Pub Date : 2025-03-01DOI: 10.1016/j.injury.2025.112228
Isabel Van Rie Richards , Peter V. Giannoudis
{"title":"AO In-Hospital program: A truly novel educational platform for operating room personnel (ORP) and clinicians?","authors":"Isabel Van Rie Richards , Peter V. Giannoudis","doi":"10.1016/j.injury.2025.112228","DOIUrl":"10.1016/j.injury.2025.112228","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112228"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511737","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 : 2025-02-22DOI: 10.1016/j.injury.2025.112227
Alexander L. Vlasak , Lindsey S. Palm , Jennifer E. Hagen , Matthew R. Patrick , Marissa N. Pazik , Richard G. Vlasak , Michael T. Talerico
Interlocking screw backout is a significant complication of femoral nailing that may lead to pain, fixation failure, and need for reoperation. The risk for this is increased in osteoporotic bone or in cases of so-called “extreme nailing” when the articular segment is short, and fixation is limited. A newly developed retrograde femoral nailing system (DePuy Synthes RFN-Advanced™ Retrograde Femoral Nailing System (DePuy Synthes, Monument, CO)) was designed specifically to prevent this known failure mode and was recently approved for use within the United States. A preassembled polymer inlay at the distal portion of the nail (through which the distal interlocking screws are placed) is marketed as eliminating interfragmentary motion and screw toggle which can ultimately lead to screw backout. Despite this purposeful design, multiple surgeons at our Level I trauma center in the southeastern US have noted a relatively high occurrence of distal interlocking screw backout when compared to other nail designs used in the same time. We present a single institution retrospective review of placed retrograde femoral nails and their complications, particular loss of interlock bolt fixation and revision surgery in the DePuy Synthes RFN-A group (21.43 %), compared to other implant designs (5.41 %) during the initial implementation period at our institution.
{"title":"Interlocking screw backout from a preassembled polymer inlay in a retrograde femoral nail system: A retrospective review","authors":"Alexander L. Vlasak , Lindsey S. Palm , Jennifer E. Hagen , Matthew R. Patrick , Marissa N. Pazik , Richard G. Vlasak , Michael T. Talerico","doi":"10.1016/j.injury.2025.112227","DOIUrl":"10.1016/j.injury.2025.112227","url":null,"abstract":"<div><div>Interlocking screw backout is a significant complication of femoral nailing that may lead to pain, fixation failure, and need for reoperation. The risk for this is increased in osteoporotic bone or in cases of so-called “extreme nailing” when the articular segment is short, and fixation is limited. A newly developed retrograde femoral nailing system (DePuy Synthes RFN-Advanced™ Retrograde Femoral Nailing System (DePuy Synthes, Monument, CO)) was designed specifically to prevent this known failure mode and was recently approved for use within the United States. A preassembled polymer inlay at the distal portion of the nail (through which the distal interlocking screws are placed) is marketed as eliminating interfragmentary motion and screw toggle which can ultimately lead to screw backout. Despite this purposeful design, multiple surgeons at our Level I trauma center in the southeastern US have noted a relatively high occurrence of distal interlocking screw backout when compared to other nail designs used in the same time. We present a single institution retrospective review of placed retrograde femoral nails and their complications, particular loss of interlock bolt fixation and revision surgery in the DePuy Synthes RFN-A group (21.43 %), compared to other implant designs (5.41 %) during the initial implementation period at our institution.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112227"},"PeriodicalIF":2.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.injury.2025.112226
Belal Amini , Sara Kadhm , Alex Trompeter
Diabetes mellitus is a chronic condition which disrupts bone homeostasis leading to impaired healing and profound complications in ankle fractures. Hyperglycaemia and chronic inflammation cause increased generation of advanced glycation end products and reactive oxygen species which ultimately drive osteoclastogenesis and increase bone resorption. Together with a lack of insulin signalling, these mechanisms compromise bone metabolism and increase the risk of complications in fracture healing. Diabetes is associated with comorbidities such as vasculopathy and neuropathy which further contribute to the risk of complications. The complications identified in diabetic patients with ankle fractures include non-union, malunion, infection, amputation, and mortality. Thus, careful consideration is needed when deciding between surgical and conservative treatment. This narrative review provides a synthesis of the literature covering the impact of diabetes on ankle fractures, considering their high prevalence in the UK.
{"title":"The impact of diabetes mellitus on the management and outcome of ankle fractures","authors":"Belal Amini , Sara Kadhm , Alex Trompeter","doi":"10.1016/j.injury.2025.112226","DOIUrl":"10.1016/j.injury.2025.112226","url":null,"abstract":"<div><div>Diabetes mellitus is a chronic condition which disrupts bone homeostasis leading to impaired healing and profound complications in ankle fractures. Hyperglycaemia and chronic inflammation cause increased generation of advanced glycation end products and reactive oxygen species which ultimately drive osteoclastogenesis and increase bone resorption. Together with a lack of insulin signalling, these mechanisms compromise bone metabolism and increase the risk of complications in fracture healing. Diabetes is associated with comorbidities such as vasculopathy and neuropathy which further contribute to the risk of complications. The complications identified in diabetic patients with ankle fractures include non-union, malunion, infection, amputation, and mortality. Thus, careful consideration is needed when deciding between surgical and conservative treatment. This narrative review provides a synthesis of the literature covering the impact of diabetes on ankle fractures, considering their high prevalence in the UK.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112226"},"PeriodicalIF":2.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.injury.2025.112225
Yun Xiu Lam , Spencer Jia Jie Loh , Jerome Yung Kang Chan , Nicole Kim Luan Lee , Shu Ling Chong , Ronald Ming Ren Tan , Mohammad Ashik bin Zainuddin , Arjandas Mahadev , Kenneth Pak Leung Wong
Lacerations rank as the most common paediatric injury that requires a physician evaluation. Glass is a frequent cause of such lacerations, however there is currently little to no information on this. Hence, this paper aims to describe the burden and characteristics of such injuries in Singapore. This study is a retrospective review of glass-related trauma presented to paediatric hospital KKH Emergency Department between 1st January 2017 and 4th July 2023. Data on patient and injury characteristics, as well as treatment plans were collected.
680 patients up to 18 years old (average 6.93) were included in the study. 420 (62 %) were male. The number of glass-related injuries were stable at about 100 per year from 2017 to 2023. 649 (95 %) cases were unintentional. 528 (78 %) injuries occurred indoors.159 (23 %) children had adult supervision at time of injury. A majority of 458 (67 %) injuries occurred during the weekday. Primary blunt injuries were the highest at 414 (61 %), followed by 230 (34 %) penetrating injuries. 317 (37 %) injuries occurred at the lower limb, 305 (36 %) at the upper limb, and 105 (12 %) at the face. 596 (87.6 %) patients had “None to mild” injuries, 31 (4.6 %) with “Moderate” injuries, and 53 (7.8 %) with “Severe” injuries. Glass doors led to 315 (46 %) cases, with glass shards and glass panels causing 85 (12.5 %) and 84 (12.5 %) cases respectively.
555 (82 %) of patients received definitive treatment in the Emergency Department and 74 (11 %) required surgery. The average duration of hospitalization of all patients is 0.36 days. 430 patients averaged 3.66 weeks of follow-up, while 247 were discharged immediately. 85 (13 %) patients required inpatient care. Only 1 patient required fluid resuscitation in the Emergency Department. Most glass injuries are unintentional, caused by glass doors, occur indoors and are, fortunately, mild cases.
{"title":"Glass injuries seen in a paediatric tertiary hospital in Singapore: An epidemiology study","authors":"Yun Xiu Lam , Spencer Jia Jie Loh , Jerome Yung Kang Chan , Nicole Kim Luan Lee , Shu Ling Chong , Ronald Ming Ren Tan , Mohammad Ashik bin Zainuddin , Arjandas Mahadev , Kenneth Pak Leung Wong","doi":"10.1016/j.injury.2025.112225","DOIUrl":"10.1016/j.injury.2025.112225","url":null,"abstract":"<div><div>Lacerations rank as the most common paediatric injury that requires a physician evaluation. Glass is a frequent cause of such lacerations, however there is currently little to no information on this. Hence, this paper aims to describe the burden and characteristics of such injuries in Singapore. This study is a retrospective review of glass-related trauma presented to paediatric hospital KKH Emergency Department between 1st January 2017 and 4th July 2023. Data on patient and injury characteristics, as well as treatment plans were collected.</div><div>680 patients up to 18 years old (average 6.93) were included in the study. 420 (62 %) were male. The number of glass-related injuries were stable at about 100 per year from 2017 to 2023. 649 (95 %) cases were unintentional. 528 (78 %) injuries occurred indoors.159 (23 %) children had adult supervision at time of injury. A majority of 458 (67 %) injuries occurred during the weekday. Primary blunt injuries were the highest at 414 (61 %), followed by 230 (34 %) penetrating injuries. 317 (37 %) injuries occurred at the lower limb, 305 (36 %) at the upper limb, and 105 (12 %) at the face. 596 (87.6 %) patients had “None to mild” injuries, 31 (4.6 %) with “Moderate” injuries, and 53 (7.8 %) with “Severe” injuries. Glass doors led to 315 (46 %) cases, with glass shards and glass panels causing 85 (12.5 %) and 84 (12.5 %) cases respectively.</div><div>555 (82 %) of patients received definitive treatment in the Emergency Department and 74 (11 %) required surgery. The average duration of hospitalization of all patients is 0.36 days. 430 patients averaged 3.66 weeks of follow-up, while 247 were discharged immediately. 85 (13 %) patients required inpatient care. Only 1 patient required fluid resuscitation in the Emergency Department. Most glass injuries are unintentional, caused by glass doors, occur indoors and are, fortunately, mild cases.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112225"},"PeriodicalIF":2.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.injury.2025.112224
Qiyue Zhang , Aierken Rehemutula , Maimaitiyiming Maitudi , Qin Yang , Ainizier Yalikun , Hongyu Zhou , Yu Si , Zihao Chen , Dun Liu , Qian Li , Tao Liu , Li Li , Aihemaitijiang Yusufu
Introduction
The soft tissue of the heel is weak, and calcaneal bone defects occur easily post-infection, resulting in the inability of paediatric patients to walk normally. Calcaneal reconstruction is challenging. We aimed to evaluate the methodology and clinical effects of the Ilizarov technique in the treatment of calcaneal infectious bone defects.
Methods
We retrospectively analyzed the cases of 12 children with infectious calcaneal bone defects treated by the Ilizarov technique in our center from January 2018 to August 2022.Stump lengthening of the calcaneus was performed in nine cases. Due to severe calcaneus infection the calcaneus was removed, and talus lengthening was performed in three children. Two children were treated with drug-loaded spacer bone cement to control peripheral soft tissue infection before bone elongation could be performed, while the other ten cases underwent bone lengthening at one stage after radical debridement. Pain, foot function, self-care ability and hind foot function were evaluated using a Visual Analogue Scale (VAS), the Maryland Foot Score, Activity of Daily Living scale, and the American Orthopaedic Foot and Ankle Society retro ankle foot score.
Results
In this cohort of 12 children, the time for bone lengthening ranged from 32 to 64 days (mean 41.75 ± 10.09 days), and the distance of bone lengthening was between 2.6 cm and 5.4 cm (mean 3.57 ± 0.86 cm). The inflammation indicators CRP, ESR, and IL-6 were significantly reduced after radical debridement (15.72 ± 3.09 vs 6.04 ± 1.28, 25.20 ± 2.72 vs 15.11 ± 1.56, 16.39 ± 3.75 vs 2.99 ± 1.08, respectively; p < 0.01). Bone reconstruction effectively reduced pain in the affected limb and significantly improved foot function, self-care ability, and hind foot function in these children. In four cases, external fixators were removed and an Achilles tendon lengthening operation was performed to further reconstruct calcaneal bone function. After surgical treatment, all the children in this cohort were able to return to normal life.
Conclusion
The Ilizarov technique for treating large infectious calcaneal bone defects and bone lengthening can effectively reconstruct the function of the calcaneal bone without significantly affecting the ankle joint.
{"title":"Surgical treatment of infectious severe calcaneal bone defects in children by the Ilizarov technique","authors":"Qiyue Zhang , Aierken Rehemutula , Maimaitiyiming Maitudi , Qin Yang , Ainizier Yalikun , Hongyu Zhou , Yu Si , Zihao Chen , Dun Liu , Qian Li , Tao Liu , Li Li , Aihemaitijiang Yusufu","doi":"10.1016/j.injury.2025.112224","DOIUrl":"10.1016/j.injury.2025.112224","url":null,"abstract":"<div><h3>Introduction</h3><div>The soft tissue of the heel is weak, and calcaneal bone defects occur easily post-infection, resulting in the inability of paediatric patients to walk normally. Calcaneal reconstruction is challenging. We aimed to evaluate the methodology and clinical effects of the Ilizarov technique in the treatment of calcaneal infectious bone defects.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the cases of 12 children with infectious calcaneal bone defects treated by the Ilizarov technique in our center from January 2018 to August 2022.Stump lengthening of the calcaneus was performed in nine cases. Due to severe calcaneus infection the calcaneus was removed, and talus lengthening was performed in three children. Two children were treated with drug-loaded spacer bone cement to control peripheral soft tissue infection before bone elongation could be performed, while the other ten cases underwent bone lengthening at one stage after radical debridement. Pain, foot function, self-care ability and hind foot function were evaluated using a Visual Analogue Scale (VAS), the Maryland Foot Score, Activity of Daily Living scale, and the American Orthopaedic Foot and Ankle Society retro ankle foot score.</div></div><div><h3>Results</h3><div>In this cohort of 12 children, the time for bone lengthening ranged from 32 to 64 days (mean 41.75 ± 10.09 days), and the distance of bone lengthening was between 2.6 cm and 5.4 cm (mean 3.57 ± 0.86 cm). The inflammation indicators CRP, ESR, and IL-6 were significantly reduced after radical debridement (15.72 ± 3.09 vs 6.04 ± 1.28, 25.20 ± 2.72 vs 15.11 ± 1.56, 16.39 ± 3.75 vs 2.99 ± 1.08, respectively; <em>p</em> < 0.01). Bone reconstruction effectively reduced pain in the affected limb and significantly improved foot function, self-care ability, and hind foot function in these children. In four cases, external fixators were removed and an Achilles tendon lengthening operation was performed to further reconstruct calcaneal bone function. After surgical treatment, all the children in this cohort were able to return to normal life.</div></div><div><h3>Conclusion</h3><div>The Ilizarov technique for treating large infectious calcaneal bone defects and bone lengthening can effectively reconstruct the function of the calcaneal bone without significantly affecting the ankle joint.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 4","pages":"Article 112224"},"PeriodicalIF":2.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-16DOI: 10.1016/j.injury.2025.112221
Kan Wang, Zhanfei Li
Background
Road injuries remain a significant global health issue, contributing to a high burden of mortality and disability, particularly in low- and middle-income countries. Understanding the global trends in incidence, mortality, and Years Lived with Disability (YLDs) due to road injuries is essential for developing effective prevention strategies.
Methods
We used data from the Global Burden of Disease (GBD) 2021 to analyze road injury trends from 1990 to 2021. Age-standardized incidence rates (ASIR), mortality rates (ASMR), and YLDs were calculated across different socio-demographic index (SDI) regions. Trends were assessed using the Estimated Annual Percentage Change (EAPC), and disparities by age, sex, and cause of injury were evaluated.
Results
From 1990 to 2021, the global ASIR, ASMR, and YLDs due to road injuries showed a declining trend. However, road injury cases and deaths increased in low and middle-SDI regions, while declining in high-SDI regions. In 2021, the highest ASIR was observed in high-SDI regions (851.75 per 100,000 population), while low-SDI regions experienced the highest mortality rates (22.6 per 100,000 population). Males, particularly those aged 15–49 years, bore the greatest burden of road injuries, accounting for over 60% of YLDs globally. Pedestrian and motorcycle-related injuries were predominant in low-SDI regions.
Conclusion
While global road safety interventions have reduced the burden of road injuries, substantial disparities remain between SDI regions. Targeted interventions are needed to address the high burden of road injuries in low-SDI regions, focusing on improving infrastructure and healthcare access.
{"title":"Global, regional, and national burdens of road injuries from 1990 to 2021: Findings from the 2021 Global Burden of Disease Study","authors":"Kan Wang, Zhanfei Li","doi":"10.1016/j.injury.2025.112221","DOIUrl":"10.1016/j.injury.2025.112221","url":null,"abstract":"<div><h3>Background</h3><div>Road injuries remain a significant global health issue, contributing to a high burden of mortality and disability, particularly in low- and middle-income countries. Understanding the global trends in incidence, mortality, and Years Lived with Disability (YLDs) due to road injuries is essential for developing effective prevention strategies.</div></div><div><h3>Methods</h3><div>We used data from the Global Burden of Disease (GBD) 2021 to analyze road injury trends from 1990 to 2021. Age-standardized incidence rates (ASIR), mortality rates (ASMR), and YLDs were calculated across different socio-demographic index (SDI) regions. Trends were assessed using the Estimated Annual Percentage Change (EAPC), and disparities by age, sex, and cause of injury were evaluated.</div></div><div><h3>Results</h3><div>From 1990 to 2021, the global ASIR, ASMR, and YLDs due to road injuries showed a declining trend. However, road injury cases and deaths increased in low and middle-SDI regions, while declining in high-SDI regions. In 2021, the highest ASIR was observed in high-SDI regions (851.75 per 100,000 population), while low-SDI regions experienced the highest mortality rates (22.6 per 100,000 population). Males, particularly those aged 15–49 years, bore the greatest burden of road injuries, accounting for over 60% of YLDs globally. Pedestrian and motorcycle-related injuries were predominant in low-SDI regions.</div></div><div><h3>Conclusion</h3><div>While global road safety interventions have reduced the burden of road injuries, substantial disparities remain between SDI regions. Targeted interventions are needed to address the high burden of road injuries in low-SDI regions, focusing on improving infrastructure and healthcare access.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112221"},"PeriodicalIF":2.2,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143438227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cefazolin is the primary antibiotic for surgical prophylaxis in orthopedic procedures. The cessation of cefazolin supply in approximately 60 % of Japanese hospitals from 2019 to 2020 provided an opportunity to evaluate the effectiveness of alternative beta-lactams for preventing surgical site infection (SSI). Given the global potential for antibiotics shortages, confirming the effectiveness of alternative beta-lactams is critical.
Purpose
This study aims to evaluate the differences in risk of reoperation for SSI between cefazolin and alternative beta-lactams in patients undergoing lower extremity fracture surgeries.
Methods
We emulated a target trial to compare the effectiveness of cefazolin with alternative beta-lactams—specifically broad-spectrum penicillins and cephalosporins—in preventing SSI using a Japanese hospital administrative database provided by JMDC Inc. We included patients undergoing initial open reduction and internal fixation for closed lower extremity fractures between March 1, 2019, and February 29, 2020. The outcome was reoperation for SSI within 30 days after surgery. Risks were estimated using pooled logistic regression with adjustment for confounders via inverse probability weighting. Sensitivity analyses extended the follow-up period to 90 and 365 days.
Results
Of the 16,602 patients analyzed, 35 patients (0.30 %) in the cefazolin group (11,538 patients) and 16 patients (0.32 %) in the alternative beta-lactam group (5,064 patients) underwent reoperation for SSI within 30 days. The estimated 30-day risk was 0.31 % in the cefazolin group and 0.37 % in the alternative beta-lactam group, resulting in a risk difference of −0.06 % (95 % confidence interval [CI], −0.33 to 0.14) and a risk ratio of 0.82 (95 % CI, 0.50 to 1.52). In sensitivity analyses, the estimated 90-day risk was 0.67 % in the cefazolin group and 0.57 % in the alternative beta-lactam group, with a risk difference of 0.10 % (95 % CI, −0.15 to 0.32) and a risk ratio of 1.19 (95 % CI, 0.80 to 1.62). The 365-day risk was 1.02 % and 0.90 %, respectively, with a risk difference of 0.12 % (95 % CI, −0.29 to 0.39) and a risk ratio of 1.13 (95 % CI, 0.78 to 1.51).
Conclusions
In surgeries for lower extremity fractures, substituting cefazolin with alternative beta-lactams did not result in substantial differences in the risk of reoperation for SSI.
{"title":"Cefazolin vs. alternative beta-lactams for prophylaxis in lower extremity fracture surgery: A target trial emulation","authors":"Takaki Yoshiyama , Toshiki Fukasawa , Soichiro Masuda , Shuichi Matsuda , Koji Kawakami","doi":"10.1016/j.injury.2025.112215","DOIUrl":"10.1016/j.injury.2025.112215","url":null,"abstract":"<div><h3>Background</h3><div>Cefazolin is the primary antibiotic for surgical prophylaxis in orthopedic procedures. The cessation of cefazolin supply in approximately 60 % of Japanese hospitals from 2019 to 2020 provided an opportunity to evaluate the effectiveness of alternative beta-lactams for preventing surgical site infection (SSI). Given the global potential for antibiotics shortages, confirming the effectiveness of alternative beta-lactams is critical.</div></div><div><h3>Purpose</h3><div>This study aims to evaluate the differences in risk of reoperation for SSI between cefazolin and alternative beta-lactams in patients undergoing lower extremity fracture surgeries.</div></div><div><h3>Methods</h3><div>We emulated a target trial to compare the effectiveness of cefazolin with alternative beta-lactams—specifically broad-spectrum penicillins and cephalosporins—in preventing SSI using a Japanese hospital administrative database provided by JMDC Inc. We included patients undergoing initial open reduction and internal fixation for closed lower extremity fractures between March 1, 2019, and February 29, 2020. The outcome was reoperation for SSI within 30 days after surgery. Risks were estimated using pooled logistic regression with adjustment for confounders via inverse probability weighting. Sensitivity analyses extended the follow-up period to 90 and 365 days.</div></div><div><h3>Results</h3><div>Of the 16,602 patients analyzed, 35 patients (0.30 %) in the cefazolin group (11,538 patients) and 16 patients (0.32 %) in the alternative beta-lactam group (5,064 patients) underwent reoperation for SSI within 30 days. The estimated 30-day risk was 0.31 % in the cefazolin group and 0.37 % in the alternative beta-lactam group, resulting in a risk difference of −0.06 % (95 % confidence interval [CI], −0.33 to 0.14) and a risk ratio of 0.82 (95 % CI, 0.50 to 1.52). In sensitivity analyses, the estimated 90-day risk was 0.67 % in the cefazolin group and 0.57 % in the alternative beta-lactam group, with a risk difference of 0.10 % (95 % CI, −0.15 to 0.32) and a risk ratio of 1.19 (95 % CI, 0.80 to 1.62). The 365-day risk was 1.02 % and 0.90 %, respectively, with a risk difference of 0.12 % (95 % CI, −0.29 to 0.39) and a risk ratio of 1.13 (95 % CI, 0.78 to 1.51).</div></div><div><h3>Conclusions</h3><div>In surgeries for lower extremity fractures, substituting cefazolin with alternative beta-lactams did not result in substantial differences in the risk of reoperation for SSI.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112215"},"PeriodicalIF":2.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-15DOI: 10.1016/j.injury.2025.112217
Joshua B. Baldino , Nicholas J. Bellas , Matthew J. Solomito , Mandeep Kumar , Stephen L. Davis
Introduction
Fragility fractures of the proximal femur are common injuries with significant morbidity and mortality. The use of direct oral anticoagulant (DOAC) medications is increasing among the elderly and is associated with perioperative bleeding-related complications. The primary aim of this study was to examine how DOAC use affects surgical timing and postoperative hematologic complications in patients treated operatively for fragility fractures of the proximal femur. The effect of an institutional tranexamic acid (TXA) protocol implemented during the study period was investigated as a secondary aim.
Materials and methods
This was a retrospective analysis performed at a Level I trauma center. Between March 1, 2018 and April 1, 2022, 746 patients age 50 years and older who underwent surgical treatment for a fragility fracture of the femoral neck, intertrochanteric, or subtrochanteric region of the proximal femur (AO/OTA 31A, 31B, 32) and who were either on no chemical anticoagulation, warfarin, or a DOAC at the time of injury were included. The primary outcomes were time to operating room (TTOR), postoperative transfusion, 30-day venous thromboembolism (VTE), and 30-day hospital readmission. Multivariable logistic regression modeling was used to analyze the effect of anticoagulant, TXA use, and TTOR on these outcomes.
Results
TTOR was increased for patients on warfarin (38.3 ± 26.1 h) or a DOAC (46.4 ± 23.4 h) compared to patients not on anticoagulation (28.0 ± 19.0 h) (p < 0.001). There was no significant difference in transfusion rates among patients not on anticoagulants (31.8 %), warfarin (43.4 %), or a DOAC (29.6 %). Multivariable regression showed a decrease in transfusion rate (OR 0.35, 95 % CI 0.23–0.53) and 30-day readmission (OR 0.31, 95 % CI 0.15–0.61) for intravenous (IV) TXA.
Conclusions
DOAC use was associated with an increase in TTOR without increased rates of transfusion, VTE, or hospital readmission in patients with fragility fractures of the proximal femur. Intravenous TXA was associated with reduced postoperative transfusion and 30-day readmission.
{"title":"Direct oral anticoagulants (DOACs) increase time to operating room without increasing postoperative hematologic complications in patients with fragility fractures of the proximal femur","authors":"Joshua B. Baldino , Nicholas J. Bellas , Matthew J. Solomito , Mandeep Kumar , Stephen L. Davis","doi":"10.1016/j.injury.2025.112217","DOIUrl":"10.1016/j.injury.2025.112217","url":null,"abstract":"<div><h3>Introduction</h3><div>Fragility fractures of the proximal femur are common injuries with significant morbidity and mortality. The use of direct oral anticoagulant (DOAC) medications is increasing among the elderly and is associated with perioperative bleeding-related complications. The primary aim of this study was to examine how DOAC use affects surgical timing and postoperative hematologic complications in patients treated operatively for fragility fractures of the proximal femur. The effect of an institutional tranexamic acid (TXA) protocol implemented during the study period was investigated as a secondary aim.</div></div><div><h3>Materials and methods</h3><div>This was a retrospective analysis performed at a Level I trauma center. Between March 1, 2018 and April 1, 2022, 746 patients age 50 years and older who underwent surgical treatment for a fragility fracture of the femoral neck, intertrochanteric, or subtrochanteric region of the proximal femur (AO/OTA 31A, 31B, 32) and who were either on no chemical anticoagulation, warfarin, or a DOAC at the time of injury were included. The primary outcomes were time to operating room (TTOR), postoperative transfusion, 30-day venous thromboembolism (VTE), and 30-day hospital readmission. Multivariable logistic regression modeling was used to analyze the effect of anticoagulant, TXA use, and TTOR on these outcomes.</div></div><div><h3>Results</h3><div>TTOR was increased for patients on warfarin (38.3 ± 26.1 h) or a DOAC (46.4 ± 23.4 h) compared to patients not on anticoagulation (28.0 ± 19.0 h) (p < 0.001). There was no significant difference in transfusion rates among patients not on anticoagulants (31.8 %), warfarin (43.4 %), or a DOAC (29.6 %). Multivariable regression showed a decrease in transfusion rate (OR 0.35, 95 % CI 0.23–0.53) and 30-day readmission (OR 0.31, 95 % CI 0.15–0.61) for intravenous (IV) TXA.</div></div><div><h3>Conclusions</h3><div>DOAC use was associated with an increase in TTOR without increased rates of transfusion, VTE, or hospital readmission in patients with fragility fractures of the proximal femur. Intravenous TXA was associated with reduced postoperative transfusion and 30-day readmission.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112217"},"PeriodicalIF":2.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454640","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 : 2025-02-15DOI: 10.1016/j.injury.2025.112219
Jessica M Welch , Christopher S Klifto , Kevin M Klifto , Kiera N Lunn , Kwabena Adu-Kwarteng , Warren C Hammert , Christian A Pean , Tyler S Pidgeon
Background
Osteoporosis screening guidelines recommend bone mineral density (BMD) testing following fragility fractures. Nevertheless, previous studies have demonstrated low rates of osteoporosis screening. Diagnosis and treatment of osteoporosis is essential for prevention of future fractures, however not much is known about the factors associated with receiving BMD testing in this patient population. The purpose of this study was to evaluate the prevalence, timing, and predictors of BMD testing following distal radius fractures (DRF) in menopausal women.
Methods
We queried a national insurance database to identify menopausal women aged 45–64 years with a DRF between years 2013 and 2020. The rate of BMD testing within 1 year of injury was calculated. Multivariable logistic regression analysis was used to evaluate the effect of patient- and injury-related variables on the likelihood of undergoing BMD testing following DRF.
Results
Among 31,728 patients meeting inclusion criteria (mean ± SD age: 57.5 ± 4.3), 3,886 (12.2 %) received a BMD test within 1 year following DRF. The rate of BMD tests decreased with the highest rate of 14.5 % in 2015 and the lowest rate of 10.5 % in 2020. Mean time from DRF to BMD testing was 143 ± 102 days. Patients aged 60–64 had the highest adjusted odds of receiving BMD testing (OR 2.85 [95 % CI: 2.26 to 3.64]). Factors associated with increased likelihood of BMD testing included surgical intervention (OR 1.38 [1.28–1.48]), rheumatoid arthritis (OR 1.22 [1.06–1.40]), osteoarthritis (OR 1.28 [1.19–1.37]), breast cancer (OR 1.35 [1.16–1.56]), and vitamin D deficiency (OR 1.29 [1.17–1.43]). Factors associated with decreased likelihood of testing included tobacco use (OR 0.90 [0.84–0.97]), patients with Medicaid (OR 0.73 [0.61–0.86]) or Medicare (OR 0.76 [0.65–0.88]) insurance, and living in Southern (OR 0.67 [0.62–0.73]) or Western (OR 0.69 [0.62–0.77]) regions of the United States. Obesity, diabetes, renal disease, and early menopause were not associated with BMD testing.
Conclusions
Despite guidelines recommending BMD testing after low-energy fractures, rates of BMD testing were low and decreased among menopausal women with DRF. Mean time to BMD testing was 4.7 months, indicating substantial delays in workup. Known risk factors for osteoporosis did not reliably predict likelihood of BMD testing.
{"title":"Prevalence and predictors of bone mineral density testing after distal radius fracture in menopausal women","authors":"Jessica M Welch , Christopher S Klifto , Kevin M Klifto , Kiera N Lunn , Kwabena Adu-Kwarteng , Warren C Hammert , Christian A Pean , Tyler S Pidgeon","doi":"10.1016/j.injury.2025.112219","DOIUrl":"10.1016/j.injury.2025.112219","url":null,"abstract":"<div><h3>Background</h3><div>Osteoporosis screening guidelines recommend bone mineral density (BMD) testing following fragility fractures. Nevertheless, previous studies have demonstrated low rates of osteoporosis screening. Diagnosis and treatment of osteoporosis is essential for prevention of future fractures, however not much is known about the factors associated with receiving BMD testing in this patient population. The purpose of this study was to evaluate the prevalence, timing, and predictors of BMD testing following distal radius fractures (DRF) in menopausal women.</div></div><div><h3>Methods</h3><div>We queried a national insurance database to identify menopausal women aged 45–64 years with a DRF between years 2013 and 2020. The rate of BMD testing within 1 year of injury was calculated. Multivariable logistic regression analysis was used to evaluate the effect of patient- and injury-related variables on the likelihood of undergoing BMD testing following DRF.</div></div><div><h3>Results</h3><div>Among 31,728 patients meeting inclusion criteria (mean ± SD age: 57.5 ± 4.3), 3,886 (12.2 %) received a BMD test within 1 year following DRF. The rate of BMD tests decreased with the highest rate of 14.5 % in 2015 and the lowest rate of 10.5 % in 2020. Mean time from DRF to BMD testing was 143 ± 102 days. Patients aged 60–64 had the highest adjusted odds of receiving BMD testing (OR 2.85 [95 % CI: 2.26 to 3.64]). Factors associated with increased likelihood of BMD testing included surgical intervention (OR 1.38 [1.28–1.48]), rheumatoid arthritis (OR 1.22 [1.06–1.40]), osteoarthritis (OR 1.28 [1.19–1.37]), breast cancer (OR 1.35 [1.16–1.56]), and vitamin D deficiency (OR 1.29 [1.17–1.43]). Factors associated with decreased likelihood of testing included tobacco use (OR 0.90 [0.84–0.97]), patients with Medicaid (OR 0.73 [0.61–0.86]) or Medicare (OR 0.76 [0.65–0.88]) insurance, and living in Southern (OR 0.67 [0.62–0.73]) or Western (OR 0.69 [0.62–0.77]) regions of the United States. Obesity, diabetes, renal disease, and early menopause were not associated with BMD testing.</div></div><div><h3>Conclusions</h3><div>Despite guidelines recommending BMD testing after low-energy fractures, rates of BMD testing were low and decreased among menopausal women with DRF. Mean time to BMD testing was 4.7 months, indicating substantial delays in workup. Known risk factors for osteoporosis did not reliably predict likelihood of BMD testing.</div></div><div><h3>Level of Evidence</h3><div>Level III, prognostic</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112219"},"PeriodicalIF":2.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445385","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 : 2025-02-12DOI: 10.1016/j.injury.2025.112213
Fan Yang , Jing Dong , Jing Hu, Zhezhen Jiang, Regis Ernest Mendame Ehya
Introduction
Foot and ankle soft tissue defects with exposed bone pose significant challenges in wound healing and patient satisfaction
Objective
The study aims to assess the impact of nursing care quality and patient satisfaction on optimizing outcomes for complex foot and ankles injuries, focusing on the timing of rh-FGF administration after reconstructive surgery
Methods
This study included eighteen patients (15 males and 3 females) with traumatic foot and ankle soft tissue defects and exposed bone wounds, treated between January 2021 and December 2022. Patients were randomly assigned to three groups, underwent reconstructive surgery, and received rh-bFGF at varying times postoperatively. Key outcomes included wound healing time, hospital stay duration, satisfaction with nursing care scale, American Orthopedic Foot and Ankle Society (AOFAS) score, and Visual Analogue Scale for pain. All patients were followed for at least three months
Results
The study population had an average age of 41.1 years, with a range from 16 to 74 years. Findings indicated an average hospital stay of 17 days and a corresponding wound healing time of 17 days. At three months post-operation, the average American Orthopedic Foot and Ankle Society (AOFAS) score was 88. A notable 88.9 % of patients expressed satisfaction with the attentiveness of nursing staff and the privacy afforded to them. Furthermore, 84.3 % rated the nurses’ competence positively, and 83.3 % appreciated the support provided to family and friends, along with personalized care and nurses’ expertise in patient management. The results demonstrated a consistent trend of improvement in all assessed outcomes across the three treatment groups. Patients in Group 1, who received rh-bFGF one day after surgery, demonstrated the most favorable outcomes. This was followed by Group 3, which received rh-bFGF until ischemic changes were noted. In contrast, Group 2, which received rh-bFGF once inflammatory granulation had subsided, exhibited the least improvement
Conclusion
The results of this study highlight the crucial role of timing in the administration of rh-bFGF for optimizing soft tissue repair in patients with foot and ankle defects. Timely application of rh-bFGF post-surgery is essential for achieving favorable patient outcomes, improving patient satisfaction with nursing care, and facilitating faster recovery.
{"title":"A nurse-led approach to enhancing foot and ankle tissue repair: A study using fibroblast growth factor and skin flap technique","authors":"Fan Yang , Jing Dong , Jing Hu, Zhezhen Jiang, Regis Ernest Mendame Ehya","doi":"10.1016/j.injury.2025.112213","DOIUrl":"10.1016/j.injury.2025.112213","url":null,"abstract":"<div><h3>Introduction</h3><div>Foot and ankle soft tissue defects with exposed bone pose significant challenges in wound healing and patient satisfaction</div></div><div><h3>Objective</h3><div>The study aims to assess the impact of nursing care quality and patient satisfaction on optimizing outcomes for complex foot and ankles injuries, focusing on the timing of rh-FGF administration after reconstructive surgery</div></div><div><h3>Methods</h3><div>This study included eighteen patients (15 males and 3 females) with traumatic foot and ankle soft tissue defects and exposed bone wounds, treated between January 2021 and December 2022. Patients were randomly assigned to three groups, underwent reconstructive surgery, and received rh-bFGF at varying times postoperatively. Key outcomes included wound healing time, hospital stay duration, satisfaction with nursing care scale, American Orthopedic Foot and Ankle Society (AOFAS) score, and Visual Analogue Scale for pain. All patients were followed for at least three months</div></div><div><h3>Results</h3><div>The study population had an average age of 41.1 years, with a range from 16 to 74 years. Findings indicated an average hospital stay of 17 days and a corresponding wound healing time of 17 days. At three months post-operation, the average American Orthopedic Foot and Ankle Society (AOFAS) score was 88. A notable 88.9 % of patients expressed satisfaction with the attentiveness of nursing staff and the privacy afforded to them. Furthermore, 84.3 % rated the nurses’ competence positively, and 83.3 % appreciated the support provided to family and friends, along with personalized care and nurses’ expertise in patient management. The results demonstrated a consistent trend of improvement in all assessed outcomes across the three treatment groups. Patients in Group 1, who received rh-bFGF one day after surgery, demonstrated the most favorable outcomes. This was followed by Group 3, which received rh-bFGF until ischemic changes were noted. In contrast, Group 2, which received rh-bFGF once inflammatory granulation had subsided, exhibited the least improvement</div></div><div><h3>Conclusion</h3><div>The results of this study highlight the crucial role of timing in the administration of rh-bFGF for optimizing soft tissue repair in patients with foot and ankle defects. Timely application of rh-bFGF post-surgery is essential for achieving favorable patient outcomes, improving patient satisfaction with nursing care, and facilitating faster recovery.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112213"},"PeriodicalIF":2.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143418875","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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