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

{"title":"Different inflammatory responses in the remote organs after tourniquet-induced ischemia-reperfusion in mouse hindlimb","authors":"Linda Xu ,&nbsp;Lauren Whitney ,&nbsp;Huiyin Tu ,&nbsp;Anthony J. Evans,&nbsp;Abigail Klammer,&nbsp;Aaron N. Barksdale,&nbsp;Michael C. Wadman,&nbsp;Yu-Long Li","doi":"10.1016/j.injury.2026.113060","DOIUrl":"10.1016/j.injury.2026.113060","url":null,"abstract":"<div><div>Tourniquet use is the most effective tool for controlling life-threatening extremity hemorrhage before other treatments and for creating bloodless operating fields in surgical procedures. However, tourniquet-induced ischemia-reperfusion (tourniquet/IR) also causes skeletal muscle injury and is associated with secondary remote organ injuries. Our previous studies have demonstrated that there is involvement of inflammatory cytokines in tourniquet-induced skeletal muscle IR injuries. In this study, we investigated the inflammatory responses and tissue injuries in remote organs after tourniquet/IR. The unilateral hindlimbs of mice were subjected to 3 h of tourniquet application by placing a rubber band at the hip joint. Then the rubber bands were released to initiate reperfusion, and tissues were harvested after 1, 3, 7, 14, and 28 days of reperfusion. The data from real-time RT-PCR and western blot showed that the levels of IL-1β and TNFα (two pro-inflammatory cytokines) mRNAs and proteins increased in the lungs and livers, whereas these cytokines did not rise in hearts and kidneys during 28 days of tourniquet/IR, compared to the sham tissues. Histological images also confirmed the infiltration of inflammatory cells in lungs and livers, but not in hearts and kidneys during 28 days of tourniquet/IR. Tourniquet/IR induced tissue structural injuries in the lungs but not the livers, hearts, and kidneys. Additionally, 21.8 % (12/55) of mice died at 1 day and 3 days of tourniquet/IR. These results suggest that inflammatory responses and severity of tissue injuries are different among remote organs and tourniquet/IR-related lung injuries could be a major cause of death during tourniquet/IR, which can help to develop therapeutic strategies for reducing mortality and improving outcomes after the use of tourniquet.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113060"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038948","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":"Application of the posterolateral approach in the surgical treatment of ankle fractures","authors":"Heng Zhang,&nbsp;Yue Wang,&nbsp;Zhiliang Guo,&nbsp;Minhui Zhang,&nbsp;Ruojie Bi","doi":"10.1016/j.injury.2026.113021","DOIUrl":"10.1016/j.injury.2026.113021","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to compare the efficacy of the posterolateral and posteromedial approaches in the surgical treatment of trimalleolar ankle fractures involving the posterior malleolus.</div></div><div><h3>Methods</h3><div>A total of 120 patients with trimalleolar ankle fractures (Haraguchi type II posterior malleolar fractures confirmed by computed tomography scans involving &gt;30% of the tibial articular surface) admitted to our hospital were separated into two subgroups according to different intervention methods. The posterolateral approach subgroup had 60 patients (finally, 58 patients were included), and the posteromedial approach subgroup had 60 patients (finally, 57 patients were included). Open reduction and internal fixation (ORIF) were conducted in all patients, addressing the fibula through the same posterolateral incision or through a separate lateral incision in the posteromedial group. The general operation, fracture healing and complication rate of the two subgroups were compared.</div></div><div><h3>Results</h3><div>The operation time, intraoperative bleeding, incision length and postoperative hospitalisation time of the posterolateral approach subgroup were significantly shorter than those of the posteromedial approach subgroup. The fracture healing time in the posterolateral approach subgroup was significantly shorter than that in the posteromedial approach subgroup, and the complication rate was significantly less than that in the posteromedial approach subgroup. At a mean follow-up of 14.3 months (range: 12–18 months), there was no notable distinction in the excellent and good rates for the posterolateral approach subgroup (94.83%) and the posteromedial approach subgroup (87.72%).</div></div><div><h3>Conclusion</h3><div>The posterolateral approach for the treatment of trimalleolar ankle fractures shortens the operation time, promotes fracture healing through improved visualisation and reduction quality, lessens the incidence of complications and, compared with posteromedial ORIF, does not affect the functional recovery of the ankle joint.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113021"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032472","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":"Pilot validation study for a large image database of proximal femur fracture anteroposterior radiographs: Searching for the ground truth","authors":"Andrea Audisio ,&nbsp;Tracy Zhu ,&nbsp;Alexander Joeris ,&nbsp;An Sermon ,&nbsp;Frank F.A. IJpma ,&nbsp;Vincenzo Giordano ,&nbsp;Dhaval Desai ,&nbsp;Peter V. Giannoudis ,&nbsp;Alessandro Aprato","doi":"10.1016/j.injury.2026.113056","DOIUrl":"10.1016/j.injury.2026.113056","url":null,"abstract":"<div><h3>Purpose</h3><div>This pilot study aims to validate the \"ground truth\" accuracy and consistency of proximal femur fracture classification using a large radiographic image database. The project, a collaboration between expert groups from the University of Turin and the AO Foundation, seeks to ensure that expert consensus-based annotations are reliable for future artificial intelligence (AI) model development.</div></div><div><h3>Methods</h3><div>A cross-sectional, diagnostic accuracy study was conducted using a randomly selected subset of 300 anteroposterior pelvic radiographs from a single-center image repository created at the University of Turin within the AO Innovation Translation Center framework. Fracture classification annotations were independently provided by the local clinical expert group (LC-EG) and by an independent AO expert group of surgeons (AO-EG). To assess interrater reliability between the two groups, Cohen’s kappa coefficient was calculated for categorical agreement on the presence of a fracture and AO/OTA classification.</div></div><div><h3>Results</h3><div>The comparison of annotations from LC-EG and AO-EG yielded a Cohen’s kappa of 0.81 (95 % confidence interval: 0.75–0.87) and a percentage agreement of 87.67 % (95 % confidence interval: 87.63–87.70) for the classification of proximal femur fractures into three defined categories: no fracture, fracture type 31A, and fracture type 31B. These results confirm a high level of consistency between the two expert groups in annotating the image dataset.</div></div><div><h3>Conclusion</h3><div>The observed interrater reliability between the LC-EG and AO-EG supports the credibility of the reference annotations, establishing a validated ground truth for proximal femur fractures. This evidence justifies using the radiographic image database as a benchmark for future studies and as a foundation for transparent, reproducible AI development and evaluation, thereby facilitating safer integration of decision support tools into orthopedic trauma workflows.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113056"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079377","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":"Scoping review on motorcycle crashes patterns, risk factors, and potential in setting policy priorities in the gulf cooperation council countries (GCC)","authors":"Simple Sibi Joseph ,&nbsp;Layth Al-Jarrah ,&nbsp;Mohamed H. Ahmed ,&nbsp;Ayman El-Menyar ,&nbsp;Naushad Ahmad Khan ,&nbsp;Husham Abdelrahman ,&nbsp;Rafael Consunji ,&nbsp;Yassir Abdulrahman ,&nbsp;Sandro Rizoli ,&nbsp;Hassan Al-Thani","doi":"10.1016/j.injury.2026.113017","DOIUrl":"10.1016/j.injury.2026.113017","url":null,"abstract":"<div><h3>Background</h3><div>Although road traffic injuries (RTIs) pose a significant public health burden in the Gulf Cooperation Council countries (GCC), the true extent of motorcycle crash injuries (MCCIs) remains unclear because of limited published data from this region. Emerging evidence suggests that MCCIs are on the rise because of the growing use of motorcycles for transport and delivery services, even though road safety overall has improved. We sought to review regional evidence on MCCIs' patterns, key risk factors, and temporal trends to inform policy interventions and research priorities for effective prevention.</div></div><div><h3>Methods</h3><div>A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Articles on GCC MCCIs published from July 2008 to October 2025, examining injury patterns, mortality, and safety practices, were included in the review. Search was conducted across PubMed, Scopus, Google Scholar, and grey literature sources. The GCC consists of six countries: Saudi Arabia (KSA), Qatar, Kuwait, the United Arab Emirates (UAE), Bahrain, and Oman.</div></div><div><h3>Results</h3><div>Of 1344 studies identified, 9 met the inclusion criteria and were analyzed. The GCC has seen an increase in the number of motorcycles registered, resulting in higher MCC rates over time. During the COVID-19 pandemic, these rates surged again as the delivery sector grew. MCCI victims were mainly young males (mean age of 29 years). Extremity injuries were the most frequent (two-thirds), followed by head injuries (20–41%), often associated with poor helmet use compliance (range 13–17%). Delivery riders represented a high-risk subgroup, reflecting occupational exposure, fatigue, and time pressure. Despite advances in trauma care, geographic gaps persist. Helmet use non-compliance, alcohol use, and inadequate documentation remain significant risk factors. Extremity injuries were the most common in the GCC.</div></div><div><h3>Conclusion</h3><div>MCCIs in the GCC are on the rise with high rates of extremity and head trauma. Poor helmet use compliance is a significant factor. Therefore, we suggest strengthening helmet use laws and safety standards, increasing community efforts, and establishing motorcycle lanes with lower speed limits. Protection for riders at work should be enhanced. Road infrastructure and robust data systems also need improvement.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113017"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021237","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 patient demographics and implant complications in patients with multiple sclerosis undergoing total hip arthroplasty versus hemiarthroplasty for femoral neck fractures","authors":"Adam M. Gordon ,&nbsp;Faisal R. Elali ,&nbsp;Gabriel A. Lama ,&nbsp;Matthew L. Magruder ,&nbsp;Kevin K. Kang","doi":"10.1016/j.injury.2026.113055","DOIUrl":"10.1016/j.injury.2026.113055","url":null,"abstract":"<div><h3>Introduction</h3><div>Multiple sclerosis (MS) is a chronic neurological condition characterized by muscle spasticity, which may influence the outcomes of hip arthroplasty procedures, particularly in patients undergoing total hip arthroplasty (THA) or hemiarthroplasty for femoral neck fractures. It is unclear whether implant complications and revision rates differ between these two surgical approaches in patients with MS. The aim of this study was to compare patient demographics and 2-year implant complications in patients with MS undergoing THA versus hemiarthroplasty for femoral neck fractures.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed using a nationwide claims database (2010–2022). MS patients who did not have dementia who underwent THA or hemiarthroplasty for femoral neck fractures were identified. Two-year implant complications, including hip dislocations, aseptic loosenings, periprosthetic joint infections (PJIs), periprosthetic fractures, and all-cause revisions, were compared between the two groups using multivariable logistic regressions while controlling for age, sex, comorbidities, and overall Elixhauser Comorbidity Index (ECI).</div></div><div><h3>Results</h3><div>A total of 2018 patients with MS (604 THA and 1414 hemiarthroplasty) were included. Patients had no difference in overall comorbidity burden (ECI 7.47 vs. 6.93, <em>p</em> = 0.015). At 2 years, THA was associated with significantly higher rates of aseptic loosenings (OR: 4.17, <em>p</em> = 0.001) and all-cause revisions (OR: 3.04, <em>p</em> &lt; 0.0001). Patients undergoing THA also showed trends toward higher rates of hip dislocations (OR: 1.53, <em>p</em> = 0.087) and PJIs (OR: 1.73, <em>p</em> = 0.059) compared to hemiarthroplasty.</div></div><div><h3>Conclusions</h3><div>Patients with MS undergoing THA for femoral neck fractures are associated with a higher risk for implant complications, including aseptic loosening and all-cause revisions, compared to those undergoing hemiarthroplasty. Surgeons should consider these outcomes when selecting the appropriate surgical option for patients with MS who do not have dementia with femoral neck fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113055"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115272","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":"Updated literature review of distal locking techniques for long femoral nails: Advantages and disadvantages","authors":"Ollagnon Stella,&nbsp;Maszelin Benjamin,&nbsp;Hamcha Hamid,&nbsp;Pries Pierre,&nbsp;Lacroix Richard,&nbsp;Marty Diloy Thibault,&nbsp;Vendeuvre Tanguy","doi":"10.1016/j.injury.2026.113063","DOIUrl":"10.1016/j.injury.2026.113063","url":null,"abstract":"<div><h3>Introduction</h3><div>Distal locking during intramedullary femoral nailing remains a technically demanding and radiation-intensive procedure. Since the last systematic review by Whatling et al., numerous innovations over the past two decades have aimed to improve accuracy, shorten operative time, reduce radiation exposure, and simplify the learning curve. A comprehensive synthesis of available techniques is lacking in the recent literature.</div></div><div><h3>Methods</h3><div>A systematic review was conducted, according to PRISMA guidelines, including all studies published between January 2006 and January 2025 that reported on distal locking techniques for femoral intramedullary nails. Five databases (PubMed, Cochrane, Embase, Web of Science, Google Scholar) were screened using predefined keywords. Data were extracted on technique type, associated advantages and disadvantages, operative time, radiation exposure, accuracy, and complication rates. Risk of bias was assessed using RoB 2, ROBINS-I, JBI, NOS, and ROBIS as appropriate. PROSPERO registration: CRD42025626521</div></div><div><h3>Results</h3><div>Thirty-six studies met the inclusion criteria, covering several categories: fluoroscopy-free techniques, modification of traditional freehand, targeting devices, and navigation-assisted systems (electromagnetic, robotic, optical, laser-guided). Low-tech solutions such as the “nail-over-nail” or auditory-guided techniques demonstrated promising accuracy in low-resource settings but lacked standardization. Meta-analyses confirmed the efficacy of electromagnetic navigation systems, particularly in reducing radiation exposure and operative time, without compromising success rates. Overall, navigation-based systems showed significant reductions in radiation time and promising accuracy across multiple trials.</div></div><div><h3>Conclusion</h3><div>This review highlights the broad spectrum of available distal locking techniques, from conventional approaches to advanced technological solutions. Navigation-assisted systems offer measurable benefits but remain limited by cost and accessibility. Simpler mechanical or acoustic methods remain relevant alternatives in specific contexts. No universal gold standard currently exists that can fully replace “freehand technique”. Technique selection should be guided by clinical context, surgeon experience, and available resources. Ultimately, technique adoption will depend on clinical context, available resources, and surgeon familiarity.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113063"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121449","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":"Ultrasound in acute compartment syndrome of the extremities","authors":"Kallin Austin,&nbsp;Marco Trevino,&nbsp;Brody Harn,&nbsp;Eric Liou,&nbsp;Matthew Hazel,&nbsp;Lara Laughrey,&nbsp;Amie Mower","doi":"10.1016/j.injury.2026.113059","DOIUrl":"10.1016/j.injury.2026.113059","url":null,"abstract":"<div><div>Acute compartment syndrome (ACS) is a surgical emergency that remains challenging to diagnose. Diagnosis is primarily clinical, with invasive intracompartmental pressure (ICP) monitoring recommended when available. However, clinical findings can be unreliable, and invasive ICP measurement carries procedural risks. Ultrasound has increasingly been investigated as a noninvasive diagnostic method for ACS. This review analyzed all reported uses of ultrasound in the context of ACS. Six primary ultrasound techniques were identified: conventional two-dimensional (2D) ultrasound, Doppler ultrasound, pulse phase-locked loop (PPLL) ultrasound, contrast-enhanced ultrasound (CEUS), pressure-related ultrasound (PrUS), and shear-wave elastography (SWE). Each method was described according to its mechanism and theoretical basis, then evaluated for its current clinical relevance. SWE appeared to hold the greatest promise for clinical implementation, with additional potential noted for Doppler ultrasound and tibial fascia angle (TFA) measurements. PrUS, CEUS, and PPLL showed practical limitations that currently restrict clinical application, though further research may address these concerns. Ultrasound offers a noninvasive, repeatable means of quantitatively assessing multiple compartments without the pain or infection risk associated with invasive ICP monitoring. While several methods demonstrate promise, none have yet been validated for clinical adoption. Larger, standardized clinical trials are needed to confirm their diagnostic accuracy and utility.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113059"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127692","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":"Biomechanical comparison of triangular osteosynthesis and triangular minimally invasive spinopelvic stabilization technique for pelvic fragility fractures","authors":"Hans-Joachim Riesner ,&nbsp;Jason DePhillips ,&nbsp;Amber R. Witt ,&nbsp;Jonathan M. Mahoney ,&nbsp;Brandon S. Bucklen","doi":"10.1016/j.injury.2026.113022","DOIUrl":"10.1016/j.injury.2026.113022","url":null,"abstract":"<div><h3>Objectives</h3><div>To biomechanically compare triangular osteosynthesis (TOS) and a minimally invasive triangular spinopelvic stabilization (TMSS) technique for Type IV fragility fractures of the pelvis (FFP) in a cadaveric model.</div></div><div><h3>Methods</h3><div>Six fresh-frozen lumbopelvic specimens (L3–pelvis; mean age 61.5 ± 11.5 yrs) with simulated Type IV U-shaped sacral fractures were sequentially instrumented with TOS (bilateral iliosacral screws + lumbopelvic fixation) and TMSS (bilateral iliac screws with transverse connecting rod + lumbopelvic fixation). Constructs were cyclically loaded (200–430 N; 25,000 cycles or 1 cm axial displacement) to simulate postoperative single-leg stance loading. Fracture displacement was quantified using a motion capture system.</div></div><div><h3>Results</h3><div>All but one TOS specimen completed 25,000 cycles. Bone mineral density had no effect on displacement. TMSS showed lower maximum fracture displacement (6.05 mm) than TOS (12.12 mm; <em>p</em>= 0.071). Displacement after 1000 cycles averaged 56% (TOS) and 62% (TMSS) of the maximum.</div></div><div><h3>Conclusions</h3><div>TMSS provided comparable or improved stability versus TOS and, with its minimally invasive design, may offer a viable alternative for FFP Type IV treatment. Further clinical validation is warranted.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113022"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981494","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":"Prevalence of dysmorphic sacral features in the general population","authors":"Ian Meshay ,&nbsp;Katelyn A. Cole ,&nbsp;Sabrina M. Pescatore ,&nbsp;Kaley Haney ,&nbsp;John C. Hagedorn II","doi":"10.1016/j.injury.2026.113048","DOIUrl":"10.1016/j.injury.2026.113048","url":null,"abstract":"<div><h3>Background</h3><div>Posterior pelvic ring injuries, including sacral fractures and sacroiliac (SI) joint disruption, can have potentially serious sequelae and are becoming increasingly common. Management, especially in the setting of instability, consists of internal fixation to decrease the risk of complications. Placement of SI screws requires a thorough knowledge of normal pelvic anatomy and the available osseous fixation pathways. The aim of this study was to define the prevalence of individual features of sacral dysmorphism in the general population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of standard and 3D-reconstructed computed tomography (CT) images of the pelvis to record the presence or absence of each dysmorphic feature. All adult trauma patients who presented within a 5-year period at a single, academic, Level I trauma center were eligible for inclusion. Patients &lt;18 years of age, without advanced pelvic imaging, or who presented with any current or prior pelvic ring injury, tumor, or instrumentation were excluded. The prevalence of each dysmorphic feature was calculated and associations between dysmorphism and demographic factors were investigated.</div></div><div><h3>Results</h3><div>A total of 2667 patients were eligible for inclusion and the first 1000 were selected for review. Six subjects were excluded during review of CT images. One or more dysmorphic feature was seen in 96.8% of subjects. Each subject displayed an average of 2.7 abnormal features. Residual S1 discs were the most prevalent feature (72.2%). While tongue-in-groove (TIG) sacroiliac (SI) joints were the rarest (7.7% prevalence), they were associated with a significantly higher average number of concurrent dysmorphic features (3.29, <em>P</em> &lt; .0001). Demographic subgroup analysis demonstrated a significantly higher prevalence of S1 discs (<em>P</em> = .0007), TIG SI joints (<em>P</em> &lt; .0001), and colinear upper sacra (<em>P</em> &lt; .0001) in women. Residual S1 discs were also significantly more common in White patients (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>Sacral anatomy exists on a spectrum from normal to dysmorphic. This study demonstrates that completely “normal” sacral morphology is seen in &lt;4% of patients. TIG sacroiliac joints may serve as a quick indicator for a higher degree of dysmorphism which may complicate or preclude transiliac-transsacral screw placement.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113048"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981572","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":"Measurement properties of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for patella fractures","authors":"Peter Larsen ,&nbsp;Rasmus Jorgensen ,&nbsp;Martin Jensen ,&nbsp;Soeren Lundbye-Christensen ,&nbsp;Rasmus Elsoe","doi":"10.1016/j.injury.2026.113033","DOIUrl":"10.1016/j.injury.2026.113033","url":null,"abstract":"<div><h3>Background</h3><div>The study aimed to investigate relevance, construct validity, reliability, and responsiveness and estimate the minimal clinically important difference of the Knee Injury and Osteoarthritis Outcome Score (KOOS) to adult patients with patella fractures.</div></div><div><h3>Materials and methods</h3><div>The study design was a prospective cohort study including patients treated conservatively and surgically following a patella fracture (AO-34). The primary outcome measure was the KOOS. The KOOS was repeated at 14 days, 15 days, six weeks, and finally at six and 12 months. Relevance was evaluated by patients and surgeons ranking of relevance of the 42 items in the KOOS, construct validity by correlation to Eq5d, test-retest reliability by an interclass correlation coefficient, and responsiveness by a priori hypothesis and supplemented by effect size. Furthermore, estimation of minimal clinically important difference (MCID) based on longitudinal confirmatory factor analysis.</div></div><div><h3>Results</h3><div>Included were 65 patients with a mean age of 63.3 years (range 24 to 89) with 74 % female gender. Results showed an acceptable relevance and construct validity. The test-retest reliability was high for all five subscales, with an interclass correlation coefficient ranging from 0.8 to 0.9. Evaluation of responsiveness showed high correlation to the predefined hypothesis (<em>r</em> &lt; 0.6) and moderate to large effect sizes. The MCID of the KOOS subscales were Pain 7.0 (1.6 - 9.8), Symptoms 7.3 (2.0 - 12.6), ADL11.8 (3.2 - 16.0), Sport/Rec 9.3 (3.4 - 15.3) and QOL 8.8 (6.1 - 17.8).</div></div><div><h3>Conclusion</h3><div>The Knee Injury and Osteoarthritis Outcome Score (KOOS) showed acceptable relevance, construct validity and responsiveness and high reliability to adult patients with patella fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113033"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981575","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}