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A 58-yr-old woman presented to our mineral metabolism center, complaining of localized and continuous pain, which worsened with movements, and weakness of the right foot. The patient reported having had a fracture of the fifth metatarsal bone of the right foot about 4 mo ago. She was initially treated with a cast that she did not tolerate and then with an orthopedic brace. After about 1 mo, she noticed swelling of the right foot and started complaining of continuous pain. The physical examination when came to our center seemed partly improved in respect to the initial one referred by the patient even though she still presented with a mild swelling, reddish skin color, and mild sweating on the right foot. Allodynia and hyperalgesia still persisted but at a lower grade. Main biochemical parameters of calcium metabolism were in the normal range. After excluding other clinical conditions, a diagnosis of complex regional pain syndrome type I was made. She was treated with neridronate iv with resolution of symptoms while continuing with physical therapy and pain relievers. Similar milder episodes were reported by the patient in the following months. However, they were immediately resolved by prompt neridronate infusion. No further complaints have been reported during the next 3 yr follow-up., (© The Author(s) 2025. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aims: HIV and musculoskeletal injuries both disproportionately affect individuals living in low- and middle-income countries (LMICs), leading to a significant number of fractures in HIV-positive patients. Despite this, little is known about the long-term outcomes for these patients. This prospective cohort study investigated whether HIV infection is associated with fracture-related infections (FRIs)., Methods: All adult patients between September 2017 and December 2018 who received intramedullary nail fixation of lower limb fractures in two tertiary referral hospitals in Cape Town, South Africa, were deemed eligible. In total, 358 participants were recruited for this study, 33 of whom were lost to follow-up. Of the 325 participants, 37 (11.4%) developed a total of 39 FRIs over the study period; 25 were early FRIs (64.1%) and 14 were late FRIs (35.9%). Participants were followed up for a minimum of 24 months. Throughout follow-up, participants were monitored for FRIs. These were categorized as early FRIs (< 90 days) and late FRIs (> 90 days)., Results: Overall, 71 participants (21.8%) were HIV-positive and 254 participants were HIV-negative (78.2%). In the HIV-positive population, 15 participants (21.1%) suffered 16 FRIs: seven early FRIs (9.9%) and nine late FRIs (7.0%). In the HIV-negative population, 22 participants (8.7%) experienced 23 FRIs, 18 were early FRIs (7.1%), and five participants experienced late FRIs (2.0%). On univariate and multivariate regression, being HIV-positive increased a participant's likelihood of suffering late FRIs, and FRIs overall. HIV status made no significant difference to early FRI rates., Conclusion: Contrary to recent evidence, this study demonstrates an association between HIV and an increased risk of a patient developing late FRIs. However, there was no significant difference in early FRI rates., Competing Interests: This study was funded by the Wellcome Trust, AOUK, and AO Alliance, as awarded via institutional grants to S. M. Graham. W. J. Harrison is a consultant for AO Alliance – a non-profit developmental foundation with no commercial affiliation to this study. M. Laubscher reports institutional funding from Zimmer Biomet, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Smith & Nephew and AO Trauma, unrelated to this study. N. Ferreira reports institutional funding from AO, Orthofix, and Smith & Nephew, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Orthofix and Smith & Nephew, unrelated to this study., (© 2025 The British Editorial Society of Bone & Joint Surgery.)

Background: The aim of the study was to evaluate the clinical and functional outcomes following suturing of sheath of peroneal tendons to the calcaneal plate as an innovative technique for reduction of peroneal tendon instability (PTI) accompanying calcaneal fracture surgically treated via extensile lateral approach (ELA)., Methods: In a retrospective comparative study, among 245 operatively treated calcaneal fractures through ELA, we had 33 cases with PTI who underwent relocation of the peroneal tendons with ethibond suture in a figure-of-8 shape, passed through 2 parts of sheath of peroneal tendons and stitched to the calcaneal plate. Of the 33 cases, 12 were evaluated in the experimental group. Twelve surgically treated calcaneal fractures without PTI were matched as the control group. The outcome of the patients was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI) percentage, Visual Analog Scale (VAS) pain, changes in Tegner activity level, maximal peroneal muscles strength testing, modified Star Excursion Balance Test (mSEBT), and triple hop for distance (THD) test. For the last 3 tests, the difference between operated and normal feet was calculated for each patient and this difference was compared between the 2 groups., Results: There was no statistically significant difference between the 2 groups for AOFAS Ankle-Hindfoot Scale (P = .09), FFI percentage (P = .12), VAS pain (P = .73), changes in Tegner activity level (P = .87), maximal peroneal muscles strength testing (P = .45), mSEBT (P > .05), and THD (P = .87) tests. We had a case with point tenderness on retromalleolar groove and 4 cases with paresthesia in the territory of the sural nerve in the experimental group in contrary to one case of sural nerve paresthesia in the control group (P = .31)., Conclusions: Relocation of peroneal tendons in PTI accompanying calcaneal fractures by fixing sheath of peroneal tendons to the calcaneal plate could be an acceptable procedure with good outcomes but may have increased chance of sural nerve injury., Levels of Evidence: Therapeutic, Level III: Retrospective., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Lower limb fractures cause local pain, swelling, ecchymosis, and dysfunction. Clinically, incision and reduction surgery are often employed to treat lower limb fractures. However, postoperative pain can be intense, leading to adverse emotions that hinder subsequent recovery., Methods: A total of 99 postoperative patients with lower limb fractures were randomly divided into 3 groups: the control group (routine care, 33 patients), the auricular acupressure group (routine care plus auricular acupressure, 33 patients), and the combined group (routine care, auricular acupressure, and emotional freedom techniques [EFT], 33 patients). Pain levels were measured using the visual analog scale (VAS), and anxiety levels were measured using the self-rating anxiety scale (SAS) at various time points post-intervention. Patient satisfaction with nursing care was also evaluated at the end of the intervention., Results: The VAS scores in the combined group were significantly lower than those in the auricular acupressure and control groups at 4, 12, 24, and 48 hours post-intervention (P < .05). Additionally, the SAS scores in the combined group were significantly lower than those in the auricular acupressure and control groups at 72 hours post-intervention (P < .05). The combined group also reported significantly higher satisfaction with nursing care compared to the other 2 groups at the end of the intervention (P < .05)., Conclusion: Auricular acupressure combined with EFT effectively reduces pain levels, alleviates anxiety, and increases patient satisfaction with nursing care in postoperative patients with lower limb fractures., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Case: We present the case of a 24-year-old woman who sustained a left midshaft clavicle fracture with acute subclavian artery compression, subclavian vein laceration, and complete brachial plexus palsy after a motor vehicle collision. The patient underwent urgent open reduction internal fixation of the clavicle and repair of the subclavian vein. Two years later, she underwent opponensplasty and flexor digitorum profundus tendon transfers. She regained satisfactory hand function, allowing her to return to full-duty work., Conclusion: Clavicle fractures with associated acute neurovascular and brachial plexus injuries are rare pathologies that result from high-energy trauma and should undergo urgent fixation., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C524)., (Copyright © 2025 by The Journal of Bone and Joint Surgery, Incorporated.)

Introduction: Pelvic ring fractures are known to be associated with complications associated with adjacent organ injuries, such as the urogenital tract (e.g. erectile dysfunction (ED), which are sometimes diagnosed in a delayed fashion. Therefore, we assessed the quality of life (QoL) and the rate of erectile dysfunction (ED) following pelvic ring fractures at a minimum of 3 years after pelvic ring injury., Methods: Between January 1, 2016, and December 31, 2020, adult male patients (≥ 18 years) with pelvic ring injuries were included in the study. Fractures were classified according to the Young & Burgess (Y&B) classification system, while pelvic contusions were categorized as the control group. Data were collected using a written questionnaire that assessed Quality of Life (QoL) by Short Form 12 (SF-12) and erectile dysfunction (ED) with the International Index of Erectile Function 5 (IIEF-5). ED was stratified as follows: no ED (21-25 points), mild ED (16-21 points), moderate ED (9-15 points), and severe ED (5-7 points). Comorbidities and risk factors for ED were also assessed, including vasculopathy, peripheral artery disease, hypercholesterolemia, coronary artery disease, diabetes, and smoking., Results: A total of 182 patients were included, with a mean age at injury of 53.5 years (SD 17.1) and a mean age at the time of the questionnaire of 57.8 years (SD 17.4). The distribution of patients was as follows: APC Group (n = 20, 11.1%), LC Group (n = 94, 52.2%), CMVS Group (n = 6, 3.3%), and Control Group (n = 60, 33.3%). The mean Injury Severity Score (ISS) was 24.6 points (SD 16.4). Regarding erectile dysfunction, 8 patients (17.4%) had no ED, 10 (21.7%) had mild ED, 6 (13.0%) had moderate ED, and 22 (47.8%) had severe ED. Quality of Life (QoL) was significantly reduced in patients with CMVS pelvic fractures, particularly in physical role function, which scored 62.5 points (SD 29.6, p < 0.001). All patients in the APC Group reported at least a mild form of ED. APC injuries were identified as an independent risk factor for lower IIEF-5 scores (OR -4.5, 95% CI -8.3 to -0.7, p = 0.02), comparable to other risk factors such as hypertension (OR -9.2, 95% CI -12.8 to -5.6, p < 0.001), diabetes (OR -5.3, 95% CI -9.4 to -1.2, p = 0.012), and smoking (OR -2.6, 95% CI -5.2 to -0.04, p = 0.05)., Conclusion: Vertical shear fractures are associated with significantly lower quality of life compared to APC or LC fractures three years post-injury. The APC type of pelvic ring injury was identified as an independent risk factor for the development of erectile dysfunction (ED). Early screening and appropriate management should be initiated for patients with APC injuries to address and mitigate the risk of ED., Competing Interests: Declarations. Conflict of interest: None of the authors declared any conflicts of interest. Ethical approval: The cantonal ethical committee Zurich approved the study protocol and the questionnaire (KEK Zürich, BASEC-Nr.: 2020–02811)., (© 2025. The Author(s).)

» Anemia is a common comorbidity in orthopaedic trauma patients with important clinical consequences, significantly negatively affecting a patient's course following orthopaedic trauma.» Anemia remains relatively understudied in the orthopaedic trauma population with a large amount of current literature focused solely on geriatric hip fracture patients.» Greater investigation into alternatives to blood transfusions such as iron therapy or cell salvaging for treatment of anemia in the orthopaedic trauma population is needed., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B190)., (Copyright © 2025 by The Journal of Bone and Joint Surgery, Incorporated.)

Deep vein thrombosis (DVT) is one of the important factors leading to death in patients undergoing fracture surgery. This study aims to investigating the predictive value of the Caprini score combined with thrombus molecular markers for the risk of DVT in patients after traumatic fracture surgery. A total of 342 patients who underwent surgery for traumatic fractures were included in the study. The patients were divided into two groups based on the occurrence of DVT after surgery: the DVT group (n = 57) and the non-DVT group (n = 285). A univariate analysis and logistic regression analysis were conducted on clinical factors and laboratory indicators that might be associated with DVT in patients with traumatic fractures. A predictive model for DVT risk was then constructed by combining thrombus molecular markers with the Caprini score. The median age of all patients was 65 years (54-75 years), the postoperative Caprini score was 9 (6-11), and the length of hospital stay was 11 days (8-16 days). In univariate analysis, age (P = 0.029), postoperative Caprini score (P < 0.001), and length of hospital stay (P = 0.009) were significantly associated with the occurrence of DVT. Logistic regression analysis showed that the risk of developing DVT increased with higher postoperative Caprini scores (P < 0.001), longer hospital stays (P = 0.024), and higher PIC levels (P = 0.046). Among these, the postoperative Caprini score was the most effective factor for diagnosing DVT, with an area under the curve (AUC) of 0.814 (P < 0.001) and a diagnostic cutoff of 11 points. The overall diagnostic efficacy of individual thrombus molecular markers from highest to lowest was TM, DD, PIC, t-PAIC, and TAT, with all except TAT showing statistical significance. The combined diagnostic efficacy of the postoperative Caprini score and PIC also showed statistical significance (AUC = 0.869, P < 0.001). Thrombus molecular markers combined with the postoperative Caprini score have potential predictive value for the risk of DVT in patients after traumatic fracture surgery., Competing Interests: Declarations. Ethical approval: Ethical approval of this study was approved by the ethics committee of Zhejiang Provincial People’s Hospital (approval NO. 2024 − 106). Informed consent was waived by Zhejiang Provincial People’s Hospital ethics committee. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: A prospective longitudinal cohort study was performed to gain insight into the course of recovery in terms of pain, opioid consumption, and mobility in patients with a lateral compression (LC) pelvic injury., Methods: Adult patients with an LC injury, without any cognitive disorders or limited mobility and who could communicate in Dutch were asked to participate. Pain in terms of NRS (numeric rating scale, range 0-10), opioid use and mobility were recorded at eight time points: at hospital admission, and three days, one week, six weeks, three months, six months, one year and two years after the injury. A sub-analysis was performed for nonoperatively and operatively treated patients., Results: Ninety-seven patients were included, of which 23 (24%) were treated operatively and 74 (76%) conservatively. Pain at rest and exertion, were highest upon admission (mean NRS of 3.4 (SD = 2.6) and 4.4 (SD = 2.8), respectively) but decreased within six weeks (mean NRS of 0.8 (SD = 1.6) and 2.0 (2.0), respectively). After two years, the mean NRS was 0.5 (SD = 1.6) and 0.9 (SD = 2.1), respectively. Upon admission, 85% were given opioids, however only 11% used opioids after three months and 4% after two years. At three months, 35% were walking using walking aids and 58% were walking independently. After two years, 98% were walking independently., Conclusions: Pain rapidly decreased within the first six weeks. Most patients did not need opioids after three months. Furthermore, most patients were walking with walking aids after six weeks. After two years, few patients experienced pain, used opioids or had difficulties walking., Competing Interests: Declarations. Conflict of interest: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members., (© 2025. The Author(s).)

Frailty and fractures are closely associated with adverse clinical outcomes. This retrospective study investigated the prognostic impact of frailty, prevalent fractures, and the coexistence of both in patients with cirrhosis. Frailty was defined according to the Fried frailty phenotype criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. Prevalent fractures were assessed using questionnaires and lateral thoracolumbar spine radiographs. Cumulative survival rates were compared between the frailty and non-frailty groups, fracture and non-fracture groups, and all four groups stratified by the presence or absence of frailty and/or prevalent fractures. Among 189 patients with cirrhosis, 70 (37.0%) and 74 (39.2%) had frailty and prevalent fractures, respectively. The median observation period was 64.4 (38.6-71.7) months, during which 50 (26.5%) liver disease-related deaths occurred. Multivariate analysis identified frailty and prevalent fractures as significant independent prognostic factors in the overall cohort (p < 0.001 and p = 0.003, respectively). The cumulative survival rates were lower in the frailty or fracture groups than in the non-frailty or non-fracture groups, respectively, in the overall cohort and in patients with compensated and decompensated cirrhosis. Patients with both frailty and prevalent fractures showed the lowest cumulative survival rates, whereas those without these comorbidities showed the highest cumulative survival rates among the four stratified groups. Frailty and prevalent fractures were independently associated with mortality in patients with cirrhosis. Additionally, the coexistence of both comorbidities worsened the prognosis., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Musculoskeletal injuries in children offer unique challenges compared with those in adults. Even low-energy injuries that involve the physis have the potential to cause a growth disturbance that could require treatment. Higher-energy injuries can be complicated by the same soft-tissue disruption, fracture contamination, and bone loss that are seen in adults. However, small patient size and injury proximity to a physis can complicate both immediate and long-term management. It is important to be aware of treatment tools and strategies when managing complex injuries in young patients.

Fracture-related infection (FRI) is a serious complication that occurs primarily in surgically treated fractures. FRIs occur when bacteria enter the site of bony injury and alter the healing inflammatory response within the bone. This can prevent bone regeneration and can lead to long-lasting complications such as chronic infection, pain, nonunion, and amputation. FRIs can span a wide range of severity, and only recently has the international community come to a consensus on specific definitions and guidelines for treatment. Principles of FRI management include identification of at-risk injuries with correction of modifiable risk factors, the achievement of adequate bony union and fracture healing, thorough eradication of the offending microorganism, and restoration of function. Treatment strategies involving implant retention versus removal depend on several factors, including the acuity of the infection, host physiology, initial reduction quality and fracture stability, and implant stability. Antibiotic treatment of FRI has historically been intravenous; however, emerging data suggest oral antibiotics may be just as efficacious.

Following fracture fixation, fracture-related infection (FRI) is a common complication and requires systematic evaluation to allow for an optimal treatment strategy. A high index of suspicion is necessary for early and timely diagnosis, to diagnose occult infection, and to prevent untreated infections from worsening. Diagnosis of FRI includes evaluation based on history and clinical examination, surgical exploration, serum inflammatory markers, imaging modalities, microbiology, histopathology, and, when needed, molecular biology. FRI can be early, delayed, or late onset, and symptom presentation and the pathogenic organism may vary with each type. Key considerations during the evaluation of FRI include if the fracture has united, the onset of symptoms, the location of the infection, the stability of fixation, the quality of reduction, the quality of soft tissues, history of infection, and host physiology. Although the common treatment for early FRI includes débridement, implant retention, and antibiotics, the treatment for delayed-onset or late-onset FRI typically includes staged surgeries starting with removal of implants and antibiotic treatment.

Chronic fracture-related infection is a complex, costly clinical problem with a wide spectrum of clinical presentations. The goals of treatment are infection control with a healed fracture covered by well-vascularized soft tissue and improvement of patient pain and function. Management is both medical, with culture-targeted antimicrobial agents, and surgical, requiring meticulous irrigation and débridement. Overall surgical treatment paradigms depend on several critical factors, including whether the bone is united, the location of fracture-related infection, implant stability, soft-tissue status, and host fitness for undergoing surgeries. Specific surgical considerations such as the technical management of bony defects are a source of controversy and ongoing research, although there is emerging evidence that suggests bone transport methods may be the most reliable option for large bone defects. With host optimization and proper treatment, high rates of infection control can be achieved. However, relapse of infection may occur, which would add a costly burden to both the patient and society.

Background: Current guidelines recommend 24-hour telemetry monitoring for isolated sternal fractures (ISFs) with electrocardiogram (ECG) abnormalities or troponin elevation. However, a single-center study suggested ISF patients with minor ECG abnormalities (sinus tachycardia/bradycardia, nonspecific arrhythmia/ST-changes, and bundle branch block) may not require 24-hour telemetry monitoring. This study sought to corroborate this, hypothesizing ISF patients would not develop blunt cardiac injury (BCI)., Materials & Methods: A retrospective study was performed at 8 trauma centers (1/2018-8/2020). Patients with ISF (abbreviated injury scale <2 for the head/neck/face/abdomen/extremities) and minor ECG abnormalities or troponin elevations were included. Patients with multiple rib fractures or hemothorax/pneumothorax were excluded. The primary outcome was an echocardiogram confirmed BCI. The secondary outcome was significant BCI defined as cardiogenic shock, dysrhythmia requiring treatment, post-traumatic cardiac structural defects, unexplained hypotension, or cardiac-related procedures. Descriptive statistics were performed., Results: Of 124 ISF patients with minor ECG abnormalities or troponin elevation, 90% were admitted with a mean stay of 35 hours. Echocardiogram was performed for 31.5% of patients, 10 (25.6%) of which had abnormalities. However, no patient had BCI diagnosed on echocardiography. In total, 2 patients (1.6%) had a significant BCI (atrial fibrillation and supraventricular tachycardia at 10 and 82 hours after injury). No patient died., Conclusions: Following ISF with minor ECG changes or troponin elevation, <2% suffered significant BCI, and none had an echocardiogram diagnosed BCI, despite >30% receiving echocardiogram. These findings challenge the dogma of mandatory observation periods following ISF with associated ECG abnormalities and support the lack of utility for routine echocardiography in these patients., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Fracture-related infections are a significant burden to the patient, associated with high health care costs and use of resources. Therefore, prevention is more critical than treatment of infection. There are injury- and patient-related risk factors that are mostly not modifiable, with the exception of a few patient-specific ones such as control of blood glucose levels in patients with diabetes. Measures of prevention can be implemented preoperatively, intraoperatively, and postoperatively.

Purpose: To assess the rate of heterotopic ossification (HO) following acetabular surgery with a standardized protocol via the Kocher-Langenbeck. Secondarily, to evaluate patient characteristics, injury variables, and perioperative data among patients with HO and no HO., Methods: This was a retrospective case series from an academic Level I trauma center. Included patients had displaced acetabular fractures treated via Kocher-Langenbeck approach with debridement of (1) gluteus minimus muscle (GMM) from the posterior wall and column up to the superior gluteal neurovascular bundle, (2) unhealthy appearing piriformis muscle without fascial disruption, and (3) superior and inferior gemelli in the location of implant placement. Those with posterior hip dislocations and gluteus medius injury received prophylactic indomethacin., Results: Fifty-seven patients met inclusion criteria. Thirteen patients (22.8%) developed HO, and 44 patients (77.2%) had no evidence of HO. Ten (17%) patients developed mild HO (Brooker classification (BC) I/II), 3 (5%) developed moderate HO (BC III), and no patients developed severe HO (BC IV). There were no differences in the prevalence of elementary versus associated acetabular fracture patterns or individual fracture patterns among cohorts. Patients with HO had longer times to surgical intervention (5.3 ± 5.1 days vs. 2.4 ± 1.6 days, p = 0.002) and length of intensive care unit (ICU) stay (6.7 ± 12.2 days vs. 1.5 ± 3.3 days, p = 0.013) compared with the no HO cohort. There was no difference in rates of HO prophylaxis use and subsequent HO among cohorts., Conclusion: This study describes a standardized protocol developed by the senior author that resulted in low rates of HO following acetabular fixation via the Kocher-Langenbeck approach. Patients with HO had a significantly longer time to surgical intervention and length of ICU level of care., Level of Evidence: Therapeutic Level IV. See Instructions for Authors of a complete description of levels of evidence., Competing Interests: Declarations. Conflicts of interest: The authors report no potential conflicts of interest regarding this work., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Introduction: Low rates of venous thromboembolism (VTE) have been found in patients with isolated orthopaedic trauma below the knee. Many surgeons routinely provide chemical thromboprophylaxis in these injuries, however. This is not without inherent risks, and this remains a controversial topic in perioperative care in orthopaedic trauma. This systematic review and meta-analysis was performed to look at rates of VTE in patients with isolated orthopaedic fractures below the knee, grouped by whether they received chemical prophylaxis versus no chemical prophylaxis., Methods: A systematic review was performed comparing VTE with and without chemical thromboprophylaxis following isolated orthopaedic fracture below the knee. A chi-square analysis was then performed on data including patients who received chemical prophylaxis versus those who did not from all 25 included articles. The articles were grouped according to type of study, such as observational versus randomized controlled trial (RCT), and then further subdivided according to surgical intervention status, and whether routine screening for thromboembolism was utilized to diagnose. Risk of bias assessment was performed using the ROBINS-I criteria for cohort studies and the Cochrane RoB 2 tool for randomized controlled trials. A random effects pooled logistic regression and Fisher's exact tests were then performed., Results: 222,188 patients were found from 25 articles. Chemical prophylaxis was given to 8,666 patients, and VTE was reported in 347 cases (4.0%). 213,522 patients did not receive chemical prophylaxis, and VTE was reported in 2,185 (1.02%) (χ 2 (1, n = 222,188) = 656.8, p < .00001). Pooled logistic regression revealed that patients receiving prophylaxis were 0.5 times less likely to develop VTE. With a calculated population baseline risk of 1.5% for developing VTE, the number needed to treat (NNT) with chemical prophylaxis is 134 to prevent 1 VTE after fracture below the knee., Conclusions: In patients with isolated orthopaedic trauma below the knee, indiscriminate use of chemical VTE prophylaxis is not recommended due to the lack of significant benefit and high NNT., Level of Evidence: Level III., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: To explore the correlation between the levels of D-dimer (D-D), fibrinogen (FIB), fibrinogen degradation products (FDP) and platelets (PLT) in peripheral blood of patients with lower limb fractures and the formation of deep vein thrombosis in lower limbs, and to establish a new thrombosis prediction model for patients with lower limb fractures., Methods: The patients were divided into DVT group and non DVT group according to whether there was deep vein thrombosis of the lower extremity. The differences in the levels of D-D, FIB, FDP and platelets between the two groups were analyzed and compared. ROC curve was used to evaluate the levels of D-D, FIB, FDP and PLT in the peripheral blood of patients with lower extremity fracture to predict the formation of deep vein thrombosis of the lower extremity. Logistic regression analysis was used to analyze the related risk factors of deep vein thrombosis, and the corresponding nomogram risk prediction model of lower limb deep vein thrombosis in patients with lower limb fractures was drawn according to the regression coefficient, which was verified by calibration curve, receiver operating characteristic curve (ROC) and consistency index (C-index)., Results: The levels of D-D, FIB, FDP, and PLT in the DVT group were higher than those in the non DVT group, with statistical significance (P < 0.05); Moreover, FIB is superior to D-D, FDP, and PLT in predicting the risk of fractures and thrombosis, while PLT has the weakest predictive power. Multivariate logistic analysis showed that platelet, D-D, FIB and FDP were independent risk factors for deep vein thrombosis in patients with lower limb fractures (P < 0.05); Based on the independent risk factors mentioned above, the complex logistic regression formula was transformed into a visual column chart, and the consistency index (C-index) was 0.962 and 0.936, and the external verification C-index was 0.841. The calibration curve showed that the nomogram is in high agreement with the actual results. The AUC value of ROC curve indicated that the nomogram has high prediction value., Conclusions: The levels of D-D, FIB, FDP and PLT in peripheral blood of patients with lower limb fracture and DVT were significantly increased. Early monitoring of D-D, FIB, FDP and PLT levels in patients with lower limb fracture can effectively screen for lower limb deep vein thrombosis., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted according to the ethical principles of medical research involving human subjects in the Declaration of Helsinki and have been approved by the biomedical ethics committee of the 900th Hospital of Joint Logistics Support Force (Number: 2024–093). Patients and their families signed informed consent before operation. Written consent has been received from the subject. Consent for publication: Written informed consent for publication was obtained from the participant. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Deep vein thrombosis (DVT) is an obstructive disease with a hindering venous reflux mechanism. The aim of this study was to identify independent risk factors for deep vein thrombosis (DVT) in patients with traumatic lower extremity fractures and assess the diagnostic value of thromboelastogram (TEG) and thrombus molecular markers., Methods: Reviewed patients with lower extremity fractures were admitted from October 2022 to September 2023. DVT was screened using color Doppler ultrasonography postoperation. Patients were categorized into two groups: those with DVT (n = 61) and those without (n = 191). Logistic regression was utilized to analyze DVT risk factors in these patients, and the diagnostic effectiveness of each marker was determined using the receiver operating characteristic curve (ROC curve)., Results: Significant differences were found in the incidence of hip (44.8%), and tibia (16.4%) fractures in the DVT groups (P < 0.001). Elevated levels of tPAIC, PIC, sTM, TAT, APTT, and TEG parameters (angle, MA, and CI) were observed in the DVT group (P < 0.05). Multivariate logistic regression revealed that PIC, sTM, TAT, angle, MA, CI, Caprini score, and hip fracture were significant risk factors for DVT., Conclusions: Patients with hip fractures showed a higher incidence of perioperative DVT. Factors such as PIC, sTM, TAT, angle, MA, CI, Caprini score, and hip fracture significantly contributed to the risk of DVT in traumatic lower limb fractures. Both thromboelastogram and thrombus molecular markers demonstrated strong diagnostic capabilities in the early detection of DVT, with comparable diagnostic efficiency., Competing Interests: Declarations. Ethics approval and consent to participate: This study was in accordance with the institutional Ethics Committee of People’s Hospital of Deyang City (Approval No. 2023–06-013-K01). Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Case: A 34-year-old patient was involved in a motorcycle accident, resulting in an anterior hip dislocation associated with an open book pelvic fracture and compression to the femoral artery. He required an emergent closed reduction of the hip dislocation and open reduction and internal fixation of the pelvic fracture., Conclusion: This case underscores the importance of maintaining a high level of suspicion for anterior hip dislocation, particularly in patients involved in motorcycle accidents, where a flexed, abducted, and externally rotated hip is common. Timely diagnosis allows for prompt treatment, leading to better functional prognosis and improved survival opportunities., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C499)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: The relationship between thromboelastogram (TEG) hypercoagulation status and perioperative deep vein thrombosis (DVT) in patients with femoral and pelvic fractures is not well understood. We aimed to investigate the relationship between hypercoagulation status identified by thromboelastography and postoperative DVT formation in patients with femoral and pelvic fractures, as well as to evaluate the role of thromboelastography in assessing hypercoagulation status and predicting postoperative DVT formation., Methods: Data from 2,065 patients with femoral and pelvic fractures who underwent surgical treatment at a hospital in China between May 2018 and December 2023 were retrospectively analysed. Hypercoagulable TEG was defined as reaction time (R) < 5 min, coagulation time (K) < 1 min, alpha angle (α) > 72 degrees, maximum amplitude (MA) > 70 mm, and/or coagulation index (CI) > 3. The correlation between preoperative hypercoagulability identified by TEG and postoperative DVT formation was assessed using multivariate logistic regression. Propensity score matching (PSM) was performed to control for confounding factors., Results: Compared to the non-DVT group, the DVT group had decreased R and K values, while the α, MA, and CI values significantly increased (P < 0.05). Multivariate logistic regression analysis demonstrated that hypercoagulable TEG findings were predictive of postoperative DVT formation. PSM, using a 0.1 calliper value, matched 296 patients from the hypercoagulation and non-hypercoagulation groups in a 1:1 ratio. Before PSM, hypercoagulable TEG was associated with DVT in femoral and pelvic fractures (P < 0.001, odds ratio [OR]:1.860, 95% confidence interval: 1.389-2.492). After PSM, these two variables remained correlated (P = 0.001, OR = 1.878, 95% confidence interval:1.301 - 2.709)., Conclusions: The hypercoagulable state identified by TEG can predict thromboembolic events in patients with femoral and pelvic fractures., Trial Registration: The study was registered in the Chinese Clinical Trial Register ( https://www.chictr.org.cn/bin/home ) on April 16, 2024, with registration number ChiCTR2400083135., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital at Chongqing Medical University (K2023-526) on October 12, 2023, which waived the need for written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Fracture-related infection (FRI) is a serious orthopaedic complication and its diagnosis, particularly in the upper extremity, is difficult and poorly defined in current literature. An international consensus definition of FRI was published in 2018, and our scoping review aims to investigate FRI diagnostic tools reported in the primary literature and their biostatistical utility. A review of articles generated from the PubMed/NCBI search term "fracture-related infection" was undertaken using PRISMA methodology. The included studies were published from January 2018 to June 2022 and referred to FRI diagnosis in the upper extremity. Of 224 returned studies, 32 articles were selected for further review after fellowship-trained senior author assessment. Of these, 16 had quantitative and reportable data regarding the diagnosis of upper extremity FRI. The most common diagnostic methods reported were CRP (8 studies), WBC (7), and ESR (5), consistent with 1 of the six suggestive criteria from the consensus definition. Meta-analysis was performed. Primary literature regarding the diagnosis of upper extremity fracture-related infections is sparse and variable despite FRI's diagnostic and therapeutic complexity. Recent literature does not reflect the proposed criteria of the 2018 consensus definition; further primary research is needed to validate these criteria and their accuracy and utility Level of Evidence: 3b.

Deep venous thrombosis (DVT) has insidious clinical symptoms, and only a few patients suffer from lower limb swelling, tenderness and dorsal flexion pain. We aimed to explore the ultrasonographic features and risk factors of postoperative lower limb DVT in patients with lower limb fractures. Ninety patients with lower limb fractures admitted from January 1st, 2021 to June 30th, 2023 were selected. Color Doppler ultrasonography was performed one month after operation, and the ultrasonographic features were recorded. DVT was diagnosed according to the results of venography, based on which the patients were divided into a DVT group and a non-DVT group. Their basic and treatment-related data were compared. The risk factors for postoperative DVT were screened by multivariate logistic regression analysis. A total of 63 cases were diagnosed with DVT by venography, with a detection rate of 70.00%. A total of 69 cases were diagnosed with DVT by ultrasonography, with a detection rate of 76.67% (P>0.05). The concurrent internal medicine diseases, associated injuries, no preventive measures for thrombosis, operation time ≥2 h, no active or passive exercise after operation, pelvic and proximal femoral fractures, knee fractures and tibiofibular fractures were risk factors for postoperative DVT in patients with lower limb fractures (P<0.05). Ultrasonography is effective for diagnosing postoperative lower limb DVT in patients with lower limb fractures. Related preventive measures should be taken promptly to control the risk factors.

Background: The authors believe that the L5-S1 facet joint injury in the setting of pelvic fractures is underappreciated by orthopedic traumatologists. The purpose of this study was to draw attention to the L5/S1 facet joint in the setting of pelvic ring injuries., Methods: This was a retrospective comparative study of all patients greater than or equal to 18 years of age with an acute pelvic ring injury (AO/OTA 62 B to C) presenting to a single level I trauma center. The primary objective was to determine demographic and injury characteristics associated with L5-S1 facet joint injuries in patients with pelvic ring injuries. The secondary objective was to determine the proportion of L5-S1 facet joint injuries that were missed on initial radiographic workup., Results: There were 476 patients included in the analysis, 53 (11.1%) of whom had an L5-S1 facet joint injury. Patients with an L5-S1 injury were more likely to be younger (44.1 vs. 53.2 years, p = 0.001) and experience a high energy mechanism of injury (95.0% vs. 78.0%, p = 0.002). Certain injury patterns were associated with L5-S1 facet joint injuries: any sacral fracture (96.2% vs. 73.8%, p < 0.001), Denis zone 2 fractures (43.4% vs. 20.1%, p  < 0.001), Denis zone 3 fractures (34.0% vs. 4.7%, p  < 0.001), bilateral displaced sacral fractures (18.9% vs. 3.5%, p  < 0.001), and L5 transverse process fractures (64.2% vs. 18.0%, p < 0.001). Only 16.0% of radiology reports identified an L5-S1 injury., Conclusions: Orthopedic traumatologists should scrutinize imaging for L5-S1 facet joint injuries in the presence of pelvic ring injuries, especially in patients with certain sacral fracture patterns., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Infants with birth brachial plexus injury (BPBI) may have various comorbidities such as fractures, torticollis, plagiocephaly, central nervous system disorders. In infants with BPBI, it is important to identify fractures, which are common among comorbidities, objectively assess pain, and investigate factors that may be associated with pain., Aim: The aim of this study is to determine the pain level, comorbidities, and motor function in infants with BPBI and to examine the relationship between these parameters. The second aim is to determine the cut-off value of the pain score that may be a sign of fracture in patients with BPBI, in order to suspect and predict a fracture in the shoulder region and to request additional examinations., Subjects and Measurements: 59 infants with BPBI aged 15-90 days were included in the study. Comorbidities, active joint movements, and total upper extremity function assessed with the Active Movement Scale and pain scores measured with the FLACC Pain Scale were retrospectively analyzed. In addition, pain, comorbidities and motor function were investigated according to types of Narakas, which indicates the degree of nerve injury., Results: Of the 59 participants, 18 (30.5 %) had at least one comorbidity and 12 (20.3 %) had fractures. The number of comorbidities (p = 0.41), the number of fractures (p = 0.84), and the level of pain (p = 0.71) did not differ by types of Narakas. There was a moderate negative correlation between pain level and upper extremity motor function in upper trunk injuries (p < 0.5, -0.67 < r < -0.46). There was a difference in pain level measured by palpation (p < 0.01) and passive joint movement (p < 0.01) in infants with and without comorbidities. To suspect a fracture in the shoulder region and to request further evaluation, the cut-off value of the Flacc pain level, which may predict a fracture, was 3.5 points for palpation and passive shoulder abduction and 4.5 points for passive external rotation., Conclusion: This is the first study in the BPBI to measure pain in infants using a quantifiable and widely used assessment. Pain level was ranked from high to low as infants with fractures, infants with comorbidities other than fractures and infants without comorbidities. Increased pain adversely affects motor function and pain above the cut-off values is a predictor of fracture., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

An 11-month-old female, neutered domestic short-haired cat was presented for non-pruritic alopecia of the dorso-lumbar area which had appeared 1 month after a road accident. After the trauma, a fracture of the left hind limb was demonstrated without dermatological lesions on the dorso-lumbar area. One month later, hair loss was observed in this area. Four months later, clinical examination revealed dorso-lumbar alopecia. Histopathological findings included an absence of all adnexae, a mild fibroplasia and fibrosis without oriented collagen deposition, individual to coalescing pyogranulomas at the dermo-hypodermal junction and a moderately stenotic hypodermal artery. Clinical history, physical examination and histopathological findings were compatible with post-traumatic dorso-lumbar alopecia. Special features of this case include the location of the fracture and the more developed histopathological lesions with pyogranulomas at the dermo-hypodermal junction, the absence of hair follicles and a stenosing arteriopathy., (© 2024 British Small Animal Veterinary Association.)

Purpose: The optimal duration of antibiotic therapy for fracture-related infection (FRI) has not been well defined. Our aim was to assess the recurrence rate of infection in patients who underwent six, 12, or 24 weeks of antibiotic therapy following surgical treatment for FRI one year after antibiotic discontinuation. Additionally, complications were monitored., Methods: Patients with FRI underwent surgical treatment, and antibiotic therapy was initiated. The patients were divided into groups at the 6th and 12th weeks of antibiotic therapy. The primary endpoint was the recurrence of deep or superficial infection at 90 days and one year after the end of antimicrobial therapy., Results: There was no difference in the recurrence of infection 90 days or one year after stopping antibiotic therapy among patients treated for six, 12, or 24 weeks (p = 0.98 and p = 0.19, respectively). The overall recurrence rate of infection 90 days after stopping antibiotic therapy was 4.9% (8/163), and one year after discontinuation of antibiotic therapy was 9.8% (16/163). There was a statistically significant difference in the incidence of adverse effects among the three groups (chi-square; p = 0.01). Adverse effects were more common in the group treated for 24 weeks than in the groups treated for 6 weeks (z score, p = 0.017) or 12 weeks (z score, p = 0.005)., Conclusion: Antibiotic therapy longer than 6 weeks did not reduce the recurrence of FRI after one year of follow-up. Additionally, antibiotic treatment for 24 weeks increases adverse events such as skin reactions and acute renal failure., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Navicular fractures are rare injuries. The navicular is a key part of normal hindfoot function and serves as the key link from the hindfoot to the midfoot in the medial column of the foot. Management of navicular fractures is complicated by the relatively poor soft tissue envelope, tenuous blood supply and high percentage of articular surface. The navicular is frequently injured as part of a more complex injury and is rarely fractured in isolation. Strategies for managing navicular complications including arthritis, malunion, nonunion, instability, and hardware related are reviewed., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Patients with diabetes have an increased risk of both foot and ankle fractures. Patients with mild disease may be managed similarly to the population with no diabetes, although patients with advanced diabetes are likely to require more robust fixation with prolonged periods of non-weight-bearing. All patients with diabetes should be screened for peripheral neuropathy, as this is a marker for poor outcomes following both surgical and nonsurgical management. The overall goal of treatment is to achieve a stable, plantigrade foot that fits into normal footwear, supports functional ambulation, and avoids ulceration., Competing Interests: Disclosure The authors have no financial disclosures or conflicts of interest to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Avascular necrosis (AVN) of the talus in a posttraumatic setting describes a condition of temporary or permanent bone death of a different extent, initiated by a circulatory disturbance. It is estimated that about 75% of all talar AVNs are caused by a prior trauma. The incidence of posttraumatic AVN rises with higher energy of injury, severity of talar body or neck displacement, fracture comminution, and injury to the soft tissues and major vessels in the lower leg and ankle region. These conditions are often seen in open fractures, fracture dislocations, and pure dislocations., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The prevalence of foot and ankle injuries associated with tibial and fibular shaft fractures is estimated to be 25%. A myriad of injury mechanisms and surrounding soft tissue damage related to this type of fracture can lead to distal complications and sequelae in the foot and ankle. Early recognition of concomitant acute injuries and adequate management of delayed complications can optimize the functional outcomes and quality of life in most patients.., Competing Interests: Disclosure Dr G.F. Bastias is a paid consultant for Zimmer Biomet. Dr M. Abarca has no disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Fracture-related infection (FRI) poses significant challenges in the management of foot and ankle fractures, potentially leading to functional impairment and heightened health care expenses. This review addresses the diagnosis, risk factors, and management strategies for FRI. Surgical management involves multidisciplinary collaboration, emphasizing debridement, antimicrobial therapy, and implant removal when indicated. Specific considerations for limited soft tissue coverage, tenuous blood supply, and fracture type in the foot and the ankle underscore the importance of tailored approaches to optimize outcomes and reduce complications in FRI management., Competing Interests: Disclosures A.N. Krez has nothing to disclose. A.T. Anastasio declares interests with QPIX Solutions (Paid consultant). S.B. Adams declares interests with American Orthopaedic Foot and Ankle Society (Board or committee member), Conventus/Flower (Paid consultant), DJO (Paid consultant), Exactech, Inc (Paid consultant) , Medshape (Stock or stock Options), Orthofix, Inc (Paid consultant), Regeneration Technologies, Inc (Paid consultant), Stryker (Paid consultant)., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This study aims to evaluate the efficacy and clinical outcomes of Nice knot-assisted fixation in the management of comminuted and displaced clavicle fractures., Methods: A systematic search was conducted across multiple electronic databases, including PubMed, Embase, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database, to identify studies comparing Nice knot-assisted fixation with traditional surgical treatment for displaced midshaft clavicle fractures. The primary outcomes assessed included fracture healing times, hospitalization days, complications, and functional outcomes. Secondary outcomes such as intraoperative blood loss, operative time, incision length, and fluoroscopy time were also evaluated. Data were analyzed using random-effects models, and summary statistics including Mean Difference (MD), risk ratios (RRs) and theirs' 95% confidence intervals (CIs) were calculated., Results: Screening of the literature yielded a total of 11 studies meeting the inclusion criteria, involving 754 patients. Meta-analysis of the pooled data demonstrated a significant advantage of Nice knot-assisted fixation over traditional surgical treatment in terms of operative time (MD = -11.53, 95% CI: -18.16 to -4.91, p = 0.0006) and blood loss (MD = -14.19, 95% CI: -20.93 to -7.45, p = 0.00001). Additionally, Nice knot-assisted fixation was associated with reduced fracture healing time (MD = -0.63, 95% CI: -1.12 to -0.14, p = 0.01) rather than hospitalization days (MD = -0.47, 95% CI: -1.14 to 0.21, p = 0.18) and complications (RR = 0.48, 95% CI: 0.23 to 1.01, p = 0.05) compared to traditional surgical treatment. Moreover, nice knot-assisted fixation was associated with increased constant-murley score and Neer score, and reduced visual analogue scale (VAS) score compared to traditional surgical treatment., Conclusion: This study highlights that Nice knot assistance offers advantages in reducing intraoperative blood loss, shortening operation time, and achieving favorable postoperative outcomes., (© 2024. The Author(s).)

BACKGROUND Clavicle fractures are a common injury, and the standard surgical treatment for displaced shaft fractures is plate fixation using a single superiorly-placed plate. However, the use of this technique in dementia patients poses challenges, including increased risk of postoperative complications such as fixation failure, mal-union, and non-union. CASE REPORT This is a case series of 2 patients who had clavicle shaft fracture with dementia. The first was a 90-year-old woman with right clavicle fracture and vascular dementia. She underwent superior locking compression plate fixation, but the plate was pulled out because of her uncooperativeness. Therefore, we performed dual-plate fixation. She did not immobilize her arm after the surgery, but the plate did not pull out and she was doing well without any problems in daily life. The second patient was a 78-year-old man with advanced dementia who had a displaced midshaft clavicle fracture after a fall. Due to his inability to cooperate and follow postoperative instructions, a decision was made to employ a dual plating technique with plates applied anteriorly and superiorly. At 6-month follow-up, he had satisfactory functional outcomes and radiographic evidence of fracture healing. CONCLUSIONS The use of dual-plate fixation in the treatment of clavicle fractures in dementia patients is a viable option that can lead to successful outcomes and no failure-related implants.

Introduction: Dynamic interaction of cam and pincer deformities can result in pathological contact forces in femoroacetabular impingement (FAI) syndrome. Similar deformities were noted during acetabular fracture reconstruction. We hypothesise that the prevalence of FAI deformity is higher in patients sustaining acetabular fractures than in a control group., Methods: This retrospective radiographic study compared the parameters that define FAI deformity in 100 patients consecutively admitted to a trauma unit with an acetabular fracture and a control group of 100 patients with lateral compression pelvic fracture without acetabular injury. Both underwent identical clinical imaging. Centre-edge angles (CEA) and alpha angles were used to define patients with pincer, cam, or mixed FAI deformity., Results: There were significantly more patients with FAI deformity in the acetabular fracture group than in the control group (71% vs. 18%, p  < 0.0001). There were considerably more fractures involving both anterior and posterior acetabular columns in patients with 'pincer' sockets ( p  = 0.02, OR = 2.95, 95% CI, 1.12-7.78)., Conclusions: There is a high prevalence of cam and pincer deformities in patients with acetabular fractures, particularly bi-column fractures., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Intrapelvic hemorrhage following pelvic fractures, including pelvic ring and acetabular fractures, originates from the venous system and the fracture. Arterial injury often causes significant bleeding and hemodynamic instability. The superior gluteal artery (SGA) is a frequently injured artery in patients with pelvic fractures. This study investigated the incidence and pattern of SGA injuries associated with pelvic fractures., Methods: We retrospectively reviewed the medical records of patients with pelvic fractures who visited our institution between January 2016 and April 2022. Patients who underwent angiography for suspected arterial injury and SGA embolization were identified. Furthermore, the demographics and patterns of pelvic fractures were evaluated., Results: In total, 2042 patients with pelvic fractures visited our trauma emergency department and 498 patients (24.4%) underwent embolization for arterial injuries. Of these, 30 patients (1.5% of the total and 6.0% of the patients who underwent procedures) received embolization therapy of the main trunk of the SGA. The mean age of patients was 51.2 (23-85 years), and the injury mechanisms were all high-energy injuries. There were 19 pelvic ring injuries, eight acetabular fractures, and three combined injuries. Acetabular fractures involved mostly both columns. The three combined injuries were lateral compression involving both columns, vertical shear involving both columns, and lateral compression with T-type fractures. Twelve (40.0%) occurred through the sciatic notch of different patterns., Conclusions: SGA injury occurred in 1.5% of all pelvic fractures and was identified in 6% of patients receiving embolization. SGA injury occurs through various injury mechanisms and fracture patterns, even in the absence of a fracture in the sciatic notch. However, no conclusions could be drawn in this study on the association between SGA injuries, injury mechanisms, and fracture patterns. Since the prediction of SGA injury by fracture pattern is limited, angiography should be performed regardless of fracture pattern when an injury is suspected., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Pelvic fracture (PF) is a rare emergency, which led to pelvic fracture urethral injury (PFUI) in 1.6% to 25% of cases. Urethral injury assessment requires a thorough analysis of the initial injury history and imaging that combine cystourethrography acutely, repeat urethral imaging as well as adjunctive use of MRI in the follow-up period. A more complex surgical approach to the delayed reconstruction of PFUI may be predicted by the urethral gap length (cysto-urethrography) or a lower pubo-urethral angle (MRI). Delayed urethroplasty is the treatment of choice, performed once the patient has recovered from other acute injuries, typically at least 3months post-injury. It consists in men in a bulbo-prostatic anastomotic urethroplasty which may require several steps of increasing complexity to allow a tension-free anastomosis: corpora splitting, partial inferior pubectomy, and rarely total pubectomy or urethra rerouting. More complex cases of PFUI repair may be encountered (long gap between the two urethral segments, bulbar necrosis, false passage after failed endoscopic realignment, orthopedic hardware in pubic symphyseal region, pediatric PFUI, failed previous urethroplasty, associated anterior urethral stricture, or recto-urethral fistula) and should be managed in expert centers. Urethral patency is achieved by surgical reconstruction with an overall success rate of 86%. Evaluation of potential associated sequelae including erectile dysfunction and urinary incontinence must be anticipated and taken into consideration in the path of rehabilitation., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Although fracture-related infection (FRI) is a serious complication following bone fractures, a comprehensive definition and diagnostic criteria have only emerged in recent years. According to this consensus definition, the diagnosis of FRI is based on preoperative and intraoperative suggestive or confirmatory criteria. Serum markers, histology, and microbiological cultures are considered to play a crucial role in the FRI diagnostic pathway. However, at the time of publication of the FRI consensus definition in 2018 and its update in 2020, limited data was available on the accuracy of these diagnostic methods. This review aims to provide an overview of recent publications and discuss whether new evidence has been obtained regarding the value of these current diagnostic techniques. Meanwhile, several studies have confirmed the limited prognostic value of C-reactive protein, erythrocyte sedimentation ratio, and white blood cell count. Other serologic markers for preoperative diagnosis of FRI with promising diagnostic performance are d-dimer, plasma fibrinogen, platelet count to mean platelet volume ratio, and a risk prediction model that includes soft tissue injury type and fracture complexity in addition to blood markers. However, their true diagnostic value in daily clinical practice needs to be investigated in further studies. Data on histology in FRI diagnosis is still limited, but its potential as a confirmatory criterion seems to lie in its high specificity. Recent studies indicate that tissue culture exhibits moderate sensitivity and high specificity, with sensitivity improvements achieved by sampling of five specimens and long-term culture. Implant sonication also appears to enhance the sensitivity of culture and the detection rate of polymicrobial infections. In conclusion, the true value of diagnostic techniques is difficult to assess, in part because it is measured against a gold standard that is itself imperfect and still evolving, but also because of methodological differences in sample processing or the use of different thresholds. Nevertheless, this review has identified that the value of current diagnostic techniques is high when used in combination. To draw more accurate conclusions about the value of serum markers, histology, and culture including sonication, future studies should be prospective and utilize a greater standardization in sampling and methodological protocols., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

In this case report, we presented to a 90-year-old female with multiple comorbidities presented to the emergency department of our hospital three weeks following a fall from standing height. Upon arrival, the patient exhibited a Glasgow Coma Scale (GCS) 12, blood pressure of 100/60 mmHg, heart rate of 117 beats/min, respiratory rate of 24 breaths/min. Examination revealed atrophy, skin color change, sensory disturbance, or motor palsy in the left upper extremity. Chest X-ray showed a fractured left clavicle, with its free fragment dislocated toward the thorax. She was diagnosed with a displaced midshaft clavicle fracture, Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 15.2B2. On doppler ultrasound examination, flow loss secondary to compression was observed in the proximal left subclavian artery (SA). No flow was observed in the axillary, brachial, radial and ulnar arteries. Due to the patient's high number of comorbid diseases and poor general condition, disarticulation was performed from the shoulder joint, which is the proximal region of arterial occlusion. No other symptoms of circulatory dysfunction were observed at the 3 months follow-up. This case report emphasizes that delayed clavicle fracture can lead to catastrophic consequences. Trauma surgeons should also consider surgical treatment of clavicle fractures, depending on the patient's condition.

In orthopaedic trauma, fracture-related infections (FRI) are still dreadful challenges that can cause non-union, amputation and even death. Standardization of general treatment strategies for FRI is still lacking. Due to the complexity of FRI, a multidisciplinary approach addressing host status, state of the fracture and causative microorganism has been applied in the management of FRI. Surgical treatment, antibiotic therapy and host optimization for FRI were summarized and discussed. The goal of this review is to provide an overview and summary of current approaches of FRI management and to make suggestions on FRI prevention and treatment based on multidisciplinary principles., Competing Interests: Declaration of competing interest There are no conflicts of interest within this paper, (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Pelvic fractures are associated with a high risk of venous thromboembolism (VTE). Among treatment options, including pelvic angioembolization (PA), preperitoneal pelvic packing (PPP), and pelvic open reduction internal fixation (ORIF), PPP has been postulated as a VTE risk factor. We aimed to characterize the risk of VTE among pelvic fracture patients receiving PPP, PA or ORIF., Methods: We used observational data from a 17-site Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) study group, a US level I trauma center collaborative working to identify factors associated with posttraumatic VTE, deep venous thrombosis, pulmonary embolism, or pulmonary thrombosis. The CLOTT criteria included age 18 to 40 years with at least one independent VTE risk factor. We compared outcomes of PPP, PA, and pelvic ORIF to reference of no pelvic intervention. Our primary outcome was VTE. A competing risk analysis was performed., Results: Among 1,387 pelvic fracture patients, VTE incidence was 5.6%. The ORIF patients were most likely to develop VTE (24.7%), while VTE incidence for PPP was 9.0% and 2.6% for PA. After multivariate, risk-competing analysis, none of the three treatment interventions for pelvic fractures were significantly associated with VTE. Initiation of VTE prophylaxis in the first 24 hours of admission independently halved VTE incidence (hazard ratio, 0.55; confidence interval, 0.33-0.91)., Conclusion: Pelvic fracture interventions do not appear to be independent risk factors for VTE in our study. Initiation of VTE pharmacoprophylaxis within the first 24 hours of admission remains critical to significantly decreasing VTE formation in this high-risk population., Level of Evidence: Therapeutic Study; Level III., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To evaluate the orthopaedic management, associated injuries, and outcomes in patients treated for low-velocity ballistic pelvic fractures., Design: Retrospective chart review., Setting: Single, urban, Level I trauma center., Patient Selection Criteria: Patients 15 years or older treated for low-velocity ballistic pelvic (OTA/AO 61 and 62) fractures from May 2018 to August 2021., Outcome Measures and Comparisons: Primary study measures included pelvic fracture location, concomitant associated injuries, surgical interventions, and antibiotic treatment. Postinjury sequelae evaluated include infection, neurologic deficit, and need for orthopaedic removal of foreign body. Risk factors of postinjury sequelae were investigated., Results: A total of 156 patients with ballistic pelvic fractures were included. The cohort consisted of 135 (86.5%) male patients with a mean age of 29.8 years. One hundred ten (70.5%) patients sustained 2 or more gunshot wounds. Ninety-eight (62.8%) patients underwent an exploratory laparotomy with 79 (50.6%) having a confirmed concomitant intestinal injury. Additional associated injuries included nerve injury (13.5%), vascular injury requiring repair or embolization (10.9%), and bladder injury (10.3%). Nine (5.7%) patients underwent orthopaedic operative management-five (3.2%) patients for operative fixation and 4 (2.5%) patients for removal of intra-articular foreign bodies. Diabetes (odds ratio [OR]: 33.1, P = 0.025), neurologic deficit on presentation (OR: 525.2, P < 0.001), vascular injury requiring repair or embolization (OR: 8.7, P = 0.033), and orthopaedic pelvic fixation (OR: 163.5, P = 0.004) were positively associated with the defined postinjury sequelae at 30 and 90 days of follow-up. There was not a statistically significant association between infection and retained foreign body (OR: 3.95 [95% CI 0.3-58.7, P = 0.318]) or bowel contamination (OR: 6.91 [95% CI 0.4-58.7, P = 0.178])., Conclusions: Ballistic fractures of the pelvis and acetabulum rarely required operative fixation (3.2%) or irrigation and debridement. Neither retained foreign body nor presumed bowel contamination of pelvic fractures had a statistically significant association with infection, which further supports conservative management of these injuries. Patients with diabetes, neurologic deficit on presentation, vascular injury necessitating intervention, and orthopaedic fixation of pelvic fracture are associated with increased risk of postinjury sequelae., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To explore the ultrasonographic features and influencing factors of free-floating thrombus (FFT) detachment in the lower extremity deep veins (LEDVs) of patients with fractures., Methods: Clinical data of patients diagnosed with FFT in the LEDVs and implanted with an inferior vena cava filter (IVCF) in our hospital between July 2021 and August 2023 were retrospectively analysed. The patients were divided into the thrombus detachment group (the experimental group, n = 92) and the non-thrombus detachment group (the control group, n = 103) based on the presence of detached thrombus in the IVCF. The effects of thrombus echogenicity, floating degree, thrombus location, thrombin time, D-dimer and fibrinogen on thrombus shedding were analysed. The nomogram method was used to establish the model and predict the probability of delayed postoperative recovery., Results: The proportions of patients with extremely hypoechoic thrombus and medium and high floating degrees increased in the experimental group compared with those in the control group, and the differences between the two groups were statistically significant (P < 0.05). Extremely hypoechoic thrombus (P = 0.021, 95 % CI: 1.109-13.748) and high (P = 0.001, 95 % CI: 3.854-28.573) and medium floating degrees (P = 0.004, 95 % CI: 1.792-13.453) were risk factors for deep veins FFT (DV FFT) detachment. The results of receiver operating characteristic curve analysis showed that the area under the curve of the model was 0.893, with a 95 % CI of 0.856-0.937, indicating a high prediction accuracy., Conclusion: Ultrasonographic parameters, including thrombus echogenicity and floating degree, are valuable in predicting DV FFT detachment in patients with traumatic fractures, providing references for IVCF implantation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Patients with severe knee osteoarthritis combined with patellar fracture are rare, and it is unclear whether single-stage surgery affects the enhanced recovery after surgery., Case Presentation: This case report describes two patients of Han nationality. A 69-year-old male patient was previously diagnosed with severe knee osteoarthritis of the left knee joint and was treated conservatively with long-term oral nonsteroidal antiinflammatory drugs and intraarticular injection of sodium hyaluronate. He was hospitalized for acute left knee injury owing to a fall from a height. He was diagnosed with knee osteoarthritis of the left knee joint and patellar fracture. Another 74-year-old female patient was previously diagnosed with severe knee osteoarthritis, long-term oral nonsteroidal antiinflammatory drugs and topical Chinese medicine to relieve the pain. A month ago, she fell down the stairs and fractured the patella in her left knee, she was diagnosed with severe left knee osteoarthritis combined with an old left patella fracture. Both patients were successfully treated by single-stage primary total knee arthroplasty and fixation of the patellar fracture. They both carried out early functional exercise normally and successfully achieved enhanced recovery., Conclusion: Successful single stage total knee replacement with patella management can not only reduce the number of operations, but also enable patients to achieve rapid postoperative recovery. However, single stage may increase the risk of local surgical complications. Therefore, for most patients, especially those with low risk of anesthesia related complications, standard of treatment remains first fixing the patellar fracture and when the fracture is healed proceed with the total knee arthroplasty., (© 2024. The Author(s).)

Background: Although treatments have improved dramatically in recent years, mortality following gunshot wounds (GSW) to the pelvis continue to range between 3 and 20 %. This project was designed to determine the incidence and risk factors associated with pelvic fracture-related infection (FRI) following GSWs to the pelvis given the paucity of evidence regarding this complication., Methods: A retrospective review of 13 years (1/2010-12/2022) of patients with GSW to the pelvis was performed. Patients meeting inclusion criteria underwent chart review for the development of pelvic FRI and the following additional data elements were extracted: demographics, presence and type of bowel injury, operations performed, complications, use of postoperative antibiotics (≤24 h vs. >24 h), surgical osseous debridement, presence of retained bullet fragments, and bullet trajectory. Discrete variables were analyzed using Wilcoxon rank-sum test, chi-square, and Fischer's exact test. Pearson correlation coefficients were calculated for continuous variables., Results: 242 patients were included in the study. Concomitant bowel injury was present in 108 patients (45 %). Eleven patients (4.5 %) developed FRI, all of whom had a concomitant bowel injury (p < 0.001). Neither the presence of retained bullet fragments nor the bullet trajectory (through bowel before the bone) was associated with FRI. Antibiotic duration >24 h was not associated with a lower rate of pelvic FRI., Conclusion: Development of FRI after a GSW to the pelvis occurs in 4.5 % of patients and is significantly associated with concomitant bowel injury, specifically colonic injury. These findings can be used to help guide further studies on the role of prophylactic antibiotics or other strategies to prevent pelvic FRI., Competing Interests: Declaration of competing interest Dr Thomas Carver is a consultant for InnoVital, Inc and Cytovale, Inc, but these relationships are not relevant to the submitted work. None of the other authors have any conflicts of interest to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: In recent years, the incidence of pelvic fractures has been on the rise, predominantly affecting the elderly population. Deep vein thrombosis may lead to poor prognosis in patients. monocyte-to-lymphocyte ratio is novel biomarkers of inflammation, and this study aims to verify their predictive effect and construct the nomogram model., Method: This study used binary logistic regression analysis to predict the predictive effect of MLR on the occurrence of DVT in pelvic fractures patients. And use R studio to construct nomogram model., Result: The results showed that Age (1.04 [1.01, 1.07], p = 0.006), WBC (1.44 [1.28, 1.61], p < 0.001), and MLR (2.11 [1.08, 4.13], p = 0.029) were independent predictive factors. The nomogram demonstrated good predictive performance with small errors in both the training and validation groups, and most clinical patients could benefit from them., Conclusion: The nomogram constructed based on MLR can assist clinicians in early assessment of the probability of DVT occurrence., (© 2024. The Author(s).)

Background: Rice body formation is an uncommon, nonspecific inflammatory process. Certain clinical features, such as chronic synovitis associated with rheumatoid arthritis, tuberculous arthritis, and osteoarthritis, can induce a non-specific response that may lead to the development of rice bodies. Currently, the etiological and prognostic significance of rice bodies remains unknown. Magnetic resonance imaging (MRI) is the preferred diagnostic imaging modality for evaluating rice body formation., Case Presentation: The patient, a 44-year-old female, presented with bursitis of the hip joint and the presence of numerous rice bodies. This case is exceptionally rare and unusual as it involves a combination of hip dysplasia and pelvic fracture. The patient underwent a one-stage resection of the rice body, internal fixation of the acetabular fracture, and two-stage total hip arthroplasty, resulting in an immediate improvement in her symptoms. We reviewed the relevant literature and observed that the majority of rice bodies were predominantly found within the capsules of the shoulder and knee joints, while instances of hip joint rice body bursitis were relatively infrequent. To our knowledge, there have been no previous reports documenting a case of hip joint rice body bursitis in conjunction with hip dysplasia and pelvic fracture., Conclusion: This paper presents the rare case of hip joint rice body bursitis combined with hip dysplasia and pelvic fracture, and is one of the highlights., (© 2024. The Author(s).)

Case: This is a rare case describing the management of a traumatic chylous effusion discovered during operative fixation of a Sanders type III calcaneus fracture in a 58-year-old man, sustained after a fall from height. Chylous effusions are uncommon and can mimic septic arthritis. Given the concern for possible infection intraoperatively, provisional K-wire-assisted reduction was performed and definitively maintained through antibiotic mixed polymethylmethacrylate cement. Despite foregoing traditional fixation techniques, an excellent outcome was achieved., Conclusion: This case outlines the use of antibiotic cement as a reduction aid for an intra-articular calcaneus fracture in the setting of a traumatic chylous effusion., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C460)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Rationale: Anterior dislocation of the sacroiliac joint combined with pelvic fractures is relatively rare in clinical practice. It is often associated with hemodynamic instability and severe injuries to other regions, resulting in a complex condition, prolonged treatment duration, and high rates of mortality and disability. However, there are few reports in the literature describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint. In this case, the patient sustained a pelvic fracture with anterior sacroiliac joint dislocation and rupture of both the internal and external iliac arteries following a motor vehicle accident, making it an even rarer and more challenging case to treat. Reporting such cases can enhance the understanding of the diagnosis and treatment of anterior sacroiliac joint dislocation with rupture of the iliac arteries and provide valuable references for similar cases., Patient Concerns: The patient was riding an electric bicycle and was hit by a small truck, resulting in a pelvic fracture, anterior dislocation of the sacroiliac joint, and rupture of the internal and external iliac arteries., Diagnosis: The patient was diagnosed with open pelvic fracture (type C1.2), left complete anterior dislocation of the sacroiliac joint, left acetabular fracture, left internal and external iliac arteriovenous rupture., Interventions: emergency room resuscitation, intensive care unit resuscitation, 6 surgeries and perioperative management., Results: He has been discharged from the hospital for more than 1 year and was rechecked every month after discharge, the fracture has healed, there is no obvious pain and discomfort in and around the wound, he has been fitted with a prosthesis, and he is doing the walking function exercise., Lessons: Pelvic fracture with anterior sacroiliac dislocation is clinically rare and critical, and is associated with large vessel rupture, severe organ damage, and high mortality and disability rates. Rapid restoration of pelvic stability and hemodynamic stability is the key to treatment. Rapid transfer to a tertiary trauma center, rapid examination through the green channel to clarify the diagnosis, close intensive care, and reasonable multidisciplinary teamwork for surgical intervention are all valuable experiences that we have concluded., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)