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

{"title":"Updated literature review of distal locking techniques for long femoral nails: Advantages and disadvantages","authors":"Ollagnon Stella,&nbsp;Maszelin Benjamin,&nbsp;Hamcha Hamid,&nbsp;Pries Pierre,&nbsp;Lacroix Richard,&nbsp;Marty Diloy Thibault,&nbsp;Vendeuvre Tanguy","doi":"10.1016/j.injury.2026.113063","DOIUrl":"10.1016/j.injury.2026.113063","url":null,"abstract":"<div><h3>Introduction</h3><div>Distal locking during intramedullary femoral nailing remains a technically demanding and radiation-intensive procedure. Since the last systematic review by Whatling et al., numerous innovations over the past two decades have aimed to improve accuracy, shorten operative time, reduce radiation exposure, and simplify the learning curve. A comprehensive synthesis of available techniques is lacking in the recent literature.</div></div><div><h3>Methods</h3><div>A systematic review was conducted, according to PRISMA guidelines, including all studies published between January 2006 and January 2025 that reported on distal locking techniques for femoral intramedullary nails. Five databases (PubMed, Cochrane, Embase, Web of Science, Google Scholar) were screened using predefined keywords. Data were extracted on technique type, associated advantages and disadvantages, operative time, radiation exposure, accuracy, and complication rates. Risk of bias was assessed using RoB 2, ROBINS-I, JBI, NOS, and ROBIS as appropriate. PROSPERO registration: CRD42025626521</div></div><div><h3>Results</h3><div>Thirty-six studies met the inclusion criteria, covering several categories: fluoroscopy-free techniques, modification of traditional freehand, targeting devices, and navigation-assisted systems (electromagnetic, robotic, optical, laser-guided). Low-tech solutions such as the “nail-over-nail” or auditory-guided techniques demonstrated promising accuracy in low-resource settings but lacked standardization. Meta-analyses confirmed the efficacy of electromagnetic navigation systems, particularly in reducing radiation exposure and operative time, without compromising success rates. Overall, navigation-based systems showed significant reductions in radiation time and promising accuracy across multiple trials.</div></div><div><h3>Conclusion</h3><div>This review highlights the broad spectrum of available distal locking techniques, from conventional approaches to advanced technological solutions. Navigation-assisted systems offer measurable benefits but remain limited by cost and accessibility. Simpler mechanical or acoustic methods remain relevant alternatives in specific contexts. No universal gold standard currently exists that can fully replace “freehand technique”. Technique selection should be guided by clinical context, surgeon experience, and available resources. Ultimately, technique adoption will depend on clinical context, available resources, and surgeon familiarity.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113063"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121449","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":"Ultrasound in acute compartment syndrome of the extremities","authors":"Kallin Austin,&nbsp;Marco Trevino,&nbsp;Brody Harn,&nbsp;Eric Liou,&nbsp;Matthew Hazel,&nbsp;Lara Laughrey,&nbsp;Amie Mower","doi":"10.1016/j.injury.2026.113059","DOIUrl":"10.1016/j.injury.2026.113059","url":null,"abstract":"<div><div>Acute compartment syndrome (ACS) is a surgical emergency that remains challenging to diagnose. Diagnosis is primarily clinical, with invasive intracompartmental pressure (ICP) monitoring recommended when available. However, clinical findings can be unreliable, and invasive ICP measurement carries procedural risks. Ultrasound has increasingly been investigated as a noninvasive diagnostic method for ACS. This review analyzed all reported uses of ultrasound in the context of ACS. Six primary ultrasound techniques were identified: conventional two-dimensional (2D) ultrasound, Doppler ultrasound, pulse phase-locked loop (PPLL) ultrasound, contrast-enhanced ultrasound (CEUS), pressure-related ultrasound (PrUS), and shear-wave elastography (SWE). Each method was described according to its mechanism and theoretical basis, then evaluated for its current clinical relevance. SWE appeared to hold the greatest promise for clinical implementation, with additional potential noted for Doppler ultrasound and tibial fascia angle (TFA) measurements. PrUS, CEUS, and PPLL showed practical limitations that currently restrict clinical application, though further research may address these concerns. Ultrasound offers a noninvasive, repeatable means of quantitatively assessing multiple compartments without the pain or infection risk associated with invasive ICP monitoring. While several methods demonstrate promise, none have yet been validated for clinical adoption. Larger, standardized clinical trials are needed to confirm their diagnostic accuracy and utility.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113059"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127692","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":"Prevalence of dysmorphic sacral features in the general population","authors":"Ian Meshay ,&nbsp;Katelyn A. Cole ,&nbsp;Sabrina M. Pescatore ,&nbsp;Kaley Haney ,&nbsp;John C. Hagedorn II","doi":"10.1016/j.injury.2026.113048","DOIUrl":"10.1016/j.injury.2026.113048","url":null,"abstract":"<div><h3>Background</h3><div>Posterior pelvic ring injuries, including sacral fractures and sacroiliac (SI) joint disruption, can have potentially serious sequelae and are becoming increasingly common. Management, especially in the setting of instability, consists of internal fixation to decrease the risk of complications. Placement of SI screws requires a thorough knowledge of normal pelvic anatomy and the available osseous fixation pathways. The aim of this study was to define the prevalence of individual features of sacral dysmorphism in the general population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of standard and 3D-reconstructed computed tomography (CT) images of the pelvis to record the presence or absence of each dysmorphic feature. All adult trauma patients who presented within a 5-year period at a single, academic, Level I trauma center were eligible for inclusion. Patients &lt;18 years of age, without advanced pelvic imaging, or who presented with any current or prior pelvic ring injury, tumor, or instrumentation were excluded. The prevalence of each dysmorphic feature was calculated and associations between dysmorphism and demographic factors were investigated.</div></div><div><h3>Results</h3><div>A total of 2667 patients were eligible for inclusion and the first 1000 were selected for review. Six subjects were excluded during review of CT images. One or more dysmorphic feature was seen in 96.8% of subjects. Each subject displayed an average of 2.7 abnormal features. Residual S1 discs were the most prevalent feature (72.2%). While tongue-in-groove (TIG) sacroiliac (SI) joints were the rarest (7.7% prevalence), they were associated with a significantly higher average number of concurrent dysmorphic features (3.29, <em>P</em> &lt; .0001). Demographic subgroup analysis demonstrated a significantly higher prevalence of S1 discs (<em>P</em> = .0007), TIG SI joints (<em>P</em> &lt; .0001), and colinear upper sacra (<em>P</em> &lt; .0001) in women. Residual S1 discs were also significantly more common in White patients (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>Sacral anatomy exists on a spectrum from normal to dysmorphic. This study demonstrates that completely “normal” sacral morphology is seen in &lt;4% of patients. TIG sacroiliac joints may serve as a quick indicator for a higher degree of dysmorphism which may complicate or preclude transiliac-transsacral screw placement.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113048"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement properties of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for patella fractures","authors":"Peter Larsen ,&nbsp;Rasmus Jorgensen ,&nbsp;Martin Jensen ,&nbsp;Soeren Lundbye-Christensen ,&nbsp;Rasmus Elsoe","doi":"10.1016/j.injury.2026.113033","DOIUrl":"10.1016/j.injury.2026.113033","url":null,"abstract":"<div><h3>Background</h3><div>The study aimed to investigate relevance, construct validity, reliability, and responsiveness and estimate the minimal clinically important difference of the Knee Injury and Osteoarthritis Outcome Score (KOOS) to adult patients with patella fractures.</div></div><div><h3>Materials and methods</h3><div>The study design was a prospective cohort study including patients treated conservatively and surgically following a patella fracture (AO-34). The primary outcome measure was the KOOS. The KOOS was repeated at 14 days, 15 days, six weeks, and finally at six and 12 months. Relevance was evaluated by patients and surgeons ranking of relevance of the 42 items in the KOOS, construct validity by correlation to Eq5d, test-retest reliability by an interclass correlation coefficient, and responsiveness by a priori hypothesis and supplemented by effect size. Furthermore, estimation of minimal clinically important difference (MCID) based on longitudinal confirmatory factor analysis.</div></div><div><h3>Results</h3><div>Included were 65 patients with a mean age of 63.3 years (range 24 to 89) with 74 % female gender. Results showed an acceptable relevance and construct validity. The test-retest reliability was high for all five subscales, with an interclass correlation coefficient ranging from 0.8 to 0.9. Evaluation of responsiveness showed high correlation to the predefined hypothesis (<em>r</em> &lt; 0.6) and moderate to large effect sizes. The MCID of the KOOS subscales were Pain 7.0 (1.6 - 9.8), Symptoms 7.3 (2.0 - 12.6), ADL11.8 (3.2 - 16.0), Sport/Rec 9.3 (3.4 - 15.3) and QOL 8.8 (6.1 - 17.8).</div></div><div><h3>Conclusion</h3><div>The Knee Injury and Osteoarthritis Outcome Score (KOOS) showed acceptable relevance, construct validity and responsiveness and high reliability to adult patients with patella fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113033"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction and validation of a machine learning model based on clinical indicators: Risk of bloodstream infections in patients with deep second- and third-degree burns","authors":"Min Peng ,&nbsp;ShaSha Zhang ,&nbsp;DongFang Chang","doi":"10.1016/j.injury.2026.113046","DOIUrl":"10.1016/j.injury.2026.113046","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with deep second- and third-degree burns are at high risk of bloodstream infections (BSIs) due to skin barrier disruption and immune suppression, with poor prognosis. Early risk identification is crucial for improving outcomes. This study aimed to construct and validate a machine learning model using multidimensional clinical indicators to accurately predict BSI risk in such patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study enrolled 301 patients with deep second- and third-degree burns (75 with BSIs) from Yongchuan Hospital Affiliated to Chongqing Medical University between January 2020 and January 2025. Multidimensional data on burn characteristics, laboratory indicators, and therapeutic measures were collected within 72 h of admission. After data preprocessing and feature screening, four models were built: logistic regression (LR), support vector machine (SVM), naive Bayes (NB), and back propagation artificial neural network (BP-ANN). Model performance was evaluated via stratified sampling and 5-fold cross-validation.</div></div><div><h3>Results</h3><div>Eight key predictors were identified: total body surface area, lymphocytes (LYM, most important), platelet crit, total bilirubin, creatinine, C-reactive protein, procalcitonin, and 24-hour rehydration. The BP-ANN model performed best in the test set, with accuracy, recall, precision, F1 value, and AUC all reaching 0.857, good calibration (Hosmer-Lemeshow test, <em>P</em> = 0.142), and significant net benefit in the 0–0.3 risk threshold interval (decision curve analysis). The LR model had an AUC of 0.891 and high generalization stability (0.999) but less balanced indicators. SVM was overfitted (limited practical value), and NB had insufficient generalization (test set AUC=0.775).</div></div><div><h3>Conclusion</h3><div>The BP-ANN model based on multidimensional clinical indicators accurately predicts BSI risk in patients with deep second- and third-degree burns, with good differentiation, calibration, and clinical utility, providing a reliable tool for early intervention.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113046"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079378","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":"Impact of surgical timing on perioperative outcomes after open reduction and internal fixation of periprosthetic proximal femoral fractures","authors":"Christopher Lampert,&nbsp;Leon Faust,&nbsp;Tobias Helfen,&nbsp;Carl Neuerburg,&nbsp;Boris Michael Holzapfel,&nbsp;Wolfgang Böcker,&nbsp;Eduardo Suero ,&nbsp;Florian Pachmann","doi":"10.1016/j.injury.2026.113049","DOIUrl":"10.1016/j.injury.2026.113049","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic proximal femoral fractures (PPFF) are expected to increase substantially due to demographic changes and the rising number of total hip arthroplasties. While early surgery is clearly recommended for native hip fractures, the optimal timing of surgery for PPFF remains controversial. The present study aimed to evaluate the effect of early versus delayed surgery on perioperative outcomes in patients with PPFF treated by open reduction and internal fixation (ORIF).</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 110 patients with PPFF who underwent ORIF at a Level 1 trauma center between January 2017 and August 2023. We analyzed the effect of early (within 24 hours) versus delayed (after 24 hours) surgical treatment after admission on the primary outcome measures: surgical and non-surgical complications, reoperation rate, in-hospital mortality, and postoperative immobility. Secondary outcome measures included the duration of surgery, length of hospital stay, and bleeding complications.</div></div><div><h3>Results</h3><div>Baseline demographics, comorbidities, and fracture patterns were comparable between the groups. No significant differences were observed in surgical (18.2 % vs. 14.6 %; p = 0.622) and non-surgical (27.3 % vs. 27.3 %; p = 0.992) complication rates, length of hospital stay (15.6 ± 13.5 vs. 15.4 ± 8.2 days; p = 0.747), reoperation rates (14.6 % vs. 10.9 %; p = 0.621). In-hospital mortality was low (7.3 % vs. 5.5 %; p = 0.672) and was not affected by the time of surgery. A longer operative time in patients undergoing surgery within 24 hours (150.5 ± 56.6 vs. 115.9 ± 54.6 min; p = 0.001) was not associated with an increase in morbidity or mortality.</div></div><div><h3>Conclusion</h3><div>Timing of surgical intervention had no impact on perioperative outcomes in patients with PPFF treated with ORIF. However, considering the elderly and frail nature of this patient population, timely surgery should be recommended to enable early mobilization, which is essential for preventing complications and may improve long-term functional outcomes.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113049"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suture button versus syndesmotic screw fixation in acute ankle fractures with syndesmotic injury: An umbrella review of functional outcomes and clinical relevance based on the minimal clinically important difference","authors":"Carmen L. Nieuwenkamp,&nbsp;Jasper Tausendfreund,&nbsp;Tim Schepers","doi":"10.1016/j.injury.2026.113054","DOIUrl":"10.1016/j.injury.2026.113054","url":null,"abstract":"<div><h3>Background</h3><div>Literature increasingly suggests that suture button (SB) fixation yields higher functional outcome scores, specifically the American Orthopaedic Foot Ankle Society (AOFAS) Ankle-Hindfoot score and the Olerud-Molander Ankle Score (OMAS), compared with syndesmotic screws (SS). This umbrella review evaluates whether these differences extend beyond statistical significance and meet thresholds for clinical relevance, using the Minimal Clinically Important Difference (MCID) as reference standard.</div></div><div><h3>Method</h3><div>A comprehensive PubMed search identified systematic reviews and meta-analyses published between 2010 and 2025. The methodological quality was assessed using the Joanna Briggs Institute checklist. Reported AOFAS and OMAS outcomes, as well as mean differences between SB and SS fixation, were extracted or independently calculated. These values were evaluated against established MCID ranges (OMAS 7.5–11.4, AOFAS 4.1–7.8), to determine whether statistically significant findings corresponded to clinically meaningful improvements</div></div><div><h3>Results</h3><div>Nineteen systematic reviews were included, of which fifteen performed a meta-analysis. Across these reviews, SB fixation was reported 18 times to result in statistically higher AOFAS and/or OMAS compared with SS fixation. However, most weighted mean differences fell below the MCID thresholds: in 11 reviews for OMAS and in 12 reviews for the AOFAS did not reach clinical relevance. Only one review reported an OMAS difference within the MCID range, and seven reviews reported AOFAS differences within or above the MCID range. These findings indicate that, although statistically significant results were observed, the corresponding functional gains were generally too small to be clinically meaningful.</div></div><div><h3>Conclusion</h3><div>While SB fixation often demonstrates superior functional scores relative to SS fixation, these differences seldom exceed established MCID thresholds. The clinical relevance of these improvements therefore remains uncertain. As routine removal of syndesmotic screws is no longer advocated in the contemporary literature, and considering the findings of the present study, one could argue that the cost-effectiveness of using a suture-button in under scrutiny. Future studies should focus on refining MCID values for ankle-specific PROMs and improving methodological rigour in systematic reviews and meta-analyses to better determine whether SB fixation provides a meaningful advantage for patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113054"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor regarding “Discordance between surgeon opinion and institutional policy on explant handling after hardware removal”","authors":"Arman Vahabi,&nbsp;Ali Engin Daştan,&nbsp;Hüseyin Günay,&nbsp;Kemal Aktuğlu","doi":"10.1016/j.injury.2025.112869","DOIUrl":"10.1016/j.injury.2025.112869","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112869"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472569","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":"Is percutaneous pelvic fixation becoming more prevalent among new orthopaedic trauma surgeons? - Trends in pelvic ring fixation","authors":"Thirushan Wignakumar ,&nbsp;Devon T. Brameier ,&nbsp;Christopher R. Leland ,&nbsp;Duco W.P.M. Laane ,&nbsp;Annabelle Swenson ,&nbsp;Eric H. Tischler ,&nbsp;Derek S. Stenquist ,&nbsp;Arvind G. Von Keudell ,&nbsp;Michael J. Weaver ,&nbsp;Nishant Suneja","doi":"10.1016/j.injury.2025.112960","DOIUrl":"10.1016/j.injury.2025.112960","url":null,"abstract":"<div><h3>Introduction</h3><div>The treatment paradigm of pelvic ring injuries has undulated over recent decades. Open reduction and internal fixation (ORIF) became more common in the 1990s and early 2000s followed by a decline in the late 2000s and 2010s, in favor of nonoperative management. Recently, minimally invasive pelvic stabilization using percutaneous pelvic fixation (PFF) has gained popularity. The trends of ORIF, PPF, and nonoperative management of pelvic ring injuries over the last decade is not well described. This study aims to characterize such trends among early-career orthopaedic trauma surgeons from 2003 to 2023.</div></div><div><h3>Methods</h3><div>Data was collected from the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List database for Candidates who indicated that their subspecialty was trauma over a time period involving 20 years of Case List submissions (2003–2023). Pelvic ring fixation was identified using CPT codes for ORIF (27,217, 27,218) and PPF (27,216). Total case volumes and trends in fixation type were analyzed, including an age-based subgroup analysis of younger (age 18–50) and older (age ≥65) adults,</div></div><div><h3>Results</h3><div>Of 15,164 total ABOS Part II Candidates, 795 indicated a trauma subspecialty and performed at least one pelvic ring fixation, with a total of 7311 pelvic fixation cases (3317 ORIF; 3994 PPF). Annual pelvic ring injury fixations increased five-fold during the study period, from 110 in 2003 to 592 in 2023. The proportion of ORIF decreased from 70 % to 40 %, while PPF increased from 30 % to 60 %. The share of early-career surgeons' practice dedicated to percutaneous fixation tripled. Operative fixation (both PPF and ORIF) of pelvic ring injuries in older adult patients became more common over this period.</div></div><div><h3>Conclusion</h3><div>Percutaneous stabilization of pelvic ring injuries is increasing over time, reflecting evolving practice patterns among early-career trauma surgeons. Future studies should evaluate the clinical implications of this trend, including the impact on fellow and resident training.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112960"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981496","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":"Preoperative malnutrition is associated with increased early complications and higher two-year nonunion risk after Tibial shaft fracture fixation","authors":"Jawad Saad ,&nbsp;David Abdelnour ,&nbsp;Magd Boutany ,&nbsp;Alqasim Elnaggar ,&nbsp;Hadi Elmenini ,&nbsp;Ahmad Almaat ,&nbsp;Ali Mehaidli ,&nbsp;Rahul Vaidya","doi":"10.1016/j.injury.2026.113084","DOIUrl":"10.1016/j.injury.2026.113084","url":null,"abstract":"<div><h3>Background</h3><div>Malnutrition is a potentially modifiable risk factor that may influence perioperative complications and fracture healing. This study evaluated the association between preoperative laboratory-defined malnutrition and short-term complications and 2-year outcomes following operative fixation of tibial shaft fractures.</div></div><div><h3>Methods</h3><div>Using the TriNetX Research Network (112 healthcare organizations), adults (≥18 years) undergoing operative management for tibial shaft fracture were identified. Preoperative malnutrition was defined as albumin ≤3.5 g/dL and/or leukocytes ≤1.5 × 10³/µL within 1 year prior to the index event. Cohorts were propensity score matched 1:1 on demographics and comorbidities. Outcomes were assessed from day 1 post-index through 90 days (medical/surgical complications) and 730 days (healing-related and limb outcomes). Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were reported.</div></div><div><h3>Results</h3><div>After matching, 44,780 patients were included in each cohort (89,560 total), with good balance across covariates (all SMDs &lt;0.10). At 90 days, malnutrition was associated with higher risk of acute respiratory failure/mechanical ventilation (13.9% vs 3.4%; RR 4.10 [95% CI 3.88–4.33].; HR 4.32 [4.09–4.57].), sepsis (5.2% vs 1.2%; RR 4.35 [3.97–4.77].; HR 4.47 [4.07–4.91].), postoperative infection (5.7% vs 1.8%; RR 3.14 [2.90–3.39].; HR 3.23 [2.99–3.50].), acute kidney injury (8.6% vs 3.0%; RR 2.90 [2.73–3.08].; HR 2.99 [2.81–3.18].), and DVT/PE (6.5% vs 2.7%; RR 2.36 [2.21–2.52].; HR 2.42 [2.26–2.59].) (all <em>p</em> &lt; 0.001). At 2 years, malnutrition was associated with increased nonunion (4.4% vs 1.6%; RR 2.69 [2.47–2.92].; HR 2.85 [2.62–3.10].), chronic osteomyelitis (12.5% vs 3.9%; RR 3.19 [3.02–3.36].; HR 3.50 [3.32–3.69].), hardware removal (10.1% vs 6.0%; RR 1.68 [1.61–1.76].; HR 1.83 [1.74–1.92].), and amputation (1.4% vs 0.4%; RR 3.47 [2.95–4.08].; HR 3.59 [3.05–4.23].) (all <em>p</em> &lt; 0.001). Revision fixation did not differ (8.4% vs 8.1%; <em>p</em> = 0.096).</div></div><div><h3>Conclusions</h3><div>Preoperative laboratory-defined malnutrition was independently associated with substantially higher 90-day morbidity and increased 2-year nonunion and limb-complication risk following operative tibial shaft fracture management. These findings support preoperative nutritional risk stratification and targeted optimization efforts in this population.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 113084"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115232","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}