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

{"title":"Intraoperative complications in acetabular fracture management using the Stoppa approach: A retrospective cohort study","authors":"Dharmendra Kumar ,&nbsp;Shailendra Singh ,&nbsp;Balwinder Singh ,&nbsp;Arpit Singh ,&nbsp;Ankit Sriwastava ,&nbsp;Anand Kumar ,&nbsp;Ashish Kumar","doi":"10.1016/j.injury.2025.112208","DOIUrl":"10.1016/j.injury.2025.112208","url":null,"abstract":"<div><h3>Aim</h3><div>The Aim of the study is to retrospectively analyse intraoperative complications in acetabular fractures treated via the Stoppa approach, identify their frequency and nature, and define potential risk factors, in addition to evaluating clinical outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included a total of 136 acetabulum fracture cases (aged 16 to 82 years) that were managed using Stoppa approach. Records related with age, sex, mode of injury, body mass index, history and type of associated injury and time gap between injury and surgery were noted. Intraoperative records for complications, viz., vascular injury, nerve injury, peritoneum, bowel and bladder injury were retrieved. Data was analysed using SPSS 24.0 software. Chi-square and Independent samples ‘t’-tests were used for comparison.</div></div><div><h3>Results</h3><div>Mean age of patients was 40.14±14.95 years. Majority (74.3 %) of patients were males and had road traffic accident (83.8 %) as the cause of injury. Mean BMI of patients was 22.4 ± 2.43 kg/m². ACPHT (41.2 %) and ACF (27.9 %) were the most common diagnoses. A total of 16 (11.8 %) had associated injuries. Mean time gap between injury and surgery was 6.35±4.25 days. Intraoperative complication rate was 8.8 % (3.7 % peritoneum tear, 2.9 % superior iliac vein injury and 2.2 % external iliac vein injury). Intraoperative complications had a significant association with time gap between injury and surgery (<em>p</em> = 0.015).</div></div><div><h3>Conclusion</h3><div>Stoppa technique was a safe approach for management of acetabulum fractures with a low incidence of intraoperative complications. Early intervention could help to reduce rate of complications further.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 3","pages":"Article 112208"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387061","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":"Fracture-related infections of the lower extremity – Analysis of costs and their drivers","authors":"Ramon Nyffeler ,&nbsp;Mario Morgenstern ,&nbsp;Rik Osinga ,&nbsp;Richard Kuehl ,&nbsp;Brigitta Gahl ,&nbsp;Anna Imhof ,&nbsp;Carl-Philipp Meyer ,&nbsp;Seraina Müller ,&nbsp;Thadeus Muri ,&nbsp;Dirk Johannes Schaefer ,&nbsp;Parham Sendi ,&nbsp;Martin Clauss","doi":"10.1016/j.injury.2024.112138","DOIUrl":"10.1016/j.injury.2024.112138","url":null,"abstract":"<div><h3>Objectives</h3><div>Fracture-related infection (FRI) is a feared complication in orthopaedic trauma surgery. They are associated with multiple surgical interventions and prolonged antibiotic treatment duration, and hence, increased costs. The objective of this study was to assess the costs of FRI treatment in a Tertiary Swiss Trauma Center and to identify the variables associated with increased costs.</div></div><div><h3>Patients and methods</h3><div>In this retrospective cohort study, 116 patients with an FRI treated in a Swiss tertiary center between 01/2012 and 12/2019 were included. Clinical data and the costs of each hospital stay were evaluated. Predefined variables were categorized as modifiable and non-modifiable factors and examined for their influence on costs and hospital length of stay (LOS) in univariable and multivariable analyses.</div></div><div><h3>Results</h3><div>The median cost per patient was 39,219 [interquartile range (IQR) 22,657 to 68,588] CHF. The median LOS was 21 [IQR 14 to 36] days. Most patients were male (67%) with a median age of 58 years [40–70]. The median duration of IV antibiotic use was 16 [9–27] days. Costs related to hospitalization (nursing and physiotherapy) accounted for the highest expenses with a relative share of 49%, whereas surgical procedures had a minor impact on the total cost with a relative share of 19%. In the univariable analysis, significant drivers of both costs and LOS were the number of FRI surgeries, the use of negative pressure wound therapy, duration of IV antibiotic treatment, and cases with a change of surgical strategy. After adjustment for patient and treatment factors, duration of IV antibiotics and change of surgical strategy were associated with higher costs.</div></div><div><h3>Conclusions</h3><div>This study illustrates the financial burden of FRI in a DRG system and identifies potential drivers for these costs. Since repeated surgeries or unplanned surgical revisions are drivers of costs, optimal pre-operative planning and coordination between the involved disciplines is key to minimize costs. Management in multidisciplinary teams that are specialized in the treatment of these complex and cost-intensive patients may therefore reduce the financial burden.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112138"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916361","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}

{"title":"What is the best surgical treatment for a young patient with a combination displaced ipsilateral femoral neck and femoral shaft fracture – one or two implants?","authors":"Joon Ha ,&nbsp;Will Oliver ,&nbsp;Richard Buckley","doi":"10.1016/j.injury.2025.112141","DOIUrl":"10.1016/j.injury.2025.112141","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112141"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960505","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":"Optimising reduction and implant positioning in intertrochanteric fracture treatment: An evaluation of the effects of a structured educational program","authors":"Matthias Wittauer ,&nbsp;Pavel Sklorz ,&nbsp;Philip Przybilla ,&nbsp;Werner Vach ,&nbsp;Henrik Eckardt","doi":"10.1016/j.injury.2025.112146","DOIUrl":"10.1016/j.injury.2025.112146","url":null,"abstract":"<div><h3>Introduction</h3><div>Intertrochanteric fractures are common in older adults and pose significant challenges in terms of morbidity and mortality. Accurate reduction and optimal implant positioning during operative stabilisation of these fractures reduce the rates of complications and reoperations while improving functional outcomes in this population. This study aimed to assess the effects of a structured educational intervention on the radiographic outcomes, reduction quality, and revision rates of intertrochanteric fractures.</div></div><div><h3>Methods</h3><div>We initiated a training program that included an instructional video on interpreting intraoperative fluoroscopic views, as well as instructions and an algorithm for reducing and stabilising intertrochanteric fractures and mandated its implementation for all operating surgeons. We thus established an intervention cohort (<em>n</em> = 209) of patients who underwent surgery after the program's introduction, which we compared with a historical control cohort (<em>n</em> = 207) of patients who had undergone surgery before the program's implementation. The analysed postoperative radiographic parameters included the Baumgaertner reduction index, tip-apex distance (TAD), restoration of the caput-collum-diaphyseal angle, and calcar displacement. Mortality and the need for revision surgery were monitored for 2 years postoperatively.</div></div><div><h3>Results</h3><div>We observed significant improvements in the intervention cohort, particularly among the less experienced surgeons. The TAD was reduced by 7 %, indicating improved implant positioning. Similarly, the Baumgaertner reduction index revealed an increase in ‘good’ reductions (40.2% vs. 37.2 %). Additionally, the rates of revision surgery (4.8% vs. 11.1 %) and mechanical complications (1.9% vs. 6.3 %) were lower in the intervention cohort than in the control cohort.</div></div><div><h3>Conclusion</h3><div>Implementation of the structured training program led to better radiographic outcomes for intertrochanteric fractures, especially among less experienced surgeons. The observed improvements in reduction quality and decrease in revision rates underscore the potential benefits of incorporating educational interventions in orthopaedic trauma treatment.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112146"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974077","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}

{"title":"Demographic trends of boxing-associated fractures over 10 years","authors":"Gurbinder Singh ,&nbsp;Sergei O. Alexeev ,&nbsp;Cameron Nosrat ,&nbsp;Mohammad Arammash ,&nbsp;Ryan Halvorson","doi":"10.1016/j.injury.2025.112154","DOIUrl":"10.1016/j.injury.2025.112154","url":null,"abstract":"<div><h3>Background</h3><div>Boxing is a sport well-known for the risk of injury. However, the epidemiology of boxing-associated fractures has not been well studied. This study aims to report the characteristics of boxing fractures that lead to presentation to the emergency room and evaluate the demographics and practices of the patients to prevent these injuries.</div></div><div><h3>Methods</h3><div>This cross-sectional study analyzed boxing-associated fractures over a decade (2013-2022) using the National Electronic Injury Surveillance System (NEISS) database. Patients presenting to U.S. emergency departments with boxing-related injuries were categorized by age, gender, and injury location. Descriptive statistics, chi-square tests, and ANOVA were employed to assess temporal trends and associations between injury occurrence and demographic variables.</div></div><div><h3>Results</h3><div>Analysis of 959 boxing-associated fractures (BAFs) showed that hand fractures were most common (53.64%), followed by phalanx (12.73%) and facial fractures (10.91%). Significant differences were observed across body parts (χ2 = 9.74, P &lt; .001). Associated soft tissue injuries included lacerations, contusions, sprains, strains, and hematomas, with no significant differences among these categories (χ2 = 1.47, P = 0.832). Males experienced more BAFs than females overall, but females had a significant increase over time (F(1,9) = 4.308, p = 0.032). Most fractures occurred in recreational or sports settings (34.5%), followed by home (19.1%) and school (13.24%). The highest BAF incidence was in individuals aged 21-30 (32.18%), while the lowest was in those aged 41-50 (5.47%). From 2020 to 2022, BAFs decreased in recreational settings and increased at home during 2020-2022.</div></div><div><h3>Conclusion</h3><div>Hand fractures were the most common type of BAF. Males had significantly more BAFs, although the incidence of BAFs in females increased significantly since 2013. Fractures mainly occurred in recreational places, but from 2020-2022, most occurred at home. This shift coincided with the COVID-19 pandemic, suggesting increased home sparring. These findings emphasize the need for further research into protective measures and injury prevention in boxing.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112154"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018781","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":"Evolution of treatment of fragility fractures of the pelvic ring. An update","authors":"Konstantinos (Costas) G Papakostidis ,&nbsp;Peter V Giannoudis","doi":"10.1016/j.injury.2025.112145","DOIUrl":"10.1016/j.injury.2025.112145","url":null,"abstract":"<div><div>The term “fragility fractures of the pelvis” refers to the disruptions of the pelvic ring that are caused by low energy injuries (such as low-level falls or falls from the standing position) in the elderly population (age over 65 years) in the absence of metastatic bone disease. These fractures are increasing in numbers, due to the aging population, particularly in the developed countries, causing significant morbidity and mortality [<span><span>1</span></span>]. Although some fracture patterns are stable enough requiring only conservative treatment, other fracture types can cause significant pelvic instability, demanding a more insistent management protocol.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112145"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030521","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":"A scoping review and critical appraisal of orthopaedic trauma research using the American College of Surgeons National Trauma Data Bank","authors":"Reginald T.A. Conley ,&nbsp;Zodina Beiene ,&nbsp;Charlotte Lenz ,&nbsp;Meir T. Marmor","doi":"10.1016/j.injury.2025.112161","DOIUrl":"10.1016/j.injury.2025.112161","url":null,"abstract":"<div><h3>Introduction</h3><div>The development of national registries from routinely collected health data has transformed the research landscape by improving access to large sample populations. This growing volume of data enables researchers to address critical questions but also challenges clinicians in conducting, evaluating, and applying the research. The National Trauma Data Bank (NTDB), the largest aggregate of deidentified trauma data in the world, is increasingly utilized for retrospective studies on trauma. This scoping review aimed to assess the quality of reporting of NTDB-based orthopedic trauma publications.</div></div><div><h3>Methods</h3><div>We queried the Dimensions database for orthopedic studies using the NTDB. The quality of reporting was assessed by adherence to two international publication guidelines: the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the REporting of studies Conducted using Observational routinely collected data (RECORD).</div></div><div><h3>Results</h3><div>From a total of 3,720 identified articles, 137 manuscripts were available for analysis. The median scores and interquartile ranges (IQR) for STROBE and RECORD were 19 (IQR 18–20) and 7 (IQR 7–8), respectively. For STROBE scoring, the lowest fulfilled items were handling missing data and potential sources of bias. For RECORD scoring, the lowest fulfilled items were accessibility to protocol, raw code and data, validation studies, and data cleaning. A greater proportion of high-scoring studies were published in high-impact journals versus low-impact journals and in journals that enforced guidelines versus those that did not.</div></div><div><h3>Conclusion</h3><div>This study highlights the methodological gaps in the NTDB-based orthopedic trauma publications and identifies areas for improvement, including the management of missing data, selection of the study population through data cleaning, identification of sources of bias, and transparency in data accessibility. Future work should test the reproducibility of these studies and evaluate adherence to established guidelines across a broader range of databases and disciplines.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112161"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043896","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":"Overview of pain in Ukrainian war injured","authors":"Marta Garin Alegre ,&nbsp;Elsa Mallor Lopez ,&nbsp;Maria Blasco ,&nbsp;Valentin Yuste Benavente ,&nbsp;Maria Del Mar Rodero Roldan","doi":"10.1016/j.injury.2024.112046","DOIUrl":"10.1016/j.injury.2024.112046","url":null,"abstract":"<div><h3>Introduction</h3><div>Our objective is to study the relationship between armed conflict injuries and pain and the treatments that have been applied to Ukrainian injured soldiers in our hospital.</div></div><div><h3>Methods</h3><div>We performed an observational study of a sample of 91 injured soldiers. The metrics we selected for the study included time from injury, length of stay, diagnosis, treatment, type and intensity of pain and questionnaires about pain and quality of life for the group of amputees. The statistical study was carried out using SPSS v.30.</div></div><div><h3>Results</h3><div>85 % of the 91 patients suffered from pain in at least one part of their body. 53 patients experienced neuropathic pain, 15 patients had somatic pain and 29 patients had a combination of both. The average pain intensity was 6 points in the Visual Analogue Scale (VAS) and 5 points in the DN-4 scale. The most common treatments for neuropathic pain were neuromodulators, nerve blocks, capsaicin patches and TMR (targeted muscle reinnervation).</div></div><div><h3>Conclusion</h3><div>The study of injuries caused in current armed conflicts can help us anticipate complications and understand and treat pain early to improve the independence of patients, especially of amputee patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112046"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796468","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":"Mid to long term follow up of early weightbearing after open reduction internal fixation of ankle fractures","authors":"Zachary A. Rockov,&nbsp;Ryan A. Finkel,&nbsp;Sohaib Z. Hashmi,&nbsp;Connor T. Byrne,&nbsp;Evan D. Nigh,&nbsp;Jonathan H. Garfinkel,&nbsp;Naudereh B. Noori,&nbsp;Amit Pujari,&nbsp;Carol A. Lin,&nbsp;Charles N. Moon,&nbsp;Geoffrey S. Marecek,&nbsp;Mark S. Vrahas,&nbsp;Milton T.M. Little","doi":"10.1016/j.injury.2025.112157","DOIUrl":"10.1016/j.injury.2025.112157","url":null,"abstract":"<div><h3>Introduction</h3><div>Studies have demonstrated successful outcomes with early weightbearing following open reduction internal fixation (ORIF) of specific ankle fractures. The external validity of an early weightbearing protocol and its effects on patient-reported outcome information scores (PROMIS) has yet to be investigated. This study aimed to investigate the effects of an early weightbearing protocol for all operatively treated ankle fractures and its impact on clinical outcomes and complications.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 229 patients (≥ 16 years) with OTA/AO 44 A-C fractures who underwent open reduction and internal fixation (ORIF). Patients were divided into groups based on early (2–3 weeks postoperative) or delayed (&gt;6 weeks postoperative) weightbearing protocols. Primary outcomes included PROMIS score subsets including physical function, depression, and pain interference and ankle range of motion (ROM) at each follow up visit. Secondary outcomes included complications such as implant removal for pain, prominence, or surgical site infection, revision surgery for failure of fixation or loss of reduction, and post-operative sensory or motor deficits.</div></div><div><h3>Results</h3><div>There were 96 patients in the early weightbearing cohort and 133 patients in the delayed weightbearing cohort. The median follow-up time of the early weightbearing cohort was 471.47 ± 389.69 days while the delayed cohort was 459.82 ± 358.21 days. Demographics and comorbidities were distributed equally between both groups, except the presence of peripheral neuropathy which was observed more frequently in the delayed weightbearing cohort (8 versus 0, p = 0.022). Results indicated no statistically significant differences in PROMIS scores at final follow up, ankle ROM, or post-operative complications between the early and delayed weightbearing cohorts. Multivariable regression analysis identified smoking as a factor associated with worse ankle ROM at final follow-up.</div></div><div><h3>Conclusions</h3><div>This study found that early weightbearing after ORIF of unstable ankle fractures leads to similar PROMIS scores and ankle ROM without increased complications. In addition, smokers were found to have worse ankle ROM when compared to nonsmokers at final follow-up.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112157"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018790","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":"Socioeconomic disparities and trends in the utilization of regional and neuraxial anesthesia for pediatric femur fracture repair","authors":"Kelsey Murray ,&nbsp;Oluwatoba Akinleye ,&nbsp;Ammar Siddiqui ,&nbsp;Jeff Xu ,&nbsp;Jose Dominguez ,&nbsp;Damon Delbello ,&nbsp;Irim Salik","doi":"10.1016/j.injury.2024.112086","DOIUrl":"10.1016/j.injury.2024.112086","url":null,"abstract":"<div><div>Pediatric femur fractures often necessitate surgical intervention, with pain management being critical for both immediate and long-term outcomes. Peripheral nerve blocks (PNBs) and neuraxial techniques are effective in providing targeted pain relief while minimizing systemic opioid exposure. Despite their benefits, the utilization of these anesthesia techniques in pediatric orthopedic surgeries is limited, particularly among socioeconomically disadvantaged patients. This study aims to evaluate the association between socioeconomic status (SES) and the use of regional and neuraxial anesthesia in pediatric femur fracture repairs, focusing on healthcare resource utilization (HRU) outcomes such as hospital length of stay (LOS), total hospital charges, and discharge disposition.</div><div>Using the 2016–2020 NIS database, we identified 43,605 pediatric patients who underwent femur fracture repair. Only 1 % received PNB, and 0.1 % received spinal block (SB). Our analysis revealed that PNB was less likely to be administered to patients from lower SES backgrounds, those with subtrochanteric fractures, or those requiring delayed repair. Conversely, PNB was associated with reduced HRU, while SB was linked to increased HRU. The findings underscore significant disparities in the application of regional anesthesia, influenced by socioeconomic factors.</div><div>Our study highlights the need for standardized guidelines and interventions to address these disparities, ensuring equitable access to effective pain management techniques in pediatric orthopedic care. Further research is warranted to understand the barriers to the utilization of PNB and to develop strategies to enhance its adoption, particularly among underserved populations.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112086"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873697","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}