positively correlated with VBD, highlighting the importance of considering these factors in surgical planning.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112671"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826354","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":"Violence and non-fatal injuries among Thai adolescents: National prevalence, and sex-stratified risk and protective factors","authors":"Tanjin Kabir Aunto ,&nbsp;Taufique Ahmed ,&nbsp;Md Ehsanul Saad ,&nbsp;Md Khalid Hasan","doi":"10.1016/j.injury.2025.112664","DOIUrl":"10.1016/j.injury.2025.112664","url":null,"abstract":"<div><h3>Objectives</h3><div>We conducted a sex-stratified analysis to assess the prevalence and predictors of violence and non-fatal injury among adolescents attending school in Thailand.</div></div><div><h3>Methods</h3><div>The data for this study were obtained from the Thailand Global School-based Student Health Survey (GSHS), a nationally representative survey conducted in 2021 with a sample size of 5661 students aged 13–17 years. Multiple logistic regression analyses were used to examine the protective factors and risk factors that influence non-fatal injury and violence. The regression analysis was reported using adjusted odds ratios (AORs) and 95 % confidence intervals (CIs), with a <em>p</em>-value &lt; 0.05.</div></div><div><h3>Results</h3><div>The national prevalence of violence and non-fatal injury among school-going adolescents was 11.6 % and 52.6 %, respectively. Boys had a substantially higher prevalence of violence (7.6 %) and non-fatal injury (26.4 %) compared to girls (3.6 % and 24.1 %, respectively). Stratifying by sex, school truancy, and bullying were associated with violence and non-fatal injuries in girls, as well as suicidal ideation, anxiety, hunger, and various health risk behaviors, like tobacco, alcohol, and cigarette use, were found to be associated with violence and non-fatal injuries in boys. In contrast, parental supervision, peer support, and sedentary behavior were found to be protective factors for Thai adolescents.</div></div><div><h3>Conclusions</h3><div>Future policies should consider individual risk factors and parent-child-teacher bonding to mitigate the burden of violence and injury among in-school adolescents in Thailand.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112664"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826353","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":"Predictors of nonunion after nonoperative treatment of displaced midshaft clavicle fractures","authors":"Emma Manokian ,&nbsp;Ger D J van Olden ,&nbsp;Sanharib Al Shaer","doi":"10.1016/j.injury.2025.112657","DOIUrl":"10.1016/j.injury.2025.112657","url":null,"abstract":"<div><h3>Background</h3><div>Nonunion is a significant complication following nonoperative treatment of displaced midshaft clavicle fractures, potentially leading to impaired shoulder function, pain, and decreased quality of life. This study aims to identify predictors of nonunion in adults treated nonoperatively to optimize treatment decisions and improve outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using data from 374 patients treated nonoperatively between 2012 and 2024. Patient and fracture characteristics, including age, sex, smoking, diabetes mellitus, and fracture comminution, were assessed. Univariable and multivariable logistic regression analyses identified predictors of nonunion. Model performance was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Diagnostic statistics and number needed to screen (NNS) were calculated.</div></div><div><h3>Results</h3><div>Of 374 patients, 72 (19.3 %) developed nonunion. Multivariable analyses revealed that increasing age (odds ratio [OR]: 1.03, 95 % confidence interval [CI]: 1.01–1.04, <em>p</em> = 0.002) and smoking (OR: 2.49, 95 % CI: 1.31–4.71, <em>p</em> = 0.005) were independently associated with increased risk of nonunion. Fracture comminution was associated with reduced risk (OR: 0.34, 95 % CI: 0.20–0.58), <em>p</em> &lt; 0.001). The model’s AUC was 0.70. At a probability threshold of 0.4, the NNS was 6.</div></div><div><h3>Conclusions</h3><div>This study highlights the potential of predictive models to identify patients at risk for nonunion. Age and smoking increase the risk of nonunion, while comminution showed a protective effect. These findings support personalized care to optimize treatment decisions and improve patient outcomes. Further refinement and inclusion of additional risk factors are essential to improve the model’s accuracy and clinical applicability.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112657"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892262","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":"Major trauma in equestrian activities in New South Wales, Australia: An eleven-year review","authors":"Christopha J. Knee ,&nbsp;Michael Symes ,&nbsp;Brahman S. Sivakumar ,&nbsp;Jennifer R. McGready ,&nbsp;Venkatesha Venkatesha ,&nbsp;Mark Gillett","doi":"10.1016/j.injury.2025.112676","DOIUrl":"10.1016/j.injury.2025.112676","url":null,"abstract":"<div><h3>Introduction</h3><div>Equestrian activities are popular in Australia for both work and recreation. However, these activities are associated with high rates of injury [including major trauma] when compared to other physical activities and sports. Research assessing equestrian-related major trauma is limited. This study analyses the characteristics of equestrian-related major trauma in New South Wales, Australia, to guide injury prevention initiatives.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using data from the New South Wales Trauma Registry on equestrian-related major trauma cases over an 11-year period from 2012 to 2022. Major trauma was defined as patients with an Injury Severity Score (ISS) greater than 12, as well as those admitted to the Intensive Care Unit or those who died in hospital, regardless of ISS. Incidence rates per 100,000 NSW population were analysed using Poisson regression.</div></div><div><h3>Results</h3><div>A total of 624 equestrian-related major trauma cases were identified over the study period. The median age was 49 years (IQR 29–60), and the median ISS was 17 (IQR: 13–50). Females comprised 56.74 % of cases, with a significantly higher incidence rate than males (IRR 1.24, 95 % CI: 1.19–1.45, <em>p</em> = 0.007). Older individuals were at greater risk, with the highest incidence in the group aged between 40 to 59 (IRR 2.64, 95 % CI: 2.04–3.42). Most injuries occurred on farms (55.93 %), during leisure riding (28.21%) and were a result of a fall or being thrown from a horse (60.90 %). The most frequently injured anatomical regions included the thorax (25.40 %), spine (20.29 %), and head (18.73 %). Severe-to-critical injuries were proportionally highest in the thorax (65.08 %), head (46.97 %), and lower extremities (43.97 %). The incidence rate of major trauma increased steadily during the study period (IRR 1.027, 95 % CI: 1.002–1.053, <em>p</em> = 0.036).</div></div><div><h3>Conclusion</h3><div>The data presented in this paper provides an overview of the characteristics of equestrian-related major trauma. Salient points are that major equestrian-related trauma predominantly affects females and older individuals, with the thorax, spine, and head the most frequently injured anatomical regions. Farms are identified as the primary location of injuries across all age groups. These findings can guide future injury prevention initiatives.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112676"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841392","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":"Characteristics and outcomes of interprosthetic versus periprosthetic femur fractures","authors":"Nigel Blackwood ,&nbsp;Doriann M. Alcaide ,&nbsp;Jose L. Ayala-Ortiz ,&nbsp;Jodie Meeks ,&nbsp;Christian Just ,&nbsp;Alex Heatherly ,&nbsp;Clay A. Spitler ,&nbsp;Joseph P. Johnson","doi":"10.1016/j.injury.2025.112653","DOIUrl":"10.1016/j.injury.2025.112653","url":null,"abstract":"<div><h3>Objectives</h3><div>The purpose of this study was to compare demographics, treatments, and outcomes of interprosthetic (IPFFs) and periprosthetic femur fractures (PPFFs). IPFFs were hypothesized to occur in older patients and have higher rates of reoperation, implant failure, and mortality.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort at a Level 1 trauma center analyzing adults with PPFFs/IPFFs from 2012-2024. Patients with &lt; 30 days follow-up were excluded. Patient characteristics, treatments, and complications were compared between IPFFs and PPFFs.</div></div><div><h3>Results</h3><div>276 patients with 30 IPFFs and 246 PPFFs were included. IPFFs were older (74y v 69y <em>p</em>=.035), more commonly osteoporotic (33% v 11% <em>p</em>&lt;.001), and more commonly current (17% v 14%) or former smokers (7% v 0% <em>p</em>&lt;.001). IPFFs presented with 29 total hip (THA) and knee (TKA) arthroplasties and one THA and unicompartmental knee arthroplasty. PPFFs presented with 130 fractures around THAs and 116 fractures around TKAs. IPFFs more commonly presented with unstable prostheses (40% v 21% <em>p</em>=.017). Of the seven IPFFs treated with nail-plate hybrid constructs (NPCs), six (86%) were immediately weightbearing as tolerated (WBAT). Of the 23 IPFFs not treated with NPCs, 9 (39%) were immediately WBAT (<em>p</em>=.031). IPFFs had more blood loss (811mL v 513mL <em>p</em>=.016). The mortality rate was 15% in IPFFs and 4% in PPFFs (<em>p</em>=.02). IPFFs had higher rates of implant failure (23% v 7% <em>p</em>=.004) and superficial infection (15% v 4% <em>p</em>=.013). Of the seven IPFFs treated with NPCs, there were no implant failures, while 7/23 (30%) IPFFs treated with other techniques failed (<em>p</em>=.09).</div></div><div><h3>Conclusions</h3><div>IPFFs were older, more commonly osteoporotic, more likely to be smokers, and more often had unstable prostheses at presentation than PPFFs. While treatments were similar, the rate of mortality, implant failure and superficial infection was higher in IPFFs. NPCs may allow for earlier weightbearing but their long-term effects regarding outcomes and stability require further investigation in prospective studies.</div></div><div><h3>Level of evidence</h3><div>III</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112653"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829473","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}