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

{"title":"Traumatic arthrotomy: A systematic review evaluating diagnostic strategies","authors":"Pravjit Bhatti ,&nbsp;Elan A. Karlin ,&nbsp;Charles C. Lin ,&nbsp;Utkarsh Anil ,&nbsp;Steven M. Rivero","doi":"10.1016/j.injury.2025.112168","DOIUrl":"10.1016/j.injury.2025.112168","url":null,"abstract":"<div><h3>Objectives</h3><div>The purpose of this study was to systematically review available strategies for diagnosing traumatic arthrotomy.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted on October 8th, 2023 using Ovid Medline, Cochrane Central Register of Controlled Trials, Embase, and Embase Classic. Studies were included in the review if they evaluated a diagnostic strategy for traumatic arthrotomy.</div></div><div><h3>Results</h3><div>There were 26 studies included after application of the exclusion criteria. 12 studies investigated traumatic arthrotomy of the knee, 8 of the elbow, 4 of the shoulder, 4 of the wrist, and 5 of the ankle. 23 studies implemented the saline load test as a diagnostic strategy, 7 considered CT scan, 1 study used x-ray, and 1 study used ultrasound. Of the studies that considered saline load tests, 8 of them also used methylene blue. CT scans were found to have 100% sensitivity when diagnosing traumatic arthrotomy of the knee. Saline load test was shown to have 60% to 100% sensitivity when diagnosing traumatic arthrotomies of the elbow. Saline load tests had sensitivities ranging from 75% to 100% when considering a shoulder traumatic arthrotomy. The saline load test was able to diagnose traumatic arthrotomies of the wrist, and ankle with sensitivities up to 100% and 99%, respectively.</div></div><div><h3>Conclusions</h3><div>When considering the infectious risks associated with undiagnosed traumatic arthrotomy, clinicians should seek modalities with the highest diagnostic performance. The saline load test has long been considered the gold standard for diagnosing traumatic arthrotomy, however, imaging modalities hold appeal as a less invasive and technically challenging procedure. Although diagnostic performance is joint-dependent, this review indicates that the saline load test continues to be the most reliable method for diagnosing most traumatic arthrotomies other than the knee.</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 3","pages":"Article 112168"},"PeriodicalIF":2.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070500","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":"Does maintaining external fixators during definitive fixation of bicondylar tibial plateau fractures influence fracture alignment and deep infection rates?","authors":"John Mickley ,&nbsp;William Philips ,&nbsp;Sara Colosimo ,&nbsp;Dinela Kurtic ,&nbsp;Adam Gitlin ,&nbsp;Porter Young","doi":"10.1016/j.injury.2025.112180","DOIUrl":"10.1016/j.injury.2025.112180","url":null,"abstract":"<div><h3>Introduction</h3><div>External fixators are utilized to temporarily stabilize bicondylar tibial plateau fractures. They can be prepped during definitive surgery to help maintain fracture length and alignment. However, there is a potential for increased infection by leaving the external fixator on during the surgery. We hypothesize that maintaining the external fixator during surgery will result in no difference in rates of deep infection but improve reduction quality.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of all bicondylar tibial plateau fractures treated at an academic, level one trauma center over a 10-year period. The primary outcome analyzed was the rate of deep infection. Secondary outcomes analyzed included reduction quality by comparing the medial proximal tibia angle (MPTA) and posterior proximal tibia angle (PPTA), complication rate, and reoperation rate.</div></div><div><h3>Results</h3><div>One hundred and thirty-nine fractures in 133 patients met the inclusion criteria. There was no difference between the external fixator removed and prepped groups in terms of baseline patient characteristics except for more motor vehicle collisions in the removed group (42 % vs 22.99 %, <em>p</em> = 0.0193) and more open fractures in the prepped group (6 % vs 18.39 %). Operative characteristics were also not statistically different except for more patients in the prepped group underwent preoperative skin shaving (22 % vs 48.28 %, <em>p</em> = 0.0023) and more patients in the removed group had fixation constructs with plate and pin site overlap (46 % vs 24.14 %, <em>p</em> = 0.0083). There was no difference in deep infection between the groups (16.00 % vs 8.05 %, <em>p</em> = 0.1511). There was no difference in reduction quality when comparing the MPTA (87.64° vs 87.40°, <em>p</em> = 0.6607) and PPTA (83.18° vs 83.97°, <em>p</em> = 0.3592). The rates of superficial infection (20 % vs 29.89 %, <em>p</em> = 0.2056), unplanned reoperation (30 % vs 18.39 %, <em>p</em> = 0.1179), complications (58 % vs 44.83 %, <em>p</em> = 0.1376), and nonunion (8 % vs 6.89 %, <em>p</em> = 0.8111) were also similar.</div></div><div><h3>Conclusions</h3><div>Bicondylar tibial plateau fractures are challenging injuries with a high complication profile. Our findings suggest that maintaining the external fixator is not associated with increased rates of deep infection or complications. However, maintaining the external fixator during surgery did not lead to differences in final coronal or sagittal alignment reduction quality.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112180"},"PeriodicalIF":2.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049315","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 benefit of national clinical guidelines for open lower limb fractures in reducing healthcare burden: A length of inpatient stay cost-analysis","authors":"Katie Young ,&nbsp;Juan Enrique Berner ,&nbsp;Manuel Ortiz-Llorens ,&nbsp;Marieke Noorlander-Borgdorff ,&nbsp;Jagdeep Nanchahal ,&nbsp;Abhilash Jain ,&nbsp;INTELLECT Collaborative","doi":"10.1016/j.injury.2025.112178","DOIUrl":"10.1016/j.injury.2025.112178","url":null,"abstract":"<div><h3>Introduction</h3><div>Severe open lower limb fractures are complex and costly injuries. Studies reporting the costs associated with these injuries, the economic impact of complications, and the clinical benefit of adherence to national guidelines have been previously reported. However, the economic benefits of national guidelines and their relationship with length of inpatient stay have not been described.</div></div><div><h3>Methods</h3><div>An international retrospective cohort study, using length of stay as a proxy for in-hospital economic impact, comparing the duration of inpatient stay in countries with national guidelines and those without.</div></div><div><h3>Results</h3><div>In a cohort of 2641 patients from 16 countries, length of stay was 17 % lower in countries with national guidelines, equivalent to 2–3 fewer inpatient days per patient. This difference was primarily driven by a lower incidence of deep infection observed in countries with national clinical guidelines.</div></div><div><h3>Conclusion</h3><div>The presence of national guidelines for the management of severe lower limb injuries is associated with both improved clinical outcomes and reduced length of stay and therefore healthcare burden. Whilst application and adoption of national guidelines is not without challenges, their implementation is associated with significant clinical and economic benefits.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112178"},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070498","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":"High mortality among elderly with surgical treated femoral fracture in comparison to other surgical treated lower extremity fractures. A population-based register study from the Danish National Patient Registry","authors":"Michael Houlind Larsen ,&nbsp;Per Hviid Gundtoft ,&nbsp;Bjarke Viberg","doi":"10.1016/j.injury.2025.112176","DOIUrl":"10.1016/j.injury.2025.112176","url":null,"abstract":"<div><h3>Background</h3><div>Proximal femoral fractures has been associated with high mortality risk, while little is known about more distal lower extremity fractures. The aim was to report 30- and 365-days mortality in surgically treated lower extremity fractures in individuals above 65 years.</div></div><div><h3>Materials and methods</h3><div>We extracted data from the Danish National Patient Register on all surgically treated lower extremity fracture in the period 1998–2017. The primary outcome was mortality reported by fracture site defined by ICD-10 codes (femur S72*, tibia S82*, foot/ankle S92*S825–8). The secondary outcomes were mortality divided on sex, age groups (5-year span), and comorbidity. This study was conducted using descriptive statistics.</div></div><div><h3>Results</h3><div>We identified 182,013 operatively treated lower extremity fractures of which 73 % occurred in females. The 30-day mortality was 10 % for patients with femoral fractures, 2 % for tibia and 1 % for foot/ankle. The 30-day mortality were similar in femoral fractures regardless of location in the femur (8–11 %). The 365-day mortality was 29 % for femoral fractures, 8 % for tibia and 6 % for foot/ankle.</div><div>Men with a femoral fracture had higher mortality (15 % at 30 days, 37 % at 356 days) in comparison to women (8.2 % at 30 days, 26 % at 356 days). For the above 85+ year age group, the fracture location was less important for 365-day mortality.</div></div><div><h3>Conclusion</h3><div>There was an observed high risk of mortality in surgically treated femoral fractures. The mortality risks seems to rapidly decline when the fractures are below the knee.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112176"},"PeriodicalIF":2.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043900","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":"Outcomes of surgically treated posterior pelvic fractures in an Australian population: A multicenter study","authors":"Joshua Booth ,&nbsp;Prof Belinda Gabbe ,&nbsp;Teresa Neeman ,&nbsp;Diana M Perriman ,&nbsp;Paul N Smith","doi":"10.1016/j.injury.2025.112169","DOIUrl":"10.1016/j.injury.2025.112169","url":null,"abstract":"<div><h3>Background</h3><div>Unstable posterior pelvic-ring fractures are rare and difficult to manage. There are many injury patterns, they are associated with high morbidity and mortality, and optimal surgical management remains contentions. This study aims to compare outcomes and complications for different surgical management of these injuries.</div></div><div><h3>Methods</h3><div>This was a multi-centre observational study of patients with traumatic posterior pelvic-ring injuries that underwent operative management between 1st January 2010 and 1st January 2020 at three Australian MTS. Cases were identified using internal hospital databases and the Victorian State Trauma registry. Data was retrieved from medical records and included surgeries, fixation method, length of stay, and outcomes (revision surgery, infection, hardware breakage, screw misplacement and hardware removal), time to each outcome was also recorded. The extracted data was collated and then analysed using RStudio; generalised liner models and linear regression models were developed to calculate mean differences and odd ratios.</div></div><div><h3>Results</h3><div>There were 439 cases (309 males and 130 females) in the cohort with a median age of 39 years. The overall prevalence of revision was 7.7 %; 4.8 % for infection, 1.8 % for hardware failure and 13.2 % for removal of hardware. Bulkier, more prominent fixation methods had higher rates of metalware removal. Numbers were too small in subgroups to detect a significant difference in complication rates between fixation method. However, bilateral injuries had a significant effect on revision with a calculated prevalence of 16.7 % vs 5.6 % for unilateral injuries. Cases managed with open-reduction had a calculated infection rate of 15.6 % vs 4.6 %. Length-of-stay was increased in patients managed with temporising external fixators, who had bilateral injuries, where infection occurred or were restricted to non-weight bearing postoperatively.</div></div><div><h3>Conclusions</h3><div>This study highlight bilateral posterior-pelvic ring injuries as a greater management challenge than unilateral injuries. It supports the use of percutaneous fixation with closed-reduction, decreased infection risk and decreased length-of-stay. It challenges the use of external fixators and supports less restrictive post-operative restrictions. This study also serves as a descriptive analysis for the current management of pelvic fractures in an Australian setting, shedding light on complication rates and profiles.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112169"},"PeriodicalIF":2.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043901","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":"Long bone fractures with associated vascular injury: Who should go first?","authors":"Anthony M. Castro ,&nbsp;Gregory M. Connors ,&nbsp;Melissa Soderquist ,&nbsp;David K. Galos","doi":"10.1016/j.injury.2025.112174","DOIUrl":"10.1016/j.injury.2025.112174","url":null,"abstract":"<div><h3><strong>Objectives</strong></h3><div>Long bone fractures with concomitant vascular injury have the potential to be life and limb threatening injuries, with increased risk for limb loss. There is currently no established surgical order of operations for orthopaedic and vascular intervention. This study compares injury classification, warm ischemia time and patient outcomes in patients with long bone fractures and associated vascular injury after orthopaedic versus vascular primary intervention.</div></div><div><h3><strong>Methods</strong></h3><div><em>Design:</em> Retrospective review</div><div><em>Setting:</em> Level 1 Trauma Center</div><div><em>Patient Selection Criteria:</em> Included were patients treated between 2016 and 2021 with fractures of the femur, tibia, fibula, or knee dislocation (OTA/AO 32, 33, 41, 42 and 43) with associated vascular injury necessitating vascular repair.</div><div><em>Outcome Measures and Comparisons:</em> Warm ischemia time, intraoperative transfusion requirements, readmission, definitive amputation, fasciotomy, infection, need for vascular revision, and return to weight bearing were compared between the two groups (primary vascular intervention (VP) and primary orthopaedic intervention (OP)).</div></div><div><h3><strong>Results</strong></h3><div>35 patients were included with 29 patients in the VP group and 6 patients in the OP group. There was no significant difference in the warm ischemia time between groups (p = 0.52) or total operative time (p = 0.13). 3/29 patients in the VP group required definitive amputation and 0/6 patients in the OP group required amputation (p = 1.00). There were no statistically significant differences in rates of infection, fasciotomy, readmission, length of stay, vascular revision, or time to weight bearing between groups.</div></div><div><h3><strong>Conclusions</strong></h3><div>This study demonstrates collaborative care between surgical teams to minimize warm ischemia time is crucial in patients with lower extremity fractures associated with vascular injury. There is no significant difference in patient outcomes including definitive intraoperative transfusion requirements, amputation, time to weight bearing or infection when comparing primary orthopaedic versus vascular intervention.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112174"},"PeriodicalIF":2.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061759","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":"Timing in orthopaedic surgery – Rethinking traditional myths with a critical perspective","authors":"Jan Reinhard ,&nbsp;Melanie Schindler ,&nbsp;Josina Straub ,&nbsp;Susanne Baertl ,&nbsp;Dominik Szymski ,&nbsp;Nike Walter ,&nbsp;Siegmund Lang ,&nbsp;Volker Alt ,&nbsp;Markus Rupp","doi":"10.1016/j.injury.2025.112165","DOIUrl":"10.1016/j.injury.2025.112165","url":null,"abstract":"<div><h3>Purpose</h3><div>Standard operating procedures aim to achieve a standardized and assumedly high-quality therapy. However, in orthopaedic surgery, the aspect of temporal urgency is often based on surgical tradition and experience. At a time of evidence-based medicine, it is necessary to question these temporal guidelines. The following review will therefore address the most important temporal guidelines in orthopaedic surgery and discuss their practical relevance and potential need for optimization.</div></div><div><h3>Methods</h3><div>The systematic review features a literature review by database search in “PubMed” (<span><span>https://pubmed.ncbi.nlm.nih.gov</span><svg><path></path></svg></span>) for time to surgery in terms of (1) “proximal femoral fractures”, (2) “femoral neck fractures”, (3) “proximal humeral fractures”, (4) “ligament and tendon injuries”, (5) “spinal cord injuries”, (6) “open fractures” and (7) “fracture-related infections”. For every diagnosis, hypotheses on timing were set up and checked for evidence.</div></div><div><h3>Results</h3><div>There is solid clinical evidence supporting the initiation of treatment within 24 h for specific conditions like the surgical treatment of proximal femur fractures and prompt decompression of spinal cord injuries. However, for other scenarios such as the 6-hour rule for open fractures, joint-preserving femoral neck fractures, timing of ligament injuries, humeral head fractures and fracture-related infections there is currently no reliable evidence to guide prompt surgical treatment.</div></div><div><h3>Conclusion</h3><div>Based on the current data, resource-adapted surgical planning seems reasonable. Further research in these areas is necessary to determine the best timing of treatment and address existing doubts.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112165"},"PeriodicalIF":2.2,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070499","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":"The influence of pre-injury anticoagulant or antiplatelet agents on outcomes in trauma patients sustaining abdominal solid organ injuries: A scoping review","authors":"Gi Young Seo ,&nbsp;Arpita Das ,&nbsp;Silvia Manzanero ,&nbsp;Keeyeon Kim ,&nbsp;Carl Lisec ,&nbsp;Michael Muller","doi":"10.1016/j.injury.2025.112175","DOIUrl":"10.1016/j.injury.2025.112175","url":null,"abstract":"<div><h3>Background</h3><div>Indications for, and usage of, anticoagulant (AC) and antiplatelet (AP) agents is increasing. In this context, it is important to understand the evidence base of the effect of pre-injury AC/AP agents on patient outcomes in the context of traumatic solid organ injury (SOI) to inform management protocols.</div></div><div><h3>Methods</h3><div>A scoping review of the literature was undertaken with a systematic search strategy within the PubMed and Scopus databases. Study characteristics, clinical outcomes and outcome measures including mortality, hospital length of stay, admission to intensive care units, length of stay in intensive care and management details were extracted from included studies.</div></div><div><h3>Results</h3><div>The search identified six eligible studies reporting results from a total of 26,960 patients. Patients on AC/AP are more likely to fail non-operative management (NOM) than their non-AC/AP counterparts; at the same time, they are less likely to be operated on as a first line of management. Clinical outcome measures (mortality, length of stay, admission to intensive care units, and length of intensive care unit stay) were heterogeneous across studies, but it is likely that AC/AP patients have poorer outcomes in SOI. Results on transfusion requirements were inconclusive.</div></div><div><h3>Conclusion</h3><div>Few studies have examined the effect of pre-injury anticoagulation on outcomes in trauma patients sustaining solid organ injuries. Future studies should more closely examine solid organ trauma within the elderly group, as well as the effect of newer AC/AP agents in current use.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112175"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026103","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":"Osseointegration for transfemoral amputees: Influence of femur length and implant sizing on bone-implant contact and alignment","authors":"Matthew Cao ,&nbsp;David B. Doherty ,&nbsp;Hongjia He ,&nbsp;Vinay P. Vanodia ,&nbsp;Kristin Reeves ,&nbsp;Sabir K. Ismaily ,&nbsp;Jonathan J. Sauer ,&nbsp;Shuyang Han","doi":"10.1016/j.injury.2025.112162","DOIUrl":"10.1016/j.injury.2025.112162","url":null,"abstract":"<div><h3>Introduction</h3><div>Clinical data on osseointegration (OI) for limb replacement indicates a concerning increase in mechanical complications after five years post-implantation. Since adequate bone-implant contact and proper implant alignment are critical factors for successful osseointegration, it is essential to identify the factors influencing these outcomes. This study aimed to assess the effects of residual femur length and implant sizing on bone-implant contact and implant alignment.</div></div><div><h3>Methods</h3><div>Three-dimensional models of eight cadaveric femora were reconstructed from CT scans, and transfemoral amputations were simulated for each femur at three levels: short (ST: 1/3 L), medium (MD: 1/2 L), and long (LG: 2/3 L). Virtual OI surgeries were then performed using computer-aided design (CAD) models, and implant sizes were recorded. Subsequently, the effect of implant sizing was assessed by adjusting the implant size by ±1 mm. Contact length and implant alignment were compared between the groups using repeated measures analysis of variance with Bonferroni correction.</div></div><div><h3>Results</h3><div>The contact in the ST group (65.2 ± 7.3 %) was significantly less compared to the MD (96.1 ± 4.1 %, <em>p</em> &lt; 0.001) and LG (96.8 ± 3.2 %, <em>p</em> &lt; 0.001) groups. Upsizing increased contact in the ST group by 7.0 ± 2.6 % (<em>p</em> &lt; 0.001), though it did not reach levels comparable to the MD and LG groups (<em>p</em> &gt; 0.05). Additionally, sagittal implant misalignment was larger in the ST group (10.1 ± 2.0°) than in the MD (7.9 ± 1.5°) and LG (3.5 ± 1.6°) groups (<em>p</em> &lt; 0.001), while no difference was observed in coronal implant alignment.</div></div><div><h3>Conclusion</h3><div>These findings highlight the factors influencing mechanical complications of osseointegration implants and provide a basis for refined implant designs and surgical techniques for patients with short residual limbs.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112162"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054617","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":"Opportunistic screening for metabolic bone disease in high energy fracture patients","authors":"Garrett Gordon ,&nbsp;Brian Johnson ,&nbsp;Olivia Marquardt ,&nbsp;Dylan Young ,&nbsp;Michael J. Beltran ,&nbsp;Sarah N. Pierrie","doi":"10.1016/j.injury.2025.112147","DOIUrl":"10.1016/j.injury.2025.112147","url":null,"abstract":"<div><h3>Objective</h3><div>Metabolic bone disease (MBD, referring to osteopenia and osteoporosis) and its sequelae are associated with substantial morbidity, mortality, and healthcare costs. MBD screening and bone densitometry referral are underutilized in the general population despite published screening guidelines. Prior studies have correlated vertebral body Hounsfield unit (HU) measurements with MBD. The purpose of this study is to use this method to identify the prevalence of undiagnosed MBD in patients presenting to the hospital after high energy trauma, and to determine whether opportunistic MBD screening using this method would be valuable in this cohort.</div></div><div><h3>Design</h3><div>Retrospective review.</div></div><div><h3>Setting</h3><div>Level 1 trauma center and safety net hospital.</div></div><div><h3>Patients</h3><div>307 patients with a high energy femur fracture who underwent abdomen/pelvis computed tomography (CT) were identified from a trauma database.</div></div><div><h3>Intervention</h3><div>L1 vertebral body radio density (in Hounsfield units, HU) was measured from trauma CT scans. Risk factors for MBD were identified from the medical record.</div></div><div><h3>Main outcome measurements</h3><div>Prevalence of MBD and proportion of patients with MBD risk factors meriting further work-up.</div></div><div><h3>Results</h3><div>The prevalence of MBD among high energy trauma patients was similar to the age-matched general population. Over half (50.5 %) of all patients had at least one risk factor for MBD. Among patients 50 to 64 years of age with any given MBD risk factor, over a third of individuals had MBD. In this population, the prevalence of MBD was highest (40.0 %) among those who used tobacco products and had a concurrent alcohol use disorder.</div></div><div><h3>Conclusion</h3><div>Opportunistic screening for MBD using a CT measurement technique can facilitate earlier diagnosis and treatment for affected individuals presenting after high energy trauma. Opportunistic screening may be particularly impactful in pre-menopausal women and in men, who frequently have MBD risk factors but who have a low referral rate for bone density testing and treatment.</div><div>Level of evidence: Diagnostic level III.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112147"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082456","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}