Injury最新文献

The term "fragility fractures of the pelvis" refers to the disruptions of the pelvic ring that are caused by low energy injuries (such as low-level falls or falls from the standing position) in the elderly population (age over 65 years) in the absence of metastatic bone disease. These fractures are increasing in numbers, due to the aging population, particularly in the developed countries, causing significant morbidity and mortality [1]. Although some fracture patterns are stable enough requiring only conservative treatment, other fracture types can cause significant pelvic instability, demanding a more insistent management protocol.

The repair of critical-sized bone defects represents significant clinical challenge. An alternative approach is the use of 3D composite scaffolds to support bone regeneration. Hydroxyapatite (HA) and tri-calcium phosphate (β-TCP), combined with polycaprolactone (PCL), offer promising mechanical resistance and biocompatibility. Bioelectrical stimulation (ES) at physiological levels is proposed to reestablishes tissue bioeletrocity and modulates cell signaling communication, such as the BMP/TGF-β and the RANK/RANK-L/OPG pathways. This study aimed to evaluate the use HA/TCP scaffolds and ES therapy for bone regeneration and their impact on the TGF-β/BMP pathway, alongside their relationship with the RANK/RANKL/OPG pathway in critical bone defects. The scaffolds were implanted at the bone defect in animal model (calvarial bone) and the area was subjected to ES application twice a week at 10 µA intensity of current for 5 min each session. Samples were collected for histomorphometry, immunohistochemistry, and molecular analysis. The TGF-β/BMP pathway study showed the HA/TCP+ES group increased BMP-7 gene expression at 30 and 60 days, and also greater endothelial vascular formation. Moreover, the HA/TCP and HA/TCP+ES groups exhibited a bone remodeling profile, indicated by RANKL/OPG ratio. HA/TCP scaffolds with ES enhanced vascular formation and mineralization initially, while modulation of the BMP/TGF pathway maintained bone homeostasis, controlling resorption via ES with HA/TCP.

Background: Femoral neck fractures, particularly Pauwels type II and III, pose significant challenges due to their vertical instability and susceptibility to complications such as non-union and avascular necrosis (AVN). Medial buttress plates (MBPs) have emerged as a promising adjunct in fixation, offering biomechanical advantages by neutralizing shearing forces and enhancing stability. However, the clinical efficacy of MBPs across different fixation techniques, plate configurations, and positioning remains unclear.

Purpose: This study aimed to (1) analyse outcomes of femoral neck fracture fixations augmented with MBPs, focusing on Pauwels type 2 and 3 fractures, and (2) analyse the impact of plate size, positioning, and the use of MBPs in different fixation techniques.

Study design: Systematic review; Level of evidence, 4.

Methods: Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using PubMed, MEDLINE, EMBASE, and Cochrane databases. Studies published from 2010 onwards, focusing on MBPs in Pauwels type II and III femoral neck fractures, were included. Clinical outcomes and plate details were recorded.

Results: Data from 21 studies, including 11 derived from meta-analyses, encompassing 642 patients were analysed. MBP-augmented fixations demonstrated a non-union rate of 6 %, an AVN rate of 4 %, and an overall failure rate of 17.3 %. The mean time to union was 3.9 ± 1.2 months, and the average HHS was 89.5 ± 5.5 at the final follow-up. Multiple cannulated screws (MCS) combined with a MBP showed a lower failure rate (14.6 %) compared to dynamic hip screw combined with a MBP (26.8 %), though not statistically significant (p = 0.164). Medial or anteromedial plate positioning yielded better outcomes, while anterior placement was associated with high failure rates. No studies examined the outcomes of femoral neck system fixation combined with a MBP.

Conclusion: MBPs are a valuable adjunct in managing Pauwels type II and III femoral neck fractures, providing favourable outcomes with low rates of failure and complications. The combination of MBPs with various fixation techniques has shown promising results, highlighting the potential for improved stability and outcomes. Further research is needed to optimize plate size, screw type, positioning, and the role of MBPs in augmenting fixation techniques for these challenging fractures.

Introduction: Injuries and violence are among the most prominent public health problems in the world. As well as being a leading cause of mortality - particularly among children and young adults - many of the millions of non-fatal injuries result in life-long disabilities and health consequences. The aim of this study was to estimate the prevalence of unintentional injuries and violence, and their associated factors among high school students.

Methods: This cross-sectional study included a total of 1218 high-school students in Turkey. Data were collected through a facilitated self-administered questionnaire with questions adapted from the Global School-based Student Health Survey instrument. Data were analyzed in IBM SPSS Statistics 28.0 using chi-square test to find statistical significance if any. The significant variables from the chi-square test were selected for multiple logistic regression analysis.

Results: The overall prevalence of physical attack, physical fighting, and serious injuries were 8.3 %, 14.8 %, and 11.7 %, respectively. In a multiple regression analysis, student truancy and lateness, worry, suicide attempts, and not having close friends were found to be associated with physically attacked, physical fight, and serious injuries.

Conclusion: This study demonstrated that the prevalence of unintentional injuries and violence among high school students is a major public health problem in Turkey. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions.

Introduction: The development of national registries from routinely collected health data has transformed the research landscape by improving access to large sample populations. This growing volume of data enables researchers to address critical questions but also challenges clinicians in conducting, evaluating, and applying the research. The National Trauma Data Bank (NTDB), the largest aggregate of deidentified trauma data in the world, is increasingly utilized for retrospective studies on trauma. This scoping review aimed to assess the quality of reporting of NTDB-based orthopedic trauma publications.

Methods: We queried the Dimensions database for orthopedic studies using the NTDB. The quality of reporting was assessed by adherence to two international publication guidelines: the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the REporting of studies Conducted using Observational routinely collected data (RECORD).

Results: From a total of 3,720 identified articles, 137 manuscripts were available for analysis. The median scores and interquartile ranges (IQR) for STROBE and RECORD were 19 (IQR 18-20) and 7 (IQR 7-8), respectively. For STROBE scoring, the lowest fulfilled items were handling missing data and potential sources of bias. For RECORD scoring, the lowest fulfilled items were accessibility to protocol, raw code and data, validation studies, and data cleaning. A greater proportion of high-scoring studies were published in high-impact journals versus low-impact journals and in journals that enforced guidelines versus those that did not.

Conclusion: This study highlights the methodological gaps in the NTDB-based orthopedic trauma publications and identifies areas for improvement, including the management of missing data, selection of the study population through data cleaning, identification of sources of bias, and transparency in data accessibility. Future work should test the reproducibility of these studies and evaluate adherence to established guidelines across a broader range of databases and disciplines.

Background: Determining trauma as an act of Self-directed violence (SDV) or from high risk or unclear behaviours is challenging for trauma clinicians and may be affected by patient sex and mechanism of injury. The aim of this study was to examine the differences in characteristics and outcomes between those who have intentionally directed violence towards themselves with those of unclear intent, within a regional trauma system.

Methods: Data was collected between January 2018 and December 2021 in patients who had been identified as a result of either self-directed violence (SDV) defined as any intentional act that can cause injury to one's self, including death or participated in high-risk behaviours, where the intent was unclear (UI). Differences between female and male patients presenting with SDV and unclear intent were explored.

Results: Overall, 2760 patients were identified, with a median age of 39 years (IQR 28-54) and just over a quarter of females (28 %). Falls from height were the most common mechanism of injury in all groups. SDV was recorded in 45 % of patients, and previous mental health diagnoses were almost three times as prevalent in this group compared to those of unclear intent (SDV: 42 % vs UI: 13 %). In the sex-based analysis females were more likely than males to have a history of depression (49 % vs 31 %, p < 0.0001). There were few sex differences in the SDV group but women of unclear intent were older, with a quarter being aged 65 years or over (Females: 26 % vs. Males: 11 %, p < 0.0001). Females of unclear intent were also more likely to have sustained a high level fall (Females: 29 % vs. Males:11 %, p < 0.001).

Conclusion: Previous mental health co-morbidity was associated with self-directed violence in our cohort. Yet the determinants of intent for over half of the patients were unclear. Trauma clinicians should actively enquire regarding intent of injury and escalate to clinical psychology or psychiatry teams as indicated. Those with mental health comorbidities, previous depression and older women may all have an increased risk where intent is unclear and warrants further investigation. Understanding the predictors and characteristics of unclear intent and high-risk behaviours are key to implementation of public health strategies around prevention of self-directed violence and suicide.

Background: Paediatric upper limb fractures are commonly treated with Kirschner (K) wire fixation, which can be buried or left exposed. Although both techniques are widely used, controversy remains regarding infection risk, complications, and other clinical outcomes between buried and exposed K-wires. This systematic review and meta-analysis aimed to compare infection rates and secondary outcomes between buried and exposed K-wires in paediatric upper limb fractures located distal to and including the elbow, and proximal to the carpus.

Methods: A systematic review of the literature was conducted according to PRISMA guidelines, with searches performed across Medline, EMBASE, and the Cochrane Library up to July 2023. Studies were included if they directly compared buried and exposed K-wires in paediatric patients (under 18 years old) and reported on infection rates. Meta-analysis was conducted to compare overall infection rates. Pooled means were used to compare secondary outcomes. Bias was assessed using the ROBINS-I and RoB2 tools.

Results: Fifteen studies involving 1,854 participants were included. The meta-analysis showed that buried K-wires were associated with a significantly lower risk of overall postoperative infection compared to exposed K-wires (RR 0.33; 95 % CI 0.22 to 0.50; p< 0.001). The risk of deep infection requiring further surgery was 1.74 % in buried K-wires (95 % CI: 0.72 % to 2.75 %) and 2.07 % in exposed K-wires (95 % CI: 0.55 % to 3.59 %). Skin erosion was a common complication of buried K-wires, with a pooled mean rate of 13.0 %. Buried K-wires were associated with a higher likelihood of requiring removal in theatre (84.4 % vs. 4.2 %). Time to K-wire removal was longer in the buried group (10.9 weeks vs. 5.3 weeks). Re-operation and bone union failure rates were similar between groups.

Conclusion: Our systematic review and meta-analysis suggest that, while buried K-wires are associated with lower overall infection rates, the risk of deep infection is comparable between buried and exposed K-wires. Buried K-wires show higher rates of skin erosion and increased need for removal in theatre. Given these findings, exposed K-wires offer a safe and more cost-effective option for paediatric upper limb fracture fixation. Further studies are needed to assess patient-reported outcomes and environmental impacts.

Introduction: Optimizing treatment strategies in polytrauma patients is a key focus in trauma research and timing of major fracture care remains one of the most actively discussed topics. Besides physiologic factors, associated injuries, and injury patterns also require consideration. For instance, the exact impact and relevance of traumatic brain injury on the timing of fracture care have not yet been fully investigated.

Methods: In this retrospectively cohort study at a level one trauma center, patients requiring trauma team activations from 2015 to 2020 were screened. Patients with an injury severity score >16 and at least one body region requiring operative fixation were included. Patients who underwent their first definitive surgery <24 h were stratified as group SDS (Safe Definitive Surgery) and >24 h as group DFC (Delayed Fracture Care). Outcomes were early mortality (<72 h), SIRS and sepsis, timing to first definitive surgery and completed reconstruction, total number of surgeries, and factors influencing the surgical strategy (e.g., unstable physiology). Odds ratios for treatment strategies and influencing factors were calculated using the Fisher`s exact test with conditional maximum likelihood estimate.

Results: From a total of 901 patients screened, 239 were included in the analyzes (Group DFC: 151, Groups SDS: 88). Groups did not significantly differ regarding early mortality, SIRS and sepsis. Group SDS had a significantly lower mean number of operations (4.3 vs. 5.3; p = 0.037) and a significantly shorter mean time until completion of reconstructive operations (10 days vs. 15 days; p = 0.013). Unstable physiology and intracranial trauma sequelae with the necessity for neurosurgical interventions (NSI) were identified as most significant factors for delaying definitive fracture care (OR: 2.85; 95 % CIs: 1.56 to 5.33 and OR: 5.59; 95 % CIs: 1.63 to 29.85), while the presence of intracranial bleeding (IB) without NSI did not have a significant influence (OR: 1.21; 95 % CIs: 0.63 to 2.34).

Conclusion: The necessity of NSI and unstable physiology are highly relevant factors for delaying definitive fracture care in polytrauma patients, while the presence of IB without NSI had less impact. In this cohort, early definitive fracture care in physiologically stable patients without NSI, was not associated with increased patient morbidity.

Introduction: Studies have demonstrated successful outcomes with early weightbearing following open reduction internal fixation (ORIF) of specific ankle fractures. The external validity of an early weightbearing protocol and its effects on patient-reported outcome information scores (PROMIS) has yet to be investigated. This study aimed to investigate the effects of an early weightbearing protocol for all operatively treated ankle fractures and its impact on clinical outcomes and complications.

Methods: This retrospective cohort study included 229 patients (≥ 16 years) with OTA/AO 44 A-C fractures who underwent open reduction and internal fixation (ORIF). Patients were divided into groups based on early (2-3 weeks postoperative) or delayed (>6 weeks postoperative) weightbearing protocols. Primary outcomes included PROMIS score subsets including physical function, depression, and pain interference and ankle range of motion (ROM) at each follow up visit. Secondary outcomes included complications such as implant removal for pain, prominence, or surgical site infection, revision surgery for failure of fixation or loss of reduction, and post-operative sensory or motor deficits.

Results: There were 96 patients in the early weightbearing cohort and 133 patients in the delayed weightbearing cohort. The median follow-up time of the early weightbearing cohort was 471.47 ± 389.69 days while the delayed cohort was 459.82 ± 358.21 days. Demographics and comorbidities were distributed equally between both groups, except the presence of peripheral neuropathy which was observed more frequently in the delayed weightbearing cohort (8 versus 0, p = 0.022). Results indicated no statistically significant differences in PROMIS scores at final follow up, ankle ROM, or post-operative complications between the early and delayed weightbearing cohorts. Multivariable regression analysis identified smoking as a factor associated with worse ankle ROM at final follow-up.

Conclusions: This study found that early weightbearing after ORIF of unstable ankle fractures leads to similar PROMIS scores and ankle ROM without increased complications. In addition, smokers were found to have worse ankle ROM when compared to nonsmokers at final follow-up.

Introduction: Concentration of trauma care in trauma network has resulted in different trauma populations across designated levels of trauma care.

Objective: Describing psychological health status, by means of the impact event scale (IES) and the hospital anxiety and depression scale (HADS), of major trauma patients one and two years post-trauma across different levels of trauma care in trauma networks.

Methods: A multicentre retrospective cohort study was conducted.

Inclusion criteria: aged ≥ 18 and an Injury Severity Score (ISS) > 15, surviving their injuries one year after trauma. Psychological health status was self-reported with HADS and IES. Subgroup analysis, univariate, and multivariable analysis were done on level of trauma care and trauma region for HADS and IES as outcome measures.

Results: Psychological health issues were frequently reported (likely depressed n = 31, 14.7 %); likely anxious n = 32, 15.2 %; indication of a post-traumatic stress disorder n = 46, 18.0 %). Respondents admitted to a level I trauma centre reported more symptoms of anxiety (3, P₂₅-P₇₅ 1-6 vs. 5, P₂₅-P₇₅ 2-9, p = 0.002), depression (2, P₂₅-P₇₅ 1-5 vs. 5, P₂₅-P₇₅ 2-9, p < 0.001), and post-traumatic stress (6, P₂₅-P₇₅ 0-15 vs. 13, P₂₅-P₇₅ 3-33, p = 0.001), than patients admitted to a non-level I trauma centre. Differences across trauma regions were reported for depression (3, P₂₅-P₇₅ 1-6 vs. 4, P₂₅-P₇₅ 2-10, p = 0.030) and post-traumatic stress (7, P₂₅-P₇₅ 0-18 vs. 15, P₂₅-P₇₅ 4-34, p < 0.001).

Conclusions: Major trauma patients admitted to a level I trauma centre have more depressive, anxious, and post-traumatic stress symptoms than when admitted to a non-level I trauma centre. These symptoms differed across trauma regions, indicating populations differences. Level of trauma care and trauma region are important when analysing psychological health status.