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

{"title":"Humeral shaft periprosthetic fractures: Fracture patterns differ between short and standard-length arthroplasty stems","authors":"Niloofar Dehghan ,&nbsp;Richard L. Auran ,&nbsp;Tram L. Tran ,&nbsp;Michael D. McKee ,&nbsp;Evan S. Lederman","doi":"10.1016/j.injury.2025.112231","DOIUrl":"10.1016/j.injury.2025.112231","url":null,"abstract":"<div><h3>Introduction</h3><div>There have been no published studies evaluating the impact of humeral stem length on humeral shaft periprosthetic fractures. We sought evaluate the differences in fracture patterns between periprosthetic fractures around a short stem and standard stem humeral implants.</div></div><div><h3>Materials and methods</h3><div>This is a retrospective cohort study. Patients sustaining a humeral shaft periprosthetic fracture around shoulder arthroplasty implants from December 2011 to January 2021 were identified using ICD-9/10 codes. Three upper extremity trained surgeons evaluated all radiographs assessing fracture location and configuration, as well as signs of stem stability before and after the fracture. They classified the fractures based on two classification schemes: Wright &amp; Cofield, and the Unified Classification System (UCS), and they recorded their recommended treatment for each case based on fracture pattens and implant stability.</div></div><div><h3>Results</h3><div>76 patients with periprosthetic humeral shaft fractures were identified and divided into two groups: short stem (n=18) and standard stem (n=58). Patients with a short stem were more likely to be classified as having an unstable prosthesis after fracture (67% versus 33%, p=0.01). Additionally, the proposed plan for treatment was different between the two groups (p=0.004): more patients in the standard stem group were recommended open reduction internal fixation (50% vs. 33%) or non-operative treatment (17% vs. 0%), and more patients in the short stem group were recommended revision arthroplasty (50% vs. 29%).</div></div><div><h3>Conclusion</h3><div>Patients sustaining a periprosthetic fracture around a short implant may be more likely to have an unstable prosthesis compared to a standard stem, which may have an impact on treatment options.</div></div><div><h3>Level of Evidence</h3><div>Prognosis Study, Level III</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112231"},"PeriodicalIF":2.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549360","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":"Finite element analysis of the Femoral neck system for different placement positions in the fixation of Pauwels type Ⅲ femoral neck fractures","authors":"YongJia Zhu ,&nbsp;Shuai Wu ,&nbsp;JiaPeng Yan ,&nbsp;Wenhong Wang ,&nbsp;Xiao Huang ,&nbsp;HongFei Zhang","doi":"10.1016/j.injury.2025.112218","DOIUrl":"10.1016/j.injury.2025.112218","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to identify the optimal position for the femoral neck system (FNS) device when fixing Pauwels III #NOF, by analyzing the mechanical stability and stress distribution of FNS at different screw placement positions for the fixation of Pauwels III femoral neck fractures.</div></div><div><h3>Methods</h3><div>We employed finite element analysis to create a 3D model of a Pauwels type III femoral neck fracture. Six models were designed, each with varied FNS screw placement positions. Axial stresses of 600 N, 1200 N, and 1800 N were applied to simulate physiological loads during different activities: standing on two legs, standing on one leg, and walking. The mechanical properties of these screw placements were assessed by comparing stress distribution, displacement, and fracture stability across models under varying load conditions.</div></div><div><h3>Results</h3><div>Model 1, with the power rod aligned along the femoral neck axis, showed the best stability, with 42.40 % lower maximum VMS and 18.49 % less femoral displacement, compared to the worst model. Displacement of the internal fixation and fracture surface decreased by 21.72 % and 19.16 %, respectively. It also had superior results for internal fixation VMS and fracture surface compressive stress. Model 2, with the head screw centered axially, demonstrated good stability but had higher stress concentrations under 1800 N load. The displacement of the fracture surface and femur in model 2 increased by 18.37 % and 17.26 %, respectively, compared to model 1. Models 5 and 6, with the FNS nail near the lateral femoral cortex, showed significant stress concentrations, with compressive and shear forces rising by about 33 %. Model 5′s maximum VMS increased by 46.68 %, and model 6′s maximum compressive stress of the fracture surface increased by 46.37 %, compared to model 1. Models 3 and 4, with the power rod shifted up or down, displayed moderate stability, reducing displacement in some tests.</div></div><div><h3>Conclusion</h3><div>This finite element analysis highlights that centring the FNS power rod along the femoral neck axis significantly enhances fracture stability and minimises postoperative displacement. Conversely, poor screw placement may result in mechanical stress concentration, raising the risk of nonunion or malunion. Clinicians should prioritise screw placements with more excellent mechanical stability to optimise treatment outcomes.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112218"},"PeriodicalIF":2.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629022","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":"Interlocking screw backout from a preassembled polymer inlay in a retrograde femoral nail system: A retrospective review","authors":"Alexander L. Vlasak ,&nbsp;Lindsey S. Palm ,&nbsp;Jennifer E. Hagen ,&nbsp;Matthew R. Patrick ,&nbsp;Marissa N. Pazik ,&nbsp;Richard G. Vlasak ,&nbsp;Michael T. Talerico","doi":"10.1016/j.injury.2025.112227","DOIUrl":"10.1016/j.injury.2025.112227","url":null,"abstract":"<div><div>Interlocking screw backout is a significant complication of femoral nailing that may lead to pain, fixation failure, and need for reoperation. The risk for this is increased in osteoporotic bone or in cases of so-called “extreme nailing” when the articular segment is short, and fixation is limited. A newly developed retrograde femoral nailing system (DePuy Synthes RFN-Advanced™ Retrograde Femoral Nailing System (DePuy Synthes, Monument, CO)) was designed specifically to prevent this known failure mode and was recently approved for use within the United States. A preassembled polymer inlay at the distal portion of the nail (through which the distal interlocking screws are placed) is marketed as eliminating interfragmentary motion and screw toggle which can ultimately lead to screw backout. Despite this purposeful design, multiple surgeons at our Level I trauma center in the southeastern US have noted a relatively high occurrence of distal interlocking screw backout when compared to other nail designs used in the same time. We present a single institution retrospective review of placed retrograde femoral nails and their complications, particular loss of interlock bolt fixation and revision surgery in the DePuy Synthes RFN-A group (21.43 %), compared to other implant designs (5.41 %) during the initial implementation period at our institution.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112227"},"PeriodicalIF":2.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528965","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 impact of diabetes mellitus on the management and outcome of ankle fractures","authors":"Belal Amini ,&nbsp;Sara Kadhm ,&nbsp;Alex Trompeter","doi":"10.1016/j.injury.2025.112226","DOIUrl":"10.1016/j.injury.2025.112226","url":null,"abstract":"<div><div>Diabetes mellitus is a chronic condition which disrupts bone homeostasis leading to impaired healing and profound complications in ankle fractures. Hyperglycaemia and chronic inflammation cause increased generation of advanced glycation end products and reactive oxygen species which ultimately drive osteoclastogenesis and increase bone resorption. Together with a lack of insulin signalling, these mechanisms compromise bone metabolism and increase the risk of complications in fracture healing. Diabetes is associated with comorbidities such as vasculopathy and neuropathy which further contribute to the risk of complications. The complications identified in diabetic patients with ankle fractures include non-union, malunion, infection, amputation, and mortality. Thus, careful consideration is needed when deciding between surgical and conservative treatment. This narrative review provides a synthesis of the literature covering the impact of diabetes on ankle fractures, considering their high prevalence in the UK.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112226"},"PeriodicalIF":2.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519361","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":"Glass injuries seen in a paediatric tertiary hospital in Singapore: An epidemiology study","authors":"Yun Xiu Lam ,&nbsp;Spencer Jia Jie Loh ,&nbsp;Jerome Yung Kang Chan ,&nbsp;Nicole Kim Luan Lee ,&nbsp;Shu Ling Chong ,&nbsp;Ronald Ming Ren Tan ,&nbsp;Mohammad Ashik bin Zainuddin ,&nbsp;Arjandas Mahadev ,&nbsp;Kenneth Pak Leung Wong","doi":"10.1016/j.injury.2025.112225","DOIUrl":"10.1016/j.injury.2025.112225","url":null,"abstract":"<div><div>Lacerations rank as the most common paediatric injury that requires a physician evaluation. Glass is a frequent cause of such lacerations, however there is currently little to no information on this. Hence, this paper aims to describe the burden and characteristics of such injuries in Singapore. This study is a retrospective review of glass-related trauma presented to paediatric hospital KKH Emergency Department between 1st January 2017 and 4th July 2023. Data on patient and injury characteristics, as well as treatment plans were collected.</div><div>680 patients up to 18 years old (average 6.93) were included in the study. 420 (62 %) were male. The number of glass-related injuries were stable at about 100 per year from 2017 to 2023. 649 (95 %) cases were unintentional. 528 (78 %) injuries occurred indoors.159 (23 %) children had adult supervision at time of injury. A majority of 458 (67 %) injuries occurred during the weekday. Primary blunt injuries were the highest at 414 (61 %), followed by 230 (34 %) penetrating injuries. 317 (37 %) injuries occurred at the lower limb, 305 (36 %) at the upper limb, and 105 (12 %) at the face. 596 (87.6 %) patients had “None to mild” injuries, 31 (4.6 %) with “Moderate” injuries, and 53 (7.8 %) with “Severe” injuries. Glass doors led to 315 (46 %) cases, with glass shards and glass panels causing 85 (12.5 %) and 84 (12.5 %) cases respectively.</div><div>555 (82 %) of patients received definitive treatment in the Emergency Department and 74 (11 %) required surgery. The average duration of hospitalization of all patients is 0.36 days. 430 patients averaged 3.66 weeks of follow-up, while 247 were discharged immediately. 85 (13 %) patients required inpatient care. Only 1 patient required fluid resuscitation in the Emergency Department. Most glass injuries are unintentional, caused by glass doors, occur indoors and are, fortunately, mild cases.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112225"},"PeriodicalIF":2.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528932","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":"Surgical treatment of infectious severe calcaneal bone defects in children by the Ilizarov technique","authors":"Qiyue Zhang ,&nbsp;Aierken Rehemutula ,&nbsp;Maimaitiyiming Maitudi ,&nbsp;Qin Yang ,&nbsp;Ainizier Yalikun ,&nbsp;Hongyu Zhou ,&nbsp;Yu Si ,&nbsp;Zihao Chen ,&nbsp;Dun Liu ,&nbsp;Qian Li ,&nbsp;Tao Liu ,&nbsp;Li Li ,&nbsp;Aihemaitijiang Yusufu","doi":"10.1016/j.injury.2025.112224","DOIUrl":"10.1016/j.injury.2025.112224","url":null,"abstract":"<div><h3>Introduction</h3><div>The soft tissue of the heel is weak, and calcaneal bone defects occur easily post-infection, resulting in the inability of paediatric patients to walk normally. Calcaneal reconstruction is challenging. We aimed to evaluate the methodology and clinical effects of the Ilizarov technique in the treatment of calcaneal infectious bone defects.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the cases of 12 children with infectious calcaneal bone defects treated by the Ilizarov technique in our center from January 2018 to August 2022.Stump lengthening of the calcaneus was performed in nine cases. Due to severe calcaneus infection the calcaneus was removed, and talus lengthening was performed in three children. Two children were treated with drug-loaded spacer bone cement to control peripheral soft tissue infection before bone elongation could be performed, while the other ten cases underwent bone lengthening at one stage after radical debridement. Pain, foot function, self-care ability and hind foot function were evaluated using a Visual Analogue Scale (VAS), the Maryland Foot Score, Activity of Daily Living scale, and the American Orthopaedic Foot and Ankle Society retro ankle foot score.</div></div><div><h3>Results</h3><div>In this cohort of 12 children, the time for bone lengthening ranged from 32 to 64 days (mean 41.75 ± 10.09 days), and the distance of bone lengthening was between 2.6 cm and 5.4 cm (mean 3.57 ± 0.86 cm). The inflammation indicators CRP, ESR, and IL-6 were significantly reduced after radical debridement (15.72 ± 3.09 vs 6.04 ± 1.28, 25.20 ± 2.72 vs 15.11 ± 1.56, 16.39 ± 3.75 vs 2.99 ± 1.08, respectively; <em>p</em> &lt; 0.01). Bone reconstruction effectively reduced pain in the affected limb and significantly improved foot function, self-care ability, and hind foot function in these children. In four cases, external fixators were removed and an Achilles tendon lengthening operation was performed to further reconstruct calcaneal bone function. After surgical treatment, all the children in this cohort were able to return to normal life.</div></div><div><h3>Conclusion</h3><div>The Ilizarov technique for treating large infectious calcaneal bone defects and bone lengthening can effectively reconstruct the function of the calcaneal bone without significantly affecting the ankle joint.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112224"},"PeriodicalIF":2.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512503","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 amputation and limb salvage in combat injuries: Does level of injury matter? A secondary analysis of Military Extremity Trauma Amputation/Limb Salvage (METALS) study data","authors":"Ashley E. Levack ,&nbsp;Lisa Reider ,&nbsp;Susan Odum ,&nbsp;Roman Hayda ,&nbsp;Harold Frisch ,&nbsp;Romney C. Andersen ,&nbsp;James R. Ficke ,&nbsp;Michael J. Bosse","doi":"10.1016/j.injury.2025.112220","DOIUrl":"10.1016/j.injury.2025.112220","url":null,"abstract":"<div><h3>Background</h3><div>The Lower Extremity Assessment Project (LEAP) and Military Extremity Trauma Amputation/Limb Salvage Study (METALS) reported conflicting results with respect to severe lower extremity injuries treated with limb salvage versus amputation. The LEAP study reported no difference between amputation and limb salvage groups, while the METALS study reported improved outcomes with amputation. The purpose of this study was to re-evaluate the METALS data to determine whether the ankle/hindfoot injuries were the main driver of the results of improved outcome with amputation.</div></div><div><h3>Methods</h3><div>This is a retrospective secondary analysis of METALS data including military personnel deployed to Afghanistan or Iraq between 2003 and 2007 with severe lower extremity combat injuries. METALS patients with a unilateral transtibial amputation, or unilateral limb salvage of a qualifying injury distal to the femoral condyles were included. Amputation patients were compared to two separate limb salvage groups: severe ankle/hindfoot injuries (ie. ankle/hindfoot salvage group) versus mid/proximal tibia injuries (ie proximal limb salvage group). Short Musculoskeletal Function Assessment (SMFA) scores were compared between groups. Multivariable regression models compared outcomes across treatment groups, adjusting for age, race/ethnicity, time from injury, combat experience, and social support.</div></div><div><h3>Results</h3><div>161 patients were included: 60 amputation, 41 ankle/hindfoot salvage, 62 proximal limb salvage. Amputation patients reported better function (lower SMFA scores) compared to both limb salvage groups for the daily activities sub-score. Amputation patients reported better function than proximal salvage patients in all domains. There was no difference in SMFA scores between the two limb salvage groups. On adjusted analysis, amputation patients reported significantly better function for total dysfunction and daily activity scores than either limb salvage group.</div></div><div><h3>Conclusions</h3><div>This secondary analysis of the METALS data reveals that amputation resulted in superior functional outcomes compared to limb salvage after both ankle/hindfoot and more proximal tibial combat related injuries. This study highlights differences between civilian and military traumatic extremity injuries and indicates that treatment results cannot be generalized between populations.</div></div><div><h3>Level of evidence</h3><div>Prognostic Level II</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112220"},"PeriodicalIF":2.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609389","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 modified second toe nail-skin flap for refined reconstruction of the distal index finger defect","authors":"Ji Li ,&nbsp;Jian-Tao Chen ,&nbsp;Xin Zhou ,&nbsp;Xiaoxue Luo ,&nbsp;Linhui Liao ,&nbsp;Changliang Ou","doi":"10.1016/j.injury.2025.112216","DOIUrl":"10.1016/j.injury.2025.112216","url":null,"abstract":"<div><h3>Background</h3><div>The defect of the distal index finger may cause tissue necrosis, osteomyelitis, even dysfunction, disability in hand, and psychological problems. This study aimed to present our experiences using a modified second toe nail-skin flap to repair and reconstruct the distal index finger defect.</div></div><div><h3>Methods</h3><div>From February 2018 to April 2022,48 patients with the distal index finger defects received the modified second toe nail-skin flap to reconstruct the defect. Among them, 35 males and 13 females, with a mean age of 39.4 years (ranged, 11∼48 years) and irregular wound, and exposed or damaged tendons, nerves, or bones. The length of the bone defect was 0.3∼1.4 cm and the mean dimension of the soft tissue defect was 0.7 × 2.1 cm (ranged,0.4 × 1.5∼1.0 × 2.5 cm). All the flaps were individually designed according to the defect condition. Combined pedicled first dorsal metatarsal artery flap and cosmetic sutures was used for repair in all donor areas. We regularly followed up all patients and completed the results of some standardized assessment based on hand function and aesthetic scores.</div></div><div><h3>Results</h3><div>48 modified second toe nail-skin flaps survived completely. The fingers were available for a mean follow-up of 10.5 months (ranged, 6∼13 months) without serious complications, such as necrosis of distal index finger, deformity, nonunion, muscle spasms of the index finger, paronychia, pain, abnormal temperature and touch sensation. The functional and aesthetic results of all the flaps were satisfactory.</div></div><div><h3>Conclusion</h3><div>The modified second toe nail-skin flap is one of the preferred ways to reconstruct distal index finger defect. This approach provides cosmetic coverage, functional recovery, allows for faster wound healing and reduced tendon adhesion, and lessens damage to the donor area, and does not affect the functions of foot.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112216"},"PeriodicalIF":2.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549322","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":"Global, regional, and national burdens of road injuries from 1990 to 2021: Findings from the 2021 Global Burden of Disease Study","authors":"Kan Wang,&nbsp;Zhanfei Li","doi":"10.1016/j.injury.2025.112221","DOIUrl":"10.1016/j.injury.2025.112221","url":null,"abstract":"<div><h3>Background</h3><div>Road injuries remain a significant global health issue, contributing to a high burden of mortality and disability, particularly in low- and middle-income countries. Understanding the global trends in incidence, mortality, and Years Lived with Disability (YLDs) due to road injuries is essential for developing effective prevention strategies.</div></div><div><h3>Methods</h3><div>We used data from the Global Burden of Disease (GBD) 2021 to analyze road injury trends from 1990 to 2021. Age-standardized incidence rates (ASIR), mortality rates (ASMR), and YLDs were calculated across different socio-demographic index (SDI) regions. Trends were assessed using the Estimated Annual Percentage Change (EAPC), and disparities by age, sex, and cause of injury were evaluated.</div></div><div><h3>Results</h3><div>From 1990 to 2021, the global ASIR, ASMR, and YLDs due to road injuries showed a declining trend. However, road injury cases and deaths increased in low and middle-SDI regions, while declining in high-SDI regions. In 2021, the highest ASIR was observed in high-SDI regions (851.75 per 100,000 population), while low-SDI regions experienced the highest mortality rates (22.6 per 100,000 population). Males, particularly those aged 15–49 years, bore the greatest burden of road injuries, accounting for over 60% of YLDs globally. Pedestrian and motorcycle-related injuries were predominant in low-SDI regions.</div></div><div><h3>Conclusion</h3><div>While global road safety interventions have reduced the burden of road injuries, substantial disparities remain between SDI regions. Targeted interventions are needed to address the high burden of road injuries in low-SDI regions, focusing on improving infrastructure and healthcare access.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112221"},"PeriodicalIF":2.2,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143438227","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":"Cefazolin vs. alternative beta-lactams for prophylaxis in lower extremity fracture surgery: A target trial emulation","authors":"Takaki Yoshiyama ,&nbsp;Toshiki Fukasawa ,&nbsp;Soichiro Masuda ,&nbsp;Shuichi Matsuda ,&nbsp;Koji Kawakami","doi":"10.1016/j.injury.2025.112215","DOIUrl":"10.1016/j.injury.2025.112215","url":null,"abstract":"<div><h3>Background</h3><div>Cefazolin is the primary antibiotic for surgical prophylaxis in orthopedic procedures. The cessation of cefazolin supply in approximately 60 % of Japanese hospitals from 2019 to 2020 provided an opportunity to evaluate the effectiveness of alternative beta-lactams for preventing surgical site infection (SSI). Given the global potential for antibiotics shortages, confirming the effectiveness of alternative beta-lactams is critical.</div></div><div><h3>Purpose</h3><div>This study aims to evaluate the differences in risk of reoperation for SSI between cefazolin and alternative beta-lactams in patients undergoing lower extremity fracture surgeries.</div></div><div><h3>Methods</h3><div>We emulated a target trial to compare the effectiveness of cefazolin with alternative beta-lactams—specifically broad-spectrum penicillins and cephalosporins—in preventing SSI using a Japanese hospital administrative database provided by JMDC Inc. We included patients undergoing initial open reduction and internal fixation for closed lower extremity fractures between March 1, 2019, and February 29, 2020. The outcome was reoperation for SSI within 30 days after surgery. Risks were estimated using pooled logistic regression with adjustment for confounders via inverse probability weighting. Sensitivity analyses extended the follow-up period to 90 and 365 days.</div></div><div><h3>Results</h3><div>Of the 16,602 patients analyzed, 35 patients (0.30 %) in the cefazolin group (11,538 patients) and 16 patients (0.32 %) in the alternative beta-lactam group (5,064 patients) underwent reoperation for SSI within 30 days. The estimated 30-day risk was 0.31 % in the cefazolin group and 0.37 % in the alternative beta-lactam group, resulting in a risk difference of −0.06 % (95 % confidence interval [CI], −0.33 to 0.14) and a risk ratio of 0.82 (95 % CI, 0.50 to 1.52). In sensitivity analyses, the estimated 90-day risk was 0.67 % in the cefazolin group and 0.57 % in the alternative beta-lactam group, with a risk difference of 0.10 % (95 % CI, −0.15 to 0.32) and a risk ratio of 1.19 (95 % CI, 0.80 to 1.62). The 365-day risk was 1.02 % and 0.90 %, respectively, with a risk difference of 0.12 % (95 % CI, −0.29 to 0.39) and a risk ratio of 1.13 (95 % CI, 0.78 to 1.51).</div></div><div><h3>Conclusions</h3><div>In surgeries for lower extremity fractures, substituting cefazolin with alternative beta-lactams did not result in substantial differences in the risk of reoperation for SSI.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112215"},"PeriodicalIF":2.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454649","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}