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

{"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}

{"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":"2025-12-11","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}

{"title":"Fibrinogen as an early predictor of acute organ dysfunction in pelvic fractures","authors":"Po-Chun Wang ,&nbsp;Kuo-En Chen ,&nbsp;Hui-An Lin ,&nbsp;Sheng-Feng Lin","doi":"10.1016/j.injury.2025.112970","DOIUrl":"10.1016/j.injury.2025.112970","url":null,"abstract":"<div><h3>Objective</h3><div>Pelvic fractures are associated with substantial morbidity and mortality, yet the prognostic value of initial fibrinogen levels remains underexplored.</div></div><div><h3>Methods</h3><div>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 &gt;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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>A fibrinogen level of ≤ 200 mg/dL is associated with increased mortality and acute organ dysfunction in patients with pelvic fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112970"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795796","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":"2025-12-11","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":"Association between hip dislocation in pelvic fracture and concomitant knee ligament injuries","authors":"Seiya Odagiri ,&nbsp;Tsuneari Takahashi ,&nbsp;Tomohiro Matsumura ,&nbsp;Mitsuharu Nakashima ,&nbsp;Shuhei Hiyama ,&nbsp;Jiro Ando ,&nbsp;Yoshiya Nibe ,&nbsp;Katsushi Takeshita","doi":"10.1016/j.injury.2025.112965","DOIUrl":"10.1016/j.injury.2025.112965","url":null,"abstract":"<div><div><em>Background:</em> Acetabular fracture with concomitant hip dislocation (dislocation–fracture) is a high-energy injury requiring urgent management. Although less life-threatening than pelvic ring fractures, these injuries are often associated with ipsilateral knee trauma, which may be overlooked in the acute setting. Delayed recognition can lead to secondary meniscal and chondral damage.</div><div><em>Purpose:</em> To investigate whether hip dislocation in the setting of acetabular fracture is an independent risk factor for ipsilateral knee injury.</div><div><em>Methods:</em> We retrospectively reviewed 180 patients (146 men, 34 women; mean age, 57.3 ± 19.8 years) admitted with acetabular fractures between July 2006 and December 2024. Clinical variables included age, sex, mechanism of injury, concomitant upper extremity injuries, initial knee evaluation, and the presence of ipsilateral knee injuries. Knee injury was defined as ligament injury, tibial plateau fracture, or meniscal injury. Notably, tibial plateau fractures that were not clearly identified on radiographs were diagnosed by MRI. Patients were stratified according to the presence of hip dislocation, and logistic regression analysis was performed to identify independent risk factors for knee injury.</div><div><em>Results:</em> Mechanisms of injury included falls (25.6 %), traffic accidents (69.4 %), and tumbling (5.0 %). Concomitant upper extremity injuries were found in 21.7 % of patients. Ipsilateral hip dislocation–fracture occurred in 46 patients (25.6 %), with directions and fracture types recorded as Thompson and Epstein classification. Knee injury was significantly more frequent in Group pH (12/46, 26.1 %) than in Group AH (5/134, 3.7 %) (<em>P</em> &lt; 0.001). Logistic regression showed that age, sex, mechanism of injury, and upper extremity injuries were not independent predictors of knee or PCL injury, whereas hip dislocation–fracture significantly increased the risk (OR 7.25; 95 % CI, 2.30–22.9; <em>P</em> &lt; 0.001). Among knee injuries, posterior cruciate ligament (PCL) injury was most common (41.2 %), followed by meniscal injury (17.6 %) and anterior cruciate ligament (ACL) injury (5.6 %). Concomitant tibial plateau fractures were observed in 23.5 % of cases, all confirmed by MRI. Soft-tissue–only knee injuries (ligament and/or meniscus without fracture) accounted for 10 cases.</div><div><em>Conclusion:</em> Hip dislocation–fracture significantly increases the risk of ipsilateral knee injury, particularly PCL injury. Clinicians should maintain a high index of suspicion and perform systematic knee evaluation, including MRI when feasible, to enable early diagnosis and prevent secondary joint deterioration.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112965"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770518","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":"Traumatic spinal injuries: A retrospective epidemiological analysis following the 2018 driving policy reform in Saudi Arabia","authors":"Nizar A. Algarni ,&nbsp;Rushaid N. Aljurayyan ,&nbsp;Khalid F. Alrasheed ,&nbsp;Nawaf M. Alrefaei ,&nbsp;Omar Y. Alkadhi ,&nbsp;Abdulkareem M. Alotaibi ,&nbsp;Huthayfah T. Alkhliwi","doi":"10.1016/j.injury.2025.112968","DOIUrl":"10.1016/j.injury.2025.112968","url":null,"abstract":"<div><h3>Background</h3><div>The epidemiology of traumatic spinal injuries (TSI) differs across various regions and is influenced by national income, infrastructure, and culture. TSIs are a source of high morbidity and mortality, requiring considerable resource allocation. Saudi Arabia’s 2018 decision allowing women to drive introduced a new demographic element, potentially shifting TSI epidemiology. In this paper, we aimed to study patterns and outcomes of TSIs, including sex-based analyses, and to identify demographic, injury-related, and in-hospital factors associated with length of hospital stay, neurological severity, and spinal surgery requirement.</div></div><div><h3>Methods</h3><div>This is a retrospective observational study conducted in a tertiary center between 2018 and May 2025. A total of 5380 computed tomography scans were screened. All patients with a diagnosis of spinal injury caused by a traumatic mechanism were included. Patients' demographics, mechanism of injury, injury level, associated injuries, AIS grade, hospital course, and disposition were collected and analyzed.</div></div><div><h3>Results</h3><div>623 TSI patients were included. Most of them were males (78.5 %) and Saudi nationals (74.2 %), with a male-to-female ratio of 3.7. The average age was 32.5 (±15.9) years. Substance use was documented in 7.4 % of cases. Four-wheel motorized-vehicle accidents (Four W-MVA) predominated (57.6 %) and were more common among Saudis (68.4 %), whereas falls from height (36.0 %), pedestrian injuries (21.1 %) were more common among non-Saudis. The most common injury was at the lumbar region (53.9 %), and most patients were neurologically intact (AIS E 93.7 %). Female sex and older age were associated with longer length of stay (LOS). Longer LOS was independently associated with prior psychiatric illness (RR=3.77), higher AIS severity (RR=1.22), pulmonary infection (RR=3.11), and ICU admission (RR=2.01). Higher AIS severity was linked to cervical involvement (per injured level RR=1.10) and vertebral subluxation/dislocation (RR=1.24).</div></div><div><h3>Conclusion</h3><div>The epidemiology of TSIs has demonstrated notable shifts in demographics, patterns of injury, and outcomes. This study highlights the need for targeted interventions, including intensified efforts to enforce traffic regulations, addressing health disparities experienced by non-Saudi residents, and an expansion of mental health services.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112968"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807216","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 «gull sign» in acetabular fractures revisited: is it predictive for failure after osteosynthesis in older adults?","authors":"Silviya Ivanova ,&nbsp;Andromachi Chantzara ,&nbsp;Rainer J Egli ,&nbsp;Marius JB Keel ,&nbsp;Johannes D Bastian","doi":"10.1016/j.injury.2025.112971","DOIUrl":"10.1016/j.injury.2025.112971","url":null,"abstract":"<div><h3>Background</h3><div>The gull sign was described as a radiographic marker of superomedial dome impaction in acetabular fractures and was considered predictive of failure after osteosynthesis in older patients (≥ 60 years).</div></div><div><h3>Aim</h3><div>To determine whether the radiographic gull sign is associated with higher conversion rates to total hip arthroplasty (THA) within 24 months after open reduction and internal fixation (ORIF) for displaced acetabular fractures in patients aged ≥ 60 years.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, 126 patients aged ≥ 60 years (mean 76 years, range 60.1–93.6) underwent ORIF for displaced acetabular fractures via the Pararectus approach between 2009 and 2020. Preoperative pelvic radiographs were assessed for the presence of the gull sign, and CT scans were evaluated for dome impaction. Failure was defined as conversion to total hip arthroplasty (THA) within 24 months after ORIF. Kaplan–Meier analyses with log-rank tests were performed on the entire cohort, and diagnostic performance was analysed in the subset with complete two-year follow-up (<em>n</em> = 93).</div></div><div><h3>Results</h3><div>At two years, 20 of 93 patients (22 %) had undergone THA, occurring on average 12.1 months after the index surgery (range 2–45 months). A radiographic gull sign was identified in 21 patients (23 %). The subsequent THA conversion rate was similar between those with and without the sign (5/21 [24 %] vs 15/72 [21 %]; <em>p</em> = 0.99). Concordance between radiographs and CT was limited: only 12 of 21 gull-positive patients (57 %) showed a true dome impaction on CT, while CT nevertheless revealed impaction in 21 of 72 gull-negative patients (29 %). Among patients with CT-confirmed impaction, 8 of 33 (24 %) underwent THA within 24 months, compared with 12 of 60 (20 %) without impaction (<em>p</em> = 0.79). Kaplan–Meier analysis of the entire cohort (<em>n</em> = 126) likewise showed no difference in THA-free survival between groups.</div></div><div><h3>Conclusion</h3><div>Neither a radiographic gull sign nor CT-confirmed dome impaction predicted early conversion in our series of acetabular fractures managed via Pararectus approach; overall conversion rates were acceptable. Accordingly, the gull sign is not a harbinger per se for failure of osteosynthesis in older adults.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112971"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776796","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":"Modified calcar ratio for predicting varus collapse in proximal humerus fractures","authors":"Kemal Şibar ,&nbsp;Abdülsamet Emet ,&nbsp;Yasin Erdoğan ,&nbsp;Hatice Ezgi Rifaioğlu ,&nbsp;Erkan Akgün ,&nbsp;Ahmet Fırat","doi":"10.1016/j.injury.2025.112961","DOIUrl":"10.1016/j.injury.2025.112961","url":null,"abstract":"<div><h3>Introduction</h3><div>Proximal humerus fractures are common, especially in older adults, and often result in complications such as varus collapse after open reduction and internal fixation (ORIF). Despite successful surgical methods, complication rates remain significant, with varus collapse being a primary cause of failure. Ensuring proper screw placement, particularly the calcar screw, is vital to prevent this issue. This study introduces a modified calcar ratio (MCR) that combines two key measurements - tip distance and calcar distance - to predict varus collapse and improve surgical outcomes.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed patients treated for proximal humerus fractures from September 2022 to June 2024. Inclusion criteria were adults with 3- or 4-part fractures who underwent ORIF with a proximal humerus plate within two weeks of injury. Preoperative and postoperative radiographs were evaluated to determine fracture classification, reduction quality, and radiological parameters, including MCR. MCR was calculated as the sum of the tip distance and calcar distance divided by the humeral head radius. Statistical analysis, including ROC curve analysis, assessed MCR’s ability to predict varus collapse.</div></div><div><h3>Results</h3><div>A total of 108 patients were included. MCR was significantly higher in patients who experienced varus collapse (median MCR: 0.7) compared to those who healed (median MCR: 0.5). Varus collapse occurred in 17.6 % of patients, with a median onset time of 8 weeks post-surgery. Statistical analysis showed a strong correlation between higher MCR and varus collapse, with a sensitivity of 100 % and a specificity of 47 %, at a cut-off point of 0.46 for predicting failure. The ROC curve demonstrated 78 % discriminatory ability for MCR.</div></div><div><h3>Conclusion</h3><div>The MCR is a reliable, practical tool for predicting varus collapse following ORIF in proximal humerus fractures. By considering both the tip and calcar distances, MCR provides a single, effective measure to optimize surgical outcomes. An intraoperative MCR value below 0.46 demonstrated high sensitivity for predicting lower risk of varus collapse, and may serve as a useful intraoperative reference.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112961"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784095","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":"Orthopedic trauma in pregnancy: A literature review","authors":"William H. Fang ,&nbsp;Vitaley Kovalev ,&nbsp;Theresa Pak","doi":"10.1016/j.injury.2025.112969","DOIUrl":"10.1016/j.injury.2025.112969","url":null,"abstract":"<div><div>Orthopedic injuries during pregnancy pose unique risks to maternal and fetal health. This review identifies different epidemiological data, maternal physiological changes, imaging considerations, pain management strategies, and operative considerations. Motor vehicle accidents, falls, and domestic violence contribute to fractures, emphasizing the need for tailored management. Special attention is given to imaging modalities, with a focus on fetal safety. Pain management strategies balance effective analgesia with fetal well-being, emphasizing the cautious use of opioids. Perioperative fetal monitoring and anticoagulation considerations address the intricacies of managing orthopedic injuries during pregnancy. Prevention strategies, such as promoting seat belt use and intimate partner violence screening, are crucial for minimizing risks. This concise review serves as a comprehensive guide for healthcare professionals managing orthopedic injuries in pregnant patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112969"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting anxiety, depression, PTSD and psychotic disorders after traumatic brain injury in civilian adults: A systematic review of multivariable prognostic models","authors":"John Perera ,&nbsp;Sue Patterson ,&nbsp;Natalie Barker ,&nbsp;Dylan Flaws ,&nbsp;Zemedu Ferede","doi":"10.1016/j.injury.2025.112959","DOIUrl":"10.1016/j.injury.2025.112959","url":null,"abstract":"<div><h3>Background</h3><div>Psychiatric disorders are common after traumatic brain injury, impeding recovery and increasing health and social costs internationally. clinicians caring for patients with TBI need an evidence base to support assessment of risk of and intervention to reduce psychiatric morbidity.</div></div><div><h3>Method</h3><div>We systematically searched for original studies published in English reporting development of multivariate models predicting anxiety, depression, PTSD and psychotic disorders in civilian adults at least six months after injury. The electronic search was conducted on 12 August 2024. Authors independently screened records, assessed study quality, and extracted data for descriptive analysis and narrative synthesis.</div></div><div><h3>Results</h3><div>We included 34 studies presenting 47 multivariable models predicting psychiatric disorder six to 120 months after TBI of varying severity. Study samples, ranging from 43 to 207,354, were predominantly male and Caucasian/White and aged 30–45 years. Models inconsistently included demographic, psychosocial and injury-related variables with mixed results. Female sex, psychiatric history, race/ethnicity, physical health and assault/violent mechanism of injury were statistically significant two-thirds of models in which they were included. Infrequently included variables including coping style and intoxication at injury were strongly associated with disorder.</div></div><div><h3>Discussion</h3><div>Faced with inconsistency in evidence we recommend that clinicians assess risk of suboptimal outcome broadly, asking not whether a given patient is at risk of a specific psychiatric condition but of <em>any</em> psychiatric disturbance following TBI. Patients with a psychiatric history and/or injured violently should be monitored but assessment must encompass biopsychosocial circumstances. Employment of a conceptual model of psychiatric disorder would support development of a cohesive evidence base.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"57 2","pages":"Article 112959"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}