Injury最新文献

Introduction: To help address the continuing epidemic of firearm-related trauma in the United States (US), we conducted a detailed analysis of recent trauma center discharge data and compared firearm-related injuries to mechanisms such as falls, pedestrian injuries, and motor vehicle crashes.

Methods: We combined Trauma Quality Improvement Program (TQIP) data for 2011 to 2022 and analyzed variables for patient demographics, injury mechanisms, disposition, and hospital characteristics over time. Analyses consisted of descriptive statistics, bar plots, time series plots, and comparative tables.

Results: There were 3,597,688 US trauma hospital discharges in the TQIP data set for 2011 to 2022 of which 307,062 (8.4%) involved firearms-a higher proportion than those involving pedestrian injuries (3.8%), pedal cycles (2.0%), or motorcycles (6.2%). The case-fatality rate of inpatient hospital deaths for firearm injuries was 8.8%, surpassed only by that of pedestrian injuries (9.9%). Firearms accounted for the youngest patient population over the 12-year study period for the six injury mechanisms analyzed. Over time, firearm-related assaults increased from 75.7% of all firearm injuries in 2011 to 88.6% in 2020. Most, if not all, of this increase appeared to occur in the post-2014 time period.

Conclusions: Better defining national injury trends allows for targeted injury prevention efforts, prioritized research endeavors, and optimized resource allocation.

Background: The Noto Peninsula earthquake of January 1, 2024, was the most destructive seismic event in Japan since 2011, affecting a region characterized by its super-aging population, geographical isolation, and status as a medically underserved area. These vulnerabilities require a detailed analysis of the acute-phase medical response to improve disaster preparedness in similar environments. This study aims to characterize the morbidity and features of earthquake-affected patients admitted to a regional tertiary university hospital.

Methods: We conducted a retrospective observational study of patients presenting to the emergency department of Kanazawa University Hospital between January 1, 2024, and January 31, 2024, with earthquake-related conditions. Patients with direct trauma or secondary health issues (e.g., exacerbation of chronic illness) were identified by a multidisciplinary Disaster Response Committee. All patients were triaged using the Japan Triage and Acuity Scale (JTAS). Descriptive statistics were used to summarize demographics, clinical characteristics, and transport modalities.

Results: A total of 144 earthquake-related patients were managed. The cohort was characterized by a high mean age (79.7 years) and a female predominance (61.1%). The primary medical burden was the exacerbation of intrinsic diseases (74.3%), while trauma cases were less frequent (23.6%). The majority of patients presented with low to moderate acuity; severe cases (JTAS Levels 1-2) constituted 7.0% of the cohort, whereas low-acuity Level 4 was the largest (63.2%). Patient transport peaked on day five, almost exclusively by air evacuation (97.7% of arrivals that day), which was essential to overcome extensive road damage. The base-isolated hospital sustained no major damage and remained fully operational, serving as a regional DMAT command post.

Conclusions: The medical response to the Noto earthquake highlights a paradigm shift in disaster care for aging societies, where management of geriatric and chronic diseases takes precedence over mass-casualty trauma care. In isolated regions, air evacuation is a critical yet weather-vulnerable modality for effective patient transport. Future disaster preparedness requires a dual focus: medical response plans must prioritize systems for chronic and geriatric care, and strategic investment in seismically resilient tertiary hospitals is essential for them to function as stable operational hubs, ensuring regional continuity of care.

Introduction: Trauma is a leading global health challenge, with hemorrhage being a major cause of preventable death. Resuscitative endovascular balloon occlusion of the aorta (REBOA) effectively halts hemorrhage but poses risks such as ischemic injury, especially to the kidneys. Partial REBOA (pREBOA) mitigates these effects by allowing limited distal blood flow. This study investigates crystalloid resuscitation as an alternative to whole blood during pREBOA release in a swine model, where all groups received an additional 2000 mL of Ringer's acetate prior to balloon deflation.

Materials and methods: 15 castrated male swine weighing 51-65 kg underwent controlled mean (SD) hemorrhage of 1200 (233) mL, followed by 60 minutes of pREBOA application and a 20-minute resuscitation phase, where the animals were randomized into three groups: low Ringer's acetate (0 mL) (n=5), high Ringer's acetate (2000 mL) (n=5), or whole blood transfusion (1000 mL)+ Ringer's acetate (1000 mL) (n=5). Hemodynamic variables, metabolic parameters, and renal blood flow were continuously monitored. Animals were observed for 60 minutes post-REBOA deflation.

Results: High-volume Ringer's acetate improved stroke volume compared to low-volume crystalloids (p<0.001) and reduced heart rate (p<0.005) and systemic vascular resistance (p<0.01) immediately post-resuscitation. Hemoglobin levels were lower in the high-volume group than in the low-volume group (p<0.01), persisting for 40 minutes. Potassium remained within physiological limits.

Conclusion: Crystalloid resuscitation during pREBOA maintained mean arterial pressure and cardiac output comparable to whole blood, with high-volume crystalloids offering superior hemodynamic support compared to low-volume resuscitation. High-volume crystalloids improved stroke volume. Metabolic stability was preserved across groups, with no severe derangements observed. These findings highlight crystalloids as a potential alternative in resource-limited settings, although reduced renal perfusion warrants further investigation to optimize outcomes and ensure broader clinical applicability.

Background: Violence-related injuries (VRIs) remain a major contributor to trauma-related mortality worldwide. We evaluated the case fatality rates (CFRs) of VRIs stratified by sex. We hypothesized that sex differences affect the CRF following VRIs.

Methods: A retrospective analysis was conducted using data from the American College of Surgeons Trauma Quality Programs and ICD-10 for VRIs.

Results: Among 522,939 VRIs patients, males accounted for 82.8% with higher mortality than females (7.5% vs. 5.6%). Males had higher CFRs than females among firearm-related injuries (16.3% vs. 15.2%), and Self-inflicted harm (SIH) (21.9% vs. 12.1%). In Interpersonal violence, CFRs among White females and Black males were 19.7% and 15.8%, respectively. For SIH, firearm lethality was higher among older White males ≥ 65 years (64.3%) and young Black males aged 36-45 (57.8%). Firearm injury (OR 18.49) and male sex (OR 1.21) were independent predictors for mortality.

Conclusion: Sex-based disparities in VRIs in the United States are evident, notably in firearm injuries and SIH, underscoring the need for targeted injury prevention.

Background: Malnutrition is a potentially modifiable risk factor that may influence perioperative complications and fracture healing. This study evaluated the association between preoperative laboratory-defined malnutrition and short-term complications and 2-year outcomes following operative fixation of tibial shaft fractures.

Methods: Using the TriNetX Research Network (112 healthcare organizations), adults (≥18 years) undergoing operative management for tibial shaft fracture were identified. Preoperative malnutrition was defined as albumin ≤3.5 g/dL and/or leukocytes ≤1.5 × 10³/µL within 1 year prior to the index event. Cohorts were propensity score matched 1:1 on demographics and comorbidities. Outcomes were assessed from day 1 post-index through 90 days (medical/surgical complications) and 730 days (healing-related and limb outcomes). Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were reported.

Results: After matching, 44,780 patients were included in each cohort (89,560 total), with good balance across covariates (all SMDs <0.10). At 90 days, malnutrition was associated with higher risk of acute respiratory failure/mechanical ventilation (13.9% vs 3.4%; RR 4.10 [95% CI 3.88-4.33].; HR 4.32 [4.09-4.57].), sepsis (5.2% vs 1.2%; RR 4.35 [3.97-4.77].; HR 4.47 [4.07-4.91].), postoperative infection (5.7% vs 1.8%; RR 3.14 [2.90-3.39].; HR 3.23 [2.99-3.50].), acute kidney injury (8.6% vs 3.0%; RR 2.90 [2.73-3.08].; HR 2.99 [2.81-3.18].), and DVT/PE (6.5% vs 2.7%; RR 2.36 [2.21-2.52].; HR 2.42 [2.26-2.59].) (all p < 0.001). At 2 years, malnutrition was associated with increased nonunion (4.4% vs 1.6%; RR 2.69 [2.47-2.92].; HR 2.85 [2.62-3.10].), chronic osteomyelitis (12.5% vs 3.9%; RR 3.19 [3.02-3.36].; HR 3.50 [3.32-3.69].), hardware removal (10.1% vs 6.0%; RR 1.68 [1.61-1.76].; HR 1.83 [1.74-1.92].), and amputation (1.4% vs 0.4%; RR 3.47 [2.95-4.08].; HR 3.59 [3.05-4.23].) (all p < 0.001). Revision fixation did not differ (8.4% vs 8.1%; p = 0.096).

Conclusions: Preoperative laboratory-defined malnutrition was independently associated with substantially higher 90-day morbidity and increased 2-year nonunion and limb-complication risk following operative tibial shaft fracture management. These findings support preoperative nutritional risk stratification and targeted optimization efforts in this population.

Introduction: Rapid economic growth may impact trauma mortality. We investigated the epidemiology, risk factors and trends in hospital mortality of admitted trauma patients in Guyana during a 5-year period of rapid economic growth in this country.

Patients and methods: The study was conducted at the Georgetown Public Hospital Corporation, Guyana's largest tertiary healthcare facility. The medical records of all patients admitted following trauma between 2018 and 2022 were reviewed. Patient demographics, injury characteristics, and clinical outcomes (mortality and length of stay) were obtained for each study year. Univariate analyses assessed the distributions of all variables while adjusted regression analyses were used to identify potential risk factors for in-hospital mortality. P-values ≤ 0.05 were considered statistically significant.

Results: The in-hospital mortality rate was 3.5% (n=190). The highest in-hospital mortality rate occurred among burns patients (11.2%), and the lowest from assaults (1.9%). Risk factors for death were mechanism of injury, ethnicity, injury severity at presentation, and age. The leading mechanisms of injury for trauma-related deaths were motor vehicle crashes (39.5%) and falls (24.7%). Females had over twice the rate of death from falls compared to males (6.3% vs. 3.1%). Among ethnicities, Indo-Guyanese patients had the highest odds of dying from trauma compared to Afro-Guyanese (OR 2.37 CI 1.57-3.56, p<0.01) primarily driven by motor vehicle crashes (OR 3.29, CI 1.65, 6.55 p<0.01). The median (Q1, Q3) length of stay was 3 (1, 6) days. Most patients (73.5%) died within 7 days of admission. Late deaths (≥24h of admission) occurred in 53.6% of patients. Annual mortality rates fluctuated during the study period coinciding with Covid -19 restrictions but rose overall by 86.5% from 3.7% in 2018 to 6.9% in 2022. Annual comparisons of mortality rate with GDP growth rate showed parallel increases over most of the study period.

Conclusion: This study provides evidence to support targeted clinical practice and public health initiatives to prevent increases in trauma mortality in Guyana and other rapidly developing countries facing rising injury risks.

Introduction: Post Traumatic Stress Disorder (PTSD) is not uncommon following major trauma. Despite increasing awareness of the psychological sequelae of trauma, there is often inadequate mental health follow-up for trauma patients. This can lead to significant rates of under-diagnosis and under-treatment.

Aims: To examine rates of under-diagnosis and under-treatment of probable PTSD amongst major trauma patients admitted to Christchurch Hospital, New Zealand.

Methods: A prospective questionnaire-based cohort study including patients 16 years and older who presented to Christchurch Hospital with major trauma (Injury Severity Score >/=12) between May 2016 and September 2018. Patients with severe brain injury were excluded. Patients who consented completed the Posttraumatic Stress Disorder Checklist for DSM-V (PCL-5), plus answered questions on any assessment, treatment or diagnosis of PTSD, depression or anxiety before and/or after injury. Demographic, injury-specific and hospital care data were collated from the New Zealand Major Trauma Registry.

Results: There were 836 patients who met the eligibility criteria and were invited to participate in the study, with a 24% response rate (203 patients). Thirty-seven (18%) scored at or above the PTSD threshold, however only 8 (22%) reported having received a formal diagnosis of PTSD. All 8 patients who had received a formal diagnosis of PTSD were receiving some form of mental health treatment (either medication, 'talk therapy' or both). By comparison, within the group of 29 patients who had not received a diagnosis of PTSD but met criteria, only 11 (38%) were receiving any form of mental health treatment.

Conclusion: Many people who develop PTSD following trauma fail to receive appropriate assessment, diagnosis or treatment. Further work is needed to ensure adequate systems are in place to allow identification and treatment of patients who develop PTSD following a major trauma.

Background: This study examines 90-day outcomes and one-year outcomes following surgical fixation of upper extremity fractures in homeless patients.

Methods: A retrospective analysis was conducted using a nationwide database to identify patients who underwent open reduction and internal fixation of upper extremity fractures including (shoulder and upper arm, elbow and forearm, wrist and hand) and had documented homelessness status. Patients were 1:1 propensity score-matched to controls based on demographic factors, comorbidities (including chronic kidney disease, hypertension, heart failure, diabetes mellitus, liver diseases, substance abuse and opioid dependence) and BMI yielding 2,584 patients per group. Primary outcomes included fracture related outcomes while secondary outcomes were healthcare utilization, medical and substance related outcomes. Relative risks (RR), 95% confidence intervals (CI), and p-values were calculated.

Results: At 90 days, homeless patients had significantly higher risks of emergency department visits (RR: 5.18, p < 0.001), sepsis (p = 0.002), opioid dependence (RR: 2.88, p = 0.002), substance abuse (RR: 5.87, p < 0.001), renal failure (RR: 3.34, p < 0.001), pneumonia (RR: 2.90, p < 0.001), transfusion (RR: 2.61, p = 0.003), readmission (RR: 3.22, p < 0.001), wound complications (RR: 1.97, p < 0.001), and postoperative infection (RR: 2.70, p < 0.001). At 1 year, homeless patients had elevated risks of opioid dependence (RR: 4.69, p < 0.001), substance abuse (RR: 5.72, p < 0.001), opioid use (RR: 1.58, p = 0.011), revision surgery (RR: 1.78, p = 0.017), and malunion (RR: 1.92, p = 0.013).

Conclusion: Homeless patients undergoing upper extremity fractures ORIF face significantly higher risks of 90 day and 1 year adverse outcomes compared to housed patients. These findings highlight the critical need for tailored interventions to improve care continuity, minimize risks and improve outcomes in homeless individuals.

Level of evidence: Level III, Retrospective Cohort.

Background: Literature increasingly suggests that suture button (SB) fixation yields higher functional outcome scores, specifically the American Orthopaedic Foot Ankle Society (AOFAS) Ankle-Hindfoot score and the Olerud-Molander Ankle Score (OMAS), compared with syndesmotic screws (SS). This umbrella review evaluates whether these differences extend beyond statistical significance and meet thresholds for clinical relevance, using the Minimal Clinically Important Difference (MCID) as reference standard.

Method: A comprehensive PubMed search identified systematic reviews and meta-analyses published between 2010 and 2025. The methodological quality was assessed using the Joanna Briggs Institute checklist. Reported AOFAS and OMAS outcomes, as well as mean differences between SB and SS fixation, were extracted or independently calculated. These values were evaluated against established MCID ranges (OMAS 7.5-11.4, AOFAS 4.1-7.8), to determine whether statistically significant findings corresponded to clinically meaningful improvements RESULTS: Nineteen systematic reviews were included, of which fifteen performed a meta-analysis. Across these reviews, SB fixation was reported 18 times to result in statistically higher AOFAS and/or OMAS compared with SS fixation. However, most weighted mean differences fell below the MCID thresholds: in 11 reviews for OMAS and in 12 reviews for the AOFAS did not reach clinical relevance. Only one review reported an OMAS difference within the MCID range, and seven reviews reported AOFAS differences within or above the MCID range. These findings indicate that, although statistically significant results were observed, the corresponding functional gains were generally too small to be clinically meaningful.

Conclusion: While SB fixation often demonstrates superior functional scores relative to SS fixation, these differences seldom exceed established MCID thresholds. The clinical relevance of these improvements therefore remains uncertain. As routine removal of syndesmotic screws is no longer advocated in the contemporary literature, and considering the findings of the present study, one could argue that the cost-effectiveness of using a suture-button in under scrutiny. Future studies should focus on refining MCID values for ankle-specific PROMs and improving methodological rigour in systematic reviews and meta-analyses to better determine whether SB fixation provides a meaningful advantage for patients.

Introduction: Distal radius fractures (DRFs) are frequently managed with volar locking plates (VLP). The Soong classification, which grades plate prominence relative to the volar rim, is widely used because of its association with flexor tendon irritation, but its value in predicting postoperative radiographic restoration and patient-reported outcomes is less clear. This study examined whether Soong grade correlates with alignment (radial height and radial inclination) and patient-rated outcomes after VLP fixation of DRFs.

Methods: We conducted a retrospective review of consecutive patients undergoing surgical fixation for DRF, 44 met the inclusion criteria. Demographics, fracture characteristics, operator grade, time from injury to operation, radiation dose, postoperative imaging and clinic utilisation, antibiotic use, and a patient-rated outcome score were collected. Pre- and postoperative anteroposterior radiographs were used to measure radial height and radial inclination. Plate prominence was graded as Soong 0-2.

Results: The cohort was predominantly female (72.7%) with a mean age of 53.5 years (range 23-82, SD 16.3). Most fractures were intra-articular (88.6%) and dorsally angulated (79.5%). Mean time from injury to operation was 9.8 days (SD 5.8). Patient-rated outcome scores typically ranged 60-80 and did not appear to vary by sex, operator grade, or fracture configuration. By Soong grade, Grade 0 (n = 23) demonstrated the most favourable radiological restoration with mean postoperative radial height 13.6 mm and inclination 26.4°, alongside the highest mean patient-rated outcome score of 74.1. Grade 1 (n = 14) showed slightly lower restoration (radial height 12.1 mm, inclination 26.4°) and a mean outcome score of 65.3 with wider variability. Grade 2 (n = 7) had the least favourable radiology (radial height 11.7 mm, inclination 24.3°) and the lowest mean outcome score of 61.5; one patient in this group underwent plate removal for flexor tendon irritation.

Conclusions: In this single-centre retrospective series of VLP fixation for DRF, lower Soong grade-particularly Grade 0-was associated with better restoration of radial height and inclination and higher patient-rated outcome scores, whereas higher grades demonstrated a stepwise reduction in radiographic and functional results. These findings support meticulous plate positioning to minimise volar rim prominence and justify prospective, adequately powered studies to confirm the observed trends and evaluate longer-term tendon-related complications.