Pub Date : 2026-01-13DOI: 10.1016/j.injury.2026.113029
Jieyu Chen , Huawu Liu , Lei Bai , Sergei V. Petrenko , Jianhui Yan , Chaohui Wang , Bixiu Lei , Shuangping He , Meilan Zhai
Purpose
This study aimed to hierarchically analyse the fixation effects of single and multiple screws on quadrilateral fractures in the acetabular region using finite element technology.
Methods
A three-dimensional finite element model of the normal pelvis was constructed based on normal adult CT data using Mimics, Geomagic, SolidWorks, ANSYS. Six transverse equidistant fracture lines were designed for the hierarchical analysis, and five simulated human body positions were considered.
Results
We compared the mechanical properties of single and multiple screws used for fixation under various operating conditions. The results indicated a layer-by-layer decrease in the relative displacement of the fracture lines from top to bottom under different strength conditions in the standing position and the lumbar spine. In the lateral decubitus position, fracture lines 1–5 decreased layer by layer, whereas fracture line 6 increased. Moreover, in the multiple-screw model, posterior column corridor screw experienced lower stress than in the single-screw model, while blocking screws bore significantly higher stress than posterior column corridor screw. Additionally, pronounced displacement occurred along the anterior and posterior columns sides of the quadrilateral region, while the central segment showed only minor shifting under different loading states in the standing and lumbar postures; in contrast, such behavior was not observed in the lateral decubitus position.
Conclusion
Multiple-screw fixation suggests better stability with smaller relative displacement than single-screw fixation under different loading conditions in the finite element analysis.
{"title":"Analysis of mechanical characteristics of different screw fixation methods based on digital models of acetabular quadrilateral fracture line","authors":"Jieyu Chen , Huawu Liu , Lei Bai , Sergei V. Petrenko , Jianhui Yan , Chaohui Wang , Bixiu Lei , Shuangping He , Meilan Zhai","doi":"10.1016/j.injury.2026.113029","DOIUrl":"10.1016/j.injury.2026.113029","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to hierarchically analyse the fixation effects of single and multiple screws on quadrilateral fractures in the acetabular region using finite element technology.</div></div><div><h3>Methods</h3><div>A three-dimensional finite element model of the normal pelvis was constructed based on normal adult CT data using Mimics, Geomagic, SolidWorks, ANSYS. Six transverse equidistant fracture lines were designed for the hierarchical analysis, and five simulated human body positions were considered.</div></div><div><h3>Results</h3><div>We compared the mechanical properties of single and multiple screws used for fixation under various operating conditions. The results indicated a layer-by-layer decrease in the relative displacement of the fracture lines from top to bottom under different strength conditions in the standing position and the lumbar spine. In the lateral decubitus position, fracture lines 1–5 decreased layer by layer, whereas fracture line 6 increased. Moreover, in the multiple-screw model, posterior column corridor screw experienced lower stress than in the single-screw model, while blocking screws bore significantly higher stress than posterior column corridor screw. Additionally, pronounced displacement occurred along the anterior and posterior columns sides of the quadrilateral region, while the central segment showed only minor shifting under different loading states in the standing and lumbar postures; in contrast, such behavior was not observed in the lateral decubitus position.</div></div><div><h3>Conclusion</h3><div>Multiple-screw fixation suggests better stability with smaller relative displacement than single-screw fixation under different loading conditions in the finite element analysis.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113029"},"PeriodicalIF":2.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981571","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}
The sural flap is widely recognized as an effective method for soft tissue coverage in severe lower limb trauma or sequelae. This retrospective cohort study investigates the impact of vascular pedicle length in reverse sural fasciocutaneous flaps on vascular complications, specifically whether longer pedicles are associated with increased complications.
Methods
We included patients with distal third leg and foot soft tissue defects, treated between March 2008 and March 2021, with a minimum follow-up of 1 year. The cohort was divided into two groups based on the location of the flap: those with flaps above the ankle joint (short pedicle) and those below (long pedicle). Patient demographics, comorbidities (e.g., diabetes, peripheral vascular disease, smoking), and the causes of defects (including fractures, ulcers, and degloving injuries) were assessed. The occurrence of complications, including epidermolysis, partial necrosis, and total necrosis, were compared between groups using bivariate linear regression.
Results
A total of 44 patients received flaps above the ankle joint, while 34 had flaps below the ankle joint. Overall, 35% of patients experienced complications: 5% epidermolysis, 20% partial necrosis, and 10% total necrosis. In the short-pedicle group (flaps above the ankle), 13 complications were observed: 3 cases of epidermolysis, 5 of partial necrosis, and 5 of total necrosis. In the long-pedicle group (flaps below the ankle), 15 complications occurred: 1 case of epidermolysis, 11 of partial necrosis, and 3 of total necrosis. Although complication rates were similar between the two groups, a trend toward a higher incidence of partial necrosis was observed in the longer pedicle group. Statistical analysis using bivariate linear regression found no significant difference in complication rates based on pedicle length (p=0.407). For individual complications, there were no statistically significant differences: epidermolysis (p=0.504), total necrosis (p=0.808), and partial necrosis (p=0.098).
Conclusion
Flap rotation points positioned 5-6 cm above the lateral malleolus, with a wide, short pedicle, may reduce vascular complications. For defects beyond the ankle joint, careful surgical planning is crucial, to minimize the risk of partial necrosis and other complications.
{"title":"Comparative study of the sural flap in 78 patients with a minimum follow-up of 1 year: does pedicle length matter?","authors":"Guido Carabelli , Lionel Llano , Gonzalo Garcia Barreiro , Sebastian Gomez , Danilo Taype , Carlos Sancineto , Jorge Barla","doi":"10.1016/j.injury.2026.113045","DOIUrl":"10.1016/j.injury.2026.113045","url":null,"abstract":"<div><h3>Purpose</h3><div>The sural flap is widely recognized as an effective method for soft tissue coverage in severe lower limb trauma or sequelae. This retrospective cohort study investigates the impact of vascular pedicle length in reverse sural fasciocutaneous flaps on vascular complications, specifically whether longer pedicles are associated with increased complications.</div></div><div><h3>Methods</h3><div>We included patients with distal third leg and foot soft tissue defects, treated between March 2008 and March 2021, with a minimum follow-up of 1 year. The cohort was divided into two groups based on the location of the flap: those with flaps above the ankle joint (short pedicle) and those below (long pedicle). Patient demographics, comorbidities (e.g., diabetes, peripheral vascular disease, smoking), and the causes of defects (including fractures, ulcers, and degloving injuries) were assessed. The occurrence of complications, including epidermolysis, partial necrosis, and total necrosis, were compared between groups using bivariate linear regression.</div></div><div><h3>Results</h3><div>A total of 44 patients received flaps above the ankle joint, while 34 had flaps below the ankle joint. Overall, 35% of patients experienced complications: 5% epidermolysis, 20% partial necrosis, and 10% total necrosis. In the short-pedicle group (flaps above the ankle), 13 complications were observed: 3 cases of epidermolysis, 5 of partial necrosis, and 5 of total necrosis. In the long-pedicle group (flaps below the ankle), 15 complications occurred: 1 case of epidermolysis, 11 of partial necrosis, and 3 of total necrosis. Although complication rates were similar between the two groups, a trend toward a higher incidence of partial necrosis was observed in the longer pedicle group. Statistical analysis using bivariate linear regression found no significant difference in complication rates based on pedicle length (p=0.407). For individual complications, there were no statistically significant differences: epidermolysis (p=0.504), total necrosis (p=0.808), and partial necrosis (p=0.098).</div></div><div><h3>Conclusion</h3><div>Flap rotation points positioned 5-6 cm above the lateral malleolus, with a wide, short pedicle, may reduce vascular complications. For defects beyond the ankle joint, careful surgical planning is crucial, to minimize the risk of partial necrosis and other complications.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113045"},"PeriodicalIF":2.0,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981576","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}
Pub Date : 2026-01-10DOI: 10.1016/j.injury.2026.113023
David A Zuelzer , Andrew Coskey , Yugant Patel , Christopher Meuth , Milton L “Chip” Routt , Raymond D. Wright
Objectives
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.
Methods
Design: Retrospective, combined case-control and cohort analyses
Setting: Single, Level 1 regional trauma center
Patient Selection Criteria: Treated with iliosacral screws identified by CPT code search 27,216 and 27218
Outcome Measures and Variables: 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.
Results
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, p = 0.02) or transsacral if non-dysmorphic (OR = 1.55, 95% CI 1.25–1.93, p < 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, p = 0.0014). MS was not a risk factor for juxtacortical or extraosseous screw placement (RR = 1.93, 95%CI 0.66–5.65, p = 0.23).
Conclusion
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.
目的1)评估在单一骶骨通路中使用多枚髂骶螺钉治疗损伤的共同特征，以评估何时可能有用；2)确定在单一骶骨OFP中放置多枚髂骶螺钉是否会增加不安全螺钉的风险。设计：回顾性、病例对照和队列分析。设置：单一、1级区域性创伤中心。患者选择标准：使用经CPT编码检索27216和27218确定的髂骶螺钉治疗。结果测量和变量：人群分为多螺钉组（MS）和单螺钉组（SS）。关注的结果是与MS组和术后CT扫描螺钉安全性相关的因素。结果133例患者中，MS组53/133例（39.8%），SS组80/133例（60.2%）。在logistic回归中，CT测量值每增加2mm，骶髂畸形（OR = 1.34, 95% CI 1.05-1.71, p = 0.02）或经骶畸形（OR = 1.55, 95% CI 1.25-1.93, p < 0.001）接受多螺钉治疗的几率就会增加。MS组患者出现c型损伤的可能性是b型损伤的3.4倍（OR = 3.40, 95%CI 1.61 ~ 7.22, p = 0.0014）。MS不是皮质旁或骨外置入螺钉的危险因素（RR = 1.93, 95%CI 0.66-5.65, p = 0.23）。结论本研究的结果表明，在更复杂或不稳定的损伤和/或术前影像学存在较大安全通道的情况下，外科医生可以在单个OFP内放置多枚髂骶螺钉，并且多枚髂骶螺钉可能不会增加不安全螺钉放置的风险。
{"title":"Multiple iliosacral screws in a single osseous fixation pathway: Utility and safety","authors":"David A Zuelzer , Andrew Coskey , Yugant Patel , Christopher Meuth , Milton L “Chip” Routt , 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> < 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":"2026-01-10","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}
Pub Date : 2026-01-10DOI: 10.1016/j.injury.2026.113040
Mao Xu , Xin Gao , Shujin Li , Xuhuizi Liu , Bing Li , Xinxin Jin
Background
Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, synovial inflammation and subchondral bone sclerosis. There is currently no effective drug treatments for late stage OA.
Methods
Here, we prepare injectable resveratrol (Res) thermosensitive hydrogels, detect its microscopic morphology and release in vitro. Then observing its therapeutic effect on C57BL/6 mice in vivo and femoral heads in vitro also used. Characterization of temperature-sensitive resveratrol gel, chondrosynthesis and catabolism genes, morphology of joint and femoral head from mice. Expression of sirtuin1(SIRT1) and hypoxia inducible factor-1α (HIF1α) is also detected in vivo and in vitro. IL-1β is used to imitate an in vitro osteoarthritis model.
Results
Res hydrogels show excellent strain, injectability and temperature sensitive properties, and have an apparent protective effect on the OA articular cartilage. P53 and P21 elevated in DMM mice, when HIF1α and matrix metalloproteinase 13 (MMP13) both increased similarly. While Res activates SIRT1 by suppressing HIF1α nucleus-shuttling to promote chondrocytes proliferation and reduce hypertrophy.
Conclusion
Taken together, injectable resveratrol thermosensitive hydrogel protects the articular cartilage from degradation and reduces the damage to joints caused by mechanical stress via SIRT1/ HIF1α/MMP13 pathway.
{"title":"Injectable thermosensitive hydrogel delivering resveratrol protects articular cartilage via SIRT1/HIF1α/MMP13 signaling","authors":"Mao Xu , Xin Gao , Shujin Li , Xuhuizi Liu , Bing Li , Xinxin Jin","doi":"10.1016/j.injury.2026.113040","DOIUrl":"10.1016/j.injury.2026.113040","url":null,"abstract":"<div><h3>Background</h3><div>Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, synovial inflammation and subchondral bone sclerosis. There is currently no effective drug treatments for late stage OA.</div></div><div><h3>Methods</h3><div>Here, we prepare injectable resveratrol (Res) thermosensitive hydrogels, detect its microscopic morphology and release <em>in vitro</em>. Then observing its therapeutic effect on C57BL/6 mice <em>in vivo</em> and femoral heads <em>in vitro</em> also used. Characterization of temperature-sensitive resveratrol gel, chondrosynthesis and catabolism genes, morphology of joint and femoral head from mice. Expression of sirtuin1(SIRT1) and hypoxia inducible factor-1α (HIF1α) is also detected <em>in vivo</em> and <em>in vitro</em>. IL-1β is used to imitate an <em>in vitro</em> osteoarthritis model.</div></div><div><h3>Results</h3><div>Res hydrogels show excellent strain, injectability and temperature sensitive properties, and have an apparent protective effect on the OA articular cartilage. P53 and P21 elevated in DMM mice, when HIF1α and matrix metalloproteinase 13 (MMP13) both increased similarly. While Res activates SIRT1 by suppressing HIF1α nucleus-shuttling to promote chondrocytes proliferation and reduce hypertrophy.</div></div><div><h3>Conclusion</h3><div>Taken together, injectable resveratrol thermosensitive hydrogel protects the articular cartilage from degradation and reduces the damage to joints caused by mechanical stress via SIRT1/ HIF1α/MMP13 pathway.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113040"},"PeriodicalIF":2.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981623","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}
Pub Date : 2026-01-10DOI: 10.1016/j.injury.2026.113049
Christopher Lampert, Leon Faust, Tobias Helfen, Carl Neuerburg, Boris Michael Holzapfel, Wolfgang Böcker, Eduardo Suero , Florian Pachmann
Background
Periprosthetic proximal femoral fractures (PPFF) are expected to increase substantially due to demographic changes and the rising number of total hip arthroplasties. While early surgery is clearly recommended for native hip fractures, the optimal timing of surgery for PPFF remains controversial. The present study aimed to evaluate the effect of early versus delayed surgery on perioperative outcomes in patients with PPFF treated by open reduction and internal fixation (ORIF).
Methods
We conducted a retrospective analysis of 110 patients with PPFF who underwent ORIF at a Level 1 trauma center between January 2017 and August 2023. We analyzed the effect of early (within 24 hours) versus delayed (after 24 hours) surgical treatment after admission on the primary outcome measures: surgical and non-surgical complications, reoperation rate, in-hospital mortality, and postoperative immobility. Secondary outcome measures included the duration of surgery, length of hospital stay, and bleeding complications.
Results
Baseline demographics, comorbidities, and fracture patterns were comparable between the groups. No significant differences were observed in surgical (18.2 % vs. 14.6 %; p = 0.622) and non-surgical (27.3 % vs. 27.3 %; p = 0.992) complication rates, length of hospital stay (15.6 ± 13.5 vs. 15.4 ± 8.2 days; p = 0.747), reoperation rates (14.6 % vs. 10.9 %; p = 0.621). In-hospital mortality was low (7.3 % vs. 5.5 %; p = 0.672) and was not affected by the time of surgery. A longer operative time in patients undergoing surgery within 24 hours (150.5 ± 56.6 vs. 115.9 ± 54.6 min; p = 0.001) was not associated with an increase in morbidity or mortality.
Conclusion
Timing of surgical intervention had no impact on perioperative outcomes in patients with PPFF treated with ORIF. However, considering the elderly and frail nature of this patient population, timely surgery should be recommended to enable early mobilization, which is essential for preventing complications and may improve long-term functional outcomes.
背景：由于人口结构的变化和全髋关节置换术数量的增加，股骨近端假体周围骨折（PPFF）预计将大幅增加。虽然早期手术被明确推荐用于治疗先天性髋部骨折，但PPFF的最佳手术时机仍存在争议。本研究旨在评估早期手术与延迟手术对经切开复位内固定（ORIF）治疗的PPFF患者围手术期结局的影响。方法回顾性分析2017年1月至2023年8月在某一级创伤中心接受ORIF治疗的110例PPFF患者。我们分析了入院后早期（24小时内）和延迟（24小时后）手术治疗对主要结局指标的影响：手术和非手术并发症、再手术率、住院死亡率和术后不动。次要结局指标包括手术时间、住院时间和出血并发症。结果两组之间的基线人口统计学、合并症和骨折模式具有可比性。手术（18.2%比14.6%,p = 0.622）和非手术（27.3%比27.3%,p = 0.992）并发症发生率、住院时间（15.6±13.5比15.4±8.2天，p = 0.747）、再手术率（14.6%比10.9%,p = 0.621）差异无统计学意义。住院死亡率较低（7.3%对5.5%;p = 0.672），且不受手术时间的影响。24小时内接受手术的患者手术时间较长（150.5±56.6 vs 115.9±54.6 min; p = 0.001）与发病率或死亡率的增加无关。结论手术干预时机对经ORIF治疗的PPFF患者围手术期预后无影响。然而，考虑到这类患者的年老体弱，应建议及时手术以实现早期活动，这对于预防并发症和改善长期功能预后至关重要。
{"title":"Impact of surgical timing on perioperative outcomes after open reduction and internal fixation of periprosthetic proximal femoral fractures","authors":"Christopher Lampert, Leon Faust, Tobias Helfen, Carl Neuerburg, Boris Michael Holzapfel, Wolfgang Böcker, Eduardo Suero , Florian Pachmann","doi":"10.1016/j.injury.2026.113049","DOIUrl":"10.1016/j.injury.2026.113049","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic proximal femoral fractures (PPFF) are expected to increase substantially due to demographic changes and the rising number of total hip arthroplasties. While early surgery is clearly recommended for native hip fractures, the optimal timing of surgery for PPFF remains controversial. The present study aimed to evaluate the effect of early versus delayed surgery on perioperative outcomes in patients with PPFF treated by open reduction and internal fixation (ORIF).</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 110 patients with PPFF who underwent ORIF at a Level 1 trauma center between January 2017 and August 2023. We analyzed the effect of early (within 24 hours) versus delayed (after 24 hours) surgical treatment after admission on the primary outcome measures: surgical and non-surgical complications, reoperation rate, in-hospital mortality, and postoperative immobility. Secondary outcome measures included the duration of surgery, length of hospital stay, and bleeding complications.</div></div><div><h3>Results</h3><div>Baseline demographics, comorbidities, and fracture patterns were comparable between the groups. No significant differences were observed in surgical (18.2 % vs. 14.6 %; p = 0.622) and non-surgical (27.3 % vs. 27.3 %; p = 0.992) complication rates, length of hospital stay (15.6 ± 13.5 vs. 15.4 ± 8.2 days; p = 0.747), reoperation rates (14.6 % vs. 10.9 %; p = 0.621). In-hospital mortality was low (7.3 % vs. 5.5 %; p = 0.672) and was not affected by the time of surgery. A longer operative time in patients undergoing surgery within 24 hours (150.5 ± 56.6 vs. 115.9 ± 54.6 min; p = 0.001) was not associated with an increase in morbidity or mortality.</div></div><div><h3>Conclusion</h3><div>Timing of surgical intervention had no impact on perioperative outcomes in patients with PPFF treated with ORIF. However, considering the elderly and frail nature of this patient population, timely surgery should be recommended to enable early mobilization, which is essential for preventing complications and may improve long-term functional outcomes.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113049"},"PeriodicalIF":2.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950139","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}
Pub Date : 2026-01-10DOI: 10.1016/j.injury.2026.113048
Ian Meshay , Katelyn A. Cole , Sabrina M. Pescatore , Kaley Haney , John C. Hagedorn II
Background
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.
Methods
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 <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.
Results
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, P < .0001). Demographic subgroup analysis demonstrated a significantly higher prevalence of S1 discs (P = .0007), TIG SI joints (P < .0001), and colinear upper sacra (P < .0001) in women. Residual S1 discs were also significantly more common in White patients (P < .0001).
Conclusions
Sacral anatomy exists on a spectrum from normal to dysmorphic. This study demonstrates that completely “normal” sacral morphology is seen in <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.
{"title":"Prevalence of dysmorphic sacral features in the general population","authors":"Ian Meshay , Katelyn A. Cole , Sabrina M. Pescatore , Kaley Haney , 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 <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> < .0001). Demographic subgroup analysis demonstrated a significantly higher prevalence of S1 discs (<em>P</em> = .0007), TIG SI joints (<em>P</em> < .0001), and colinear upper sacra (<em>P</em> < .0001) in women. Residual S1 discs were also significantly more common in White patients (<em>P</em> < .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 <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":"2026-01-10","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}
Pub Date : 2026-01-10DOI: 10.1016/j.injury.2026.113033
Peter Larsen , Rasmus Jorgensen , Martin Jensen , Soeren Lundbye-Christensen , Rasmus Elsoe
Background
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.
Materials and methods
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.
Results
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 (r < 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).
Conclusion
The Knee Injury and Osteoarthritis Outcome Score (KOOS) showed acceptable relevance, construct validity and responsiveness and high reliability to adult patients with patella fractures.
{"title":"Measurement properties of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for patella fractures","authors":"Peter Larsen , Rasmus Jorgensen , Martin Jensen , Soeren Lundbye-Christensen , 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> < 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":"2026-01-10","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}
Pub Date : 2026-01-10DOI: 10.1016/j.injury.2026.113041
Mahmoud Omar , Nailah Ghouse , Alexander Azar , Sarah Atta , Wassim Malak
Introduction
Open globe injury is a surgical emergency requiring prompt diagnosis to minimize morbidity. Orbital CT is frequently performed in trauma settings and is crucial for globe evaluation, particularly when bedside assessment is limited.
The primary objective was to evaluate the diagnostic accuracy of overall CT impression for detecting open globe injury. The secondary objective was to assess the diagnostic accuracy of CT imaging signs.
Methods
A systematic review protocol was prospectively registered (PROSPERO CRD42025638703). On January 16, 2025, Embase, Pubmed, Scopus, and Google Scholar were searched without date restrictions. Diagnostic accuracy meta-analyses were performed on overall CT impression and individual CT imaging signs for open globe injury. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
Results
Eight studies met inclusion criteria representing 827 patients, 830 injured globes, and 339 confirmed open globe injury. The pooled sensitivity and specificity of overall CT impression was 75% (95% CI, 0.69–0.79) and 94% (95% CI, 0.91–0.96), respectively. Among individual signs, change in globe contour or scleral irregularity had the highest diagnostic odds ratio (109; 95% CI, 17–718) with sensitivity and specificity of 71% (95% CI, 0.61–0.79) and 98% (95% CI, 0.86–1.00), respectively. Change in anterior chamber depth, vitreous hemorrhage, lens abnormality, and intraocular air were insensitive but highly specific signs.
Conclusions
Overall CT impression and individual imaging signs demonstrate high specificity but limited sensitivity for open globe injury. Surgical exploration remains necessary when clinical suspicion persists despite inconclusive imaging.
{"title":"Diagnostic test accuracy of CT for open globe injury: A systematic review and meta-analysis of overall impression and individual imaging signs","authors":"Mahmoud Omar , Nailah Ghouse , Alexander Azar , Sarah Atta , Wassim Malak","doi":"10.1016/j.injury.2026.113041","DOIUrl":"10.1016/j.injury.2026.113041","url":null,"abstract":"<div><h3>Introduction</h3><div>Open globe injury is a surgical emergency requiring prompt diagnosis to minimize morbidity. Orbital CT is frequently performed in trauma settings and is crucial for globe evaluation, particularly when bedside assessment is limited.</div><div>The primary objective was to evaluate the diagnostic accuracy of overall CT impression for detecting open globe injury. The secondary objective was to assess the diagnostic accuracy of CT imaging signs.</div></div><div><h3>Methods</h3><div>A systematic review protocol was prospectively registered (PROSPERO CRD42025638703). On January 16, 2025, Embase, Pubmed, Scopus, and Google Scholar were searched without date restrictions. Diagnostic accuracy meta-analyses were performed on overall CT impression and individual CT imaging signs for open globe injury. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.</div></div><div><h3>Results</h3><div>Eight studies met inclusion criteria representing 827 patients, 830 injured globes, and 339 confirmed open globe injury. The pooled sensitivity and specificity of overall CT impression was 75% (95% CI, 0.69–0.79) and 94% (95% CI, 0.91–0.96), respectively. Among individual signs, change in globe contour or scleral irregularity had the highest diagnostic odds ratio (109; 95% CI, 17–718) with sensitivity and specificity of 71% (95% CI, 0.61–0.79) and 98% (95% CI, 0.86–1.00), respectively. Change in anterior chamber depth, vitreous hemorrhage, lens abnormality, and intraocular air were insensitive but highly specific signs.</div></div><div><h3>Conclusions</h3><div>Overall CT impression and individual imaging signs demonstrate high specificity but limited sensitivity for open globe injury. Surgical exploration remains necessary when clinical suspicion persists despite inconclusive imaging.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113041"},"PeriodicalIF":2.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950137","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}
Pub Date : 2026-01-10DOI: 10.1016/j.injury.2026.113036
Huhu Wang , Hongying He , Jianwen Zhao , Li Han , Weidong Shi , Zhuo Wu , Lin Yang , Wenxing Han , Hao Wang , Shaoguang Li , Xiaowei Zhang , Jianzheng Zhang
<div><h3>Background</h3><div>Bone infection with large bone defects presents a significant challenge for orthopedic surgeons. Free vascularized fibula grafting (FVFG) and the Masquelet technique have proven to be a practical reconstructive approach for addressing large bone defects. Although various strategies have been utilized to manage bone infection with large bone defects, there remains debate concerning the optimal treatment approach. The aim of this study was to observe the outcomes of a new surgical procedure of the modified Masquelet technique for bone infection with large bone defects.</div></div><div><h3>Methods</h3><div>From October 2021 to October 2023, 10 patients of bone infection with large bone defects underwent the surgery of the modified Masquelet technique. A large bone defect was defined as bone defects >6 cm. Among the 10 cases, 8 were male, and 2 were female, with a mean age of 54.7 ± 11.1 years. The median and interquartile range of the infection history was 6 (2, 66) months. The infected skeletal sites included 7 cases in the tibia and 3 in the femur. All cases underwent the modified Masquelet technique, which included two-stage surgical approaches: the first-stage surgery (FSS) involved debridement, bone cement filling, soft tissue coverage, and external fixation; the second-stage surgery (SSS) included removal of the bone cement, FVFG, iliac bone grafting, and external fixation. The bone defect sizes ranging from 9.7 to 22.4 cm (16.4 ± 4.1 cm). The median and quartile of the bone defect volume were 70.1 (52.1, 139.9) cm<sup>3</sup>. The size of the vascularized fibula varied from 11.3 to 21.0 cm (17.2 ± 3.7 cm). Postoperatively, patients were followed for a duration ranging from 12 to 31 (19.7 ± 6.4) months. Bone graft fusion was assessed according to the radiographic union score (RUS), with scores greater than 8 indicating successful bone fusion. The pain was measured by the visual analogue scale (VAS), limb function was assessed with the lower extremity functional scale (LEFS), and anxiety levels were evaluated using the self-rating anxiety scale (SAS).</div></div><div><h3>Results</h3><div>All patients achieved complete resolution of their infections, resulting in an infection cure rate of 100%, with no recurrences observed during the follow-up period. All patients achieved osseous fusion, resulting in an overall bony union rate of 100%. The average RUS recorded was 10.6 ± 1.5, and no instances of re-fracture were observed during the follow-up period. There were no wound-related complications at the donor site of the fibula graft, nor were there any issues such as toe flexion weakness, ankle instability, or pain. Compared with the preoperative scores, the last follow-up VAS scores (0.6 ± 0.5 vs. 5.8 ± 1.0, <em>p</em> < 0.001) and SAS scores (33.3 ± 2.3 vs. 59.7 ± 4.1, <em>p</em> < 0.001) were significantly lower. Compared with the preoperative scores, the last follow-up LEFS scores (63.3 ± 7.8 vs. 20.8 ± 3.8,
{"title":"Modified Masquelet technique using free vascularized fibula grafting for reconstruction of large bone defects after bone infection","authors":"Huhu Wang , Hongying He , Jianwen Zhao , Li Han , Weidong Shi , Zhuo Wu , Lin Yang , Wenxing Han , Hao Wang , Shaoguang Li , Xiaowei Zhang , Jianzheng Zhang","doi":"10.1016/j.injury.2026.113036","DOIUrl":"10.1016/j.injury.2026.113036","url":null,"abstract":"<div><h3>Background</h3><div>Bone infection with large bone defects presents a significant challenge for orthopedic surgeons. Free vascularized fibula grafting (FVFG) and the Masquelet technique have proven to be a practical reconstructive approach for addressing large bone defects. Although various strategies have been utilized to manage bone infection with large bone defects, there remains debate concerning the optimal treatment approach. The aim of this study was to observe the outcomes of a new surgical procedure of the modified Masquelet technique for bone infection with large bone defects.</div></div><div><h3>Methods</h3><div>From October 2021 to October 2023, 10 patients of bone infection with large bone defects underwent the surgery of the modified Masquelet technique. A large bone defect was defined as bone defects >6 cm. Among the 10 cases, 8 were male, and 2 were female, with a mean age of 54.7 ± 11.1 years. The median and interquartile range of the infection history was 6 (2, 66) months. The infected skeletal sites included 7 cases in the tibia and 3 in the femur. All cases underwent the modified Masquelet technique, which included two-stage surgical approaches: the first-stage surgery (FSS) involved debridement, bone cement filling, soft tissue coverage, and external fixation; the second-stage surgery (SSS) included removal of the bone cement, FVFG, iliac bone grafting, and external fixation. The bone defect sizes ranging from 9.7 to 22.4 cm (16.4 ± 4.1 cm). The median and quartile of the bone defect volume were 70.1 (52.1, 139.9) cm<sup>3</sup>. The size of the vascularized fibula varied from 11.3 to 21.0 cm (17.2 ± 3.7 cm). Postoperatively, patients were followed for a duration ranging from 12 to 31 (19.7 ± 6.4) months. Bone graft fusion was assessed according to the radiographic union score (RUS), with scores greater than 8 indicating successful bone fusion. The pain was measured by the visual analogue scale (VAS), limb function was assessed with the lower extremity functional scale (LEFS), and anxiety levels were evaluated using the self-rating anxiety scale (SAS).</div></div><div><h3>Results</h3><div>All patients achieved complete resolution of their infections, resulting in an infection cure rate of 100%, with no recurrences observed during the follow-up period. All patients achieved osseous fusion, resulting in an overall bony union rate of 100%. The average RUS recorded was 10.6 ± 1.5, and no instances of re-fracture were observed during the follow-up period. There were no wound-related complications at the donor site of the fibula graft, nor were there any issues such as toe flexion weakness, ankle instability, or pain. Compared with the preoperative scores, the last follow-up VAS scores (0.6 ± 0.5 vs. 5.8 ± 1.0, <em>p</em> < 0.001) and SAS scores (33.3 ± 2.3 vs. 59.7 ± 4.1, <em>p</em> < 0.001) were significantly lower. Compared with the preoperative scores, the last follow-up LEFS scores (63.3 ± 7.8 vs. 20.8 ± 3.8,","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113036"},"PeriodicalIF":2.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950138","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}
Pub Date : 2026-01-10DOI: 10.1016/j.injury.2026.113043
Bianca Rocha da Silva Barreto , Eduardo Carvalho Lira , Severino Alves Júnior , Luzia Abilio da Silva , Yuri José de Albuquerque Silva , Widarlane Ângela da Silva Alves , Madson Manoel Nunes da Silva , Rosallyne Hosana Vanderlei das Chagas , Larissa Cardeal da Rocha Carvalho , Jasmine Martins Vieira Cunha , Jamily Isabel Viana de Lima , Ester Francisca Gomes de Lima , Ícaro Mota Oliveira , Jeymesson Raphael Cardoso Vieira
Skin flaps are widely used in plastic and reconstructive surgery. However, inadequate blood perfusion during flap mobilization can trigger an ischemic process that may lead to tissue necrosis in the absence of effective management of the inflammatory process. In this context, the search for new biocompatible strategies to ensure the viability of ischemic skin flaps (ISFs) remains necessary. Therefore, this study evaluated novel alginate-ZIF-8 (ALG-ZIF-8) hydrogel systems with Rhizophora mangle (R. mangle) extract and tannic acid (TA) to assess their potential in preventing necrosis in ISF. Twenty-two male Wistar rats underwent the surgical creation of ISF and were divided into four groups: 0.9% saline (negative control - NegC), placebo alginate hydrogel (pALGgel), ALG-ZIF-8 hydrogel system with 5% TA (ALGzTA), and finally, ALG-ZIF-8 hydrogel system with 5% R. mangle (ALGzRm). Flap outcomes were evaluated through macroscopic observation, followed by morphometric analysis of viable and necrotic areas, and histomorphometric analysis of fibroblasts, blood vessels, and leukocytes, using ImageJ and PrimeCam 5.1 software. Statistical analysis was performed using IBM SPSS software (version 27). The results suggest that the formulations produced divergent outcomes by differentially modulating inflammatory and angiogenic responses. The ALGzRm formulation tended to show a protective profile, associated with a significant reduction in leukocyte infiltration (p < 0.001), while the ALGzTA formulation was linked to a detrimental response, including exacerbated inflammation and a pathologically high blood vessel count (p = 0.015). In conclusion, findings suggest that the ALGzRm-gel has a potential for tissue repair, mediated by the modulation of inflammatory and angiogenic responses.
皮瓣广泛应用于整形和重建手术。然而，在皮瓣动员过程中，血液灌注不足会引发缺血过程，在炎症过程缺乏有效管理的情况下可能导致组织坏死。在这种情况下，寻找新的生物相容性策略来确保缺血皮瓣（isf）的生存能力仍然是必要的。因此，本研究评估了新型海藻酸盐- zif -8 （ALG-ZIF-8）水凝胶体系与根霉（R. mangle）提取物和单宁酸（TA），以评估其预防ISF坏死的潜力。22只雄性Wistar大鼠手术生成ISF，分为四组：0.9%生理盐水（阴性对照- NegC）、安慰剂海藻酸盐水凝胶（pALGgel）、5% TA的ALG-ZIF-8水凝胶体系（ALGzTA）和5% R. mangle的ALG-ZIF-8水凝胶体系（ALGzRm）。采用ImageJ和PrimeCam 5.1软件对皮瓣进行宏观观察、活区和坏死区形态学分析、成纤维细胞、血管和白细胞的组织形态学分析。采用IBM SPSS软件（27版）进行统计分析。结果表明，配方产生不同的结果，通过不同的调节炎症和血管生成反应。ALGzRm配方倾向于显示出保护作用，与白细胞浸润的显著减少有关（p < 0.001），而ALGzTA配方与有害反应有关，包括炎症加剧和病理性高血管计数（p = 0.015）。总之，研究结果表明，通过调节炎症和血管生成反应，algzrm -凝胶具有组织修复的潜力。
{"title":"Ischemic skin flap viability: in vivo study of alginate-ZIF-8 hydrogel systems with Rhizophora mangle and tannic acid","authors":"Bianca Rocha da Silva Barreto , Eduardo Carvalho Lira , Severino Alves Júnior , Luzia Abilio da Silva , Yuri José de Albuquerque Silva , Widarlane Ângela da Silva Alves , Madson Manoel Nunes da Silva , Rosallyne Hosana Vanderlei das Chagas , Larissa Cardeal da Rocha Carvalho , Jasmine Martins Vieira Cunha , Jamily Isabel Viana de Lima , Ester Francisca Gomes de Lima , Ícaro Mota Oliveira , Jeymesson Raphael Cardoso Vieira","doi":"10.1016/j.injury.2026.113043","DOIUrl":"10.1016/j.injury.2026.113043","url":null,"abstract":"<div><div>Skin flaps are widely used in plastic and reconstructive surgery. However, inadequate blood perfusion during flap mobilization can trigger an ischemic process that may lead to tissue necrosis in the absence of effective management of the inflammatory process. In this context, the search for new biocompatible strategies to ensure the viability of ischemic skin flaps (ISFs) remains necessary. Therefore, this study evaluated novel alginate-ZIF-8 (ALG-ZIF-8) hydrogel systems with <em>Rhizophora mangle</em> (<em>R. mangle</em>) extract and tannic acid (TA) to assess their potential in preventing necrosis in ISF. Twenty-two male Wistar rats underwent the surgical creation of ISF and were divided into four groups: 0.9% saline (negative control - NegC), placebo alginate hydrogel (pALGgel), ALG-ZIF-8 hydrogel system with 5% TA (ALGzTA), and finally, ALG-ZIF-8 hydrogel system with 5% <em>R. mangle</em> (ALGzRm). Flap outcomes were evaluated through macroscopic observation, followed by morphometric analysis of viable and necrotic areas, and histomorphometric analysis of fibroblasts, blood vessels, and leukocytes, using ImageJ and PrimeCam 5.1 software. Statistical analysis was performed using IBM SPSS software (version 27). The results suggest that the formulations produced divergent outcomes by differentially modulating inflammatory and angiogenic responses. The ALGzRm formulation tended to show a protective profile, associated with a significant reduction in leukocyte infiltration (<em>p</em> < 0.001), while the ALGzTA formulation was linked to a detrimental response, including exacerbated inflammation and a pathologically high blood vessel count (<em>p</em> = 0.015). In conclusion, findings suggest that the ALGzRm-gel has a potential for tissue repair, mediated by the modulation of inflammatory and angiogenic responses.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113043"},"PeriodicalIF":2.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981493","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}
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