Injury最新文献

{"title":"Postoperative morbidity among survivors of emergency war trauma surgery in a conflict setting: a descriptive cohort study.","authors":"Nour Eldin Elbayoumi, Ghazi Mezied, Farah Elbayoumi, Nadia Alshawwa, Hosam Shaikhkhalil, Mohammed Aladini, Karam M Alslaibi","doi":"10.1016/j.injury.2026.113747","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113747","url":null,"abstract":"<p><strong>Background: </strong>Evidence on surgical outcomes in active conflict settings remains limited, particularly regarding postoperative morbidity and its relationship to injury severity among civilians with severe war-related injuries. This study describes the pattern of postoperative morbidity following emergency surgery for conflict-related abdominal and thoracic trauma.</p><p><strong>Methods: </strong>We conducted a cohort study of patients undergoing emergency war trauma surgery at a single surgical unit during the 2024 Gaza conflict. Data were collected prospectively and supplemented through retrospective review when needed. To avoid conflating early postoperative death with an absence of morbidity, postoperative morbidity was described only among patients who survived to hospital discharge.</p><p><strong>Results: </strong>Seventy-nine patients were included. Five patients (6%) died intraoperatively and were excluded from postoperative analysis. Of the remaining 74 patients, 20 (27%) died during the index admission and 54 (73%) survived to discharge; non-survivors had substantially higher Injury Severity Scores than survivors (median ISS 32 vs 16) and were less often haemodynamically stable on arrival (12% vs 67%). Among the 54 survivors, postoperative morbidity occurred in 46 (85%), mainly due to infectious complications (81%), particularly surgical site infection (74%). Descriptive comparison of survivors with and without morbidity showed similar injury severity between groups (median ISS 16 vs 16.5), suggesting that once patients survived long enough to be at risk of complications, morbidity was common across the injury-severity spectrum rather than concentrated among the most severely injured.</p><p><strong>Conclusions: </strong>Postoperative morbidity after conflict-related emergency surgery was high among survivors and was largely driven by infectious complications. Mortality, rather than morbidity, was most closely related to injury severity. These findings support the need for consistent injury severity assessment, improved infection prevention strategies, and cautious interpretation of morbidity data in conflict cohorts where early mortality limits the population at risk of developing recorded complications.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113747"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, AO morphology, and diagnostic delay of discontinuous thoracolumbar fractures: A 10-year single-center cohort study.","authors":"Yuzhe Zeng, Chenquan Tu, Lingling Zhu, Xiaoyang Hu, Hongxin Shi, Lianchi Lv, Taoyi Cai, Bin Lin","doi":"10.1016/j.injury.2026.113702","DOIUrl":"10.1016/j.injury.2026.113702","url":null,"abstract":"<p><strong>Background: </strong>Discontinuous thoracolumbar fractures are uncommon but clinically important injuries that may be overlooked during the initial evaluation. Their epidemiological features, morphological characteristics, and patterns of diagnosis remain incompletely defined.</p><p><strong>Methods: </strong>We retrospectively screened 4394 patients with spinal fractures treated at a single center between January 2016 and December 2025. After predefined exclusions, 186 patients with discontinuous thoracolumbar fractures were included. Baseline demographic and injury characteristics were compared with those of patients with single-level fractures. Within the discontinuous fracture cohort, we analyzed the number of fractured levels, regional distribution, number of intact vertebrae between fractures, vertebral-level involvement, AO Spine morphology according to fracture order, patient-level AO combination patterns, and time to diagnosis of initially missed lesions.</p><p><strong>Results: </strong>Discontinuous thoracolumbar fractures accounted for 4.2% of all spinal fractures and 64.4% of multilevel vertebral fractures. Two-level injuries were most common (49.5%), followed by three-level (35.5%) and ≥ 4-level patterns (15.1%). All cases involved the lumbar region, and 72.6% had one or two intact vertebrae between the injured levels. Compared with single-level fractures, discontinuous fractures were more frequently associated with falls from height, concomitant injuries, and polytrauma. The fracture burden was concentrated at the thoracolumbar junction and lower lumbar spine, and L1 was the most common site of the most severe injury. AO morphology exhibited a severity gradient: the most severely injured vertebra was usually classified as A3, A4, or B2, whereas subsequent injured vertebrae were predominantly classified as A1. At the patient level, A-only combinations were most common (50.5%), followed by A + B combinations with a single B-type level (38.7%); C-type injuries were rare (1.1%). The second fracture was initially missed in 44.1% of cases; cumulative recognition increased to 81.7% within 24 h and 94.6% within 48 h.</p><p><strong>Conclusions: </strong>Discontinuous thoracolumbar fractures have distinct epidemiological and morphological characteristics, including clustering at the thoracolumbar-lumbar junction, a predominance of compression-based AO combinations, and a high rate of initially missed diagnoses. These findings support systematic whole-spine assessment and careful imaging review in patients who sustain high-energy spinal trauma.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":"57 10","pages":"113702"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma governance and system maturity: A cross-national analysis of authority, funding, enforcement, and surveillance in 37 countries.","authors":"Divya Kewalramani, Justin Benton, Rachel L Choron, Amanda Teichman, Zachary Englert, Chaia Gelster, Julianne Goncalves, Elizabeth Skobelev, Daniel Whitley, Julie Goswami, Joseph Hanna, Gautam Singh, Piyush Tewari, Philip Barie, Mahesh C Misra, Mayur Narayan","doi":"10.1016/j.injury.2026.113742","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113742","url":null,"abstract":"<p><strong>Background: </strong>Organized trauma systems reduce mortality, yet most countries lack such systems and among those that exist, maturity varies widely. While the World Health Organization (WHO) emphasizes governance components including authority, funding, enforcement, and surveillance, empirical evidence linking these elements to measurable system outcomes is absent. We hypothesized that trauma governance entities (TGE) would demonstrate a dose-dependent association with WHO's Trauma System Maturity Index (TSMI) scores after adjusting for macro-economic resources.</p><p><strong>Methods: </strong>WHO reports, peer-reviewed literature, and national trauma registry publications spanning 2017-2024 were used to perform a cross-sectional analysis of 37 countries representing all World Bank regions and three income tiers (lower-middle, upper-middle, high). TSMI scores were assigned to four TSMI domains: prehospital care, facility-based care, education/training, quality assurance. For each nation, a composite mean TSMI score was calculated. A novel TGE score (0-4) was created to assess four domains: authority, funding, enforcement, surveillance (AFES). Spearman correlation and multivariable ordinary least-squares regression adjusting for income level, injury mortality rate (IMR), and system type were employed to assess associations between AFES and system maturity. The primary effect estimate was the contrast between countries with any governance component present (AFES≥1) and countries with none (AFES=0).</p><p><strong>Results: </strong>Of 37 nations, 15 (41%) nations had a TGE. Nations with a TGE demonstrated lower median IMR per 1000 persons (6.9 [IQR 5.2-8.1] vs 22.2 [IQR 8.7-34.9], p = 0.002) and higher composite TSMI scores (3.50 [IQR 3.25-4.00] vs 3.00 [IQR 1.81-3.44], p = 0.003). TSMI did not increase monotonically across AFES categories (median 2.25, 3.25, 3.88, 2.50 and 3.50 for AFES=0 through AFES=4). In an adjusted OLS model, countries with any governance components present (AFES≥1) had TSMI scores 0.66 points higher than countries with no governance components (β=0.66, 95% CI [0.13, 1.18], p = 0.016).</p><p><strong>Conclusions: </strong>Trauma governance, operationalized through establishment of AFES domains, is strongly associated with trauma system maturity with the difference concentrated between countries that have no formal governance and those that have any. Establishing any formal governance structure may be a particularly high-yield, scalable target to improve trauma system outcomes, especially in high-burdened, lower-middle income nations.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level III.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113742"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous thromboembolism in children with lower limb fractures: A systematic review and meta-analysis.","authors":"Zain Habib, Emadeldin M Ahmed, Christos S Zipitis, Paul M Sutton, Rayaz A Malik, Charalambos P Charalambous","doi":"10.1016/j.injury.2026.113396","DOIUrl":"10.1016/j.injury.2026.113396","url":null,"abstract":"<p><strong>Objectives: </strong>There is limited evidence regarding Venous Thromboembolism (VTE) in children with lower limb fractures. Our primary objective was to assess the rate, risk factors, mortality and role of pharmacological prophylaxis of VTE in children with lower limb fractures.</p><p><strong>Methods: </strong>Systematic review and meta-analysis. PubMed, CINAHL, and Cochrane CENTRAL were searched. Full published studies reporting on the rate of venous thromboembolism and/or on the efficacy of chemical thromboprophylaxis in children with lower limb fractures. Data extraction and quality appraisal were performed. Meta-analysis was conducted using a random effects model. The protocol was prospectively registered with PROSPERO (CRD42021278566).</p><p><strong>Results: </strong>Literature search identified 8342 articles of which 8 were included. All included studies were retrospective and studied paediatric populations in the USA and China. Meta-analysis of 5 studies reporting on children aged equal to or less than 18 years showed an overall estimated VTE rate of 0.53% (95%CI 0.20-1.38). There was sparse evidence related to risk factors for VTE and mortality rates in this patient population, and no evidence related to the impact of VTE prophylaxis.</p><p><strong>Conclusions: </strong>VTE is a recognised occurrence in children with lower limb fractures, but it is estimated to be infrequent. There is a need for high-quality research to further evaluate the rates of VTE in subgroups of paediatric patients as well as to determine the risk factors, mortality and efficacy of pharmacological prophylaxis. Individualised assessment and management is recommended in the meantime.</p><p><strong>Level of evidence: </strong>Level III, systematic review of Level III retrospective studies.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113396"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148458222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in martial arts injuries presenting to emergency departments in the United States from 2015 to 2024.","authors":"Karrie L Hamstra-Wright, Helena Kremer, John E Coumbe-Lilley, Shaveta Khosla","doi":"10.1016/j.injury.2026.113658","DOIUrl":"10.1016/j.injury.2026.113658","url":null,"abstract":"<p><strong>Introduction: </strong>Martial arts participation in the United States is increasing, particularly among females, but sex-specific injury patterns remain poorly understood. The purpose of our study was to examine sex differences in martial arts injuries presenting to United States emergency departments by year, age, body region, diagnosis, and martial arts style. We hypothesized injury distributions would differ between females and males METHODS: We conducted a retrospective cohort study where we queried the National Electronic Injury Surveillance for martial arts injuries recorded from 2015 to 2024. We calculated national injury estimates, injury incidence per 100,000 patients, and crude risk differences with 95% confidence intervals between females and males by age, region, diagnosis, and style.</p><p><strong>Results: </strong>A total of 7613 cases corresponded to a national estimate of 277,753 martial arts injuries. Females had a significantly higher proportion of injuries among youth ages 2-17 years (46.1% vs 33.1%; RD 0.13; 95% CI, 0.09-0.17); foot (23.8% vs 17.3%; RD 0.07; 95% CI, 0.04-0.09), hand (14.7% vs 11.9%; RD 0.03; 95% CI, 0.01-0.05), and leg injuries (16.7% vs 14.4%; RD 0.02; 95% CI, 0.00-0.04); strains and sprains (29.9% vs 21.2%; RD 0.09; 95% CI, 0.05-0.12); and striking-style injuries (53.2% vs 32.2%; RD 0.21; 95% CI, 0.18-0.25). Most female injury incidence patterns post-2020 decreased or remained stable, while many male injury incidence patterns sharply rose, particularly those associated with grappling and mixed martial arts.</p><p><strong>Discussion: </strong>Significant sex differences exist in martial arts injuries presenting to United States emergency departments. Injury distributions align with style categories, with females accounting for more striking-related injuries and males more grappling/mixed martial arts-related injuries. Post-2020 trends show widening sex differences in injury incidence.</p><p><strong>Conclusion: </strong>We highlight specific sex differences in martial arts emergency department injuries for use by healthcare professionals, coaches, and organizations. Recognition of sex-specific injury patterns may inform sex-specific training, injury prevention, and rehabilitation strategies for martial arts athletes across the lifespan.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":"57 10","pages":"113658"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity of fluoroscopic methods along the transsyndesmotic axis: A cadaveric study.","authors":"Hirofumi Nakajima, Seiji Kimura, Satoshi Yamaguchi, Shotaro Watanabe, Takahisa Sasho, Seiji Ohtori","doi":"10.1016/j.injury.2026.113629","DOIUrl":"10.1016/j.injury.2026.113629","url":null,"abstract":"<p><strong>Purpose: </strong>Alignment along the transsyndesmotic (TS) axis is necessary to fix syndesmotic diastasis associated with ankle fractures. Fluoroscopic clamp techniques for the tibiofibular joint along the TS axis include the center-center (CC), talar dome lateral (TL), and incisura tangent (IT) methods. However, whether the clamp placement along the TS axis is feasible under fluoroscopy and the effects of metal artefacts from fracture fixation remain unclear. The purpose of this study was to clarify the differences from the TS axis using three methods under fluoroscopy on a cadaver and to compare the differences from the TS axis before and after implant placement for each method.</p><p><strong>Materials and methods: </strong>Ten fresh-frozen cadaveric feet were used in this study. We used three methods and determined the interaxis angle and distance as the differences from the TS axis. Furthermore, implant placement was made in cadaveric feet, and these differences were evaluated using the three methods. The differences obtained by the three methods were compared using one-way repeated measures analysis of variance. Paired t-tests were used to compare the differences before and after implant placement.</p><p><strong>Results: </strong>Both the interaxis angle and distance showed significant differences among the three fluoroscopic methods, irrespective of implant placement (p < 0.001). The CC method demonstrated pronounced internal rotation and posterior displacement relative to the TS axis. In contrast, both the TL and IT methods demonstrated minimal angular and translational deviations. Post-hoc analyses confirmed that both TL and IT methods were significantly closer to the TS axis than the CC method for both parameters, whereas no significant differences were observed between the TL and IT methods (p < 0.001). Implant placement did not significantly affect the interaxis angle or distance for any of the three methods (p > 0.05).</p><p><strong>Conclusion: </strong>Among the fluoroscopic methods, the TL and IT methods allowed clamping along the TS axis. Additionally, implant placement by any of the three methods had no effect on the interaxis angle or distance. The TL and IT methods may help reduce iatrogenic malreduction.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":"57 10","pages":"113629"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the null result: Unpacking the clinical nuance of concomitant carpal tunnel release with distal radius fracture fixation.","authors":"Jinwen Sima, Mingyao Jiang, Xing Chen, Jingxi Wang, Mingxuan Gao","doi":"10.1016/j.injury.2026.113590","DOIUrl":"10.1016/j.injury.2026.113590","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113590"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loading conditions during femoral preparation for THA procedures: Mechanical effects of broach holder offset.","authors":"Thomas Bridoux, François Zot, Arnaud Germaneau, Tanguy Vendeuvre, Guillaume Anthony Odri, Mathieu Severyns","doi":"10.1016/j.injury.2026.113646","DOIUrl":"10.1016/j.injury.2026.113646","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to compare the cumulative loading needed to seat the planned stem size between straight and offset broach handles. We hypothesized that the cumulative loading is higher when using the offset broach handle, whose force vector is not truly in the axis of the recipient femoral shaft. Thus, the increased stresses applied to the femur intraoperatively could contribute to increased risk of perioperative fracture.</p><p><strong>Methods: </strong>For each broach insertion and for each of our 20 femurs specimens, the mean force, maximum force and cumulative force were recorded. The number of strikes was also collected. Thus, the primary outcomes were the cumulative force, mean force, maximum force and the number of strikes made by the surgeon until the planned broach size was fully seated. A subgroup analysis was done based on the morphology of the intramedullary canal (Dorr classification). An inter-rater analysis was also done to remove the surgeon effect on the femoral preparation.</p><p><strong>Results: </strong>Using an offset broach handle required significantly more strikes to insert the broaches into the femurs until the planned size was seated (p = 0.049). No significant differences were observed between the two broach handle types in the maximum force, mean force, or cumulative force.</p><p><strong>Conclusion: </strong>This biomechanics study showed that use of an offset broach handle requires significantly more strikes and repeated impacts than use of a more conventional straight broach handle. While there was no significant difference in terms of forces applied between the two strategies, if the surgeon wants to have the same operating time for both techniques, he/she will be required to apply larger forces at each strike to achieve the same advancement of the broach in the femur.</p><p><strong>Registration: </strong>Authorization of the Minister of Education and Research No. DC-2008-137.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":"57 10","pages":"113646"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing alcohol and drug positivity among adult pedestrians injured in motor vehicle-pedestrian collisions: A level I trauma center study (2007-2022).","authors":"Nishita Sinha, Eva Shipp, Robert Wunderlich, Laura Zima, Glenda Torres, Ryan S Kitagawa, Shashank Patil, Christopher R Conner","doi":"10.1016/j.injury.2026.113668","DOIUrl":"10.1016/j.injury.2026.113668","url":null,"abstract":"<p><strong>Purpose: </strong>While prior research has documented substance involvement among pedestrians injured in motor-vehicle collisions, fewer studies have examined how alcohol and drug positivity varies across temporal, demographic, and socioeconomic characteristics. This study characterized alcohol and drug positivity among adult pedestrians injured in motor vehicle-pedestrian collisions and examined variation in positivity across these characteristics.</p><p><strong>Methods: </strong>Patient-level data were retrospectively obtained for adult pedestrians (≥18 years) evaluated at Memorial Hermann-Texas Medical Center following trauma activation for motor vehicle-pedestrian collisions between 2007 and 2022. The study included 3220 injured pedestrians treated at this Level I trauma center in Houston, Texas. Data included age, sex, race/ethnicity, date and time of injury, residential ZIP code, clinical outcomes, blood alcohol concentration (BAC), and urine toxicology results for amphetamines, barbiturates, marijuana, cocaine, opiates, benzodiazepines, and phencyclidine (PCP). Alcohol and drug testing were performed according to institutional trauma evaluation practices and were not universal. Descriptive and bivariate analyses examined substance positivity across temporal, demographic, and area-level socioeconomic characteristics.</p><p><strong>Results: </strong>Of the 3220 injured pedestrians, 2136 (66.3%) underwent alcohol testing and 975 (30.3%) underwent drug testing. Among those tested, 40.4% (n = 862) were positive for alcohol and 83.8% (n = 817) for at least one drug. Alcohol positivity was highest during early morning and evening periods and was significantly higher among males. Alcohol positivity also varied significantly by age, peaking among pedestrians aged 35-49 years and declining substantially among those aged ≥ 65 years. Drug positivity also varied significantly by age. Pedestrians residing in more socioeconomically disadvantaged ZIP codes accounted for a greater share of injuries, and drug positivity differed significantly across quartiles of socioeconomic disadvantage, with generally higher positivity among residents of more disadvantaged areas.</p><p><strong>Conclusion: </strong>Substance positivity among injured pedestrians varied across temporal, demographic, and socioeconomic characteristics. Higher nighttime alcohol positivity and drug positivity among pedestrians residing in lower-SES areas highlight opportunities for targeted pedestrian-safety and public-health interventions. More systematic toxicological testing and linkage of trauma records with crash, roadway, and neighborhood-level data could improve understanding of substance involvement and inform prevention strategies.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":"57 10","pages":"113668"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric perineal trauma: a prospective observational study of mechanisms, surgical management, and outcomes.","authors":"Ezza Ahmed, Nabila Talat, Hafiz Muhammad Waqar Afzal, Hafiz Muhammad Adnan, Umar Mahmood","doi":"10.1016/j.injury.2026.113751","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113751","url":null,"abstract":"<p><strong>Background: </strong>Paediatric perineal trauma is uncommon but may involve the genital, urinary, anorectal, and pelvic-floor structures. Accurate assessment and individualized reconstruction are essential to preserve function and achieve satisfactory anatomical and cosmetic outcomes. This study evaluated the mechanisms, injury patterns, surgical management, and outcomes of surgically managed paediatric perineal trauma.</p><p><strong>Methods: </strong>This prospective observational study included consecutive children with perineal trauma requiring surgical management at the Children's Hospital and University of Child Health Sciences, Lahore, between October 2020 and October 2021. All patients underwent examination under general anaesthesia, with vaginoscopy, cystoscopy, or proctoscopy performed according to the suspected anatomical involvement. Injuries were categorized using the Genital Injury Score. Functional and cosmetic outcomes were assessed during follow-up.</p><p><strong>Results: </strong>Twenty-eight children were included; the median age was 6 years (range, 1-11), and 21 (75.0%) were female. Falls onto objects accounted for 15 injuries (53.6%), road traffic accidents for nine (32.1%), and child sexual abuse for four (14.3%). Seven patients had GIS Grade I injuries, three Grade II, five Grade III, five Grade IV, and eight Grade V. All road traffic accident-related injuries were GIS Grade III-V. Vaginoscopy, cystoscopy, and proctoscopy were performed in 21, 11, and 16 patients, respectively. Primary repair was undertaken in 22 patients (78.6%), while six (21.4%) required delayed reconstruction. Eleven patients underwent anal sphincter repair. Three adverse outcomes occurred. Anal sphincter function was good in 23 patients (82.1%), weak in four (14.3%), and absent in one (3.6%). No vaginal stenosis was identified during follow-up.</p><p><strong>Conclusion: </strong>Examination under general anaesthesia with selective endoscopic evaluation enables accurate assessment of surgically managed paediatric perineal trauma. Primary anatomical repair is feasible in most patients, while delayed reconstruction and selective diversion may be required for infected or complex injuries. Structured multidisciplinary management can achieve favourable functional and cosmetic outcomes.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113751"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}