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

{"title":"Letter to the Editor: “Health behavior, health, and socioeconomic background in adolescence as risk factors for traumatic brain injuries: A longitudinal study”","authors":"Shashank Dokania , Dr. Parth Aphale , Himanshu Shekhar","doi":"10.1016/j.injury.2025.112598","DOIUrl":"10.1016/j.injury.2025.112598","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112598"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated acetabular anterior wall fractures: fracture patterns, fixation methods and a new proposed classification system for a rare injury","authors":"Michela Saracco ,&nbsp;Vincenzo Ciriello ,&nbsp;Nikolaos K. Kanakaris ,&nbsp;Peter V. Giannoudis","doi":"10.1016/j.injury.2025.112958","DOIUrl":"10.1016/j.injury.2025.112958","url":null,"abstract":"<div><h3>Background</h3><div>Isolated anterior wall acetabulum fracture (AWF) represents a rare injury. There is a paucity of information available about this fracture and no classification has been proposed so far. The aim of this study was to analyse the various possible fracture patterns, related treatment approaches and to develop a new classification system.</div></div><div><h3>Methods</h3><div>Common search engines were systematically searched, according to the PRISMA guidelines. Data relating to the studies that reported surgical approaches and results about isolated AW fractures were included. Data quality was also assessed. We topographically subdivided the fractures, according to the percentage of the anterior wall involved, location of the fracture, and the degree of comminution. The mean follow-up was 38.8 months (6–240).</div></div><div><h3>Results</h3><div>17 papers were eligible for this study. The ilio-inguinal (ILI) approach was the most used one (58.2 %). Different reconstruction techniques were deployed. Anatomical reduction was obtained in 46.6 % of the cases. 3 patients required hip prosthesis within 18 months. Based on the evidence gathered the anterior wall was divided into 3 segments (proximal, (P) middle (M) and distal (D)1/3 segment. Based on the area of involvement in each zone was also divided into Type <em>I</em> &lt; 25 %; Type II 25–50 % and Type III &gt;50 %. Comminution (C) was also assigned if present in any of the 3 zones.</div></div><div><h3>Conclusion</h3><div>Isolated anterior wall acetabulum fracture is an uncommon injury. The IIL approach was the most used for fixation. A new classification system was developed to guide surgical approach and fixation techniques.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112958"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury Characteristics in Pedelec Users: A 7-Year Study Highlighting Risks in the Elderly Male Population at an Urban University Hospital in Germany","authors":"Frederik Aasen-Hartz ,&nbsp;Tobias Resch ,&nbsp;Victoria Hartmann,&nbsp;Philipp Zehnder,&nbsp;Ahmed Ellafi,&nbsp;Markus Schwarz,&nbsp;Peter Biberthaler,&nbsp;Michael Zyskowski","doi":"10.1016/j.injury.2025.112940","DOIUrl":"10.1016/j.injury.2025.112940","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze characteristics, accident mechanisms, injury patterns, and treatment of pedelec accidents, focusing on older riders (≥65 years) and those requiring intensive care.</div></div><div><h3>Methods</h3><div>This descriptive single-center study included all patients presenting after a pedelec accident at a level I trauma center (January 2017–December 2023). Data included demographics, accident mechanisms, injuries, and treatments. A subgroup analysis was performed for patients requiring intensive care.</div></div><div><h3>Results</h3><div>Between 2017 and 2023, 103 pedelec riders were injured, with annual cases rising steadily, peaking at 45 in 2023. Patients were predominantly male (57 %) with a mean age of 53 ± 19 years; 30 % were ≥65 years. Helmet use was documented in 34 %, alcohol in 10 %, and anticoagulant therapy in 15 %. Most accidents occurred during warmer months (66 %), in the afternoon (47 %), and were caused by rider errors (36 %) or car collisions (17 %). A total of 229 injuries were recorded (2.2 per patient), mainly affecting the head (33 %) and upper extremities (29 %).</div><div>Thirty patients (30 %) required surgery, 41 (40 %) were hospitalized, and 11 (11 %) needed ICU care. The predominant reason for ICU admission was severe traumatic brain injury (TBI) with intracranial hemorrhage, present in 91 % of ICU patients. These patients were significantly older (mean 77 ± 13 years; OR 1.11 per year, 95 % CI [1.05–1.20]; p = 0.002), more often on anticoagulants (45 %; OR 5.33, 95 % CI [1.37–20.80]; p = 0.022), and none wore a helmet (0 %; OR 0.07, 95 % CI [0.00–1.23]; p = 0.015, Haldane correction). Males ≥65 years had a 25-fold increased ICU admission risk (OR 25.07, 95 % CI [4.89–128.53]; p &lt; 0.001). Helmet use was associated with a 16.4 % absolute risk reduction (ARR) for ICU admission with a Number Needed to Treat (NNT) of 6. In-hospital mortality was 1.9 %.</div></div><div><h3>Conclusion</h3><div>Pedelec accidents have sharply increased, with injuries to the head and upper extremities most common. Older adults, especially men ≥65, face the highest risk of severe outcomes, including traumatic brain injury requiring ICU admission. Two-thirds of riders did not wear a helmet; helmet use significantly reduced critical injury risk. Focused prevention efforts—particularly promoting helmet use and rider safety education—are urgently needed.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112940"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of varenicline as an adjunct to analgesic and anti-inflammatory therapy in acute nerve injury","authors":"Volga Ozturk ,&nbsp;Yasemen Adali Rusen ,&nbsp;Ozge Ertener ,&nbsp;Yasemin Seval-Celik ,&nbsp;Ali Engin Dastan ,&nbsp;Serhat Ozgenc ,&nbsp;Elif Baris","doi":"10.1016/j.injury.2025.112908","DOIUrl":"10.1016/j.injury.2025.112908","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute nerve injury (ANI) leads to significant neuropathic pain and functional impairment. Current treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs) like meloxicam, provide symptomatic relief but have limited neuroregenerative effects. Varenicline, a nicotinic acetylcholine receptor (nAChR) agonist, has demonstrated neuroprotective and anti-inflammatory properties.</div></div><div><h3>Aim</h3><div>This study evaluates the effects of varenicline as an add-on therapy to meloxicam in a rat model of ANI.</div></div><div><h3>Methods</h3><div>Eighteen female Wistar rats were randomized into four groups: Control (CONT), Sham (SHAM), Acute Nerve Injury + Meloxicam (ANI+Melox), and Acute Nerve Injury + Meloxicam + Varenicline (ANI+Melox+VAR). Varenicline (2.5 mg/kg, s.c.) was administered alongside meloxicam (2 mg/kg, s.c.). Functional recovery, histopathological changes, and biochemical markers, including prostaglandins (PGE₂, PGI₂), substance P, IL-6, levels, were assessed after 30 days.</div></div><div><h3>Results</h3><div>Varenicline and meloxicam co-treatment significantly reduced inflammatory and pain biomarkers including prostaglandins, interleukin-6 and substance P, compared to meloxicam alone. Histopathological evaluation revealed enhanced Schwann cell proliferation, reduced fibrosis, and increased Bands of Büngner formation, suggesting nerve regeneration.</div></div><div><h3>Conclusion</h3><div>Varenicline, as an adjunct to meloxicam, enhances neuroprotection, reduces inflammation, and promotes histological and biochemical indicators of regeneration in rats with acute sciatic nerve injury. Future studies should explore its long-term effects and potential as a monotherapy for peripheral nerve injuries.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112908"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact and burden of spinal fractures in a small island state: Pre-, acute, and post-COVID-19 trends from Malta","authors":"Stephan Grech ,&nbsp;Andrea Cuschieri ,&nbsp;Franziska Mintoff ,&nbsp;Darryl Pisani ,&nbsp;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&lt;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":"2026-02-01","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}

{"title":"Robot-assisted percutaneous screws fixation for displaced intra-articular glenoid Ideberg Ia fractures","authors":"Jie Tan ,&nbsp;Yufu Zhang ,&nbsp;Xigong Zhang ,&nbsp;Yanchao Li ,&nbsp;Xieyuan Jiang ,&nbsp;Maoqi Gong","doi":"10.1016/j.injury.2025.112895","DOIUrl":"10.1016/j.injury.2025.112895","url":null,"abstract":"<div><h3>Background</h3><div>The objective of this study is to compare the clinical outcomes of robot-assisted percutaneous screw fixation with traditional ORIF for treating displaced intra-articular glenoid Ideberg Ia fractures.</div></div><div><h3>Methods</h3><div>This retrospective study included all patients diagnosed with displaced intra-articular glenoid fractures between January 1, 2021, and December 31, 2024, at our Level 3 hospital who met the inclusion and exclusion criteria. Patient demographics and intraoperative parameters were meticulously documented. Clinical outcomes were measured using the Constant Murley Shoulder score, the Quick Disabilities of the Arm, Shoulder, and Hand score, and the Visual Analogue Scale for pain. Each patient was asked to assess their satisfaction with the appearance of their scars using a 10-point Likert scale. The range of motion and any complications were thoroughly documented for further analysis. In addition, the time taken to resume work, sports activities, and recover the previous range of motion in the shoulder was also recorded.</div></div><div><h3>Results</h3><div>18 patients were included in the final analysis—8 in the robot-assisted group and 9 in the ORIF group. The robot-assisted group required significantly less operative time (70.00 ± 16.04 vs. 108.22 ± 34.67minutes, P &lt; 0.05), reduced blood loss (11.25 ± 7.44 vs. 120.00 ± 65.00 mL, P &lt; 0.05), smaller incision length (1.18 ± 0.26 vs. 12.24 ± 2.74 cm, P &lt; 0.05), faster resume work (13.13 ± 1.81 vs. 23.78 ± 15.57 weeks), quicker return to sports (17.00 ± 1.85 vs. 27.53 ± 13.63 weeks, P &lt; 0.05), a shorter time to regain full range of motion (13.00 ± 1.85 vs. 29.00 ± 12.05 weeks, P &lt; 0.05), and a higher scar cosmesis score (9.88 ± 0.35 vs. 5.17 ± 3.4, P &lt; 0.05). The robot-assisted group achieved bone union substantially faster, with an average time of 8.12 ± 0.35weeks compared to 13.33 ± 2.46 weeks in the ORIF group (P &lt; 0.05). In terms of active range of motion, patients in the robot-assisted group had a significantly better function in forward flexion, abduction, and internal rotation (150.00 ± 9.26 vs. 126.67 ± 21.94, 138.75 ± 12.46 vs. 106.25 ± 32.27, 84.38 ± 4.96 vs. 59.58 ± 15.73, respectively) (P &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Robot-assisted percutaneous screw fixation offers a safe and minimally invasive treatment option for displaced intra-articular glenoid Ideberg Ia fractures. This technique not only promotes faster healing but also provides superior cosmetic results and excellent functional outcomes when compared to traditional ORIF.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112895"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular trauma from pressure cooker explosions: A retrospective analysis from South India","authors":"Sowjanya Vuyyuru ,&nbsp;Sushank Ashok Bhalerao ,&nbsp;Prerana A Shetty ,&nbsp;Divya Tara ,&nbsp;Falguni Roy","doi":"10.1016/j.injury.2025.112900","DOIUrl":"10.1016/j.injury.2025.112900","url":null,"abstract":"<div><h3>Aim</h3><div>To analyze the spectrum of ocular injuries caused by pressure cooker explosions, evaluate visual outcomes, and highlight the need for increased safety awareness.</div></div><div><h3>Methods</h3><div>This retrospective study reviewed medical records of 40 patients presenting with ocular trauma due to pressure cooker explosions between January 2010 and December 2022 across four tertiary eye care centers in South India. Data collected included demographics, injury type, clinical findings, imaging results, surgical interventions, and visual outcomes. Injuries were classified based on the Birmingham Eye Trauma Terminology (BETT) system and graded according to the presenting and final best-corrected visual acuity (BCVA).</div></div><div><h3>Results</h3><div>The mean age at presentation was 40 ± 13.4 years, with a female predominance (65 %). Urban residents (62.5 %) were more frequently affected than rural individuals (37.5 %). Closed globe injuries comprised 80 % of cases, while open globe injuries accounted for 20 %. Blast injuries were the most common mechanism (57.5 %), followed by thermal injuries (40 %). Common ocular findings included hyphema (10 %), iridodialysis (7.5 %), traumatic cataract (12.5 %), and vitreous hemorrhage (7.5 %). Surgical intervention was required in 37.5 % of cases, with procedures ranging from conjunctival tear repair to evisceration. Poor visual prognosis was associated with open globe injuries and severe blast trauma.</div></div><div><h3>Conclusion</h3><div>Pressure cooker-related ocular trauma predominantly affects women in domestic settings and can lead to severe vision loss. Increased public awareness, manufacturer adherence to safety standards, and user education on proper handling may help reduce the incidence of such injuries.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112900"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computer-vision based recognition of cervical spine stabilization during trauma resuscitation","authors":"Mary S. Kim ,&nbsp;Sifan Yuan ,&nbsp;Genevieve J. Sippel ,&nbsp;Aaron H. Mun ,&nbsp;Dylan W. Arkowitz ,&nbsp;Ivan Marsic ,&nbsp;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":"2026-02-01","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}

{"title":"Diagnosis of shoulder dislocation on AP radiographs: A comparative analysis of diagnostic performance between orthopedic surgeons, emergency physicians, and ChatGPT models","authors":"Alper Kirilmaz ,&nbsp;Turgut E. Erdem ,&nbsp;Haluk Yaka ,&nbsp;Ahmet Yildirim ,&nbsp;Mustafa Ozer","doi":"10.1016/j.injury.2025.112957","DOIUrl":"10.1016/j.injury.2025.112957","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the diagnostic performance of ChatGPT in identifying acute shoulder dislocations and to compare its accuracy with that of orthopedic specialists and emergency medicine residents.</div></div><div><h3>Methods</h3><div>A total of 250 anteroposterior (AP) shoulder radiographs were included. All images were evaluated for the presence or absence of dislocation and for dislocation subtype (anterior, posterior, inferior) by four groups: orthopedic specialists (<em>n</em> = 10), orthopedic residents (<em>n</em> = 10), emergency medicine residents (<em>n</em> = 10), and ChatGPT. ChatGPT-4o (OpenAI, May 2024) and ChatGPT-5.1 (OpenAI, July 2025) were accessed through the web interface using a standardized single image + text-based prompt. The models had no prior training with radiological images. Diagnostic performance was assessed using sensitivity, specificity, positive and negative predictive values, overall accuracy, area under the ROC curve (AUC), F1 score, and Cohen’s kappa for inter-reader agreement.</div></div><div><h3>Results</h3><div>In the detection of shoulder dislocation (yes/no), orthopedic specialists demonstrated the highest accuracy (95.0 %), whereas ChatGPT-4o showed the lowest (72.4 %). Orthopedic residents achieved 90.1 % accuracy, emergency medicine residents 89.0 %, and ChatGPT-5.1 78.0 %. When subtype classification (anterior, posterior, inferior) was included, orthopedic specialists again performed best (89.7 %), while ChatGPT-4o had the lowest accuracy (68.0 %). Orthopedic residents (84.7 %) outperformed emergency medicine residents (76.7 %), while ChatGPT-5.1 achieved 69.6 % accuracy. Internal-rotation AP images of nondislocated shoulders were frequently misinterpreted as posterior dislocations.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that the diagnostic accuracy for acute shoulder dislocation varies according to the clinicians’ level of experience. The use of a single AP shoulder radiograph alone is not sufficient for diagnosing shoulder dislocation. Clinicians most frequently misinterpreted internally rotated AP shoulder radiographs as posterior dislocations. ChatGPT models showed moderate performance and are not yet suitable as standalone diagnostic tools in clinical decision-making. However, with further development of artificial intelligence–based systems, these models may serve as rapid preliminary screening aids in emergency settings.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112957"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior iliac crescent fracture-dislocations: Evaluation of morphological aspects and mechanisms in unstable pelvic ring injuries","authors":"Leonardo Comerlatto ,&nbsp;Déborah Silveira König ,&nbsp;Natália Henz Concatto ,&nbsp;Leandro de Freitas Spinelli ,&nbsp;Marcelo Faria Silva ,&nbsp;Vincenzo Giordano","doi":"10.1016/j.injury.2025.112967","DOIUrl":"10.1016/j.injury.2025.112967","url":null,"abstract":"<div><h3>Introduction</h3><div>Posterior iliac crescent fracture-dislocations (PICFDs) were originally considered rotationally unstable and vertically stable injuries, strongly associated with lateral compression (LC) mechanism. However, it is currently recognized that PICFDs may exhibit variable injury patterns and result from different mechanisms. The purpose of this study was to evaluate relevant morphological aspects and the mechanism of injury of PICFDs in a cohort of patients presenting unstable pelvic ring injuries (PRIs)</div></div><div><h3>Patients and Methods</h3><div>Patients presenting unstable PRIs that underwent surgical treatment at two level 1 trauma centers from January 2019 to December 2024 were retrospectively reviewed. Individuals presenting PICFDs were recorded, and relevant morphological aspects scrutinized.</div></div><div><h3>Results</h3><div>363 unstable PRIs were identified and a PICFD was present in 29 (8.0%) individuals. Among these, 23 (79.3%) were attributed to LC, 4 (13.8%) to APC (anteroposterior compression) and 2 (6.9%) to CCM (complex/combined mechanism). According to Day’s classification, PICFDs were categorized as type I (n=8, 27.6%), type II (n=16, 55.2%), and type III (n=5, 17.2%). Most PICFDs (n=26, 89.6%) were displaced, 72.4% (n=21) exhibited posterior dislocation and 96,5% (n=28) presented associated ipsilateral anterior pelvic ring disruption. Comminution of the crescent-shaped fragment was seen in 13.8% (n=4) patients and vertical instability was observed in 34.5% (n=10) PICFDs.</div></div><div><h3>Conclusion</h3><div>This investigation reinforced modern concepts regarding PICFDs, suggesting that the understanding of this infrequent injury pattern warrants constant refinement. Morphological aspects of PRIs presenting with PICFDs were detailed, exhibiting variable deformity, displacement and comminution. Furthermore, PICFDs can be caused by different injury mechanisms and carry the potential to cause vertical instability.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112967"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784062","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}