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

{"title":"Performance of artificial intelligence in addressing questions regarding management of clavicle fractures","authors":"John D. Milner ,&nbsp;Matthew Quinn ,&nbsp;Ashley Knebel ,&nbsp;Phillip Schmitt ,&nbsp;Patrick Morrissey ,&nbsp;Myka Dancy ,&nbsp;Jonathan Liu ,&nbsp;Simbarashe Peresuh ,&nbsp;Michel A. Arcand ,&nbsp;Andrew R. Evans ,&nbsp;Brett D. Owens ,&nbsp;E. Scott Paxton","doi":"10.1016/j.injury.2026.113053","DOIUrl":"10.1016/j.injury.2026.113053","url":null,"abstract":"<div><h3>Objectives</h3><div>Artificial intelligence (AI) has revolutionized public access to extensive information with large language model (LLM)-based chatbots allowing users to receive comprehensive, individualized responses. In this study, we aimed to evaluate the quality of LLM responses to questions about common orthopedic conditions. We hypothesized that both ChatGPT and Gemini would demonstrate high quality, evidence-based responses across evaluation criteria.</div></div><div><h3>Methods</h3><div>Responses from ChatGPT and Gemini to prompts based on the 14 AAOS Clinical Practice Guidelines for clavicle fracture management were evaluated on six criteria by seven fellowship-trained shoulder and trauma orthopedic surgeons. Statistical analyses including mean scoring, standard deviation and two-sided t-tests were calculated to compare performance between ChatGPT and Gemini. Scores were then evaluated for inter-rater reliability (IRR).</div></div><div><h3>Results</h3><div>ChatGPT and Gemini demonstrated overall mean scores greater than 3.5 for both platforms. Mean overall score for ChatGPT was highest in evidence-based (4.52 ± 0.16) and lowest in clarity (4.22 ± 0.19). Mean overall score for Gemini was highest in clarity (4.31 ± 0.17) and lowest in evidence-based (3.81 ± 0.22). ChatGPT had significantly better performance in the overall completeness category (4.50 ± 0.17 vs 4.11 ± 0.19, p &lt; 0.005) than Gemini but scores were otherwise not significantly different. Over 70 % of respondents rated the responses of ChatGPT as higher quality than Gemini.</div></div><div><h3>Conclusions</h3><div>ChatGPT and Gemini produced responses that were generally in line with the 2022 AAOS guidelines on the treatment of clavicle fractures. Scores were comparable in every overall category except completeness, with ChatGPT outperforming Gemini. These results suggest that both LLMs are capable of providing clinically relevant responses to questions related to clavicle fracture management.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113053"},"PeriodicalIF":2.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attempted definitive revision amputations in emergency department vs operating room for traumatic finger injuries are associated with a high rate of revision surgery","authors":"Patrick Curtin ,&nbsp;Michael Flood ,&nbsp;Max Vaickus ,&nbsp;Matthew DeFazio ,&nbsp;Alexandra Conway ,&nbsp;Marci Jones","doi":"10.1016/j.injury.2026.113067","DOIUrl":"10.1016/j.injury.2026.113067","url":null,"abstract":"<div><h3>Background</h3><div>Revision amputation is a common treatment in the emergency department (ED) for traumatic finger injuries, yet there is limited data on outcomes for procedures completed in the emergency room versus the operating room. This study aims to assess outcome differences between ED revision amputation and delayed OR management.</div></div><div><h3>Methods</h3><div>103 consecutive patients with traumatic finger(s) amputations were identified from a single tertiary care center. Patients were evaluated by the on-call hand team and staffed with a fellowship-trained hand attending. ED revision amputations were performed with the goal of definitive care. Data was collected for injury/patient demographics, follow-up, and further revision procedures. Odds ratios were calculated to assess for predictive factors for ED management failure.</div></div><div><h3>Results</h3><div>55 patients were treated with ED revision amputation, 18 of whom (32.7 %) required further surgical management. Presence of multiple digit amputations was associated with increased initial treatment in the operating room. The most common indication for surgery was revision amputation and soft tissue coverage (88.9 %), followed by additional bony fixation for underlying fractures (44.4 %). Number of fingers amputated, fracture presence, and significant soft tissue injury were not associated with failure. Of the 48 patients with planned delayed management in the OR, 11 were treated with nonoperative wound care.</div></div><div><h3>Conclusions</h3><div>Definitive ED revision amputation was associated with a high rate of failure, need for revision surgery, and loss to follow up. Injuries with complex wound coverage or bony fixation may be better suited to OR management. Some patients may ultimately be appropriate for management without revision amputation and may be overtreated with this procedure in the ED.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113067"},"PeriodicalIF":2.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications for temporizing knee-spanning external fixation in the treatment of knee dislocations: A multi-center retrospective case series","authors":"Ekrem M. Ayhan ,&nbsp;Sarah J. Levitt ,&nbsp;Hugh Medvecky ,&nbsp;Aaron J. Marcel ,&nbsp;Nancy Park ,&nbsp;Isabel Chalem ,&nbsp;Michael J. Alaia ,&nbsp;Michael J. Medvecky","doi":"10.1016/j.injury.2026.113062","DOIUrl":"10.1016/j.injury.2026.113062","url":null,"abstract":"<div><h3>Background</h3><div>The indications for temporizing knee-spanning external fixation (KSEF) in the setting of knee dislocation (KD) are poorly defined, leading to significant uncertainty and inconsistency in clinical practice. This study aimed to analyze and describe the documented indications for temporizing KSEF in a series of patients with KDs.</div></div><div><h3>Methods</h3><div>A retrospective, multi-center review was conducted at two level I trauma centers from January 2001 to May 2024, identifying patients with documented KD treated with KSEF. Data were extracted from operative records, imaging, and clinical notes, and reviewed for demographics, injury characteristics, and documented indications for KSEF. A set of KSEF indications derived from the literature was developed <em>a priori</em> to individually assess the appropriateness of each KSEF application. Knees were classified as ‘did not meet criteria’ for KSEF only when both of the following conditions were true: (1) no predefined indication was met; and (2) there was no radiographic, clinical, or documented evidence of persistent post-reduction instability.</div></div><div><h3>Results</h3><div>A total of 33 patients with 36 documented KDs treated with KSEF were identified from a cohort of 289 multiple ligament injured knees (12.5 %). Of the 36 KDs, 28 (77.8 %) met the selected criteria for KSEF. The most common primary indications for KSEF were vascular injury, tibial plateau fracture-dislocation, inability to maintain tibiofemoral reduction via non-invasive means, and morbid obesity. The remaining eight KDs (22.2 %) did not meet criteria for KSEF either as isolated injuries or in the setting of “polytrauma.” The rationale for KSEF application was cited as “polytrauma” in 6/8 (75.0 %) of these cases.</div></div><div><h3>Conclusion</h3><div>Eight of the 36 (22.2 %) KSEF applications did not meet the predefined criteria for KSEF in the setting of KD, nor showed evidence of an inability to maintain tibiofemoral reduction via non-invasive means. Polytrauma is frequently cited in the literature as a primary indication for temporizing KSEF in the setting of KD without a clear definition. Further investigation into the role of temporizing KSEF is needed, particularly in the polytraumatized patient, to determine its specific role in the management of KDs.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113062"},"PeriodicalIF":2.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot validation study for a large image database of proximal femur fracture anteroposterior radiographs: Searching for the ground truth","authors":"Andrea Audisio ,&nbsp;Tracy Zhu ,&nbsp;Alexander Joeris ,&nbsp;An Sermon ,&nbsp;Frank F.A. IJpma ,&nbsp;Vincenzo Giordano ,&nbsp;Dhaval Desai ,&nbsp;Peter V. Giannoudis ,&nbsp;Alessandro Aprato","doi":"10.1016/j.injury.2026.113056","DOIUrl":"10.1016/j.injury.2026.113056","url":null,"abstract":"<div><h3>Purpose</h3><div>This pilot study aims to validate the \"ground truth\" accuracy and consistency of proximal femur fracture classification using a large radiographic image database. The project, a collaboration between expert groups from the University of Turin and the AO Foundation, seeks to ensure that expert consensus-based annotations are reliable for future artificial intelligence (AI) model development.</div></div><div><h3>Methods</h3><div>A cross-sectional, diagnostic accuracy study was conducted using a randomly selected subset of 300 anteroposterior pelvic radiographs from a single-center image repository created at the University of Turin within the AO Innovation Translation Center framework. Fracture classification annotations were independently provided by the local clinical expert group (LC-EG) and by an independent AO expert group of surgeons (AO-EG). To assess interrater reliability between the two groups, Cohen’s kappa coefficient was calculated for categorical agreement on the presence of a fracture and AO/OTA classification.</div></div><div><h3>Results</h3><div>The comparison of annotations from LC-EG and AO-EG yielded a Cohen’s kappa of 0.81 (95 % confidence interval: 0.75–0.87) and a percentage agreement of 87.67 % (95 % confidence interval: 87.63–87.70) for the classification of proximal femur fractures into three defined categories: no fracture, fracture type 31A, and fracture type 31B. These results confirm a high level of consistency between the two expert groups in annotating the image dataset.</div></div><div><h3>Conclusion</h3><div>The observed interrater reliability between the LC-EG and AO-EG supports the credibility of the reference annotations, establishing a validated ground truth for proximal femur fractures. This evidence justifies using the radiographic image database as a benchmark for future studies and as a foundation for transparent, reproducible AI development and evaluation, thereby facilitating safer integration of decision support tools into orthopedic trauma workflows.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113056"},"PeriodicalIF":2.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different inflammatory responses in the remote organs after tourniquet-induced ischemia-reperfusion in mouse hindlimb","authors":"Linda Xu ,&nbsp;Lauren Whitney ,&nbsp;Huiyin Tu ,&nbsp;Anthony J. Evans,&nbsp;Abigail Klammer,&nbsp;Aaron N. Barksdale,&nbsp;Michael C. Wadman,&nbsp;Yu-Long Li","doi":"10.1016/j.injury.2026.113060","DOIUrl":"10.1016/j.injury.2026.113060","url":null,"abstract":"<div><div>Tourniquet use is the most effective tool for controlling life-threatening extremity hemorrhage before other treatments and for creating bloodless operating fields in surgical procedures. However, tourniquet-induced ischemia-reperfusion (tourniquet/IR) also causes skeletal muscle injury and is associated with secondary remote organ injuries. Our previous studies have demonstrated that there is involvement of inflammatory cytokines in tourniquet-induced skeletal muscle IR injuries. In this study, we investigated the inflammatory responses and tissue injuries in remote organs after tourniquet/IR. The unilateral hindlimbs of mice were subjected to 3 h of tourniquet application by placing a rubber band at the hip joint. Then the rubber bands were released to initiate reperfusion, and tissues were harvested after 1, 3, 7, 14, and 28 days of reperfusion. The data from real-time RT-PCR and western blot showed that the levels of IL-1β and TNFα (two pro-inflammatory cytokines) mRNAs and proteins increased in the lungs and livers, whereas these cytokines did not rise in hearts and kidneys during 28 days of tourniquet/IR, compared to the sham tissues. Histological images also confirmed the infiltration of inflammatory cells in lungs and livers, but not in hearts and kidneys during 28 days of tourniquet/IR. Tourniquet/IR induced tissue structural injuries in the lungs but not the livers, hearts, and kidneys. Additionally, 21.8 % (12/55) of mice died at 1 day and 3 days of tourniquet/IR. These results suggest that inflammatory responses and severity of tissue injuries are different among remote organs and tourniquet/IR-related lung injuries could be a major cause of death during tourniquet/IR, which can help to develop therapeutic strategies for reducing mortality and improving outcomes after the use of tourniquet.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113060"},"PeriodicalIF":2.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in geriatric ankle fractures in the United States: An 8-year analysis","authors":"José L. Ayala-Ortiz ,&nbsp;Doriann M. Alcaide ,&nbsp;Sean Taylor ,&nbsp;Gerald McGwin ,&nbsp;Joey P. Johnson","doi":"10.1016/j.injury.2026.113066","DOIUrl":"10.1016/j.injury.2026.113066","url":null,"abstract":"<div><h3>Introduction</h3><div>Ankle fractures are among the most common fractures in older adults, associated with substantial morbidity and healthcare burden. This study aimed to evaluate recent trends in incidence and injury characteristics of ankle fractures among adults aged ≥65 years presenting to United States emergency departments.</div></div><div><h3>Methods</h3><div>The National Electronic Injury Surveillance System (NEISS) database was queried for ankle fractures in adults aged ≥65 years from 2016 to 2023. Demographics, injury mechanisms, fracture types, and hospitalization rates were analyzed. Annual incidence rates per 100,000 persons were calculated. Trends over time, as well as age- and sex-specific differences, were analyzed.</div></div><div><h3>Results</h3><div>An estimated 241,449 ankle fractures occurred among adults aged ≥65 years between 2016 and 2023, with an overall incidence rate of 55.8 per 100,000 person-years. The incidence increased from 49.1 to 63.0 per 100,000 persons during the study period (<em>P</em> &lt; 0.0001). Incidence rates increased significantly in both males (from 25.7 to 34.7 per 100,000 persons; <em>P</em> &lt; 0.0001) and females (from 67.7 to 86.4 per 100,000 persons; <em>P</em> &lt; 0.0001). Most fractures occurred in women (76.2 %), resulted from low-energy trauma (92.8 %), and were closed fractures (96.9 %). Open fracture incidence rose from 0.64 to 2.40 per 100,000 persons, representing a 275 % increase (<em>P</em> &lt; 0.0001). Hospitalization rates increased from 20.3 to 29.7 per 100,000 persons (<em>P</em> &lt; 0.0001). Women aged ≥80 years accounted for the highest fracture burden. Women were more likely to sustain low-energy injuries (<em>P</em> &lt; 0.0001), while men had a higher proportion of open fractures (<em>P</em> = 0.011). Hospitalization rates increased with age, reaching 56.6 % among patients aged ≥80 years (<em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Ankle fracture incidence among older adults in the U.S. increased significantly from 2016 to 2023, with rising rates in both males and females. Low-energy mechanisms remain the predominant cause in this population. Further studies are needed to identify optimal surgical treatments and rehabilitation strategies. Improving bone health and reducing morbidity and mortality remain key priorities in managing geriatric ankle fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113066"},"PeriodicalIF":2.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of single stage treatment of chronic bone infection in adults with antibiotic impregnated calcium sulphate beads; A single centre retrospective study with a mean follow-up of 5.5 years","authors":"Panayiotis Souroullas ,&nbsp;Hemant Sharma ,&nbsp;Gavin Barlow ,&nbsp;Andy Craig ,&nbsp;Ross Muir ,&nbsp;Yvonne Hadland ,&nbsp;Elizabeth Barron ,&nbsp;Cher Bing Chuo ,&nbsp;Joanna Bates","doi":"10.1016/j.injury.2026.113052","DOIUrl":"10.1016/j.injury.2026.113052","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic bone infection is a challenging condition to treat, often requiring multiple surgeries and prolonged antibiotic therapy, which although effective, can increase patient morbidity and are resource intensive. This study was designed to evaluate midterm results of a single-stage management approach for chronic bone infection, incorporating debridement, local antibiotic delivery via calcium sulphate antibiotic loaded carrier (CALC), and soft-tissue coverage to effectively manage infection and improve patient outcomes while minimizing morbidity associated with multi-stage procedures.</div></div><div><h3>Materials and Methods</h3><div>In this retrospective observational cohort study, patients who underwent single-stage surgery with a minimum of two-year follow-up were included. Data on demographics and clinical outcomes were collected. Key objectives included assessing disease recurrence, treatment impact, and postoperative complications.</div></div><div><h3>Results</h3><div>Ninety-three patients, of which 60 were male, were included, with a mean age of 51 years. The median follow-up period was 57.5 months. The mean postoperative stay was 13 days. Thirty-nine patients were smokers, 11 were diabetics, and 10 had peripheral vascular disease. The leading cause of chronic bone infection was fracture related infection following trauma (<em>n</em> = 68), predominantly affecting the tibia (<em>n</em> = 33). Significant microbiological growth occurred in 77 patients with Staphylococcus aureus being the predominant pathogen (<em>n</em> = 42). Cierny-Mader classification revealed 31 patients with localized lesions in Class B hosts and 25 in Class A hosts. Only 24 patients required surgical stabilization at index procedure. Most patients (<em>n</em> = 70) underwent excision with primary closure, while 22 needed a soft tissue flap. Postoperative complications included wound leakage in 21 cases, with 13 recurrent infections, 10 of which needed further surgery. An infection control rate was initially achieved at 86%, and 89.2% at a 5.5-year follow-up.</div></div><div><h3>Discussion and conclusion</h3><div>Our study constitutes a large patient cohort with one of the longest available follow-up periods. Single-stage management of chronic bone infection with intralesional debridement using antibiotic impregnated CaSO₄ pellets is safe and an effective method with low recurrence rates. Our results suggest that pre-operative sampling is not essential for successful outcomes. A multidisciplinary approach following the essential basic principles of the management of CBI is essential.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113052"},"PeriodicalIF":2.0,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The precision of CT-guided percutaneous sacral screw placement in 114 fragility fractures of the pelvis – a retrospective study","authors":"Lorena Cogliatti ,&nbsp;Werner Vach ,&nbsp;Christoph J. Zech ,&nbsp;Henrik Eckardt","doi":"10.1016/j.injury.2026.113042","DOIUrl":"10.1016/j.injury.2026.113042","url":null,"abstract":"<div><h3>Background</h3><div>Fragility fractures of the pelvis (FFP) are increasingly common, particularly in the ageing population. Traditionally, those low-energy pelvic ring fractures have been managed conservatively, but this approach can lead to immobility and therefore complications. Surgical intervention is indicated based on various factors including type of fracture, mobility, and pain. Minimal-invasive percutaneous sacroiliac and/or transsacral screw stabilisation offers an effective treatment, enabling immediate mobilisation. There are multiple technical methods for the implantation. This study aimed to assess the precision of CT-guided percutaneous screw stabilisation and functional outcomes in elderly patients with FFP.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 114 elderly patients who underwent CT-controlled percutaneous sacroiliac screw implantation for FFP between 2010 and 2021. Data on demographics, pre-operative characteristics, surgical procedure, and postoperative outcomes were collected from routine data and analysed.</div></div><div><h3>Results</h3><div>Stabilisation using CT-guidance demonstrated favourable outcomes with low rates of screw malposition. 96% of the sacroiliac screws in S1 were placed completely intraosseous. Sacroiliac placement showed higher rates of completely intraosseous placement than transsacral placement. Placement in S1 showed higher accuracy rates than placement in S2. Operations with more radiation had a higher percentage of perfectly positioned screws and the simple fracture type had more perfectly positioned screws than the more complex type FFP4. Eighteen screws showed signs of loosening after one year, necessitating re-operation in 2 cases. Patients with 3 screws had less risk of loosening. Screws inserted from the left showed lower rates of loosening than screws from the right. Postoperative mobility assessment showed that 70% were still living at home after one year and 63% were painfree. The one-year mortality was 18%.</div></div><div><h3>Conclusion</h3><div>CT-guided implantation of 231 sacrum screws had a very high precision with no malpositioned screws. The precision of implantation is not affected by the BMI or age of the patient, but the rate of perfect position was lower in complex fractures than in simple fractures. Precision of sacroiliac screw implantation is higher than that of transsacral screws but the rate of loosening is not higher. Surgery provided freedom from pain for most patients and only few patients lost their self-dependence.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113042"},"PeriodicalIF":2.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of mechanical characteristics of different screw fixation methods based on digital models of acetabular quadrilateral fracture line","authors":"Jieyu Chen ,&nbsp;Huawu Liu ,&nbsp;Lei Bai ,&nbsp;Sergei V. Petrenko ,&nbsp;Jianhui Yan ,&nbsp;Chaohui Wang ,&nbsp;Bixiu Lei ,&nbsp;Shuangping He ,&nbsp;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}

{"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 ,&nbsp;Lionel Llano ,&nbsp;Gonzalo Garcia Barreiro ,&nbsp;Sebastian Gomez ,&nbsp;Danilo Taype ,&nbsp;Carlos Sancineto ,&nbsp;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}