Injury-International Journal of the Care of the Injured最新文献_第7页

Fibrinogen as an early predictor of acute organ dysfunction in pelvic fractures 纤维蛋白原作为骨盆骨折急性器官功能障碍的早期预测因子。

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-02-01 Epub Date: 2025-12-11 DOI: 10.1016/j.injury.2025.112970

Po-Chun Wang , Kuo-En Chen , Hui-An Lin , Sheng-Feng Lin

Objective

Pelvic fractures are associated with substantial morbidity and mortality, yet the prognostic value of initial fibrinogen levels remains underexplored.

Methods

We conducted a global retrospective cohort study using data from the TriNetX Global Collaborative Network (2005–2025), with ≥30 days of follow-up. Patients with pelvic fractures and fibrinogen data were included. Propensity score matching adjusted for age, sex, race, ethnicity, comorbidities, and labs. Primary outcomes were mortality and complications in patients with fibrinogen ≤200 mg/dL compared to >200.01 mg/dL. Relative risks (RR) and number needed to harm (NNH) were calculated at 1, 3, 7, 14, and 30 days. Subgroup and sensitivity analyses tested robustness.

Results

10,552 patients were included after matching, with 5276 patients in each cohort. The low fibrinogen group exhibited significantly higher risks of adverse outcomes at 30 days, including acute kidney injury (RR, 1.30; 95 % CI, 1.21–1.41; NNH: 18), shock (RR, 1.51; 95 % CI, 1.40–1.85; NNH: 12), respiratory failure (RR, 1.29; 95 % CI, 1.24–1.34; NNH: 9), acute respiratory distress syndrome (RR, 1.28; 95 % CI, 1.08–1.52; NNH: 84), disseminated intravascular coagulation (RR, 2.06; 95 % CI, 1.70–2.47; NNH: 32), and all-cause mortality (RR, 1.90; 95 % CI, 1.70–2.14; NNH: 15). These associations were consistent across subgroups stratified by age and sex, and held steady in sensitivity analyses using lower fibrinogen thresholds.

Conclusion

A fibrinogen level of ≤ 200 mg/dL is associated with increased mortality and acute organ dysfunction in patients with pelvic fractures.

目的：骨盆骨折与大量发病率和死亡率相关，但初始纤维蛋白原水平的预后价值仍未得到充分探讨。方法：我们使用TriNetX全球协作网络（2005-2025）的数据进行了一项全球回顾性队列研究，随访时间≥30天。包括骨盆骨折患者和纤维蛋白原数据。根据年龄、性别、种族、民族、合并症和实验室调整倾向评分匹配。主要结局是纤维蛋白原≤200mg /dL患者的死亡率和并发症，而纤维蛋白原≤200.01 mg/dL患者的死亡率和并发症。在第1、3、7、14和30天计算相对危险度（RR）和所需伤害数（NNH）。亚组分析和敏感性分析检验了稳健性。结果：匹配后纳入10552例患者，每组5276例。低纤维蛋白原组在30天内表现出明显更高的不良结局风险，包括急性肾损伤（RR, 1.30; 95% CI, 1.21-1.41; NNH: 18）、休克（RR, 1.51; 95% CI, 1.40-1.85; NNH: 12）、呼吸衰竭（RR, 1.29; 95% CI, 1.24-1.34; NNH: 9）、急性呼吸窘迫综合征（RR, 1.28; 95% CI, 1.08-1.52; NNH: 84）、弥散性血管内凝血（RR, 2.06; 95% CI, 1.70-2.47; NNH: 32）和全因死亡率（RR, 1.90; 95% CI, 1.70-2.14; NNH: 15）。这些关联在按年龄和性别分层的亚组中是一致的，并且在使用较低纤维蛋白原阈值的敏感性分析中保持稳定。结论：纤维蛋白原水平≤200mg /dL与骨盆骨折患者死亡率增加和急性器官功能障碍相关。

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引用次数: 0

Injury Characteristics in Pedelec Users: A 7-Year Study Highlighting Risks in the Elderly Male Population at an Urban University Hospital in Germany Pedelec使用者的损伤特征：德国一所城市大学医院的一项7年研究突出了老年男性人群的风险。

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-02-01 Epub Date: 2025-12-05 DOI: 10.1016/j.injury.2025.112940

Frederik Aasen-Hartz , Tobias Resch , Victoria Hartmann, Philipp Zehnder, Ahmed Ellafi, Markus Schwarz, Peter Biberthaler, Michael Zyskowski

Purpose

To analyze characteristics, accident mechanisms, injury patterns, and treatment of pedelec accidents, focusing on older riders (≥65 years) and those requiring intensive care.

Methods

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.

Results

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 %).

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 < 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 %.

Conclusion

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.

目的：以年龄较大（≥65岁）及需要重症监护的骑手为研究对象，分析骑车事故的特点、事故机制、损伤模式及治疗方法。方法：本描述性单中心研究纳入了2017年1月至2023年12月在一级创伤中心发生足部事故后就诊的所有患者。数据包括人口统计、事故机制、伤害和治疗。对需要重症监护的患者进行亚组分析。结果：2017年至2023年间，共有103名骑自行车者受伤，每年的病例数量稳步上升，2023年达到45例的峰值。患者以男性为主（57%），平均年龄53±19岁；30%≥65岁。34%的人使用头盔，10%的人使用酒精，15%的人使用抗凝治疗。大多数事故发生在温暖的月份（66%），下午（47%），由骑手失误（36%）或汽车碰撞（17%）引起。共记录229例损伤（每例2.2例），主要影响头部（33%）和上肢（29%）。30例（30%）需要手术治疗，41例（40%）住院治疗，11例（11%）需要ICU护理。重症监护室住院的主要原因是严重创伤性脑损伤（TBI）合并颅内出血，占ICU患者的91%。这些患者明显年龄较大（平均77±13岁；OR为1.11，每年，95% CI [1.05-1.20]; p = 0.002），使用抗凝剂较多（45%；OR为5.33,95% CI [1.37-20.80]; p = 0.022），且没有佩戴头盔（0%；OR为0.07,95% CI [0.001 -1.23]; p = 0.015， Haldane校正）。男性≥65岁入院风险增加25倍（OR 25.07, 95% CI [4.89-128.53]; p < 0.001）。对于需要治疗的人数（NNT）为6的ICU患者，使用头盔可使绝对风险降低16.4% （ARR）。住院死亡率为1.9%。结论：下肢意外事故急剧增加，以头部和上肢损伤最为常见。老年人，特别是≥65岁的男性，面临严重后果的最高风险，包括需要进入ICU的创伤性脑损伤。三分之二的骑手没有戴头盔；头盔的使用显著降低了严重伤害的风险。迫切需要集中预防工作，特别是促进头盔使用和骑手安全教育。

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引用次数: 0

Computer-vision based recognition of cervical spine stabilization during trauma resuscitation 创伤复苏中颈椎稳定的计算机视觉识别。

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-02-01 Epub Date: 2025-12-10 DOI: 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.

背景：颈椎损伤可导致严重的残疾和死亡。虽然稳定是疑似颈椎损伤的主要治疗方法，但在创伤复苏过程中，稳定失误经常发生。为了便于评估颈椎管理，我们开发了一种计算机视觉系统来检测稳定技术。该系统可实现可扩展的监测，包括颈椎稳定的时间和持续时间。方法：我们开发了一个两阶段的计算机视觉系统来检测院前刚性c型领、医院半刚性c型领和人工在线稳定。该系统使用从2022年10月至2023年5月一家一级儿科创伤中心的86个儿科创伤复苏视频中提取的图像帧进行训练、测试和验证。第一阶段在每张图像中识别患者，第二阶段对稳定技术进行分类。对前68个用于培训/测试的复苏视频进行5倍交叉验证，最后18个病例保留用于验证。系统性能评估使用准确性、精密度、召回率、F1分数和马修斯相关系数（MCC）。为了评估人工在线检测的系统潜力，增加了10个模拟视频（8个用于培训，2个用于测试）。结果：在18例验证病例中，该系统在二元分类（0.91）和特定稳定技术检测方面均取得了较高的准确性：院前刚性c-collar(0.95)，医院半刚性c-collar（0.93）和手动在线稳定（0.97）。任意稳定化方法二元分类的精度得分为0.89，院前刚性c-collar的精度得分为0.71，医院半刚性c-collar的精度得分为0.89，手工直管的精度得分为0.04。回想一下，F1和MCC评分与这些发现一致，在稳定技术中，检测医院半刚性c型颈圈的得分最高。添加仿真视频后，手动在线稳定检测的准确率为0.62，精密度为0.88，召回率为0.58，F1得分为0.70，MCC为0.27。结论：两阶段计算机视觉系统在检测颈椎稳定方面表现优异，但由于其罕见，人工在线稳定存在局限性。模拟数据改进了手动在线检测，突出了更平衡的数据集的潜在好处。计算机视觉系统可以作为使用复苏室内摄像机基础设施对创伤复苏进行自动监测的原型。

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引用次数: 0

Diagnosis of shoulder dislocation on AP radiographs: A comparative analysis of diagnostic performance between orthopedic surgeons, emergency physicians, and ChatGPT models 肩关节脱位的AP片诊断：骨科医生、急诊医生和ChatGPT模型诊断性能的比较分析

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-02-01 Epub Date: 2025-12-11 DOI: 10.1016/j.injury.2025.112957

Alper Kirilmaz , Turgut E. Erdem , Haluk Yaka , Ahmet Yildirim , Mustafa Ozer

Objective

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.

Methods

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 (n = 10), orthopedic residents (n = 10), emergency medicine residents (n = 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.

Results

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.

Conclusion

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.

目的：本研究旨在评估ChatGPT对急性肩关节脱位的诊断性能，并将其与骨科专家和急诊住院医师的准确性进行比较。方法：共纳入250张肩关节正位x线片。所有图像均由骨科专家（n = 10）、骨科住院医师（n = 10）、急诊住院医师（n = 10）和ChatGPT四组评估脱位的存在与否和脱位亚型（前位、后位、下位）。chatgpt - 40 （OpenAI， 2024年5月）和ChatGPT-5.1 （OpenAI， 2025年7月）通过web界面使用标准化的单一图像+文本提示访问。这些模型没有事先接受过放射图像的训练。通过敏感性、特异性、阳性预测值和阴性预测值、总体准确性、ROC曲线下面积（AUC）、F1评分和科恩卡帕评分来评估诊断效果。结果：在肩部脱位（是/否）的检测中，骨科专家的准确率最高（95.0%），而chatgpt - 40的准确率最低（72.4%）。骨科住院医师的准确率为90.1%，急诊住院医师的准确率为89.0%,chatgpt - 5.1%为78.0%。当包括亚型分类（前、后、下）时，骨科专家再次表现最佳（89.7%），而chatgpt - 40的准确率最低（68.0%）。骨科住院医师（84.7%）优于急诊住院医师（76.7%），而ChatGPT-5.1的准确率为69.6%。未脱位的肩部内旋AP图像常被误解为后路脱位。结论：本研究表明，急性肩关节脱位的诊断准确性因临床医生的经验水平而异。单独使用单一的前位肩关节x线片不足以诊断肩关节脱位。临床医生最常将内旋后位肩片错误解读为后路脱位。ChatGPT模型表现出中等的性能，尚不适合作为临床决策的独立诊断工具。然而，随着基于人工智能系统的进一步发展，这些模型可以在紧急情况下作为快速初步筛选的辅助手段。

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引用次数: 0

Posterior iliac crescent fracture-dislocations: Evaluation of morphological aspects and mechanisms in unstable pelvic ring injuries 后髂月牙骨折脱位：不稳定骨盆环损伤的形态学和机制评估。

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-02-01 Epub Date: 2025-12-11 DOI: 10.1016/j.injury.2025.112967

Leonardo Comerlatto , Déborah Silveira König , Natália Henz Concatto , Leandro de Freitas Spinelli , Marcelo Faria Silva , Vincenzo Giordano

Introduction

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)

Patients and Methods

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.

Results

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.

Conclusion

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.

后髂月牙骨折脱位（picfd）最初被认为是旋转不稳定和垂直稳定的损伤，与侧压（LC）机制密切相关。然而，目前人们认识到picfd可能表现出不同的损伤模式和不同的机制。本研究的目的是评估一组不稳定骨盆环损伤（PRIs）患者picfd的相关形态学方面和损伤机制。患者和方法：回顾性分析2019年1月至2024年12月在两个一级创伤中心接受手术治疗的不稳定骨盆环损伤患者。记录了出现picfd的个体，并仔细检查了相关的形态学方面。结果：鉴定出363例不稳定PRIs，其中29例（8.0%）存在PICFD。其中LC 23例（79.3%），APC 4例（13.8%），CCM 2例（6.9%）（复杂/联合机制）。根据Day的分类，picfd分为I型（n=8, 27.6%）、II型（n=16, 55.2%）和III型（n=5, 17.2%）。大多数picfd （n=26, 89.6%）移位，72.4% （n=21）出现后路脱位，96.5% （n=28）出现同侧骨盆前环断裂。13.8% （n=4）的患者出现月牙形碎片粉碎，34.5% （n=10）的picfd出现垂直不稳定。结论：该研究强化了picfd的现代概念，表明对这种罕见损伤模式的理解需要不断完善。以picfd为表现的PRIs的形态学方面被详细描述，表现出不同的畸形、移位和粉碎。此外，picfd可能由不同的损伤机制引起，并可能导致垂直失稳。

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引用次数: 0

Better management of Sanders Ⅱ and Ⅲ calcaneus fractures via a tailored distractor-assisted percutaneous approach versus sinus tarsi approach: a comparative cohort study with 2-year follow-up 与跗骨窦入路相比，通过量身定制的牵张器辅助经皮入路更好地治疗SandersⅡ和Ⅲ跟骨骨折：一项2年随访的比较队列研究

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-02-01 Epub Date: 2025-11-19 DOI: 10.1016/j.injury.2025.112896

Xiong Liao, Jianliang Deng, Wei Liu, Di You

<div><h3>Background</h3><div>The surgical strategy of displaced intra-articular calcaneal fractures (DIACFs) remains technically challenging. While sinus tarsi approach (STA) is widely applied for DIACFs, increasing concerns regarding the wound-related sequelae drive surgeons to target and advance minimally invasive surgery (MIS). This study aims to introduce a tailored distractor-assisted MIS and compares its medium-term outcomes with conventional STA approach reduction and fixation in patients with Sanders Ⅱ and Ⅲ calcaneus fractures.</div></div><div><h3>Methods</h3><div>From Jan 2021 to Jun 2023, 133 cases (133 feet) diagnosed as DIACFs are prospectively randomized to receive either the tailored distractor-assisted MIS (MIS-arm) or conventional STA (STA-arm) reduction and fixation in the city trauma center. A 2-year follow-up is scheduled to record surgical outcomes. The medical records and radiological measurements during the follow-up are retrospectively retrieved and compared between the two treatment-arms for curative effect evaluation. At the last follow-up, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hind foot score and Visual Analog Scale (VAS) score are used to evaluate the functional rehabilitation.</div></div><div><h3>Results</h3><div>The basic demographic characteristics and clinical presentations were comparable among the MIS-arm (67 feet) and the STA-arm (66 feet). Perioperatively, the MIS-arm vs STA-arm showed significant advantages in the interval between injury to operation, the operation time, and the hospital stay (average 1.3 vs 3.8 days, <em>P</em> < .05; 40.1 vs 65.4 min, <em>P</em> < .05; 4.9 vs 8.5 days, <em>P</em> < .05; respectively). Notably, the MIS-arm vs STA-arm was less likely to develop wound infection (0 % vs 6.1 %, <em>P</em> < .05). For postoperative radiological measurements, the MIS-arm achieved significant improvement from pre-operation with regards to calcaneal height, width, Bohler’s angle, and Gissane angle (<em>p</em> < 0.05, respectively) as the STA-arm done and there were no differences between those two-arms in any above radiological indices (<em>p</em> > 0.05, respectively). At the last follow-up, the functional outcomes including AOFAS and the VAS were comparable between the two cohorts (81.4 ± 7.6 vs 79.5 ± 8.8, <em>t</em> = −2.20, <em>P</em> > .05; 1.3 ± 1.5 vs 2.30 ± 0.9, <em>t</em> = −4.33, <em>P</em> > .05; respectively). During the 2-year follow-up, no failure of reduction were observed. Further subgroup analysis confirmed no technical preference regarding MIS among Sanders type II and III.</div></div><div><h3>Conclusion</h3><div>The tailored distractor-assisted MIS actually worked out as conventional STA strategy did in radiological and functional outcomes for Sanders Ⅱ and Ⅲ calcaneus fractures. Lower rate of incision-related complications showed advantages of the tailored distractor-assisted MIS over STA. Further cohort study is required to clari

背景：移位性跟骨关节内骨折（DIACFs）的手术策略在技术上仍然具有挑战性。虽然鼻窦入路（STA）广泛应用于DIACFs，但对伤口相关后遗症的担忧日益增加，促使外科医生瞄准和推进微创手术（MIS）。本研究旨在介绍一种量身定制的牵引器辅助MIS，并将其与传统STA入路复位和固定治疗SandersⅡ和Ⅲ跟骨骨折患者的中期结果进行比较。方法：从2021年1月至2023年6月，133例（133英尺）诊断为DIACFs的患者在城市创伤中心前瞻性随机接受量身定制的分心器辅助MIS （MIS-arm）或传统STA （STA-arm）复位和固定。2年随访记录手术结果。回顾性检索随访期间的医疗记录和放射学测量，比较两治疗组的疗效。末次随访采用美国矫形足踝协会（AOFAS）踝后足评分和视觉模拟量表（VAS）评分评价功能康复情况。结果mis臂（67英尺）和sta臂（66英尺）的基本人口学特征和临床表现具有可比性。围手术期，miss臂与sta -臂在损伤至手术间隔、手术时间和住院时间上均有显著优势（平均1.3天vs 3.8天，P < 0.05； 40.1天vs 65.4分钟，P < 0.05； 4.9天vs 8.5天，P < 0.05）。值得注意的是，miss组与sta组发生伤口感染的可能性较低（0% vs 6.1%, P < 0.05）。术后影像学指标方面，与sta臂相比，miss臂的跟骨高度、宽度、Bohler角、Gissane角较术前均有显著改善（p < 0.05），两臂在上述影像学指标上均无差异（p < 0.05）。末次随访时，两组患者的AOFAS和VAS功能指标具有可比性（81.4±7.6 vs 79.5±8.8,t = - 2.20, P > 0.05; 1.3±1.5 vs 2.30±0.9,t = - 4.33, P > 0.05）。在2年的随访中，没有观察到复位失败。进一步的亚组分析证实Sanders II型和III型患者对MIS没有技术偏好。结论：在SandersⅡ和Ⅲ跟骨骨折的放射学和功能预后方面，量身定制的牵张器辅助MIS与传统STA策略一样有效。较低的切口相关并发症率显示了量身定制的牵张器辅助MIS优于STA的优势。需要进一步的队列研究来阐明其与其他MIS技术的临床意义。

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引用次数: 0

Effects of varenicline as an adjunct to analgesic and anti-inflammatory therapy in acute nerve injury 伐尼克兰辅助镇痛和抗炎治疗急性神经损伤的效果

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-02-01 Epub Date: 2025-11-26 DOI: 10.1016/j.injury.2025.112908

Volga Ozturk , Yasemen Adali Rusen , Ozge Ertener , Yasemin Seval-Celik , Ali Engin Dastan , Serhat Ozgenc , Elif Baris

Introduction

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.

Aim

This study evaluates the effects of varenicline as an add-on therapy to meloxicam in a rat model of ANI.

Methods

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.

Results

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.

Conclusion

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.

急性神经损伤（ANI）导致明显的神经性疼痛和功能障碍。目前的治疗方法，包括非甾体抗炎药（NSAIDs），如美洛昔康，可以缓解症状，但对神经再生的影响有限。Varenicline是一种尼古丁乙酰胆碱受体（nAChR）激动剂，具有神经保护和抗炎特性。目的本研究在ANI大鼠模型中评价伐尼克兰加用美洛昔康治疗的效果。方法18只雌性Wistar大鼠随机分为4组：对照组（CONT）、假手术组（Sham）、急性神经损伤+美洛昔康组（ANI+Melox）、急性神经损伤+美洛昔康+伐尼克兰组（ANI+Melox+VAR）。伐尼克兰（2.5 mg/kg, s.c）与美洛昔康（2 mg/kg, s.c）同时给药。30天后评估功能恢复、组织病理学改变和生化指标，包括前列腺素（pge2、PGI 2）、P物质、IL-6水平。结果与美洛昔康单独治疗相比，伐尼克兰与美洛昔康联合治疗可显著降低炎症和疼痛生物标志物，包括前列腺素、白细胞介素-6和P物质。组织病理学评估显示许旺细胞增殖增强，纤维化减少，神经纤维形成带增加，提示神经再生。结论伐尼克兰作为美洛昔康的辅助药物，对急性坐骨神经损伤大鼠具有增强神经保护、减轻炎症、促进组织生化指标再生的作用。未来的研究应探讨其长期效果和作为周围神经损伤单一疗法的潜力。

{"title":"Effects of varenicline as an adjunct to analgesic and anti-inflammatory therapy in acute nerve injury","authors":"Volga Ozturk , Yasemen Adali Rusen , Ozge Ertener , Yasemin Seval-Celik , Ali Engin Dastan , Serhat Ozgenc , 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}

引用次数: 0

The impact and burden of spinal fractures in a small island state: Pre-, acute, and post-COVID-19 trends from Malta 小岛屿国家脊柱骨折的影响和负担：马耳他的covid -19前、急性和后趋势

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-02-01 Epub Date: 2025-12-10 DOI: 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.

背景：脊柱骨折是发病率的重要原因，需要急性和长期护理。他们在小州的流行病学数据有限。本研究旨在描述马耳他五年来脊柱骨折的人口负担、临床特征和医疗保健影响。方法采用马耳他Mater Dei医院2019 - 2024年医院活动分析（HAA）数据库进行回顾性分析。数据包括人口统计学、骨折类型（ICD-10）、住院时间（LOS）、入院和出院来源、损伤机制、需要入住重症监护病房（ITU）、脊髓损伤和合并症。骨折类型分为颈椎、胸椎、腰椎单节段骨折和多节段骨折。采用描述性统计、卡方检验、t检验和逻辑回归，p<；0.05为显著性。结果本组共发生脊柱骨折640例（男56%，女44%）。腰椎单节段骨折最常见（38%），其次是多节段骨折（30%）。跌倒是主要的发病机制（53%）。90%的患者直接从家中入院，只有70%的患者出院回家，16%的患者需要转到康复中心。最长的LOS是颈椎单节段骨折（15.7天，p=0.019）。ITU入院的情况并不常见（4%），主要是多层骨折，这类骨折的脊髓损伤发生率也最高（36%）。合并症很常见（71%），尤其是心血管疾病（49%）。Logistic回归分析显示多发病与单节段骨折呈正相关（OR 1.66, 95% CI: 1.04-2.67, p=0.035）。结论脊柱骨折在马耳他造成了巨大的负担，从急性护理延伸到康复。跌倒是主要原因，多病对骨折类型有显著影响。这些发现强调了在小州医疗保健系统中需要综合预防跌倒策略、慢性病管理和加强康复服务。

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引用次数: 0

Robot-assisted percutaneous screws fixation for displaced intra-articular glenoid Ideberg Ia fractures 机器人辅助经皮螺钉固定术治疗移位的关节内盂内骨折

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-02-01 Epub Date: 2025-11-19 DOI: 10.1016/j.injury.2025.112895

Jie Tan , Yufu Zhang , Xigong Zhang , Yanchao Li , Xieyuan Jiang , Maoqi Gong

Background

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.

Methods

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.

Results

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 < 0.05), reduced blood loss (11.25 ± 7.44 vs. 120.00 ± 65.00 mL, P < 0.05), smaller incision length (1.18 ± 0.26 vs. 12.24 ± 2.74 cm, P < 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 < 0.05), a shorter time to regain full range of motion (13.00 ± 1.85 vs. 29.00 ± 12.05 weeks, P < 0.05), and a higher scar cosmesis score (9.88 ± 0.35 vs. 5.17 ± 3.4, P < 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 < 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 < 0.05).

Conclusion

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.

本研究的目的是比较机器人辅助经皮螺钉内固定与传统ORIF治疗移位性关节盂内骨折的临床效果。方法本回顾性研究纳入了2021年1月1日至2024年12月31日在三级医院诊断为移位性关节盂内骨折的所有患者，符合纳入和排除标准。详细记录了患者人口统计学和术中参数。临床结果采用Constant Murley肩部评分、手臂、肩部和手部快速残疾评分和疼痛视觉模拟量表进行测量。每位患者被要求用10分李克特量表评估他们对疤痕外观的满意度。运动范围和任何并发症都被彻底记录下来，以便进一步分析。此外，还记录了恢复工作、体育活动和恢复肩部先前活动范围所需的时间。结果18例患者纳入最终分析，其中机器人辅助组8例，ORIF组9例。符合集团要求大大减少手术时间(70.00±16.04和108.22±34.67分钟,P & lt; 0.05),减少失血(11.25±7.44和120.00±65.00毫升,P & lt; 0.05),小切口长度(1.18±0.26和12.24±2.74厘米,P & lt; 0.05),更快的恢复工作(13.13±1.81和23.78±15.57周),快回到体育(17.00±1.85和27.53±13.63周,P & lt; 0.05),更短的时间内恢复全面的运动(13.00±1.85和29.00±12.05周,瘢痕美容评分较高（9.88±0.35比5.17±3.4,P < 0.05）。机器人辅助组的骨愈合速度明显更快，平均时间为8.12±0.35周，而ORIF组为13.33±2.46周（P < 0.05）。在活动范围方面，机器人辅助组患者的前屈、外展和内旋功能（分别为150.00±9.26比126.67±21.94,138.75±12.46比106.25±32.27,84.38±4.96比59.58±15.73）明显更好（P < 0.05）。结论机器人辅助下经皮螺钉内固定术是治疗移位型肩关节内骨折的一种安全、微创的治疗方法。与传统的ORIF相比，该技术不仅促进了更快的愈合，而且提供了更好的美容效果和良好的功能结果。

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引用次数: 0

Ocular trauma from pressure cooker explosions: A retrospective analysis from South India 高压锅爆炸造成的眼外伤：来自印度南部的回顾性分析

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2026-02-01 Epub Date: 2025-11-20 DOI: 10.1016/j.injury.2025.112900

Sowjanya Vuyyuru , Sushank Ashok Bhalerao , Prerana A Shetty , Divya Tara , Falguni Roy

Aim

To analyze the spectrum of ocular injuries caused by pressure cooker explosions, evaluate visual outcomes, and highlight the need for increased safety awareness.

Methods

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).

Results

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.

Conclusion

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.

目的分析高压锅爆炸引起的眼部损伤，评估视觉结果，并强调提高安全意识的必要性。方法本回顾性研究回顾了2010年1月至2022年12月印度南部四家三级眼科护理中心40例因高压锅爆炸引起眼外伤的患者的医疗记录。收集的数据包括人口统计学、损伤类型、临床表现、影像学结果、手术干预和视觉结果。根据伯明翰眼外伤术语（BETT）系统对损伤进行分类，并根据表现和最终最佳矫正视力（BCVA）进行分级。结果患者平均发病年龄40±13.4岁，女性居多（65%）。城市居民（62.5%）比农村居民（37.5%）更频繁地受到影响。闭合性球损伤占80%，而开放性球损伤占20%。爆炸伤是最常见的机制（57.5%），其次是热伤（40%）。常见的眼部表现包括前房积血（10%）、虹膜透析（7.5%）、外伤性白内障（12.5%）和玻璃体出血（7.5%）。37.5%的病例需要手术干预，手术范围从结膜撕裂修复到内脏切除。视力预后差与开放球损伤和严重爆炸创伤有关。结论高压锅相关眼外伤主要影响家庭妇女，可导致严重的视力丧失。提高公众意识，制造商遵守安全标准，以及对用户进行正确处理的教育，可能有助于减少此类伤害的发生。

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