Pub Date : 2025-02-01DOI: 10.1016/j.injury.2024.112038
Jin Liang , Cong He , Qianqian Yang , Haoran Chen , Youlang Zhou , Aidong Deng , Gu Heng Wang
Restoring motor function and preventing re-rupture and adhesion during Achilles tendon healing remain significant clinical challenges. Increasing evidence suggests that miRNA plays a crucial role in tendon healing and regeneration. The previously designed nanosphere hydrogel sustained-release system enables targeted, controlled release of drugs. In this study, we developed a version of this system loaded with miR-34a-5p for localized delivery to an acute Achilles tendon injury model. The results of the Achilles functional index and Catwalk behavior analysis in rats indicated that miR-34a-5p mimic promoted early recovery of motor function following Achilles tendon injury. Although gross observation suggested that the miR-34a-5p mimic group had a minimal inhibitory effect on the adhesion of Achilles tendon tissue, tension analysis demonstrated that it effectively increased the maximum tensile strength. Additionally, in vitro experiments showed that miR-34a-5p mimic could increase tendon cells proliferation and improve tendon cells viability. This study confirmed the efficacy of the miR-34a-5p nanosphere hydrogel sustained-release system in tendon injury repair, presenting it as a promising treatment strategy for clinical practice.
{"title":"Nanosphere hydrogel-mediated delivery of miR-34a-5p improves achilles tendon function in rat model","authors":"Jin Liang , Cong He , Qianqian Yang , Haoran Chen , Youlang Zhou , Aidong Deng , Gu Heng Wang","doi":"10.1016/j.injury.2024.112038","DOIUrl":"10.1016/j.injury.2024.112038","url":null,"abstract":"<div><div>Restoring motor function and preventing re-rupture and adhesion during Achilles tendon healing remain significant clinical challenges. Increasing evidence suggests that miRNA plays a crucial role in tendon healing and regeneration. The previously designed nanosphere hydrogel sustained-release system enables targeted, controlled release of drugs. In this study, we developed a version of this system loaded with miR-34a-5p for localized delivery to an acute Achilles tendon injury model. The results of the Achilles functional index and Catwalk behavior analysis in rats indicated that miR-34a-5p mimic promoted early recovery of motor function following Achilles tendon injury. Although gross observation suggested that the miR-34a-5p mimic group had a minimal inhibitory effect on the adhesion of Achilles tendon tissue, tension analysis demonstrated that it effectively increased the maximum tensile strength. Additionally, in vitro experiments showed that miR-34a-5p mimic could increase tendon cells proliferation and improve tendon cells viability. This study confirmed the efficacy of the miR-34a-5p nanosphere hydrogel sustained-release system in tendon injury repair, presenting it as a promising treatment strategy for clinical practice.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112038"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.injury.2024.112083
Johann Christian Sittmann , Ferhana Gool , Candice Van Koningsbruggen , Katya Evans
Introduction
Trauma is a major contributor to global disease burden, disproportionally affecting low- and middle-income countries, especially in the African Region. Emergency centre thoracotomy (ECT) is a potentially life-saving procedure for a sub-group of trauma patients in extremis. Most literature regarding ECT originated in high-income countries. This study aimed to describe patient, procedure and outcome characteristics of ECTs performed at two facilities in a resource-limited setting in South Africa.
Patients and methods
A retrospective chart review was performed at two district-level facilities in Cape Town from 1 April 2017 to 31 March 2021. All patients who underwent post-trauma thoracotomy in the emergency centre (EC) were eligible for inclusion. Cases were excluded if patients did not undergo thoracotomy in the EC, or if medical records were missing. Patients were identified using an electronic EC attendance register, and theatre records, which were screened using documented diagnoses and dispositions. Clinical notes were interrogated for information regarding patient demographics, mechanism of injury, clinical presentation, procedural characteristics (such as level of clinician, injury found, use of ultrasound). Outcomes measured were survival to specified endpoints, and neurological or functional outcomes.
Results
Over 4 years, 67 ECTs were performed (50 stabs, 17 gunshots). No ECTs were performed for blunt trauma. Most patients were male, with a median age of 25 years (IQR 21–33). More than two-thirds of patients presented with their own transport, and more than 80 % presented with signs of life. Most ECTs were performed by non-specialists. Survival to hospital discharge was 24 % (32 % for stabs, 0 % for gunshots). Neurological outcome was difficult to analyse, however seemed to be good in all but one survivor.
Conclusion
The performance of ECT in this resource-limited district-level setting, followed by stabilisation and transfer of patients to tertiary hospitals seems to result in comparable or better survival rates than reported in international literature. Further research is needed to better describe the performance and outcomes of EC thoracotomies in a resource-limited setting. This study setting, with high incidence of trauma and ECT performed, provides an excellent opportunity for further research. Prospective studies may demonstrate correlations between specific patient and procedural characteristics and outcomes and may guide the development of local guidelines.
{"title":"Emergency centre thoracotomy for penetrating trauma: Insights from 2 South African district-level emergency centres","authors":"Johann Christian Sittmann , Ferhana Gool , Candice Van Koningsbruggen , Katya Evans","doi":"10.1016/j.injury.2024.112083","DOIUrl":"10.1016/j.injury.2024.112083","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma is a major contributor to global disease burden, disproportionally affecting low- and middle-income countries, especially in the African Region. Emergency centre thoracotomy (ECT) is a potentially life-saving procedure for a sub-group of trauma patients in extremis. Most literature regarding ECT originated in high-income countries. This study aimed to describe patient, procedure and outcome characteristics of ECTs performed at two facilities in a resource-limited setting in South Africa.</div></div><div><h3>Patients and methods</h3><div>A retrospective chart review was performed at two district-level facilities in Cape Town from 1 April 2017 to 31 March 2021. All patients who underwent post-trauma thoracotomy in the emergency centre (EC) were eligible for inclusion. Cases were excluded if patients did not undergo thoracotomy in the EC, or if medical records were missing. Patients were identified using an electronic EC attendance register, and theatre records, which were screened using documented diagnoses and dispositions. Clinical notes were interrogated for information regarding patient demographics, mechanism of injury, clinical presentation, procedural characteristics (such as level of clinician, injury found, use of ultrasound). Outcomes measured were survival to specified endpoints, and neurological or functional outcomes.</div></div><div><h3>Results</h3><div>Over 4 years, 67 ECTs were performed (50 stabs, 17 gunshots). No ECTs were performed for blunt trauma. Most patients were male, with a median age of 25 years (IQR 21–33). More than two-thirds of patients presented with their own transport, and more than 80 % presented with signs of life. Most ECTs were performed by non-specialists. Survival to hospital discharge was 24 % (32 % for stabs, 0 % for gunshots). Neurological outcome was difficult to analyse, however seemed to be good in all but one survivor.</div></div><div><h3>Conclusion</h3><div>The performance of ECT in this resource-limited district-level setting, followed by stabilisation and transfer of patients to tertiary hospitals seems to result in comparable or better survival rates than reported in international literature. Further research is needed to better describe the performance and outcomes of EC thoracotomies in a resource-limited setting. This study setting, with high incidence of trauma and ECT performed, provides an excellent opportunity for further research. Prospective studies may demonstrate correlations between specific patient and procedural characteristics and outcomes and may guide the development of local guidelines.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112083"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.injury.2024.112087
Alessandro Aprato , Andrea Audisio , Virginia Masoni , Chiara Guidetti , Stefano Artiaco , Alessandro Massè
Purpose
Several concerns regarding gender equality in orthopedic surgery do exists. The aim of this study was to (1) compare operative times, (2) compare mortality rates, (3) investigate gender disparities in hip fracture surgeries, and (4) analyze gender distribution among attending and resident surgeons performing Closed Reduction Internal Fixation (CRIF) and Hemiarthroplasty (HA)
Methods
All patients >75 years old treated for proximal femur fractures in a level-one trauma center in a four-year timeframe were retrospectively enrolled. Exclusion criteria were follow-up <3 years, incomplete data, active patients treated with total hip arthroplasty (THA) and other surgeries performed during the same anesthesia. Patients were grouped according to procedure: 1) Closed Reduction Internal Fixation (CRIF) and 2) Hemiarthroplasty (HA). Gender and level of expertise (residents or attending surgeon) of leading surgeons (male (M), female (F) and non-binary (NB)) was extracted from medical records. Operative time, mortality rates, and the likelihood of performing either CRIF or HA were compared across genders.
Results
A total of 172 leading surgeons (M: 141 (82%); F: 31 (18%); NB: 0 (0%)) performed 1916 surgical procedures (CRIF: 1425 (74.4%); HA: 491 (25.6%)). 14.7% were performed by female surgeons (group 1: 15.5%; group 2: 12.2%; p = 0.076). No gender disparities were observed in the mean operating times for either group 1 (p = 0.759) or group 2 (p = 0.981). Similarly, there were no significant differences in mortality rates between genders in group 1 (p = 0.5779) or group 2 (p = 0.069). Additionally, no significant gender disparities were found in the performance of CRIF (p = 0.636) or HA (p = 0.141). Finally, analysis of gender distribution among attending and resident surgeons across various procedures, including CRIF and HA, revealed no significant differences in gender distribution (CRIF: p = 0.133, HA: p = 0.468, all procedures: p = 0.122).
Conclusions
Despite orthopedics still being a male-dominated field, gender does not affect surgical outcomes or the likelihood of performing CRIF or HA. However, the focus should shift towards improving inclusivity in surgical education and practice by providing equal opportunities and removing social and educational barriers based on gender.
{"title":"Trauma surgeons: Have we achieved gender equality?","authors":"Alessandro Aprato , Andrea Audisio , Virginia Masoni , Chiara Guidetti , Stefano Artiaco , Alessandro Massè","doi":"10.1016/j.injury.2024.112087","DOIUrl":"10.1016/j.injury.2024.112087","url":null,"abstract":"<div><h3>Purpose</h3><div>Several concerns regarding gender equality in orthopedic surgery do exists. The aim of this study was to (1) compare operative times, (2) compare mortality rates, (3) investigate gender disparities in hip fracture surgeries, and (4) analyze gender distribution among attending and resident surgeons performing Closed Reduction Internal Fixation (CRIF) and Hemiarthroplasty (HA)</div></div><div><h3>Methods</h3><div>All patients >75 years old treated for proximal femur fractures in a level-one trauma center in a four-year timeframe were retrospectively enrolled. Exclusion criteria were follow-up <3 years, incomplete data, active patients treated with total hip arthroplasty (THA) and other surgeries performed during the same anesthesia. Patients were grouped according to procedure: 1) Closed Reduction Internal Fixation (CRIF) and 2) Hemiarthroplasty (HA). Gender and level of expertise (residents or attending surgeon) of leading surgeons (male (M), female (F) and non-binary (NB)) was extracted from medical records. Operative time, mortality rates, and the likelihood of performing either CRIF or HA were compared across genders.</div></div><div><h3>Results</h3><div>A total of 172 leading surgeons (M: 141 (82%); F: 31 (18%); NB: 0 (0%)) performed 1916 surgical procedures (CRIF: 1425 (74.4%); HA: 491 (25.6%)). 14.7% were performed by female surgeons (group 1: 15.5%; group 2: 12.2%; <em>p</em> = 0.076). No gender disparities were observed in the mean operating times for either group 1 (<em>p</em> = 0.759) or group 2 (<em>p</em> = 0.981). Similarly, there were no significant differences in mortality rates between genders in group 1 (<em>p</em> = 0.5779) or group 2 (<em>p</em> = 0.069). Additionally, no significant gender disparities were found in the performance of CRIF (<em>p</em> = 0.636) or HA (<em>p</em> = 0.141). Finally, analysis of gender distribution among attending and resident surgeons across various procedures, including CRIF and HA, revealed no significant differences in gender distribution (CRIF: <em>p</em> = 0.133, HA: <em>p</em> = 0.468, all procedures: <em>p</em> = 0.122).</div></div><div><h3>Conclusions</h3><div>Despite orthopedics still being a male-dominated field, gender does not affect surgical outcomes or the likelihood of performing CRIF or HA. However, the focus should shift towards improving inclusivity in surgical education and practice by providing equal opportunities and removing social and educational barriers based on gender.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112087"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934278","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}
Severe metaphyseal comminution and sizable bone defect of the distal femur are high risks of fixation failure. To date, no exact magnitude of comminution and bone loss is determined as an indication for augmentation of fixation construct. The present study aimed to investigate the influence of metaphyseal gap width, working length, and screw distribution on the stability of the fixation construct.
Methods
A finite element model of a fractured femur with 0–80 mm metaphyseal gap width stabilized by an 11-hole distal femur locking compression plate (LCP-DF) was generated. The different working length and screw distribution were created by three different screw configurations: 9–10–11 (long working length, cluster screw), 8–10–11, and 7–9–11 (short working length, spreading screw). Physiological loading conditions were applied to evaluate biomechanical performance including equivalent von Mises (EQV) stress, bone stress, and fracture strain.
Results
The EQV stress increased accordingly to a metaphyseal gap width of 0–20 mm. The EQV stress values were at the same levels for 30-mm metaphyseal gap width and higher, particularly in screw configuration 9–10–11. Screw configuration 7–9–11 produced the lowest elastic strain. A 0-mm metaphyseal gap width presented the lowest bone stress. Bone stress values were in a similar magnitude across a 10–80 mm metaphyseal gap.
Conclusion
The 30-mm and wider metaphyseal gap width with a long working length presented a risk of varus collapse and fixation failure. Short working length with spreading screw provided low EQV stress, low bone stress, and high fracture stability.
{"title":"How wide of a distal metaphyseal femoral fracture gap is a high risk of varus collapse and fixation failure? A finite element study","authors":"Surasak Jitprapaikulsarn , Nattapon Chantarapanich , Theerachai Apivatthakakul , Pasin Lertvilai , Sujin Wanchat , Arthit Gromprasit , Pasit Sengpanich , Chantas Mahaisavariya","doi":"10.1016/j.injury.2024.112091","DOIUrl":"10.1016/j.injury.2024.112091","url":null,"abstract":"<div><h3>Background</h3><div>Severe metaphyseal comminution and sizable bone defect of the distal femur are high risks of fixation failure. To date, no exact magnitude of comminution and bone loss is determined as an indication for augmentation of fixation construct. The present study aimed to investigate the influence of metaphyseal gap width, working length, and screw distribution on the stability of the fixation construct.</div></div><div><h3>Methods</h3><div>A finite element model of a fractured femur with 0–80 mm metaphyseal gap width stabilized by an 11-hole distal femur locking compression plate (LCP-DF) was generated. The different working length and screw distribution were created by three different screw configurations: 9–10–11 (long working length, cluster screw), 8–10–11, and 7–9–11 (short working length, spreading screw). Physiological loading conditions were applied to evaluate biomechanical performance including equivalent von Mises (EQV) stress, bone stress, and fracture strain.</div></div><div><h3>Results</h3><div>The EQV stress increased accordingly to a metaphyseal gap width of 0–20 mm. The EQV stress values were at the same levels for 30-mm metaphyseal gap width and higher, particularly in screw configuration 9–10–11. Screw configuration 7–9–11 produced the lowest elastic strain. A 0-mm metaphyseal gap width presented the lowest bone stress. Bone stress values were in a similar magnitude across a 10–80 mm metaphyseal gap.</div></div><div><h3>Conclusion</h3><div>The 30-mm and wider metaphyseal gap width with a long working length presented a risk of varus collapse and fixation failure. Short working length with spreading screw provided low EQV stress, low bone stress, and high fracture stability.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112091"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960498","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}
The purpose of this study was to establish typical dose values at orthopaedic operating rooms of the Larnaca General Hospital (LGH). Kerma area product (KAP), fluoroscopy time (FT) and cumulative air-kerma (Ka,r) measurements were collected for 821 patients who underwent common and reproducible trauma surgery over a five-year period, with three mobile C-arm systems; two equipped with an image-intensifier and one with a flat-panel detector. Dose indices were automatically extracted from radiation dose structured reports or DICOM meta-data files archived in the PACS, using custom-made software. The procedures were categorised based on the anatomical area and included foot/ankle, tibia/fibula, knee (distal femur, tibia plateau), femur/trochanter, hip, hand, radius/ulna, elbow, and humerus. The medians of KAP, FT and Ka,r were defined as typical dose values. Variations in dose values among the C-arm systems or different surgical operations involving femur/hip, tibia/fibula, and humerus were analysed as secondary outcomes. For the procedures on upper extremities, the typical dose values ranged between 20.1–197 mGycm2 for KAP, 4.50–14.5 s for FT and 0.07–0.71 mGy for Ka,r, whilst for the procedures on lower extremities ranged between 46.6–202 mGycm2 for KAP, 4.86–24.0 s for FT and 0.16–0.74 mGy for Ka,r. The largest values were reported for dynamic hip screw (889 mGycm2, 14.3 s, 3.10 mGy), and femur/trochanter intramedullary (long/short nail: 2007/1326 mGycm2, 52.3/36.0 s, 6.53/4.05 mGy) nailing, respectively. A decrease of up to 65 %, and 74 % was found in median KAP, and Ka,r, and an increase of up to 119 % (except knee's) in median FT values for the procedures performed with the flat-panel systems. Additionally, when comparing surgical operations, only femur/trochanter long/short and tibia intramedullary nailing demonstrated a significant increase in median KAP, FT and Ka,r values compared to dynamic hip screw and fixation with a locking plate, respectively. The typical dose values reported could be used as a guide to appropriate levels of intra-operative fluoroscopy in orthopaedic trauma surgery at LGH, and to encourage further optimisation by providing a baseline for audit of local practice in the absence of national reference doses. These values could also contribute to the establishment of the first national DRLs for orthopaedic trauma surgery.
{"title":"Typical dose values for intra-operative fluoroscopy during orthopaedic trauma surgery at Larnaca general hospital in cyprus: A five-year retrospective study","authors":"Vasileios I. Metaxas , Stavros Savvakis , Eleni Skouridi , Demetris Kaolis , Georgios Gkaras , Constantinos Hadjilampi , Eleftherios Stamatakis , Efstratios A. Papadelis , Constantinos Pistevos , Petros Prodromou","doi":"10.1016/j.injury.2024.112089","DOIUrl":"10.1016/j.injury.2024.112089","url":null,"abstract":"<div><div>The purpose of this study was to establish typical dose values at orthopaedic operating rooms of the Larnaca General Hospital (LGH). Kerma area product (KAP), fluoroscopy time (FT) and cumulative air-kerma (K<sub>a,r</sub>) measurements were collected for 821 patients who underwent common and reproducible trauma surgery over a five-year period, with three mobile C-arm systems; two equipped with an image-intensifier and one with a flat-panel detector. Dose indices were automatically extracted from radiation dose structured reports or DICOM meta-data files archived in the PACS, using custom-made software. The procedures were categorised based on the anatomical area and included foot/ankle, tibia/fibula, knee (distal femur, tibia plateau), femur/trochanter, hip, hand, radius/ulna, elbow, and humerus. The medians of KAP, FT and K<sub>a,r</sub> were defined as typical dose values. Variations in dose values among the C-arm systems or different surgical operations involving femur/hip, tibia/fibula, and humerus were analysed as secondary outcomes. For the procedures on upper extremities, the typical dose values ranged between 20.1–197 mGycm<sup>2</sup> for KAP, 4.50–14.5 s for FT and 0.07–0.71 mGy for K<sub>a,r</sub>, whilst for the procedures on lower extremities ranged between 46.6–202 mGycm<sup>2</sup> for KAP, 4.86–24.0 s for FT and 0.16–0.74 mGy for K<sub>a,r</sub>. The largest values were reported for dynamic hip screw (889 mGycm<sup>2</sup>, 14.3 s, 3.10 mGy), and femur/trochanter intramedullary (long/short nail: 2007/1326 mGycm<sup>2</sup>, 52.3/36.0 s, 6.53/4.05 mGy) nailing, respectively. A decrease of up to 65 %, and 74 % was found in median KAP, and K<sub>a,r</sub>, and an increase of up to 119 % (except knee's) in median FT values for the procedures performed with the flat-panel systems. Additionally, when comparing surgical operations, only femur/trochanter long/short and tibia intramedullary nailing demonstrated a significant increase in median KAP, FT and K<sub>a,r</sub> values compared to dynamic hip screw and fixation with a locking plate, respectively. The typical dose values reported could be used as a guide to appropriate levels of intra-operative fluoroscopy in orthopaedic trauma surgery at LGH, and to encourage further optimisation by providing a baseline for audit of local practice in the absence of national reference doses. These values could also contribute to the establishment of the first national DRLs for orthopaedic trauma surgery.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112089"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.injury.2025.112160
Luke McGarry , Jessica Rotaru , Rajitha Gunaratne , Ian Hickey
Background
Femoral neck fractures, particularly Pauwels type II and III, pose significant challenges due to their vertical instability and susceptibility to complications such as non-union and avascular necrosis (AVN). Medial buttress plates (MBPs) have emerged as a promising adjunct in fixation, offering biomechanical advantages by neutralizing shearing forces and enhancing stability. However, the clinical efficacy of MBPs across different fixation techniques, plate configurations, and positioning remains unclear.
Purpose
This study aimed to (1) analyse outcomes of femoral neck fracture fixations augmented with MBPs, focusing on Pauwels type 2 and 3 fractures, and (2) analyse the impact of plate size, positioning, and the use of MBPs in different fixation techniques.
Study design
Systematic review; Level of evidence, 4.
Methods
Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using PubMed, MEDLINE, EMBASE, and Cochrane databases. Studies published from 2010 onwards, focusing on MBPs in Pauwels type II and III femoral neck fractures, were included. Clinical outcomes and plate details were recorded.
Results
Data from 21 studies, including 11 derived from meta-analyses, encompassing 642 patients were analysed. MBP-augmented fixations demonstrated a non-union rate of 6 %, an AVN rate of 4 %, and an overall failure rate of 17.3 %. The mean time to union was 3.9 ± 1.2 months, and the average HHS was 89.5 ± 5.5 at the final follow-up. Multiple cannulated screws (MCS) combined with a MBP showed a lower failure rate (14.6 %) compared to dynamic hip screw combined with a MBP (26.8 %), though not statistically significant (p = 0.164). Medial or anteromedial plate positioning yielded better outcomes, while anterior placement was associated with high failure rates. No studies examined the outcomes of femoral neck system fixation combined with a MBP.
Conclusion
MBPs are a valuable adjunct in managing Pauwels type II and III femoral neck fractures, providing favourable outcomes with low rates of failure and complications. The combination of MBPs with various fixation techniques has shown promising results, highlighting the potential for improved stability and outcomes. Further research is needed to optimize plate size, screw type, positioning, and the role of MBPs in augmenting fixation techniques for these challenging fractures.
{"title":"Medial buttress plate use in neck of femur fracture fixations: A systematic review","authors":"Luke McGarry , Jessica Rotaru , Rajitha Gunaratne , Ian Hickey","doi":"10.1016/j.injury.2025.112160","DOIUrl":"10.1016/j.injury.2025.112160","url":null,"abstract":"<div><h3>Background</h3><div>Femoral neck fractures, particularly Pauwels type II and III, pose significant challenges due to their vertical instability and susceptibility to complications such as non-union and avascular necrosis (AVN). Medial buttress plates (MBPs) have emerged as a promising adjunct in fixation, offering biomechanical advantages by neutralizing shearing forces and enhancing stability. However, the clinical efficacy of MBPs across different fixation techniques, plate configurations, and positioning remains unclear.</div></div><div><h3>Purpose</h3><div>This study aimed to (1) analyse outcomes of femoral neck fracture fixations augmented with MBPs, focusing on Pauwels type 2 and 3 fractures, and (2) analyse the impact of plate size, positioning, and the use of MBPs in different fixation techniques.</div></div><div><h3>Study design</h3><div>Systematic review; Level of evidence, 4.</div></div><div><h3>Methods</h3><div>Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using PubMed, MEDLINE, EMBASE, and Cochrane databases. Studies published from 2010 onwards, focusing on MBPs in Pauwels type II and III femoral neck fractures, were included. Clinical outcomes and plate details were recorded.</div></div><div><h3>Results</h3><div>Data from 21 studies, including 11 derived from meta-analyses, encompassing 642 patients were analysed. MBP-augmented fixations demonstrated a non-union rate of 6 %, an AVN rate of 4 %, and an overall failure rate of 17.3 %. The mean time to union was 3.9 ± 1.2 months, and the average HHS was 89.5 ± 5.5 at the final follow-up. Multiple cannulated screws (MCS) combined with a MBP showed a lower failure rate (14.6 %) compared to dynamic hip screw combined with a MBP (26.8 %), though not statistically significant (<em>p</em> = 0.164). Medial or anteromedial plate positioning yielded better outcomes, while anterior placement was associated with high failure rates. No studies examined the outcomes of femoral neck system fixation combined with a MBP.</div></div><div><h3>Conclusion</h3><div>MBPs are a valuable adjunct in managing Pauwels type II and III femoral neck fractures, providing favourable outcomes with low rates of failure and complications. The combination of MBPs with various fixation techniques has shown promising results, highlighting the potential for improved stability and outcomes. Further research is needed to optimize plate size, screw type, positioning, and the role of MBPs in augmenting fixation techniques for these challenging fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112160"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.injury.2025.112148
Noah J. Harrison , Sally Jo , Marschall B. Berkes , Christopher M. McAndrew , Mitchel R. Obey , Anna N. Miller
Background: Ballistic fractures of the femoral neck, rare injuries that overwhelmingly affect younger adults, pose significant challenges to the treating surgeon. However, there is limited literature that the treating surgeon can leverage to guide their treatment decisions. The goal of this study is to describe the demographics, associated injuries, outcomes, and complications associated with ballistic femoral neck fractures.
Patients and methods: This retrospective case series, performed at a single, academic, urban, level-one trauma center, evaluated patients with a ballistic fracture of the femoral neck (AO/OTA 31B) between 2003 and 2022. International Classification of Disease codes were utilized to identify patients in the electronic medical record. Chart review was performed to assess patient demographics, associated injuries, success rate of operative and nonoperative intervention, and post-operative complication rate and types.
Results: Seventeen patients were included (94 % male; median age 22.5 years). Median follow up was 12.2 months (range 1–84 months). Five patients (29 %) sustained a concomitant vascular injury. Eight patients (47 %) sustained an additional osseous injury. The median injury severity score was 9 (interquartile range 4–17). Thirteen patients were treated with operative reduction and fixation, 3 patients with incomplete fractures were treated nonoperatively, and one was treated with acute total hip arthroplasty (THA). Overall, 12 of 17 patients (71 %) healed their fracture or had an uncomplicated recovery after acute THA. Of the 13 patients treated with operative reduction and fixation, 8 (62 %) healed their fracture and 5 (38 %) developed one or more post-operative complications.
Conclusions: Nearly 1 in 3 patients with ballistic femoral neck fractures sustain concomitant vascular injury and almost half sustain another osseous injury. In this series, only 62 % of patients who underwent operative reduction and fixation healed their fractures, and nearly 40 % of patients treated with operative reduction and fixation developed a post-operative complication. Given the poor outcomes and high complication rates associated with these injuries, surgeons should counsel patients with ballistic femoral neck fractures accordingly. Further research into the optimal treatment of ballistic femoral neck fractures is needed.
{"title":"Ballistic femoral neck fractures: Associated injuries and outcomes","authors":"Noah J. Harrison , Sally Jo , Marschall B. Berkes , Christopher M. McAndrew , Mitchel R. Obey , Anna N. Miller","doi":"10.1016/j.injury.2025.112148","DOIUrl":"10.1016/j.injury.2025.112148","url":null,"abstract":"<div><div><strong>Background:</strong> Ballistic fractures of the femoral neck, rare injuries that overwhelmingly affect younger adults, pose significant challenges to the treating surgeon. However, there is limited literature that the treating surgeon can leverage to guide their treatment decisions. The goal of this study is to describe the demographics, associated injuries, outcomes, and complications associated with ballistic femoral neck fractures.</div><div><strong>Patients and methods:</strong> This retrospective case series, performed at a single, academic, urban, level-one trauma center, evaluated patients with a ballistic fracture of the femoral neck (AO/OTA 31B) between 2003 and 2022. International Classification of Disease codes were utilized to identify patients in the electronic medical record. Chart review was performed to assess patient demographics, associated injuries, success rate of operative and nonoperative intervention, and post-operative complication rate and types.</div><div><strong>Results:</strong> Seventeen patients were included (94 % male; median age 22.5 years). Median follow up was 12.2 months (range 1–84 months). Five patients (29 %) sustained a concomitant vascular injury. Eight patients (47 %) sustained an additional osseous injury. The median injury severity score was 9 (interquartile range 4–17). Thirteen patients were treated with operative reduction and fixation, 3 patients with incomplete fractures were treated nonoperatively, and one was treated with acute total hip arthroplasty (THA). Overall, 12 of 17 patients (71 %) healed their fracture or had an uncomplicated recovery after acute THA. Of the 13 patients treated with operative reduction and fixation, 8 (62 %) healed their fracture and 5 (38 %) developed one or more post-operative complications.</div><div><strong>Conclusions:</strong> Nearly 1 in 3 patients with ballistic femoral neck fractures sustain concomitant vascular injury and almost half sustain another osseous injury. In this series, only 62 % of patients who underwent operative reduction and fixation healed their fractures, and nearly 40 % of patients treated with operative reduction and fixation developed a post-operative complication. Given the poor outcomes and high complication rates associated with these injuries, surgeons should counsel patients with ballistic femoral neck fractures accordingly. Further research into the optimal treatment of ballistic femoral neck fractures is needed.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112148"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.injury.2024.112135
Garrett Ruff , Nina Fisher , Danielle Markus , Toni M. McLaurin , Philipp Leucht
Introduction
In city hospitals, subway-related traumatic amputations are a frequent pattern of injury, however there is a paucity of literature on this specific injury pattern. The purpose of this study was to describe the epidemiology of subway-related traumatic amputations, as well as compare them to non-subway traumatic amputations.
Patients and Methods
Retrospective review was performed at a single Level-1 trauma center in a metropolitan area. All patients who sustained a traumatic lower-extremity amputation over a seven-year period were included. Demographics, injury, treatment-related information, and complications were collected. Subway and non-subway traumatic amputations were statistically compared. Cohorts were further subdivided into above-knee amputations (AKAs) and below-knee amputations (BKAs) for statistical comparison.
Results
Fifty-seven patients sustained 72 traumatic lower-extremity amputations, including 64 subway-related amputations. Fifteen patients with bilateral lower-extremity amputations all had subway-related injuries. Patients with subway-related injuries were more likely to have a history of alcohol use disorder (58.1 % vs. 0 %; P = 0.002), and experienced longer stays in the intensive care unit (ICU) (8.9 vs. 3.6 days; P = 0.006). Twenty-four amputations (33.3 %) were complicated by wound infection during the initial hospitalization, with wound cultures growing a variety of organisms, most frequently Enterococcus species and Enterobacter cloacae. When subway injuries were separated by AKAs and BKAs, patients with AKAs underwent more irrigation and debridement procedures on average (10.3 vs. 5.8; P = 0.006), had a higher rate of wound infections (58.8 % vs. 25.0 %; P = 0.018), and had longer hospital stays (50.4 vs. 32.2 days; P = 0.047).
Conclusion
Subway-related amputations are associated with longer ICU stays and a history of alcohol use disorder compared to non-subway traumatic amputations. Approximately 1/3 of these patients are expected to develop a wound infection, with Enterococcus and Enterobacter species being the most commonly identified organisms. Further research into high-energy, traumatic amputations, including subway injuries, may help improve prognostication of patient outcomes, identify potential in-hospital complications, and proactively direct differences in care compared to the standard for non-subway-related amputations.
Level of Evidence
Prognostic Level III.
导读：在城市医院中，与地铁相关的创伤性截肢是一种常见的损伤模式，但是关于这种特定损伤模式的文献很少。本研究的目的是描述与地铁相关的创伤性截肢的流行病学，并将其与非地铁创伤性截肢进行比较。患者和方法：回顾性审查在一个单一的一级创伤中心在一个大都市地区。所有在7年内遭受创伤性下肢截肢的患者都被纳入研究。收集人口统计、损伤、治疗相关信息和并发症。地铁与非地铁创伤性截肢的统计比较。队列进一步细分为膝上截肢（AKAs）和膝下截肢（bka）进行统计比较。结果：57例患者行创伤性下肢截肢72例，其中地铁相关截肢64例。15例双侧下肢截肢患者均有地铁相关损伤。地铁相关损伤患者更有可能有酒精使用障碍史(58.1%比0%；P = 0.002)，重症监护病房（ICU）的住院时间更长(8.9天vs. 3.6天；P = 0.006)。24例截肢患者（33.3%）在初次住院期间并发伤口感染，伤口培养物生长多种微生物，最常见的是肠球菌和阴沟肠杆菌。当地铁损伤被AKAs和bka分开时，AKAs患者平均接受了更多的冲洗和清创手术(10.3 vs. 5.8；P = 0.006)，伤口感染率较高(58.8% vs. 25.0%；P = 0.018)，且住院时间较长(50.4天vs. 32.2天；P = 0.047)。结论：与非地铁创伤性截肢相比，地铁相关截肢与ICU住院时间更长和酒精使用障碍史相关。这些患者中约有三分之一预计会发生伤口感染，其中肠球菌和肠杆菌是最常见的微生物。对高能创伤性截肢（包括地铁损伤）的进一步研究，可能有助于改善患者预后的预测，识别潜在的住院并发症，并主动指出与非地铁相关截肢标准相比的护理差异。证据等级：预后III级。
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Pub Date : 2025-02-01DOI: 10.1016/j.injury.2025.112142
Meredith Stadnyk, Stephanie Gibbon, Richard Buckley
{"title":"What is the best surgical approach for open operative reduction of a mid-humerus fracture – anterior or posterior?","authors":"Meredith Stadnyk, Stephanie Gibbon, Richard Buckley","doi":"10.1016/j.injury.2025.112142","DOIUrl":"10.1016/j.injury.2025.112142","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112142"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.injury.2025.112159
Michael Keirsey, Grace M Niziolek
Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality among trauma patients. The care of these patients continues to be a complex endeavor with prevention of associated complications, often requiring as much attention as that of the treatment of the primary injury. Paramount among these are venous thromboembolic events (VTE) due to their high incidence, additive effect on the risk of morbidity and mortality, and the careful balance that must be utilized in their diagnosis and treatment to prevent progression of the brain injury itself.
In this review, we have synthesized the most recent major studies detailing the ideal choice of chemoprophylactic agent, the timing of initiation, and continued monitoring and management strategies through the hospital course and beyond. Additional discussion is provided for subpopulations in which management can vary significantly, including the elderly, critically ill, and obese. Ultimately, current literature supports the use and safety of low molecular weight heparin over unfractionated heparin, especially when dosed using newer assays including anti-Xa levels. The timing of prophylaxis remains important, as the risk of VTE increases with each day that prophylaxis is held. Consensus findings favor initiation within 24–72 h, in the absence of documented progression, life threatening bleeding, or need for major surgical intervention. Despite available data, there continues to be significant variability in practice patterns which we hope to address with this review.
创伤性脑损伤（TBI）仍然是创伤患者发病和死亡的主要原因。对这些患者的护理仍然是一项复杂的工作，预防相关并发症往往与治疗原发性损伤同样重要。其中最重要的是静脉血栓栓塞事件（VTE），因为其发病率高，对发病和死亡风险有叠加效应，而且在诊断和治疗时必须小心平衡，以防止脑损伤本身恶化。在这篇综述中，我们综合了最新的主要研究，详细介绍了化学预防药物的理想选择、开始治疗的时机以及住院期间及以后的持续监测和管理策略。此外，还针对老年患者、重症患者和肥胖患者等管理方法可能存在显著差异的亚人群进行了讨论。最终，目前的文献支持低分子量肝素的使用和安全性优于非分细肝素，尤其是在使用包括抗 Xa 水平在内的新检测方法时。预防的时机仍然很重要，因为每推迟一天预防，VTE 的风险就会增加一天。共识研究结果倾向于在 24-72 小时内开始预防，前提是没有记录在案的病情进展、危及生命的出血或需要重大手术干预。尽管有可用的数据，但实践模式仍然存在很大的差异，我们希望通过本综述解决这一问题。
{"title":"Management of post-injury anticoagulation in the traumatic brain injury patient: A scoping review","authors":"Michael Keirsey, Grace M Niziolek","doi":"10.1016/j.injury.2025.112159","DOIUrl":"10.1016/j.injury.2025.112159","url":null,"abstract":"<div><div>Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality among trauma patients. The care of these patients continues to be a complex endeavor with prevention of associated complications, often requiring as much attention as that of the treatment of the primary injury. Paramount among these are venous thromboembolic events (VTE) due to their high incidence, additive effect on the risk of morbidity and mortality, and the careful balance that must be utilized in their diagnosis and treatment to prevent progression of the brain injury itself.</div><div>In this review, we have synthesized the most recent major studies detailing the ideal choice of chemoprophylactic agent, the timing of initiation, and continued monitoring and management strategies through the hospital course and beyond. Additional discussion is provided for subpopulations in which management can vary significantly, including the elderly, critically ill, and obese. Ultimately, current literature supports the use and safety of low molecular weight heparin over unfractionated heparin, especially when dosed using newer assays including anti-Xa levels. The timing of prophylaxis remains important, as the risk of VTE increases with each day that prophylaxis is held. Consensus findings favor initiation within 24–72 h, in the absence of documented progression, life threatening bleeding, or need for major surgical intervention. Despite available data, there continues to be significant variability in practice patterns which we hope to address with this review.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112159"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974052","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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