Injury最新文献

Background: Equestrian sports have been found to cause high rates of injuries. In clinical practise after such injuries, polytrauma protocol workups usually include whole-body computed tomography (WBCT), CT of the chest, abdomen and pelvis with intravenous iodine contrast medium, and CT of the cervical spine and brain without contrast. The purpose was to investigate the use of WBCT in equestrian-related accidents, to analyse demographics, mechanism of injury (MOI), therapy and severity of equine-related accidents, radiology, and the use of protecting equipment.

Material and methods: This is a retrospective study including a cohort of patients who were admitted to trauma centres at Queen Silvia Children's Hospital (paediatric <16 years) and Sahlgrenska University Hospital (adult ≥16 years) in Gothenburg in the period 2010 - 2020 due to equestrian-related injuries. Medical records were studied concerning patient demographics, MOI, protective equipment, injuries suffered, Injury Severity Score (ISS), surgery, and hospital length of stay.

Results: There were 1341 patients (97 % female, 43 % paediatric) with equestrian-related accidents who were admitted to the hospitals. Of these, 262 were assessed as polytrauma, of whom 77 % were adults with median age of 38 years and 23 % were paediatric with median age of 13 years. WBCT was performed in 54 % of adult and 52 % of paediatric patients. The MOI was mainly fall from a horse 241/262 (92 %), and in 27/241 (11 %) the horse also fell on the rider. In the 262 patients, spine injury was seen in 32 %, thoracic injury in 29 %, cerebral hemorrhages in 22 (8 %), tetraplegia in 2 (0.8 %), and paraplegia in 1 (0.4 %). Abdominal injury was mostly seen in liver 13/262 (5 %). The median ISS was 4 (IQR 1-9). There were 59 % of paediatric and 48 % of adult patients hospitalized for a median of 2 days (IQR 1-5), and 14 needed intensive care. Surgery was required in 33 patients. Wearing of helmets and vests was recorded in 146 (56 %) and 58 (22 %) of the individuals, respectively.

Conclusions: Only 54 % of adult and 52 % of paediatric patients underwent a WBCT after equestrian - related polytrauma indicating inadequate assessment. The documentation rate of safety equipment was low.

Introduction: Urotrauma requiring intervention can be managed by trauma surgery (TS), urologic surgery (US) or interventional radiology (IR). There is no clear consensus on preferable specialty for intervention, and limited data compare outcomes by specialty. This study aims to characterize interventions for urotrauma by specialty and analyze outcomes at our institution.

Methods: We conducted a retrospective review of patients at our Level I Trauma Center with urotrauma requiring intervention from 2020-2023. We performed a descriptive analysis of demographics, injury type, specialty involved, intervention type, injury severity score (ISS), and post-operative course.

Results: Of 387 patients identified, 23 % (87/387) required intervention with median age 32 (IQR 24-48) years. Kidney injuries were most common (68 %, 59/87), followed by ureteral (13 %, 11/87) and bladder (13 %, 11/87). TS performed most of the interventions (47 %, 41/87), followed by US (41 %, 36/87), and IR (12 %, 10/87). TS performed nephrectomy at a higher rate than US (67 %, 24/36 vs 8 %, 1/13). Of the cohort, 20 % (17/87) were readmitted, with 65 % (11/17) requiring a procedure and 63 % (7/11) of which were related to initial urologic injury. US was not initially consulted in nearly 60 % (4/7) of cases requiring urologic intervention upon readmission. The rate of urologic intervention upon readmission was 38 % (3/8) among patients who had an initial urologic consultation, compared to 100 % (4/4) among those who did not. Median length of stay (LOS) for readmitted patients was 76.7 h among those who received an initial US consultation and 134.1 h among those who did not. Follow-up occurred in 86 % (24/28) and 70 % (27/37) of patients treated by US and TS, respectively.

Discussion: TS conducted most urotrauma interventions, while US managed most non-renal cases. The nephrectomy rate for renal trauma was lower when managed by US, suggesting a more organ-preserving approach. Patients without initial US consultation had a nearly 3-fold higher rate of readmission for urologic intervention, longer readmission hospital LOS, and lower follow-up rates. These clinically meaningful trends suggest that US consultation may improve outcomes by reducing the need for nephrectomy, minimizing reinterventions, reducing hospitalization length, and improving continuity of care. Multidisciplinary collaboration should be pursued in the management of urotrauma.

Background: In recent years, more studies have focused on the outcome parameter (health-related) Quality of Life (QOL) after a severe injury. Psychological complaints are known to be associated with QOL. However, little is known about long-term QOL. Studies in other fields, have shown that, apart from disease, patients' personality may be associated with (long-term) QOL.

Aim: The aim of this study was to evaluate QOL, psychological complaints, and physical limitations about ten years after a severe injury and to compare this with the patients' situation 7 years earlier. Furthermore, the association between long-term QOL and patients' personality was examined.

Methods: The 156 patients who participated in a study to investigate QOL, psychological problems and physical limitations seven years ago, were reassessed to determine their current situation using the same questionnaires as seven years earlier. In addition, patients' personality was assessed.

Results: The response rate was 58%. Except for the social component, no significant differences in patients' QOL, psychological complaints and physical limitations were found in comparison with seven years earlier. The social domain scores had decreased. Personality was significantly associated with all QOL domains. Psychological complaints were not an important confounder in the association between personality and long-term QOL, but they did in the relationship between personality and physical complaints.

Conclusion: The QOL, psychological, and physical situation of severely injured patients ten years after their injury is comparable to their situation three years after their injury. Personality was an important factor, strongly associated with long-term QOL. Therapy focused at extending coping strategies may be helpful for patients at risk for low QOL, since no further spontaneous recovery was observed.

Level of evidence: This is a Basic Science paper and, therefore, does not require a level of evidence.

This letter evaluates the methodological shortcomings in the FEA research conducted by Ma et al. (2025) that contrasts hook plates with tension-band wiring for patellar fractures. Unresolved concerns consist of: uniform bone material characteristics simplifying biomechanics; static loads neglecting dynamic physiological forces; idealized fracture spaces missing clinical variation; and unverified interfaces exaggerating stability. These gaps may exaggerate the effectiveness of the implant. We suggest personalized modeling, simulations of dynamic loading, and studies on mesh convergence to enhance clinical significance. Tackling these issues would enhance forthcoming evaluations of orthopedic devices based on FEA.

We commend Bassa et al.'s study on VTE risk in acute SCI patients. We propose further exploring rehabilitation strategies, genetic polymorphisms (e.g., factor V Leiden), and inflammatory markers (e.g., CRP, IL-6) to refine personalized VTE prophylaxis and management in this population.