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

{"title":"The effect of reaming on the repair of a rabbit tibial osteotomy stabilised by an intramedullary locking nail","authors":"Richard Neville Brueton","doi":"10.1016/j.injury.2025.112978","DOIUrl":"10.1016/j.injury.2025.112978","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this investigation is to study the effect of intramedullary reaming on the repair of a rabbit tibial osteotomy stabilised by a specially designed locking nail.</div></div><div><h3>Materials and Methods</h3><div>A tibial osteotomy was carried out in two similar groups of ten New Zealand White rabbits. In one group, reaming was carried out prior to nailing, while in the second group, the nail was inserted without reaming. At four weeks postoperatively, CT scans of operated and non-operated contralateral tibiae enabled the percentage increase in bone volume of the whole tibial shaft to be measured in both reamed and unreamed groups.</div></div><div><h3>Results</h3><div>Although there was larger increase in callus volume in the tibial shaft of the reamed group (40.21 % ± 25.87) than the unreamed group (37.94 % ±15.12), this was not statistically significant (<em>p</em> = 0.81).</div></div><div><h3>Discussion</h3><div>Intramedullary reaming of the intact rabbit tibia results in the production of vascular external callus formation. Although the medullary circulation is initially damaged, this is subsequently restored. Intramedullary reaming produces reaming debris that enters the osteotomy gap and acts as an autologous bone graft. In this study, all the rabbit tibial osteotomies stabilised by intramedullary nails progressed to bony union. Intramedullary reaming did not produce more callus than that following the insertion of an unreamed intramedullary nail.</div></div><div><h3>Conclusion</h3><div>All of the rabbit tibial osteotomies stabilised by intramedullary nails progressed to bone union and additional intramedullary reaming did not produce additional callus. The potential of the rabbit tibia to produce callus appears to be limited to the amount of callus required to achieve bone union.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112978"},"PeriodicalIF":2.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is percutaneous pelvic fixation becoming more prevalent among new orthopaedic trauma surgeons? - Trends in pelvic ring fixation","authors":"Thirushan Wignakumar ,&nbsp;Devon T. Brameier ,&nbsp;Christopher R. Leland ,&nbsp;Duco W.P.M. Laane ,&nbsp;Annabelle Swenson ,&nbsp;Eric H. Tischler ,&nbsp;Derek S. Stenquist ,&nbsp;Arvind G. Von Keudell ,&nbsp;Michael J. Weaver ,&nbsp;Nishant Suneja","doi":"10.1016/j.injury.2025.112960","DOIUrl":"10.1016/j.injury.2025.112960","url":null,"abstract":"<div><h3>Introduction</h3><div>The treatment paradigm of pelvic ring injuries has undulated over recent decades. Open reduction and internal fixation (ORIF) became more common in the 1990s and early 2000s followed by a decline in the late 2000s and 2010s, in favor of nonoperative management. Recently, minimally invasive pelvic stabilization using percutaneous pelvic fixation (PFF) has gained popularity. The trends of ORIF, PPF, and nonoperative management of pelvic ring injuries over the last decade is not well described. This study aims to characterize such trends among early-career orthopaedic trauma surgeons from 2003 to 2023.</div></div><div><h3>Methods</h3><div>Data was collected from the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List database for Candidates who indicated that their subspecialty was trauma over a time period involving 20 years of Case List submissions (2003–2023). Pelvic ring fixation was identified using CPT codes for ORIF (27,217, 27,218) and PPF (27,216). Total case volumes and trends in fixation type were analyzed, including an age-based subgroup analysis of younger (age 18–50) and older (age ≥65) adults,</div></div><div><h3>Results</h3><div>Of 15,164 total ABOS Part II Candidates, 795 indicated a trauma subspecialty and performed at least one pelvic ring fixation, with a total of 7311 pelvic fixation cases (3317 ORIF; 3994 PPF). Annual pelvic ring injury fixations increased five-fold during the study period, from 110 in 2003 to 592 in 2023. The proportion of ORIF decreased from 70 % to 40 %, while PPF increased from 30 % to 60 %. The share of early-career surgeons' practice dedicated to percutaneous fixation tripled. Operative fixation (both PPF and ORIF) of pelvic ring injuries in older adult patients became more common over this period.</div></div><div><h3>Conclusion</h3><div>Percutaneous stabilization of pelvic ring injuries is increasing over time, reflecting evolving practice patterns among early-career trauma surgeons. Future studies should evaluate the clinical implications of this trend, including the impact on fellow and resident training.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112960"},"PeriodicalIF":2.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national burden of fractures due to road injuries: Based on the global burden of disease 2021","authors":"Meifeng Lu ,&nbsp;GuiHao Zheng ,&nbsp;Shuilin Chen ,&nbsp;Yulong Ouyang ,&nbsp;Xin Shen ,&nbsp;Guicai Sun","doi":"10.1016/j.injury.2025.112977","DOIUrl":"10.1016/j.injury.2025.112977","url":null,"abstract":"<div><h3>Objectives</h3><div>Road injury is a major cause of fractures, but its global burden remains unclear.</div></div><div><h3>Methods</h3><div>Based on data from the Global Burden of Disease (GBD) 2021 study, this study systematically analyzed the incidence, prevalence, and years lived with disability (YLDs) of road injury-related fractures at the global, regional, and national levels, as well as the trends in disease burden from 1990 to 2021. Additionally, the risk factors for road injury deaths and disability-adjusted life years (DALYs) were evaluated through the GBD study's Comparative Risk Assessment framework.</div></div><div><h3>Results</h3><div>In 2021, global fracture cases from road injuries were 19,113 thousand (95 % uncertainty interval [UI]: 16,571 thousand – 21,839 thousand), a 6.1 % decrease from 1990. From 1990 to 2021, the age-standardized incidence rate (ASIR) fell from 376.5 (95 % UI: 324.43 – 430.91) to 238.2 (95 % UI: 206.63 – 271.01), age-standardized prevalence rate (ASPR) from 1364.4 (95 % UI: 1258.88 – 1471.32) to 825.2 (95 % UI: 764.72 – 884.41), and age-standardized YLD rate (ASYR) from 78.6 (95 % UI: 54.34 – 109.89) to 45.9 (95 % UI: 31.60 – 64.55) per 100,000 population. Among fractures, patellar, tibial/fibular, or ankle fractures had the heaviest burden, with 2021 ASIR of 65.8 (95 % UI: 49.26 – 87.90) per 100,000. Geographically, disease burden varied by region and country: parts of the Middle East, South Asia, Africa, and Latin America remained heavily burdened, while ASIR rose in 19 countries (including Paraguay). Correlation analysis showed ASIR, ASPR, and ASYR correlated positively with Socio-Demographic Index (SDI). Occupational injuries, low bone mineral density, alcohol consumption, high temperature, and smoking have been identified as risk factors for road injuries. Among these, occupational injuries remain the primary global risk factor, though their proportion is decreasing; meanwhile, the risk proportion of low bone mineral density is on the rise.</div></div><div><h3>Conclusions</h3><div>Over the past three decades, the global burden of road injury-related fractures has declined, but regional and national disparities persist. While high SDI regions achieved significant reductions, severe challenges remain in the regions such as the Middle East and West Asia. Additionally, apart from occupational injuries, the risk of low bone mineral density in road injury cannot be ignored.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112977"},"PeriodicalIF":2.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835690","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 malleolar fragments contributing to syndesmotic stability: Clinical significance of lateral displacement","authors":"Kazuo Sato ,&nbsp;Hiroko Murakami ,&nbsp;Yoshio Nishida ,&nbsp;Mizuki Minegishi ,&nbsp;Toshiki Yoshino ,&nbsp;Yoshihiko Tsuchida ,&nbsp;Yuta Izawa","doi":"10.1016/j.injury.2025.112976","DOIUrl":"10.1016/j.injury.2025.112976","url":null,"abstract":"<div><h3>Introduction</h3><div>The indications for fixation of posterior malleolar fragments in ankle fractures remain controversial, and the correct interpretation of the pathology underlying fracture morphology is still unclear. This study focused on the anatomical characteristics of the posterior inferior tibiofibular ligament (PITFL) and the fracture pattern and displacement of posterior malleolar fragments, to determine which types of posterior malleolar fragments contribute to syndesmotic stability.</div></div><div><h3>Methods</h3><div>Seventy patients with Weber type B ankle fractures associated with posterior malleolar fragments involving ≤25 % of the articular surface were included. Following fibular fixation, syndesmotic stability was assessed using the Cotton test. The relationship between Mason and Molloy fracture classification, the presence of lateral displacement (LD), and syndesmotic instability were all investigated.</div></div><div><h3>Results</h3><div>Syndesmotic instability was observed in 7/70 cases (10 %), including in 27.3 % of Mason and Molloy type 1 fractures and 55.6 % of LD-type fractures. Conversely, only 1 of the 54 cases that were neither Mason and Molloy type 1 nor LD-type demonstrated syndesmotic instability.</div></div><div><h3>Conclusion</h3><div>PITFL function is likely preserved in most Weber type B fractures with Mason and Molloy type 2 posterior malleolar fragments caused by external rotation injury. In contrast, LD-type fragments suggest complete disruption of the PITFL, including the deep layer, and require treatment strategies that take this into account.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112976"},"PeriodicalIF":2.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840199","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":"A systematic review of outcomes following transhumeral amputation for brachial plexus injury","authors":"Hamza Tareen ,&nbsp;Mike Fox ,&nbsp;Anna Panagiotidou ,&nbsp;Marco Sinisi ,&nbsp;Ashley I. Simpson","doi":"10.1016/j.injury.2025.112972","DOIUrl":"10.1016/j.injury.2025.112972","url":null,"abstract":"<div><h3>Introduction</h3><div>Brachial plexus injuries (BPI) are devastating conditions that frequently result in flail, insensate upper limbs associated with severe neuropathic pain and loss of function. When reconstructive options such as nerve grafts, transfers, or free muscle transplantation fail to restore meaningful function, transhumeral amputation may be considered as a salvage strategy. The advent of advanced prosthetic technologies, particularly myoelectric and osseointegrated devices, has renewed interest in elective amputation for select patients.</div></div><div><h3>Objectives</h3><div>This systematic review evaluates functional, pain, prosthetic, and quality-of-life outcomes following transhumeral amputation for traumatic BPI.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, and Scopus (May 2025) was conducted according to PRISMA guidelines. Eligible studies reported outcomes of transhumeral amputation following traumatic BPI. Non-English, non-original, and non-BPI amputation studies were excluded. Data extraction and quality assessment were performed independently by two reviewers using the MINORS tool. Continuous data (e.g. DASH, VAS) were pooled using a random-effects meta-analysis (RevMan 5.4). Heterogeneity was assessed using the I² statistic, and subgroup analyses explored differences by prosthesis type (myoelectric vs. cosmetic/traditional).</div></div><div><h3>Results</h3><div>Ten studies encompassing 93 patients met inclusion criteria (Level III–IV evidence, follow-up 3–19 years). Mean postoperative DASH score was 35.0 (95 % CI 28.0–42.0), indicating moderate residual disability but a significant functional improvement from preoperative values (ΔDASH = −13.5; 95 % CI −21.9 to −5.1). Myoelectric users demonstrated superior functional outcomes (mean DASH 30.7) compared with cosmetic or traditional users (means 37–43; <em>p</em> = 0.008). Pooled VAS pain score was 5.6 (95 % CI 3.1–8.1) with a nonsignificant trend towards improvement (ΔVAS −1.2). Regular prosthesis use occurred in 51 % (95 % CI 27–74 %), and approximately 37 % of patients returned to work. Patient satisfaction exceeded 80 % in most series, particularly among myoelectric prosthesis users.</div></div><div><h3>Conclusion</h3><div>Transhumeral amputation following brachial plexus injury yields clinically meaningful functional gains and high patient satisfaction, especially when combined with modern prosthetic technology. Pain reduction is variable, and return-to-work rates remain modest. Amputation should be considered a valid reconstructive endpoint in selected patients when conventional nerve reconstruction fails. Future multicentre prospective studies employing standardised outcome measures are essential to refine patient selection, quantify long-term benefit, and optimise multidisciplinary rehabilitation strategies.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112972"},"PeriodicalIF":2.0,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829287","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":"Application value of a novel tappable bone grafting tool with variable angle lateral window in short-segment fixation via intermuscular approach for thoracolumbar fractures","authors":"Zhenglong Liu ,&nbsp;Fei Zhang ,&nbsp;Jiaqi Li,&nbsp;Lei Guo,&nbsp;Wei Zhang,&nbsp;Yapeng Sun","doi":"10.1016/j.injury.2025.112966","DOIUrl":"10.1016/j.injury.2025.112966","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the clinical application value of a novel tappable, lateral-hole, variable-angle bone grafting tool for injured vertebra bone grafting combined with screw placement in the injured vertebra, in the context of short-segment fixation via an intermuscular approach for thoracolumbar fractures.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on 74 patients treated between January 2022 and June 2024. Patients were divided into three groups: Group A (<em>n</em> = 25) received conventional bone grafting without screw placement in the injured vertebra; Group B (<em>n</em> = 26) received conventional bone grafting with screw fixation; Group C (<em>n</em> = 23) received grafting with the novel tool plus screw fixation. Vertebral kyphosis angle (VKA), local kyphosis angle (LKA), superior endplate displacement (SED), Visual Analog Scale (VAS) scores, and complications were analyzed preoperatively, postoperatively, and at 3-month follow-up. Bone defect volume in Groups B and C was assessed using Mimics software on CT 3D reconstructions.</div></div><div><h3>Results</h3><div>There were no significant differences in sex, age, operative time, or hospital stay among the three groups (<em>P</em> &gt; 0.05). Preoperative and 1-week postoperative VAS scores were similar among the groups (<em>P</em> &gt; 0.05). At 3 months postoperatively, VAS scores in Group C were significantly lower than in Groups A and B (<em>P</em> &lt; 0.05). Groups B and C exhibited significantly less loss of vertebral kyphosis angle (VKAloss) compared to Group A (<em>p</em> = 0.011). There were no significant differences in LKA among the three groups before surgery, after surgery, or at the 3-month follow-up (<em>P</em> &gt; 0.05). Changes in SED values before and after surgery were consistent with VKA, and the SEDloss value in Group C was significantly lower than in Groups A and B at 3 months postoperatively (<em>p</em> &lt; 0.001). Compared to Group B, Group C showed a significant reduction in fracture defect volume at 3 months postoperatively (<em>p</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>The novel bone grafting tool provides effective vertebral support with high grafting efficiency, reduced pedicle damage, and improved postoperative outcomes. Its ease of use makes it a valuable addition to thoracolumbar fracture treatment via the intermuscular approach.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 3","pages":"Article 112966"},"PeriodicalIF":2.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981495","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":"Biomechanical analysis of column fixation and acute total hip arthroplasty with an anti-protrusion cage in a typical geriatric acetabular fracture","authors":"Xavier Lannes ,&nbsp;Sylvain Steinmetz ,&nbsp;Kevin Moerenhout ,&nbsp;Cameron Smith Maxwell-Tervo ,&nbsp;Fabio Becce ,&nbsp;Olivier Borens ,&nbsp;Alexandre Terrier","doi":"10.1016/j.injury.2025.112956","DOIUrl":"10.1016/j.injury.2025.112956","url":null,"abstract":"<div><h3>Background</h3><div>Acute total hip arthroplasty (THA) plays an increasing role in the management of acetabular fractures in elderly patients. However, there is no consensus on the need for column fixation during primary THA, especially for the anterior column. This study aimed to assess the biomechanical impact of column stabilization during acute THA using a Burch-Schneider anti-protrusion cage (BSC) for a typical geriatric acetabular fracture.</div></div><div><h3>Methods</h3><div>A finite element model of a hemipelvis with an anterior column posterior hemi-transverse fracture was developed to compare four treatment strategies during acute THA with BSC: anterior and posterior column plating (CAP), posterior column plating (CnP), anterior column plating (CAn), and BSC alone (Cnn). During peak load walking, we analyzed the pelvis displacement, fracture relative motion, bone strain around screws, and metal stress.</div></div><div><h3>Results</h3><div>Pelvis displacement was lowest for CAP and highest for Cnn, while CnP and CAn showed intermediate values slightly higher than CAP. Fracture relative motion, bone strain, and metal stress followed similar patterns. Fracture relative displacement was around 1 mm on average, and below 5 mm, except for Cnn, where it exceeded this value on 22 % of the fracture surface. Peak strain far exceeded 1 % for Cnn, predominantly concentrated at screw tips and screw-plate junctions, as did peak metal stress.</div></div><div><h3>Conclusion</h3><div>This biomechanical analysis indicates that CnP alone provides mechanical stability comparable to isolated or additional anterior column plating. These findings support the single posterior approach concept for acute THA in the management of acetabular fractures in elderly patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112956"},"PeriodicalIF":2.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797238","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":"Anterior and posterior fixation versus posterior fixation only of minimally displaced lateral compression type 1 pelvic ring injuries: A multicenter propensity-matched analysis","authors":"","doi":"10.1016/j.injury.2025.112964","DOIUrl":"10.1016/j.injury.2025.112964","url":null,"abstract":"<div><h3>Introduction</h3><div>The ideal fixation construct for treatment of stress-positive lateral compression type 1 (LC1) pelvic ring injuries is controversial. The purpose of this study was determine if anterior and posterior fixation (AF+PF) versus posterior fixation only (PF) of patients with LC1 pelvic ring injuries is associated with home discharge.</div></div><div><h3>Patients and methods</h3><div>A multicenter retrospective review was performed at eight level one trauma centers of adult patients with stress-positive minimally displaced LC1 pelvic ring injuries (OTA/AO 61B) treated with AF+PF versus PF. Outcomes included length of stay, maximum feet ambulated with physical therapy (PT) while hospitalized, discharge disposition, independent ambulation at last follow-up, and mortality. AF+PF versus PF patients were compared in terms of age, sex, Charleston Comorbidity Index (CCI), injury mechanism, and Beckman score. Propensity-matching was used to control for group differences.</div></div><div><h3>Results</h3><div>There were 434 patients included; 64.5% (<em>n</em> = 280) treated with AF+PF and 35.5% (<em>n</em> = 154) with PF. Patients treated with AF+PF, versus PF, were older (47.0 vs. 38.0 years; <em>p</em> = 0.01), had a higher CCI (0 vs 0; <em>p</em> = 0.02), a higher Beckman score (8.0 vs. 7.0; <em>p</em> = 0.04), more low-energy falls (18.6% vs. 8.4%; <em>p</em> = 0.004), less independent ambulators (92.1% vs 97.4%; <em>p</em> = 0.03), and more rami fractures with 100% displacement (26.8% vs. 12.3%; <em>p</em> = 0.0004). The groups did not differ in gender, complete sacral fractures, days to surgery, or follow-up duration (<em>p</em> &gt; 0.05). Propensity-matching resulted in two groups of 141 patients, similar in age, CCI, Beckman score, low-energy falls, 100% rami fracture displacement, and follow-up duration (<em>p</em> &gt; 0.05). On matched analysis, patients treated with AF+PF, versus PF, spent fewer days in the hospital (7.0 vs. 8.0; <em>p</em> = 0.03) and were more likely to discharge home (76.6% vs. 63.1%; <em>p</em> = 0.0005). There was no observed difference between groups in terms of feet ambulated with PT, independent ambulation at last follow-up, or mortality (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>Matched patients with stress-positive minimally displaced LC1 injuries treated with AF+PF compared to PF spent fewer days in the hospital and were more likely to discharge home.</div></div><div><h3>Level of evidence</h3><div>Therapeutic Level III.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112964"},"PeriodicalIF":2.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919487","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":"Age matters: Elevated mortality and distinct injury patterns in elderly (≥75 years) patients with high-energy pelvic ring injuries","authors":"James Fletcher ,&nbsp;Vanessa Morello ,&nbsp;Elvin Gurbanov ,&nbsp;Ulysse Coneys ,&nbsp;Axel Gamulin","doi":"10.1016/j.injury.2025.112963","DOIUrl":"10.1016/j.injury.2025.112963","url":null,"abstract":"<div><h3>Background</h3><div>High-energy pelvic ring injuries (PRIs) are increasingly observed in the elderly, a population with unique physiological vulnerabilities. However, outcome data in patients aged ≥75 years remain scarce.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, 331 patients with high-energy PRIs over 11 years at a Level 1 trauma centre were analysed. Using 1:1 propensity score matching, outcomes in patients aged ≥75 years were compared with younger patients (&lt;75), adjusting for injury severity and baseline characteristics.</div></div><div><h3>Results</h3><div>Twenty-eight patients aged ≥75 were matched to 28 younger counterparts. Mortality was significantly higher in the elderly group (32 % vs. 7 %, <em>p</em> = 0.006), despite comparable injury severity scores. Elderly patients were less likely to be admitted to the intensive care unit (ICU) (29 % vs. 64 %, <em>p</em> = 0.007), with shorter ICU stays, though total hospital length of stay did not differ. Fracture morphology and mechanisms of injury also varied by age, with older adults showing simpler patterns but higher mortality.</div></div><div><h3>Conclusion</h3><div>Elderly patients with high-energy PRIs exhibit distinct injury mechanisms and patterns, experience a five-fold higher mortality despite less frequent ICU admission and matched injury severity. These findings highlight the urgent need for age-adapted trauma protocols and proactive perioperative strategies in managing pelvic trauma in the elderly.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112963"},"PeriodicalIF":2.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795778","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":"2025-12-11","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}