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

{"title":"Advanced trauma life support 2025: A brief review of updates","authors":"Akilesh Ramasamy","doi":"10.1016/j.injury.2026.113079","DOIUrl":"10.1016/j.injury.2026.113079","url":null,"abstract":"<div><div>Guidelines and practices in trauma care constantly evolve based on evidence available, and every healthcare provider who treats trauma should be up-to-date in trauma-care concepts. The Eleventh Edition of Advanced Trauma Life Support, released in 2025, contains a complete revamp of the foundational principles of acute trauma care, content design, delivery, and training, based on medical and educational evidence. In this edition, a significant update is the emphasis on control of exsanguinating/major haemorrhage (ABCDE to x-ABCDE where x stands for control of exsanguinating haemorrhage in trauma resuscitation. In addition to damage control resuscitation, some of the significant changes include recommendations for permissive hypotension, limiting crystalloids, early transfusion, neuroprotective focus, and modifications in operational principles in spine motion restriction. Some of these conceptual changes with their rationale are briefly described in this review as an update for any healthcare provider involved in trauma resuscitation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 4","pages":"Article 113079"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147345","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":"Matched comparative study of 3D printed microporous tantalum prosthesis versus autologous bone graft in the final stage of Masquelet induced membrane surgery","authors":"Yin Yang ,&nbsp;Yongqing Xu ,&nbsp;Jian Shi ,&nbsp;Wei Yu ,&nbsp;Xiaoqing He ,&nbsp;Qixiong Guo ,&nbsp;Xinyu Fan","doi":"10.1016/j.injury.2026.113087","DOIUrl":"10.1016/j.injury.2026.113087","url":null,"abstract":"<div><h3>Background</h3><div>Masquelet induced membrane surgery is a viable option for the reconstruction of extensive bone defects. This study aimed to comprehensively compare the clinical efficacy of 3D printed microporous tantalum prosthesis and autologous bone graft in the final stage of Masquelet induced membrane surgery during the treatment of lower extremity fracture-related infections(FRI) with large segmental bone defect.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the clinical data of 43 patients with large segmental bone defect caused by lower extremity FRI treated with Masquelet induced membrane surgery. Among these, 21 patients were implanted 3D printed microporous tantalum prosthesis (Prosthesis group), while 22 patients were implanted autologous bone graft (Autologous bone group) in the final-stage surgery. Follow-up was conducted for 12 months postoperatively. Clinical efficacy was evaluated using the Paley grade for bone defect healing, Visual analog scale (VAS), Lower extremity functional scale (LEFS), Fernandez-Esteve eschar score, and time to full weight-bearing. The clinical outcomes between the two treatment groups were compared.</div></div><div><h3>Results</h3><div>Postoperatively, the scores of VAS and LEFS significantly improved compared to preoperative values in both groups (all <em>P</em> &lt; 0.001). Compared to the Autologous bone group, the Prosthesis group demonstrated significantly higher LEFS scores and Fernandez-Esteve eschar scores, along with a significantly shorter time to full weight-bearing (all <em>P</em> &lt; 0.05). The complication rate was 19.0% (4/21) in the Prosthesis group and 9.1% (2/22) in the Autologous bone group; there was no statistically significant difference between the two groups (<em>P</em> &gt; 0.05). Patients experiencing complications received effective and targeted interventions.</div></div><div><h3>Conclusion</h3><div>Both implants show remarkable efficacy in the reconstruction of large segmental bone defect caused by lower limb FRI. However, 3D printed microporous tantalum prosthesis exhibits certain advantages over the autologous bone graft in terms of limb function recovery, bone callus growth, and early weight-bearing. However, when using this technique, one should be vigilant about the risk of complications.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 4","pages":"Article 113087"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147346","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":"Mechanical and clinical performance of acellular allogeneic dermis combined with autologous split-thickness skin grafts for ankle soft tissue defect repair","authors":"Yixin Zhu ,&nbsp;Qinghua Lai ,&nbsp;Zhiyi Wei ,&nbsp;Juntao Cheng","doi":"10.1016/j.injury.2026.113088","DOIUrl":"10.1016/j.injury.2026.113088","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the clinical efficacy, wound healing quality, and functional recovery of a composite grafting technique using acellular dermal matrix (ADM) and autologous split-thickness skin graft (ASTSG) for reconstructing complex ankle soft tissue defects.</div></div><div><h3>Methods</h3><div>A retrospective cohort study included 108 patients with ankle soft tissue defects (≥3 cm²). Patients were divided into an observation group (<em>n</em> = 55, ADM+ASTSG) and a control group (<em>n</em> = 53, pedicled skin flap). Primary outcomes were graft survival, wound healing time, and scar quality (Vancouver Scar Scale). Secondary outcomes included ankle function (range of motion, gait analysis), operative parameters, cost, and histological assessment of neotissue.</div></div><div><h3>Results</h3><div>The ADM+ASTSG group demonstrated a significantly higher graft survival rate (96.80 % vs. 78.22 %, <em>P</em> &lt; 0.05) and superior scar quality at 6 months (VSS total score: 2.3 ± 0.8 vs. 4.7 ± 1.1, <em>P</em> &lt; 0.05). Functional recovery was better, evidenced by greater ankle range of motion and gait symmetry (68.3 ± 5.2 % vs. 59.6 ± 4.8 %, <em>P</em> &lt; 0.05). The technique also resulted in shorter operative time (36.6 ± 6.3 vs. 118.6 ± 11.4 min, <em>P</em> &lt; 0.05) and lower hospitalization costs. Histologically, the ADM group showed more organized collagen fibers and a higher collagen I/III ratio, indicating more mature tissue regeneration.</div></div><div><h3>Conclusion</h3><div>The ADM+ASTSG composite grafting technique promotes high-quality wound healing and functional recovery in ankle soft tissue defects, offering a clinically effective and cost-efficient alternative to traditional flaps. Its ability to support structured tissue regeneration translates into superior scar quality and mechanical adaptability for the dynamic ankle joint.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 4","pages":"Article 113088"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146147696","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":"Letter to Social deprivation results in longer perioperative admission and decreased rates of home discharge after distal femur fracture","authors":"Xiaojing Bai,&nbsp;Menghui Gao","doi":"10.1016/j.injury.2025.112863","DOIUrl":"10.1016/j.injury.2025.112863","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112863"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477294","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":"Concern on “Biomechanical evaluation of three different fixation methods for treating displaced tibial avulsion fracture of the posterior cruciate ligament: A finite element analysis”","authors":"Guangdong Chen ,&nbsp;Weiguo Xu ,&nbsp;Yibing Chen ,&nbsp;Lee A. Tan","doi":"10.1016/j.injury.2025.112862","DOIUrl":"10.1016/j.injury.2025.112862","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112862"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490970","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":"Performance of artificial intelligence in addressing questions regarding management of clavicle fractures","authors":"John D. Milner ,&nbsp;Matthew Quinn ,&nbsp;Ashley Knebel ,&nbsp;Phillip Schmitt ,&nbsp;Patrick Morrissey ,&nbsp;Myka Dancy ,&nbsp;Jonathan Liu ,&nbsp;Simbarashe Peresuh ,&nbsp;Michel A. Arcand ,&nbsp;Andrew R. Evans ,&nbsp;Brett D. Owens ,&nbsp;E. Scott Paxton","doi":"10.1016/j.injury.2026.113053","DOIUrl":"10.1016/j.injury.2026.113053","url":null,"abstract":"<div><h3>Objectives</h3><div>Artificial intelligence (AI) has revolutionized public access to extensive information with large language model (LLM)-based chatbots allowing users to receive comprehensive, individualized responses. In this study, we aimed to evaluate the quality of LLM responses to questions about common orthopedic conditions. We hypothesized that both ChatGPT and Gemini would demonstrate high quality, evidence-based responses across evaluation criteria.</div></div><div><h3>Methods</h3><div>Responses from ChatGPT and Gemini to prompts based on the 14 AAOS Clinical Practice Guidelines for clavicle fracture management were evaluated on six criteria by seven fellowship-trained shoulder and trauma orthopedic surgeons. Statistical analyses including mean scoring, standard deviation and two-sided t-tests were calculated to compare performance between ChatGPT and Gemini. Scores were then evaluated for inter-rater reliability (IRR).</div></div><div><h3>Results</h3><div>ChatGPT and Gemini demonstrated overall mean scores greater than 3.5 for both platforms. Mean overall score for ChatGPT was highest in evidence-based (4.52 ± 0.16) and lowest in clarity (4.22 ± 0.19). Mean overall score for Gemini was highest in clarity (4.31 ± 0.17) and lowest in evidence-based (3.81 ± 0.22). ChatGPT had significantly better performance in the overall completeness category (4.50 ± 0.17 vs 4.11 ± 0.19, p &lt; 0.005) than Gemini but scores were otherwise not significantly different. Over 70 % of respondents rated the responses of ChatGPT as higher quality than Gemini.</div></div><div><h3>Conclusions</h3><div>ChatGPT and Gemini produced responses that were generally in line with the 2022 AAOS guidelines on the treatment of clavicle fractures. Scores were comparable in every overall category except completeness, with ChatGPT outperforming Gemini. These results suggest that both LLMs are capable of providing clinically relevant responses to questions related to clavicle fracture management.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113053"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079531","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":"Multiple iliosacral screws in a single osseous fixation pathway: Utility and safety","authors":"David A Zuelzer ,&nbsp;Andrew Coskey ,&nbsp;Yugant Patel ,&nbsp;Christopher Meuth ,&nbsp;Milton L “Chip” Routt ,&nbsp;Raymond D. Wright","doi":"10.1016/j.injury.2026.113023","DOIUrl":"10.1016/j.injury.2026.113023","url":null,"abstract":"<div><h3>Objectives</h3><div>1) To evaluate common characteristics for injuries treated with multiple iliosacral screws in a single sacral osseous pathway to evaluate when it may be useful and 2) to determine whether placing multiple iliosacral screws in a single sacral OFP increases risk for unsafe screws.</div></div><div><h3>Methods</h3><div>Design: Retrospective, combined case-control and cohort analyses</div><div><em>Setting:</em> Single, Level 1 regional trauma center</div><div><em>Patient Selection Criteria:</em> Treated with iliosacral screws identified by CPT code search 27,216 and 27218</div><div><em>Outcome Measures and Variables:</em> Population was divided into multiple screw (MS) and single screw (SS) groups. Outcomes of interest were factors associated with MS group and screw safety on postoperative CT scan.</div></div><div><h3>Results</h3><div>There were 133 patients with 53/133 (39.8%) in the MS group and 80/133 (60.2%) in the SS group. On logistic regression, each 2-mm increase in CT measurement was associated with higher odds of receiving multiple screws for sacroiliac style (OR = 1.34, 95% CI 1.05–1.71, <em>p</em> = 0.02) or transsacral if non-dysmorphic (OR = 1.55, 95% CI 1.25–1.93, <em>p</em> &lt; 0.001) in S1. Patients were 3.4 times more likely to be in the MS group with C-type than B-type injuries (OR = 3.40, 95%CI 1.61–7.22, <em>p</em> = 0.0014). MS was not a risk factor for juxtacortical or extraosseous screw placement (RR = 1.93, 95%CI 0.66–5.65, <em>p</em> = 0.23).</div></div><div><h3>Conclusion</h3><div>The results of this study suggest that surgeons may place multiple iliosacral screws in a single OFP in more complex or unstable injuries and/or when larger safe corridors exist on preoperative imaging and that multiple iliosacral screws may not be associated with an increase in risk for unsafe screw placement.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113023"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981569","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":"Prehospital spinal immobilization and motion restriction strategies: A scoping review of the literature","authors":"Federico Cucci ,&nbsp;Dario Marasciulo ,&nbsp;Roberto Lupo ,&nbsp;Luana Conte ,&nbsp;Giovanni Soldano ,&nbsp;Cosimo Caldararo ,&nbsp;Leonardo Zizzi ,&nbsp;Emanuele Lagazzi ,&nbsp;Michele Bonetti","doi":"10.1016/j.injury.2026.113024","DOIUrl":"10.1016/j.injury.2026.113024","url":null,"abstract":"<div><h3>Background</h3><div>Prehospital management of suspected spinal injury has long relied on routine full immobilization. In recent years, several studies have questioned its benefit and highlighted possible adverse effects. The aim of this scoping review is to describe the evidence on the management of patients with suspected spinal injury, focusing on models based on full immobilization with rigid devices and a cervical collar, and on strategies of selective spinal motion restriction (SMR).</div></div><div><h3>Methods</h3><div>A scoping review was conducted according to JBI methodology and PRISMA-ScR guidance, with a protocol registered on the Open Science Framework. The literature search was carried out in the PubMed, Scopus and Web of Science databases. Studies on adults or children with suspected traumatic spinal injury managed in the out-of-hospital setting were included when strategies of full immobilization, selective SMR or no immobilization were described or compared.</div></div><div><h3>Results</h3><div>Twenty-seven studies met the inclusion criteria, including observational cohorts, experimental studies on volunteers, simulation studies and qualitative research. Overall, no clear advantage of routine full immobilization over more selective strategies emerges. Selective SMR based on clinical assessment and decision rules appears to reduce the use of rigid devices without evidence of increased missed unstable injuries. Prolonged immobilization is instead associated with pain, discomfort, alterations in tissue perfusion and greater use of imaging examinations. The overall body of evidence is heterogeneous and largely based on observational studies, in which the influence of confounding factors cannot be fully ruled out.</div></div><div><h3>Conclusions</h3><div>The available evidence supports moving away from routine full immobilization towards selective SMR in the prehospital setting. Emergency medical services should update protocols and training accordingly and promote prospective studies focused on clinical outcomes and patient experience.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113024"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981573","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":"Outcomes of single stage treatment of chronic bone infection in adults with antibiotic impregnated calcium sulphate beads; A single centre retrospective study with a mean follow-up of 5.5 years","authors":"Panayiotis Souroullas ,&nbsp;Hemant Sharma ,&nbsp;Gavin Barlow ,&nbsp;Andy Craig ,&nbsp;Ross Muir ,&nbsp;Yvonne Hadland ,&nbsp;Elizabeth Barron ,&nbsp;Cher Bing Chuo ,&nbsp;Joanna Bates","doi":"10.1016/j.injury.2026.113052","DOIUrl":"10.1016/j.injury.2026.113052","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic bone infection is a challenging condition to treat, often requiring multiple surgeries and prolonged antibiotic therapy, which although effective, can increase patient morbidity and are resource intensive. This study was designed to evaluate midterm results of a single-stage management approach for chronic bone infection, incorporating debridement, local antibiotic delivery via calcium sulphate antibiotic loaded carrier (CALC), and soft-tissue coverage to effectively manage infection and improve patient outcomes while minimizing morbidity associated with multi-stage procedures.</div></div><div><h3>Materials and Methods</h3><div>In this retrospective observational cohort study, patients who underwent single-stage surgery with a minimum of two-year follow-up were included. Data on demographics and clinical outcomes were collected. Key objectives included assessing disease recurrence, treatment impact, and postoperative complications.</div></div><div><h3>Results</h3><div>Ninety-three patients, of which 60 were male, were included, with a mean age of 51 years. The median follow-up period was 57.5 months. The mean postoperative stay was 13 days. Thirty-nine patients were smokers, 11 were diabetics, and 10 had peripheral vascular disease. The leading cause of chronic bone infection was fracture related infection following trauma (<em>n</em> = 68), predominantly affecting the tibia (<em>n</em> = 33). Significant microbiological growth occurred in 77 patients with Staphylococcus aureus being the predominant pathogen (<em>n</em> = 42). Cierny-Mader classification revealed 31 patients with localized lesions in Class B hosts and 25 in Class A hosts. Only 24 patients required surgical stabilization at index procedure. Most patients (<em>n</em> = 70) underwent excision with primary closure, while 22 needed a soft tissue flap. Postoperative complications included wound leakage in 21 cases, with 13 recurrent infections, 10 of which needed further surgery. An infection control rate was initially achieved at 86%, and 89.2% at a 5.5-year follow-up.</div></div><div><h3>Discussion and conclusion</h3><div>Our study constitutes a large patient cohort with one of the longest available follow-up periods. Single-stage management of chronic bone infection with intralesional debridement using antibiotic impregnated CaSO₄ pellets is safe and an effective method with low recurrence rates. Our results suggest that pre-operative sampling is not essential for successful outcomes. A multidisciplinary approach following the essential basic principles of the management of CBI is essential.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113052"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038910","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":"Comment on timing of ultra-portable ultrasound (UPUS) examinations in detecting clinically concerning recurrent pneumothorax","authors":"Wenwen Zhao,&nbsp;Hong Fan,&nbsp;Ying Chen","doi":"10.1016/j.injury.2025.112865","DOIUrl":"10.1016/j.injury.2025.112865","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112865"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524857","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}