Pub Date : 2025-12-11DOI: 10.1016/j.injury.2025.112969
William H. Fang , Vitaley Kovalev , Theresa Pak
Orthopedic injuries during pregnancy pose unique risks to maternal and fetal health. This review identifies different epidemiological data, maternal physiological changes, imaging considerations, pain management strategies, and operative considerations. Motor vehicle accidents, falls, and domestic violence contribute to fractures, emphasizing the need for tailored management. Special attention is given to imaging modalities, with a focus on fetal safety. Pain management strategies balance effective analgesia with fetal well-being, emphasizing the cautious use of opioids. Perioperative fetal monitoring and anticoagulation considerations address the intricacies of managing orthopedic injuries during pregnancy. Prevention strategies, such as promoting seat belt use and intimate partner violence screening, are crucial for minimizing risks. This concise review serves as a comprehensive guide for healthcare professionals managing orthopedic injuries in pregnant patients.
{"title":"Orthopedic trauma in pregnancy: A literature review","authors":"William H. Fang , Vitaley Kovalev , Theresa Pak","doi":"10.1016/j.injury.2025.112969","DOIUrl":"10.1016/j.injury.2025.112969","url":null,"abstract":"<div><div>Orthopedic injuries during pregnancy pose unique risks to maternal and fetal health. This review identifies different epidemiological data, maternal physiological changes, imaging considerations, pain management strategies, and operative considerations. Motor vehicle accidents, falls, and domestic violence contribute to fractures, emphasizing the need for tailored management. Special attention is given to imaging modalities, with a focus on fetal safety. Pain management strategies balance effective analgesia with fetal well-being, emphasizing the cautious use of opioids. Perioperative fetal monitoring and anticoagulation considerations address the intricacies of managing orthopedic injuries during pregnancy. Prevention strategies, such as promoting seat belt use and intimate partner violence screening, are crucial for minimizing risks. This concise review serves as a comprehensive guide for healthcare professionals managing orthopedic injuries in pregnant patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112969"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797267","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 : 2025-12-11DOI: 10.1016/j.injury.2025.112959
John Perera , Sue Patterson , Natalie Barker , Dylan Flaws , Zemedu Ferede
Background
Psychiatric disorders are common after traumatic brain injury, impeding recovery and increasing health and social costs internationally. clinicians caring for patients with TBI need an evidence base to support assessment of risk of and intervention to reduce psychiatric morbidity.
Method
We systematically searched for original studies published in English reporting development of multivariate models predicting anxiety, depression, PTSD and psychotic disorders in civilian adults at least six months after injury. The electronic search was conducted on 12 August 2024. Authors independently screened records, assessed study quality, and extracted data for descriptive analysis and narrative synthesis.
Results
We included 34 studies presenting 47 multivariable models predicting psychiatric disorder six to 120 months after TBI of varying severity. Study samples, ranging from 43 to 207,354, were predominantly male and Caucasian/White and aged 30–45 years. Models inconsistently included demographic, psychosocial and injury-related variables with mixed results. Female sex, psychiatric history, race/ethnicity, physical health and assault/violent mechanism of injury were statistically significant two-thirds of models in which they were included. Infrequently included variables including coping style and intoxication at injury were strongly associated with disorder.
Discussion
Faced with inconsistency in evidence we recommend that clinicians assess risk of suboptimal outcome broadly, asking not whether a given patient is at risk of a specific psychiatric condition but of any psychiatric disturbance following TBI. Patients with a psychiatric history and/or injured violently should be monitored but assessment must encompass biopsychosocial circumstances. Employment of a conceptual model of psychiatric disorder would support development of a cohesive evidence base.
{"title":"Predicting anxiety, depression, PTSD and psychotic disorders after traumatic brain injury in civilian adults: A systematic review of multivariable prognostic models","authors":"John Perera , Sue Patterson , Natalie Barker , Dylan Flaws , Zemedu Ferede","doi":"10.1016/j.injury.2025.112959","DOIUrl":"10.1016/j.injury.2025.112959","url":null,"abstract":"<div><h3>Background</h3><div>Psychiatric disorders are common after traumatic brain injury, impeding recovery and increasing health and social costs internationally. clinicians caring for patients with TBI need an evidence base to support assessment of risk of and intervention to reduce psychiatric morbidity.</div></div><div><h3>Method</h3><div>We systematically searched for original studies published in English reporting development of multivariate models predicting anxiety, depression, PTSD and psychotic disorders in civilian adults at least six months after injury. The electronic search was conducted on 12 August 2024. Authors independently screened records, assessed study quality, and extracted data for descriptive analysis and narrative synthesis.</div></div><div><h3>Results</h3><div>We included 34 studies presenting 47 multivariable models predicting psychiatric disorder six to 120 months after TBI of varying severity. Study samples, ranging from 43 to 207,354, were predominantly male and Caucasian/White and aged 30–45 years. Models inconsistently included demographic, psychosocial and injury-related variables with mixed results. Female sex, psychiatric history, race/ethnicity, physical health and assault/violent mechanism of injury were statistically significant two-thirds of models in which they were included. Infrequently included variables including coping style and intoxication at injury were strongly associated with disorder.</div></div><div><h3>Discussion</h3><div>Faced with inconsistency in evidence we recommend that clinicians assess risk of suboptimal outcome broadly, asking not whether a given patient is at risk of a specific psychiatric condition but of <em>any</em> psychiatric disturbance following TBI. Patients with a psychiatric history and/or injured violently should be monitored but assessment must encompass biopsychosocial circumstances. Employment of a conceptual model of psychiatric disorder would support development of a cohesive evidence base.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112959"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914305","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 : 2025-12-11DOI: 10.1016/j.injury.2025.112962
Kevin Yoon , Amanuel Ayano , Gonzalo F. Del Rio Montesinos , Linus Lee , Jonathan P. Japa , Mark Ehioghae , Addisu Mesfin
Introduction
A notable anatomic feature of the facet joint is the lateral mass, which is comprised of the superior and inferior articular processes of the vertebral body. A unique fracture pattern involves a lamina fracture and ipsilateral pedicle fracture resulting in a separation of the lateral mass from the vertebral body, called a floating lateral mass fracture (FLM). FLMs commonly co-occur with vertebral artery or neurologic injury and is usually managed surgically. Few studies have focused on FLMs alone; thus, the objective of the current study is to provide a systematic review regarding the epidemiology and management of FLM.
Methods
A retrospective protocol was used to search Medline (via PubMed) and Embase to identify all studies focused on floating lateral mass fractures. “floating lateral mass fracture” and “cervical” or “spine” were used in conjunction with boolean terms to find related articles. Single-case studies, unpublished articles, non-English articles, and other systematic reviews were excluded. Studies focusing on C1 lateral mass fractures were also excluded. Data regarding patient characteristics, injury characteristics, diagnostic imaging, and treatment were gathered.
Result
A total of 332 patients were identified with floating lateral mass fractures (FLM) of the subaxial cervical spine. There were 217 men (63.4 %) and 68 women (20.5 %) and 47 participants with gender not reported. The mean age was 41.8 ± 7.98 years. The most common levels of injury C6 and C5. Motor vehicle accidents (MVAs) were the most reported index event. Cervical collars were the most used non-operative treatment modality, with most studies specifying the use of hard cervical collar or a halo vest. Vertebral subluxation was later identified in 22 (31 %) patients treated nonoperatively. Anterior cervical discectomy and fusion (ACDF) was the most performed procedure including a one level, with 67 patients (28.2 %) and two-level fusions with 55 patients (23.2 %), totaling to 122 patients (51.4 %). Minimal reports of subluxation post-operatively were reported.
Conclusion
Floating lateral mass fractures are an uncommon, but severe, subtype of cervical facet fractures. FLM inherently results in spinal instability, and as a result surgical management is preferred versus non-surgical.
{"title":"Management of Cervical lateral mass fractures –A systematic review","authors":"Kevin Yoon , Amanuel Ayano , Gonzalo F. Del Rio Montesinos , Linus Lee , Jonathan P. Japa , Mark Ehioghae , Addisu Mesfin","doi":"10.1016/j.injury.2025.112962","DOIUrl":"10.1016/j.injury.2025.112962","url":null,"abstract":"<div><h3>Introduction</h3><div>A notable anatomic feature of the facet joint is the lateral mass, which is comprised of the superior and inferior articular processes of the vertebral body. A unique fracture pattern involves a lamina fracture and ipsilateral pedicle fracture resulting in a separation of the lateral mass from the vertebral body, called a floating lateral mass fracture (FLM). FLMs commonly co-occur with vertebral artery or neurologic injury and is usually managed surgically. Few studies have focused on FLMs alone; thus, the objective of the current study is to provide a systematic review regarding the epidemiology and management of FLM.</div></div><div><h3>Methods</h3><div>A retrospective protocol was used to search Medline (via PubMed) and Embase to identify all studies focused on floating lateral mass fractures. “floating lateral mass fracture” and “cervical” or “spine” were used in conjunction with boolean terms to find related articles. Single-case studies, unpublished articles, non-English articles, and other systematic reviews were excluded. Studies focusing on C1 lateral mass fractures were also excluded. Data regarding patient characteristics, injury characteristics, diagnostic imaging, and treatment were gathered.</div></div><div><h3>Result</h3><div>A total of 332 patients were identified with floating lateral mass fractures (FLM) of the subaxial cervical spine. There were 217 men (63.4 %) and 68 women (20.5 %) and 47 participants with gender not reported. The mean age was 41.8 ± 7.98 years. The most common levels of injury C6 and C5. Motor vehicle accidents (MVAs) were the most reported index event. Cervical collars were the most used non-operative treatment modality, with most studies specifying the use of hard cervical collar or a halo vest. Vertebral subluxation was later identified in 22 (31 %) patients treated nonoperatively. Anterior cervical discectomy and fusion (ACDF) was the most performed procedure including a one level, with 67 patients (28.2 %) and two-level fusions with 55 patients (23.2 %), totaling to 122 patients (51.4 %). Minimal reports of subluxation post-operatively were reported.</div></div><div><h3>Conclusion</h3><div>Floating lateral mass fractures are an uncommon, but severe, subtype of cervical facet fractures. FLM inherently results in spinal instability, and as a result surgical management is preferred versus non-surgical.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112962"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795829","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 : 2025-12-10DOI: 10.1016/j.injury.2025.112950
Stephan Grech , Andrea Cuschieri , Franziska Mintoff , Darryl Pisani , Sarah Cuschieri
Background
Spinal fractures represent a significant cause of morbidity, requiring both acute and long-term care. Data on their epidemiology in small state settings are limited. This study aimed to describe the population burden, clinical characteristics, and healthcare impact of spinal fractures in Malta over a five-year period.
Methods
A retrospective analysis was conducted using the Hospital Activity Analysis (HAA) database of Mater Dei Hospital, Malta, between 2019 and 2024. Data included demographics, fracture type (ICD-10), length of stay (LOS), admission and discharge source, mechanism of injury, need for intensive care unit (ITU) admission, spinal cord injury, and co-morbidities. Fracture types were grouped as cervical, thoracic, lumbar single-level, or multi-level fractures. Descriptive statistics, chi-square, t-tests, and logistic regression were applied, with p<0.05 considered significant.
Results
A total of 640 spinal fractures were recorded (56% males, 44% females). Lumbar single-level fractures were most common (38%), followed by multi-level fractures (30%). Falls were the predominant mechanism (53%). While 90% were admitted directly from home, only 70% were discharged home, with 16% requiring transfer to rehabilitation. The longest LOS was for cervical single-level fractures (15.7 days, p=0.019). ITU admission was uncommon (4%), predominantly in multi-level fractures, which also had the highest spinal cord injury prevalence (36%). Co-morbidities were frequent (71%), particularly cardiovascular disease (49%). Logistic regression showed multimorbidity was positively associated with single-level fractures (OR 1.66, 95% CI: 1.04–2.67, p=0.035).
Conclusions
Spinal fractures in Malta impose a substantial burden, extending beyond acute care into rehabilitation. Falls were the leading cause, and multimorbidity significantly influenced fracture patterns. These findings underscore the need for integrated fall-prevention strategies, chronic disease management, and strengthened rehabilitation services in small-state healthcare systems.
{"title":"The impact and burden of spinal fractures in a small island state: Pre-, acute, and post-COVID-19 trends from Malta","authors":"Stephan Grech , Andrea Cuschieri , Franziska Mintoff , Darryl Pisani , Sarah Cuschieri","doi":"10.1016/j.injury.2025.112950","DOIUrl":"10.1016/j.injury.2025.112950","url":null,"abstract":"<div><h3>Background</h3><div>Spinal fractures represent a significant cause of morbidity, requiring both acute and long-term care. Data on their epidemiology in small state settings are limited. This study aimed to describe the population burden, clinical characteristics, and healthcare impact of spinal fractures in Malta over a five-year period.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using the Hospital Activity Analysis (HAA) database of Mater Dei Hospital, Malta, between 2019 and 2024. Data included demographics, fracture type (ICD-10), length of stay (LOS), admission and discharge source, mechanism of injury, need for intensive care unit (ITU) admission, spinal cord injury, and co-morbidities. Fracture types were grouped as cervical, thoracic, lumbar single-level, or multi-level fractures. Descriptive statistics, chi-square, t-tests, and logistic regression were applied, with p<0.05 considered significant.</div></div><div><h3>Results</h3><div>A total of 640 spinal fractures were recorded (56% males, 44% females). Lumbar single-level fractures were most common (38%), followed by multi-level fractures (30%). Falls were the predominant mechanism (53%). While 90% were admitted directly from home, only 70% were discharged home, with 16% requiring transfer to rehabilitation. The longest LOS was for cervical single-level fractures (15.7 days, p=0.019). ITU admission was uncommon (4%), predominantly in multi-level fractures, which also had the highest spinal cord injury prevalence (36%). Co-morbidities were frequent (71%), particularly cardiovascular disease (49%). Logistic regression showed multimorbidity was positively associated with single-level fractures (OR 1.66, 95% CI: 1.04–2.67, p=0.035).</div></div><div><h3>Conclusions</h3><div>Spinal fractures in Malta impose a substantial burden, extending beyond acute care into rehabilitation. Falls were the leading cause, and multimorbidity significantly influenced fracture patterns. These findings underscore the need for integrated fall-prevention strategies, chronic disease management, and strengthened rehabilitation services in small-state healthcare systems.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112950"},"PeriodicalIF":2.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748254","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 : 2025-12-10DOI: 10.1016/j.injury.2025.112951
Mary S. Kim , Sifan Yuan , Genevieve J. Sippel , Aaron H. Mun , Dylan W. Arkowitz , Ivan Marsic , Randall S. Burd
Background
Cervical spine (c-spine) injuries can lead to significant disability and mortality. Although stabilization is the primary management for suspected c-spine injuries, lapses in stabilization frequently occur during trauma resuscitation. To facilitate evaluation of c-spine management, we developed a computer vision system to detect stabilization techniques. This system would enable scalable monitoring, including the timing and duration of c-spine stabilization.
Methods
We developed a 2-stage computer vision system to detect prehospital rigid c-collar, hospital semi-rigid c-collar, and manual in-line stabilization. The system was trained, tested, and validated using image frames extracted from 86 pediatric trauma resuscitation videos at a level 1 pediatric trauma center from October 2022 to May 2023. The first stage identified the patient in each image, and the second stage classified the stabilization technique. A 5-fold cross-validation was performed on the first 68 resuscitation videos for training/testing, with the latest 18 cases reserved for validation. System performance was evaluated using accuracy, precision, recall, F1 score, and Matthews correlation coefficient (MCC). To assess system potential for manual in-line detection, 10 simulation videos were added (eight for training, two for testing).
Results
In the 18 validation cases, the system achieved high accuracy for binary classification (0.91) and for detecting specific stabilization techniques: prehospital rigid c-collar (0.95), hospital semi-rigid c-collar (0.93), and manual in-line stabilization (0.97). The precision scores were 0.89 for binary classification of any stabilization method, 0.71 for prehospital rigid c-collar, 0.89 for hospital semi-rigid c-collar, and 0.04 for manual in-line. Recall, F1, and MCC scores aligned with these findings, with the highest values observed for detecting the hospital semi-rigid c-collar among the stabilization techniques. Adding simulation videos improved manual in-line stabilization detection, with accuracy 0.62, precision 0.88, recall 0.58, F1 score 0.70, and MCC 0.27.
Conclusion
The 2-stage computer vision system showed excellent performance for detecting c-spine stabilization, with limitations for manual in-line stabilization due to its rarity. Simulation data improved manual in-line detection, highlighting potential benefits of a more balanced dataset. The computer vision system may serve as a prototype for automated monitoring of trauma resuscitation using the camera infrastructure in the resuscitation room.
{"title":"Computer-vision based recognition of cervical spine stabilization during trauma resuscitation","authors":"Mary S. Kim , Sifan Yuan , Genevieve J. Sippel , Aaron H. Mun , Dylan W. Arkowitz , Ivan Marsic , Randall S. Burd","doi":"10.1016/j.injury.2025.112951","DOIUrl":"10.1016/j.injury.2025.112951","url":null,"abstract":"<div><h3>Background</h3><div>Cervical spine (c-spine) injuries can lead to significant disability and mortality. Although stabilization is the primary management for suspected c-spine injuries, lapses in stabilization frequently occur during trauma resuscitation. To facilitate evaluation of c-spine management, we developed a computer vision system to detect stabilization techniques. This system would enable scalable monitoring, including the timing and duration of c-spine stabilization.</div></div><div><h3>Methods</h3><div>We developed a 2-stage computer vision system to detect prehospital rigid c-collar, hospital semi-rigid c-collar, and manual in-line stabilization. The system was trained, tested, and validated using image frames extracted from 86 pediatric trauma resuscitation videos at a level 1 pediatric trauma center from October 2022 to May 2023. The first stage identified the patient in each image, and the second stage classified the stabilization technique. A 5-fold cross-validation was performed on the first 68 resuscitation videos for training/testing, with the latest 18 cases reserved for validation. System performance was evaluated using accuracy, precision, recall, F1 score, and Matthews correlation coefficient (MCC). To assess system potential for manual in-line detection, 10 simulation videos were added (eight for training, two for testing).</div></div><div><h3>Results</h3><div>In the 18 validation cases, the system achieved high accuracy for binary classification (0.91) and for detecting specific stabilization techniques: prehospital rigid c-collar (0.95), hospital semi-rigid c-collar (0.93), and manual in-line stabilization (0.97). The precision scores were 0.89 for binary classification of any stabilization method, 0.71 for prehospital rigid c-collar, 0.89 for hospital semi-rigid c-collar, and 0.04 for manual in-line. Recall, F1, and MCC scores aligned with these findings, with the highest values observed for detecting the hospital semi-rigid c-collar among the stabilization techniques. Adding simulation videos improved manual in-line stabilization detection, with accuracy 0.62, precision 0.88, recall 0.58, F1 score 0.70, and MCC 0.27.</div></div><div><h3>Conclusion</h3><div>The 2-stage computer vision system showed excellent performance for detecting c-spine stabilization, with limitations for manual in-line stabilization due to its rarity. Simulation data improved manual in-line detection, highlighting potential benefits of a more balanced dataset. The computer vision system may serve as a prototype for automated monitoring of trauma resuscitation using the camera infrastructure in the resuscitation room.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112951"},"PeriodicalIF":2.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770512","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 : 2025-12-10DOI: 10.1016/j.injury.2025.112952
Joseph T. Patterson , Michael Allen , Vivek Satish , Andrew M. Duong , Reza Firoozabadi , Joshua L. Gary
Objective
To determine the diagnostic performance of single-energy CT (SECT) scan for detecting contralateral posterior pelvic ring injuries in patients with an operative pelvis fracture.
Methods
Retrospective cohort study.
Setting
Level I Trauma Center
Patient selection criteria
Consecutive adults with operatively-treated pelvic ring injuries and preoperative and postoperative pelvis CT scans. Exclusion criteria were incomplete or unreadable imaging, pelvis CT obtained on a spine board or with a pelvic binder in place, prior pelvic instrumentation, or sacroiliac joint fusion.
Outcome
Measures and Comparisons: An “occult” contralateral sacroiliac joint injury was defined as either (A) a positive change of ≥2.0 mm between preoperative and postoperative CT measurements at this level on the “uninjured” side or (B) an intraoperatively fluoroscopic finding of ≥2.0 mm of sacroiliac joint widening on either static or dynamic stress fluoroscopic imaging on the “uninjured” side not present on the initial, preoperative CT
Results
One hundred forty-six adults, 62 % male sex, with a mean age of 42.5 years were included. A unilateral posterior pelvic ring injury was identified on the initial pelvis CT in ninety patients. An occult contralateral sacroiliac joint injury was identified in 11 patients (12.2 %), 5 by intraoperative fluoroscopic examination, none during instrumentation, and 6 by postoperative pelvis CT. One U-type sacral fracture was identified on postoperative CT. The diagnostic performance of pelvis SECT in the initial trauma evaluation for correctly classifying bilateral pelvic ring injuries was 84 % sensitivity with a 16 % false negative rate, 100 % specificity, 88 % negative predictive value, and 92 % accuracy.
Conclusions
In this cohort, 16 % of bilateral posterior ring injuries were incorrectly classified as unilateral from the initial pelvis CT. A complete unilateral posterior ring injury should raise suspicion for an occult contralateral injury and may warrant additional radiographic or fluoroscopic stress examination if clinically appropriate.
{"title":"Occult contralateral sacroiliac joint injuries missed on single-energy CT of operative pelvis fractures","authors":"Joseph T. Patterson , Michael Allen , Vivek Satish , Andrew M. Duong , Reza Firoozabadi , Joshua L. Gary","doi":"10.1016/j.injury.2025.112952","DOIUrl":"10.1016/j.injury.2025.112952","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the diagnostic performance of single-energy CT (SECT) scan for detecting contralateral posterior pelvic ring injuries in patients with an operative pelvis fracture.</div></div><div><h3>Methods</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Level I Trauma Center</div></div><div><h3>Patient selection criteria</h3><div>Consecutive adults with operatively-treated pelvic ring injuries and preoperative and postoperative pelvis CT scans. Exclusion criteria were incomplete or unreadable imaging, pelvis CT obtained on a spine board or with a pelvic binder in place, prior pelvic instrumentation, or sacroiliac joint fusion.</div></div><div><h3>Outcome</h3><div><em>Measures and Comparisons</em>: An “occult” contralateral sacroiliac joint injury was defined as either (A) a positive change of ≥2.0 mm between preoperative and postoperative CT measurements at this level on the “uninjured” side or (B) an intraoperatively fluoroscopic finding of ≥2.0 mm of sacroiliac joint widening on either static or dynamic stress fluoroscopic imaging on the “uninjured” side not present on the initial, preoperative CT</div></div><div><h3>Results</h3><div>One hundred forty-six adults, 62 % male sex, with a mean age of 42.5 years were included. A unilateral posterior pelvic ring injury was identified on the initial pelvis CT in ninety patients. An occult contralateral sacroiliac joint injury was identified in 11 patients (12.2 %), 5 by intraoperative fluoroscopic examination, none during instrumentation, and 6 by postoperative pelvis CT. One U-type sacral fracture was identified on postoperative CT. The diagnostic performance of pelvis SECT in the initial trauma evaluation for correctly classifying bilateral pelvic ring injuries was 84 % sensitivity with a 16 % false negative rate, 100 % specificity, 88 % negative predictive value, and 92 % accuracy.</div></div><div><h3>Conclusions</h3><div>In this cohort, 16 % of bilateral posterior ring injuries were incorrectly classified as unilateral from the initial pelvis CT. A complete unilateral posterior ring injury should raise suspicion for an occult contralateral injury and may warrant additional radiographic or fluoroscopic stress examination if clinically appropriate.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112952"},"PeriodicalIF":2.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829295","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 : 2025-12-10DOI: 10.1016/j.injury.2025.112955
Mingjie Bai , Peng Yang
Background
The posterior cervical canal plays a critical role in the protection and function of the cervical nerve roots, particularly the C5 nerve root. Variations in its anatomical structure, notably the number of single-door segments, may impact the traction forces experienced by the C5 nerve root during surgical interventions or pathological conditions. This study aims to quantify how the number of single-door segments affects traction forces on the C5 nerve root.
Methods
A biomechanical model was developed to simulate traction forces on the C5 nerve root based on varying anatomical configurations of the posterior cervical canal. MRI scans from 60 patients were analyzed, and traction forces were calculated for different segmental configurations, specifically focusing on the number of single-door segments.
Results
The study revealed a statistically significant correlation between the number of single-door segments and the traction force on the C5 nerve root. As the number of segments increased from one to three, traction forces increased by 25%, with the mean force rising from 12.5 N to 17.2 N (p < 0.05). Furthermore, the force increased by an additional 6% when the number of segments reached four, reaching a maximum traction force of 18.3 N. These findings suggest that anatomical variations in the posterior cervical canal influence the magnitude of traction forces and could potentially alter surgical outcomes, especially in nerve root preservation during decompression procedures.
Conclusion
This study underscores the significant role of single-door segments in the posterior cervical canal in modulating traction forces on the C5 nerve root. These biomechanical insights offer valuable information for preoperative planning, particularly in surgeries involving cervical spine decompression. Understanding these dynamics could enhance the preservation of nerve root integrity and improve patient outcomes in cervical spine surgeries.
颈后管对颈神经根，特别是C5神经根的保护和功能起着至关重要的作用。其解剖结构的变化，特别是单门节段的数量，可能会影响C5神经根在手术干预或病理情况下所经历的牵引力。本研究旨在量化单门节段的数量如何影响C5神经根的牵引力。方法建立生物力学模型，模拟不同颈后管解剖形态对C5神经根的牵引力。分析了60例患者的MRI扫描结果，并计算了不同节段配置的牵引力，特别关注单门节段的数量。结果单门节段数与C5神经根牵引力有统计学意义。当节段数从1节增加到3节时，牵引力增加25%，平均牵引力从12.5 N增加到17.2 N （p < 0.05）。此外，当节段数达到4节时，牵引力增加了6%，达到18.3 n的最大牵引力。这些研究结果表明，颈后管的解剖变化会影响牵引力的大小，并可能改变手术结果，特别是在减压过程中保留神经根。结论颈椎后管单门节段对C5神经根牵引力的调节具有重要作用。这些生物力学见解为术前规划提供了有价值的信息，特别是在涉及颈椎减压的手术中。了解这些动态可以增强神经根完整性的保存，并改善颈椎手术患者的预后。
{"title":"The effect of the number of single door segments in the posterior cervical canal on the traction of the cervical 5 nerve root","authors":"Mingjie Bai , Peng Yang","doi":"10.1016/j.injury.2025.112955","DOIUrl":"10.1016/j.injury.2025.112955","url":null,"abstract":"<div><h3>Background</h3><div>The posterior cervical canal plays a critical role in the protection and function of the cervical nerve roots, particularly the C5 nerve root. Variations in its anatomical structure, notably the number of single-door segments, may impact the traction forces experienced by the C5 nerve root during surgical interventions or pathological conditions. This study aims to quantify how the number of single-door segments affects traction forces on the C5 nerve root.</div></div><div><h3>Methods</h3><div>A biomechanical model was developed to simulate traction forces on the C5 nerve root based on varying anatomical configurations of the posterior cervical canal. MRI scans from 60 patients were analyzed, and traction forces were calculated for different segmental configurations, specifically focusing on the number of single-door segments.</div></div><div><h3>Results</h3><div>The study revealed a statistically significant correlation between the number of single-door segments and the traction force on the C5 nerve root. As the number of segments increased from one to three, traction forces increased by 25%, with the mean force rising from 12.5 N to 17.2 N (p < 0.05). Furthermore, the force increased by an additional 6% when the number of segments reached four, reaching a maximum traction force of 18.3 N. These findings suggest that anatomical variations in the posterior cervical canal influence the magnitude of traction forces and could potentially alter surgical outcomes, especially in nerve root preservation during decompression procedures.</div></div><div><h3>Conclusion</h3><div>This study underscores the significant role of single-door segments in the posterior cervical canal in modulating traction forces on the C5 nerve root. These biomechanical insights offer valuable information for preoperative planning, particularly in surgeries involving cervical spine decompression. Understanding these dynamics could enhance the preservation of nerve root integrity and improve patient outcomes in cervical spine surgeries.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112955"},"PeriodicalIF":2.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976449","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 : 2025-12-10DOI: 10.1016/j.injury.2025.112936
Guilherme Pelosini Gaiarsa, Paulo Roberto dos Reis, Olavo Pires de Camargo, Kodi Edson Kojima, Jorge Dos Santos Silva
Purpose
This study assessed whether ultrasonographic (U/S) detection of bridging callus can serve as an early sign of tibial fracture healing. By comparing U/S with serial radiographs, the goal was to identify the best predictors of fracture union. Previous studies indicate that early radiographic bridging callus may signal eventual healing, and U/S could detect this sooner than X-rays. Thus, U/S may provide earlier predictions of bone union or impaired healing.
Methods
A prospective evaluation was conducted on a consecutive cohort of patients with tibial fractures managed by intramedullary nailing. Patients were followed until complete bone healing or determination of nonunion at twelve months. Demographic and clinical data were collected contemporaneously. Radiographic and ultrasound images were obtained monthly and independently assessed by two experienced orthopaedic surgeons.
Results
Of the 42 initially enrolled patients 6 were lost to follow-up, resulting in the 36 included in the final cohort. There were 29 males and 7 females, aged between 22 and 64 years (mean, 39; median, 36.5). Fourteen fractures were open, with 20 classified as AO/OTA A, seven B, and nine C patterns. Of the 36 patients who completed the study, 31 healed uneventfully, while 5 did not achieve healing. An ultrasonographic bridging callus was observed between the first and third month following surgery. A "V"-shaped ultrasound corkscrew sign appeared in areas where no callus developed, and may serve as a prognostic factor for eventual nonunion. Bridging callus detected by ultrasound during the initial three months was identified as a positive prognostic indicator of bone healing.
Conclusion
Ultrasonography is rarely used to assess fracture healing, but it may help predict outcomes. Portable point-of-care ultrasound (POCUS) can reduce radiation in follow-ups. Detecting bridging callus on ultrasound within three months reliably indicates bone healing, often appearing a month before seen on X-ray and suggesting eventual union.
{"title":"Ultrasonographic bridging callus as an early predictor of tibial fracture healing","authors":"Guilherme Pelosini Gaiarsa, Paulo Roberto dos Reis, Olavo Pires de Camargo, Kodi Edson Kojima, Jorge Dos Santos Silva","doi":"10.1016/j.injury.2025.112936","DOIUrl":"10.1016/j.injury.2025.112936","url":null,"abstract":"<div><h3>Purpose</h3><div>This study assessed whether ultrasonographic (U/S) detection of bridging callus can serve as an early sign of tibial fracture healing. By comparing U/S with serial radiographs, the goal was to identify the best predictors of fracture union. Previous studies indicate that early radiographic bridging callus may signal eventual healing, and U/S could detect this sooner than X-rays. Thus, U/S may provide earlier predictions of bone union or impaired healing.</div></div><div><h3>Methods</h3><div>A prospective evaluation was conducted on a consecutive cohort of patients with tibial fractures managed by intramedullary nailing. Patients were followed until complete bone healing or determination of nonunion at twelve months. Demographic and clinical data were collected contemporaneously. Radiographic and ultrasound images were obtained monthly and independently assessed by two experienced orthopaedic surgeons.</div></div><div><h3>Results</h3><div>Of the 42 initially enrolled patients 6 were lost to follow-up, resulting in the 36 included in the final cohort. There were 29 males and 7 females, aged between 22 and 64 years (mean, 39; median, 36.5). Fourteen fractures were open, with 20 classified as AO/OTA A, seven B, and nine C patterns. Of the 36 patients who completed the study, 31 healed uneventfully, while 5 did not achieve healing. An ultrasonographic bridging callus was observed between the first and third month following surgery. A \"V\"-shaped ultrasound corkscrew sign appeared in areas where no callus developed, and may serve as a prognostic factor for eventual nonunion. Bridging callus detected by ultrasound during the initial three months was identified as a positive prognostic indicator of bone healing.</div></div><div><h3>Conclusion</h3><div>Ultrasonography is rarely used to assess fracture healing, but it may help predict outcomes. Portable point-of-care ultrasound (POCUS) can reduce radiation in follow-ups. Detecting bridging callus on ultrasound within three months reliably indicates bone healing, often appearing a month before seen on X-ray and suggesting eventual union.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112936"},"PeriodicalIF":2.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822424","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}
Accurate placement of pedicle screws is crucial for avoiding complications such as nerve damage or vascular injury. Screws are typically placed freehand using fluoroscopy-guidance. Recently, portable CT combined with 3D navigation (3D-N-iCT) has been developed to guide the placement of pedicle screws. This study compares the accuracy of pedicle screw placement using 3D-N-iCT versus the conventional freehand fluoroscopy guidance for thoracolumbar surgery. The records of patients who underwent thoracolumbar spine surgery with pedicle screw placement from November 2017 to December 2022 at Kaohsiung Chang Gung Memorial Hospital were retrospectively reviewed. Patients were divided into those in which 3D-N-iCT was used and those in whom screws were placed with freehand fluoroscopy guidance (FH-F). Outcomes compared between the 2 groups included screw placement accuracy assessed using the Gertzbein classification, and post-operative complications. A total of 244 patients were included in the study, with 182 in the 3D-N-iCT group and 62 in the FH-F group. The accuracy of screw placement was significantly higher in the 3D-N-iCT group, with 98 % of screws classified as Grade 0 (indicating perfectly positioned) compared to 93 % in the FH-F group (p = 0.010). The placement time was similar between groups (36.0 vs. 33.0 min, p = 0.120). The 3D-N-iCT group had a significantly lower rate of post-operative neurological defects (0 % vs. 5 %, p = 0.016) and complications (0.5 % vs. 8 %, p = 0.004). In conclusions, the use of 3D-N-iCT is associated with greater accuracy in pedicle screw placement during thoracolumbar spine surgeries compared to the freehand technique, without prolonging placement time.
椎弓根螺钉的准确放置对于避免神经损伤或血管损伤等并发症至关重要。螺钉通常在透视引导下徒手放置。最近，便携式CT结合3D导航（3D- n - ict）已被开发用于指导椎弓根螺钉的放置。本研究比较了在胸腰椎手术中使用3D-N-iCT与传统的徒手透视引导椎弓根螺钉置入的准确性。回顾性分析2017年11月至2022年12月在高雄长庚纪念医院行胸腰椎手术置椎弓根螺钉患者的记录。患者分为使用3D-N-iCT组和徒手透视引导（FH-F）放置螺钉组。两组间比较的结果包括使用Gertzbein分类评估螺钉放置准确性和术后并发症。研究共纳入244例患者，其中3D-N-iCT组182例，FH-F组62例。3D-N-iCT组螺钉放置的准确性明显更高，98%的螺钉被分类为0级（表示完全定位），而FH-F组为93% （p = 0.010）。两组置入时间相似（36.0 min vs. 33.0 min, p = 0.120）。3D-N-iCT组术后神经缺损发生率（0 %比5 %，p = 0.016）和并发症发生率（0.5 %比8 %，p = 0.004）显著低于3D-N-iCT组。总之，与徒手技术相比，在胸腰椎手术中使用3D-N-iCT可以更准确地放置椎弓根螺钉，而不会延长放置时间。
{"title":"Accuracy of portable intraoperative CT with 3D computer navigation versus freehand fluoroscopy-assisted pedicle screw placement in thoracolumbar spine surgery","authors":"Hou-Tsung Chen , Yow-Ling Shiue , Cheng-Tang Pan , Re-Wen Wu","doi":"10.1016/j.injury.2025.112953","DOIUrl":"10.1016/j.injury.2025.112953","url":null,"abstract":"<div><div>Accurate placement of pedicle screws is crucial for avoiding complications such as nerve damage or vascular injury. Screws are typically placed freehand using fluoroscopy-guidance. Recently, portable CT combined with 3D navigation (3D-N-iCT) has been developed to guide the placement of pedicle screws. This study compares the accuracy of pedicle screw placement using 3D-N-iCT versus the conventional freehand fluoroscopy guidance for thoracolumbar surgery. The records of patients who underwent thoracolumbar spine surgery with pedicle screw placement from November 2017 to December 2022 at Kaohsiung Chang Gung Memorial Hospital were retrospectively reviewed. Patients were divided into those in which 3D-N-iCT was used and those in whom screws were placed with freehand fluoroscopy guidance (FH-F). Outcomes compared between the 2 groups included screw placement accuracy assessed using the Gertzbein classification, and post-operative complications. A total of 244 patients were included in the study, with 182 in the 3D-N-iCT group and 62 in the FH-F group. The accuracy of screw placement was significantly higher in the 3D-N-iCT group, with 98 % of screws classified as Grade 0 (indicating perfectly positioned) compared to 93 % in the FH-F group (<em>p</em> = 0.010). The placement time was similar between groups (36.0 vs. 33.0 min, <em>p</em> = 0.120). The 3D-N-iCT group had a significantly lower rate of post-operative neurological defects (0 % vs. 5 %, <em>p</em> = 0.016) and complications (0.5 % vs. 8 %, <em>p</em> = 0.004). In conclusions, the use of 3D-N-iCT is associated with greater accuracy in pedicle screw placement during thoracolumbar spine surgeries compared to the freehand technique, without prolonging placement time.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112953"},"PeriodicalIF":2.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835628","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 : 2025-12-09DOI: 10.1016/j.injury.2025.112949
Yixi Wang , Wenzhe Li , Jian Cui , Zexi Wang , Yuqian Li
Objective
To develop and validate a machine learning model for postoperative sepsis in critically ill traumatic spinal injury (TSI) patients, a frequent and severe complication without dedicated predictive tools.
Methods
Model development used the MIMIC-IV 3.1 database, with external validation in the eICU-CRD 2.0 database and a Chinese TSI cohort. Variables documented within 24 h of postoperative ICU admission were screened using univariable testing and refined through Boruta and Group-Lasso regression to identify the final predictors. Thirteen base learners were trained and combined in a stacking ensemble optimized by fivefold cross-validation and hyperparameter tuning. Performance was assessed using receiver operating characteristic (ROC-AUC), average precision from precision–recall (PR-AP), calibration, decision, and lift curves, along with accuracy, sensitivity, specificity, precision, and F1 scores. Interpretability was evaluated through SHAP analysis.
Results
The development cohort comprised 808 patients, with 461 (57.1 %) sepsis cases, and the external validation cohort consisted of 358 patients, with 86 (24.0 %) events. Twelve predictors entered modeling, with the stacking model achieving an ROC-AUC of 0.918 and PR-AP of 0.938 in training and 0.889 and 0.936 in validation, maintaining close calibration, superior clinical utility confirmed by decision and lift curves, and balanced classification metrics, while most first-level models deteriorated markedly. External validation confirmed consistent performance and effective high-risk stratification. SHAP analysis underscored surgical burden, severity, hemodynamic, renal, and coagulation domains as key contributors, ensuring interpretability at cohort and individual levels.
Conclusion
This first validated model for postoperative sepsis in critically ill TSI patients shows relatively robust performance and interpretability, enabling early risk stratification and supporting clinical decision-making.
{"title":"Development and multicenter validation of a machine learning model for postoperative sepsis risk in critically Ill traumatic spinal injury patients","authors":"Yixi Wang , Wenzhe Li , Jian Cui , Zexi Wang , Yuqian Li","doi":"10.1016/j.injury.2025.112949","DOIUrl":"10.1016/j.injury.2025.112949","url":null,"abstract":"<div><h3>Objective</h3><div>To develop and validate a machine learning model for postoperative sepsis in critically ill traumatic spinal injury (TSI) patients, a frequent and severe complication without dedicated predictive tools.</div></div><div><h3>Methods</h3><div>Model development used the MIMIC-IV 3.1 database, with external validation in the eICU-CRD 2.0 database and a Chinese TSI cohort. Variables documented within 24 h of postoperative ICU admission were screened using univariable testing and refined through Boruta and Group-Lasso regression to identify the final predictors. Thirteen base learners were trained and combined in a stacking ensemble optimized by fivefold cross-validation and hyperparameter tuning. Performance was assessed using receiver operating characteristic (ROC-AUC), average precision from precision–recall (PR-AP), calibration, decision, and lift curves, along with accuracy, sensitivity, specificity, precision, and F1 scores. Interpretability was evaluated through SHAP analysis.</div></div><div><h3>Results</h3><div>The development cohort comprised 808 patients, with 461 (57.1 %) sepsis cases, and the external validation cohort consisted of 358 patients, with 86 (24.0 %) events. Twelve predictors entered modeling, with the stacking model achieving an ROC-AUC of 0.918 and PR-AP of 0.938 in training and 0.889 and 0.936 in validation, maintaining close calibration, superior clinical utility confirmed by decision and lift curves, and balanced classification metrics, while most first-level models deteriorated markedly. External validation confirmed consistent performance and effective high-risk stratification. SHAP analysis underscored surgical burden, severity, hemodynamic, renal, and coagulation domains as key contributors, ensuring interpretability at cohort and individual levels.</div></div><div><h3>Conclusion</h3><div>This first validated model for postoperative sepsis in critically ill TSI patients shows relatively robust performance and interpretability, enabling early risk stratification and supporting clinical decision-making.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112949"},"PeriodicalIF":2.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747730","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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