Pre-injury anticoagulation is a well-known risk factor associated with adverse outcomes in geriatric trauma patients, but its impact in younger populations remains unclear. The study aimed to evaluate the association between pre-injury antithrombotic therapy and clinical outcomes in trauma patients aged 40–60 years. Data were obtained from the TraumaRegister DGU® (2015–2023). Patients aged 40–60 years from European trauma centers with ISS ≥ 9 were included. Patients were categorized according to the presence or absence of pre-injury antithrombotic therapy. A matched-pair analysis was performed based on age group, sex, ASA classification, and injury severity by body region. The primary endpoint was in-hospital mortality; secondary outcomes included coagulopathy, transfusion requirements, emergency surgery, and organ failure. Analyses were primarily descriptive. A total of 64,215 patients were included, of whom 6.7
Nonoperative management (NOM) in blunt pancreatic injury (BPI) is frequently complicated by pseudocyst formation and pancreatic atrophy. To address these complications, we have utilized a pancreatic stent via endoscopic retrograde cholangiopancreatography (ERCP) for children with PDI since 2019. We present our experience with ERCP-based NOM for PDI and provide a literature review of stent therapy in pediatric PDI. Ten children with BPI treated between January 2007 and December 2025 were classified according to the 2024 American Association for the Surgery of Trauma pancreatic injury grades: IB (n = 3), IIA (n = 3), IIIA (n = 2), and IIIB (n = 2). Pancreatic stents were placed in two IIIA cases and one IIIB case. The IIIB case subsequently underwent transpapillary pseudocyst drainage (TPPD) due to a pseudocyst infection. NOM was successful in all low-grade injuries (< II) without complications. One IIIB patient treated without stenting developed a pseudocyst requiring cyst-gastrostomy; 1-year follow-up demonstrated severe pancreatic atrophy. In the two IIIA stent cases, the duct injury was successfully bridged: one patient had no pseudocyst formation, and the other developed a pseudocyst that resolved spontaneously; both showed preserved pancreatic parenchyma. The IIIB patient treated with TPPD experienced rapid cyst resolution; 1-year imaging revealed approximately 50
Tibiofemoral dislocations in children and adolescents are rare, and treatment guidelines are primarily based on adult data and algorithms. This case series of four pediatric and adolescent patients aims to add to the limited literature and highlights key aspects of diagnosis, treatment, and patient-reported outcomes. We conducted a retrospective-prospective single-center case series of pediatric and adolescent patients (< 18 years, open growth plates) treated for tibiofemoral knee dislocations at a Level 1 trauma center between 2017 and 2019. Clinical, radiographic, and intraoperative data were reviewed. In addition, long-term patient-reported outcomes covering both functional recovery and health-related quality of life were assessed using KOOS, IKDC, and EQ-55 D-L. Four patients (2 male, 2 female), aged between 12 and 16 years, were included in this case series. The mean follow-up was 7.3 years (range 6 to 8 years). All patients sustained Schenck Type III-L dislocations. Early MRI and vascular imaging identified frequent associated injuries such as meniscal and chondral lesions, avulsion fractures, in one case, peroneal nerve injury. A staged surgical approach was used in two of the four cases. No growth disturbances or deformities were observed in the patients based on the available clinical and radiological follow-up. Functional outcomes ranged from moderate to excellent (KOOS: 59–92
Autologous bone grafting remains the standard for reconstruction of bone defects but is constrained by limited graft volume and loss of osteogenic capacity when expanded with acellular materials. We hypothesized that allogeneic ABCB5⁺ mesenchymal stem cells (MSCs) can serve as a biologic cell source to augment bone marrow-derived MSC (BM-MSC) populations without impairing osteogenesis. Primary human BM-MSCs from five donors were combined with GMP-manufactured ABCB5⁺ MSCs at graded replacement ratios (0–95
Armed conflict disrupts healthcare when hospital infrastructure is vulnerable to missile attacks. During a 12-day missile strike period, our hospital established an improvised operating room (OR) in an underground parking lot. This study evaluated perioperative and short-term outcomes among patients treated in the improvised OR compared with those treated in the hospital’s fortified standard OR. This retrospective cohort study included patients undergoing general or orthopaedic surgery during the 12-day conflict. Procedures identified via surgical logs were categorized by OR location (improvised or standard). Demographic, perioperative, and post-discharge data were collected from electronic records. Primary outcomes included operative time, estimated blood loss, transfusions, complications, hospital and ICU length of stay, ED visits, readmissions, and 3-month mortality. Overall, 74 surgeries took place in the improvised OR and 77 in the standard OR. Patients in each group were comparable in age, sex, comorbidities, and anesthesia. Improvised OR surgery time was longer (mean 68.1 vs. 47.7 minutes, p < 0.001). There were no significant differences between groups in terms of blood loss, transfusions, postoperative complications, or hospital length of stay. After 3-month follow-up, there were no significant differences in readmissions or mortality rates. Establishing an improvised underground OR during an armed conflict enabled maintaining surgical capacity without compromising short‑term patient outcomes. Prolonged operative time likely reflected logistical challenges in supply management.
Severe injury affects multiple health-related domains, yet comprehensive European data on patient-reported outcomes remain limited. This systematic review and meta-analysis evaluates patient-reported outcome measures (PROMs) use and outcomes in severely injured European cohorts. A systematic search of four databases up to October 14, 2025, identified European studies from 2000 onward reporting PROMs in severely injured patients. Severe injury was defined as an Injury Severity Score ≥ 16, Glasgow Coma Scale ≤ 8, intensive care unit admission, spinal cord injury, traumatic amputations, or pelvic fractures. Two reviewers independently screened records, with disagreements resolved by a third reviewer. Meta-analysis was performed when ≥ 3 studies reported comparable PROMs at similar follow-up timepoints. Of 2,479 studies, 119 were included. Most cohorts originated from the Netherlands (26
Surgical stabilization of rib fractures (SSRF) has re-emerged as an important component of chest wall trauma care, yet its history is often presented as a simple timeline rather than as a source of operative and biomechanical lessons. This literature, problem-oriented historical review re-examines earlier rib fixation strategies in order to identify the mechanical and operative problems they were intended to solve, why many disappeared, and which principles remain relevant to contemporary SSRF practice. A literature review was conducted focusing on historically important fixation techniques and conceptual milestones in the management of serious rib fractures and flail chest. PubMed/MEDLINE and Google Scholar were searched from database inception to 19 March 2026 using terms related to rib fracture fixation, flail chest, SSRF, intramedullary fixation, and history. Studies were purposively selected if they described key fixation concepts, major shifts in management strategy, recurrent technical problems still seen in modern SSRF, or contemporary guideline context. Forty-seven articles were included and synthesized using a problem-based rather than purely chronological framework. Across eras, rib fixation evolved around recurring challenges: (1) restoration of chest wall stability and thoracic continuity, (2) the tension between internal pneumatic stabilization by positive-pressure ventilation and structural repair, (3) difficult access to posterior, subscapular, and upper-rib fractures, (4) implant–rib mismatch and preservation of the intercostal neurovascular bundle, and (5) a limited evidence base. Historical methods - including suture and wire cerclage, clamp-based plates, intramedullary devices, and percutaneous or limited-incision techniques - were early attempts to solve these problems rather than obsolete curiosities. Their main limitations were invasive exposure, bulky and excessively rigid implants, poor conformity to rib curvature, neurovascular irritation, and weak clinical evidence. The most important transition was conceptual: reframing rib fracture patterns as dynamic chest wall instability in which a static CT fracture map must be translated into an operative construct that restores functional thoracic mechanics while preserving the muscular and soft-tissue envelope. Modern SSRF represents the maturation - not the replacement - of historical fixation concepts under improved biomechanical, biological, and evidentiary conditions. The lasting lessons are that fixation should target the mechanically relevant instability, balance stability with biological restraint, match access strategy to fracture location and chest wall anatomy, and expand indications selectively and discipline. Reinterpreting historical techniques through this problem-oriented lens may help refine current SSRF practice, avoid repetition of past errors with new implants, and guide future development of dynamic chest wall reconstruction.
Many European surgeons lack access to high-volume trauma training. A Trauma Traveling Fellowship, supported by the European Society of Trauma and Emergency Surgery (ESTES), could broaden educational and clinical exposure to trauma care, but feasibility and implementation factors are unclear. The aims of this survey are to assess the aspirations, expectations, and perceived challenges of prospective fellows and host centres for an ESTES Trauma Traveling Fellowship. A cross-sectional, web-based survey was distributed to all ESTES members, capturing demographics, fellowship aspirations, perceived barriers, and host centre capacities. The survey incorporated Likert scales, free-text responses, and was guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance / Practical Robust Implementation and Sustainability Model (RE-AIM/PRISM). Of 903 invited, 210 responses (23.3
Endoscopic retrograde cholangiopancreatography (ERCP) remains the predominant treatment of common bile duct stones but single-stage laparoscopic management via antegrade transcystic balloon dilatation (ATBD) offers a compelling alternative. All prior studies validate success solely by intraoperative fluoroscopic cholangiography, with no prospective trial employing postoperative magnetic resonance cholangiopancreatography (MRCP). This single-centre prospective study enrolled 100 consecutive patients with confirmed CBD stones requiring emergency laparoscopic cholecystectomy (LC). ATBD was attempted in all patients. Primary outcome was MRCP-confirmed CBD stone clearance. Secondary outcomes included operative time and postoperative complications. One hundred consecutive patients were enrolled (median age 69 years; 38 https://clinicaltrials.gov (registration date 16.03.2026).
Non-unions are a major challenge in trauma surgery. They are known to affect patients’ lives for years after the initial trauma. Nevertheless, most studies only examine the first two years after treatment. The question what the long-term results look like ten years after surgery was posed in light of observations made in everyday clinical practice. To answer this, our study was designed to examine all patients who underwent non-union surgery in our department ten years ago. All patients who underwent surgery between July 2014 and October 2015 were invited to participate in the study. During a one-site appointment, an X-ray image was taken, which was then used to assess consolidation. The patients underwent a physical examination and answered a questionnaire, covering topics such as pain on a visual analogue scale (VAS) and overall quality of life with the short-form 12 (SF-12). A total of 54 patients were included in the study. The median follow-up period was 122 months (IQR: 118-124). After 10 years 88.9
Accurate pre-operative risk prediction in emergency laparotomy (EL) is essential for appropriate resource allocation and improve patient outcomes. This study aimed to establish the accuracy of an artificial intelligence (AI) model in predicting 30-day mortality after EL using a national dataset. Data was extracted from the Australian and New Zealand Emergency Laparotomy Audit-Quality Improvement (ANZELA-QI) database from 1 July 2018 to 24 July 2023. AI models were created employing multilayer perceptron (MLP) and radial basis function (RBF) architectures. Extended AI models were developed using all available pre-operative variables and simplified AI models were developed using statistically significant variables identified through univariate analysis. We assessed the performance of AI models with that of a multivariate logistic regression (LR) and the UK-based National Emergency Laparotomy Audit (NELA) models using the area under the receiver operator characteristic curve (AUROC). Data from 8293 ELs were included in the model and were randomly divided into a training dataset of 6619 (80
To evaluate the radiographic and functional outcomes of closed reduction and percutaneous fixation (CRPF) compared to open reduction and internal fixation (ORIF) in the treatment of isolated displaced medial malleolar fractures. This randomized controlled trial included 50 adult patients with isolated displaced medial malleolar fractures, Herscovici classification type B and C, across two hospitals. Participants were randomly assigned (1:1) to either CRPF (Group A, n = 25) or ORIF (Group B, n = 25). The principal objectives were radiological union and clinical function evaluated by the American Orthopedic Foot and Ankle Society (AOFAS) score at a 6-month follow-up. Secondary outcomes included the incidence of postoperative complications and correlations with patient demographics and mechanism of injury. At 6 months, there was no significant difference between groups (p > 0.05); in Group A, 13 patients rated as “Good,” 11 as “Fair,” and 1 as “Poor,” while in Group B, 15 were “Good,” 9 “Fair,” and 1 “Poor.” AOFAS outcomes showed 13 excellent, 7 good, 4 fair, and 1 poor in Group A, versus 12 excellent, 9 good, 3 fair, and 1 poor in Group B, with no significant difference (p > 0.05). Complication rates were similar: wound infection (CRPF 4
The E-PASS scoring system, which incorporates preoperative data and surgical stress factors, may provide a reliable risk classification for predicting mortality risk in patients with Fournier’s gangrene. This study aimed to investigate the value of the E-PASS score in predicting mortality in patients with Fournier’s gangrene. The study included 41 patients who were diagnosed with FG clinically and underwent surgery. Preoperative demographic and clinical data, laboratory values, FGSI, and E-PASS scores were recorded. The patients were divided into two groups: 8 (19.5
This study investigated the rate and degree of deformity in femoral diaphyseal nonunion using preoperative bilateral CT-scans. A retrospective cohort study was conducted at a single Level 1 trauma center. Patients aged > 18 years who underwent operative treatment for femoral diaphyseal nonunion between 2015 and 2025 and had preoperative bilateral femur CT-scans were included. Axial, sagittal, coronal, and length differences between the femoral nonunion and the contralateral healthy femur were measured. Torsional deformity ≥ 15° and length discrepancy ≥ 20 mm were considered clinically relevant. Thresholds of ≥ 5° and ≥ 10° were used to identify outliers in coronal and sagittal plane deformity, respectively. Thirty-two patients met the inclusion criteria (median age 57 years, 63
Patients with multiple rib fractures (≥ 3) admitted to the intensive care unit (ICU) are at high risk of early respiratory deterioration, for which timely and effective analgesia is essential. Although multimodal analgesic strategies are widely recommended, their real-world implementation may be influenced by variability in early clinical decision-making, including treatment goal uncertainty (TGU). We aimed to investigate the association between early TGU, analgesic strategy selection, and respiratory outcomes in critically injured patients with rib fractures. This single-center observational cohort study included 236 adult ICU patients with ≥ 3 radiologically confirmed rib fractures who did not require invasive mechanical ventilation at admission (2020–2024). TGU within the first 48 h was assessed using blinded electronic medical record review as a process-level marker of variability in early care prioritization. Analgesic strategies were categorized as regional-based analgesia (RA), systemic-dominant analgesia (SA), or multimodal conservative management. The primary outcome was respiratory deterioration, defined as a composite of escalation of respiratory support, endotracheal intubation, or pulmonary complications requiring intervention. Associations were evaluated using propensity score overlap weighting and adjusted regression models. High TGU was identified in 39.8
Multifocal necrotizing fasciitis (MulNF) is a rare presentation of necrotizing fasciitis (NF) characterized by involvement of more than one non-contiguous anatomical site during the same disease episode. Comparative data between monofocal and multifocal NF remain limited. We performed a retrospective single-center cohort study of patients treated for NF between 2015 and 2026. Patients were classified as MNF (single site) or MulNF (multiple non-contiguous sites) based on chart review. Demographics, comorbidities, microbiology, laboratory values, organ failure, ICU course, surgical burden, and outcomes were compared. Forty-seven patients were included, of whom five (10.6
Retrobulbar hematoma (RBH) is a vision-threatening emergency. This large-scale study integrates clinical data and 3D analysis to identify prognostic factors, refine diagnosis, and support guideline-based emergency management. This study standardizes terminology, applies AO fracture classification, and uses CT-based 3D segmentation to analyze anatomical patterns, treatment protocols, providing evidence-based guidance for diagnosis, surgical management, and postoperative care. The Dortmund Maxillofacial Trauma Registry (2018–2025) recorded 52 RBHs among 7,671 trauma patients (0.7
Trauma remains a major contributor to global disability. While the trauma laparotomy can be a life-saving procedure in abdominal injury, a select proportion are performed with no pathology identified intra-operatively, potentially exposing patients to unnecessary morbidity. We aimed to assess the global prevalence of negative laparotomy and identify any influencing factors at both the patient- and system-level. This was a secondary analysis of the GOAL-Trauma study, a multicentre prospective international observational study on trauma laparotomy patients, conducted from April to December 2024. We defined a negative laparotomy as where no intra-abdominal injuries were identified during the index operation. A multivariable logistic regression was performed to identify predictive factors for a negative laparotomy. Of the 1769 patients included, 128 patients (7.2
To evaluate the association between admission-to-surgery time (with a focus on < 48 h) and postoperative complications and discharge mobility in patients with proximal femur fractures (PFFs), using a large administrative dataset from routine inpatient care in Germany. In this retrospective database analysis, 128,092 patient records from external inpatient quality assurance (North Rhine-Westphalia, Germany, 2016–2020) were included. All patients underwent surgical treatment for PFFs and were stratified by time to surgery as early surgery (Group A; within 48 h of admission) or delayed surgery (Group B; more than 48 h after admission). Two cohorts were analysed separately: hip arthroplasty (HA: early 57,635; delayed 7,504) and osteosynthesis (OST: early 59,466; delayed 3,487). Associations between admission-to-surgery time, postoperative complications, pre-admission anticoagulant therapy and inability to walk at discharge were assessed using descriptive statistics and binary logistic regression. Patients unable to walk before the fracture were excluded from the mobility analysis. Reporting was guided by the STROBE statement. In-hospital mortality was 4.7
Blood biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) were recently introduced into clinical practice for mild traumatic brain injury (mTBI) assessment. However, real world data demonstrating TBI biomarkers’ impact on the emergency department (ED) practice is lacking. This study aimed to describe the experience of a single tertiary hospital ED that introduced TBI biomarkers GFAP and UCH-L1 measurements using Alinity i® TBI test into routine mTBI assessment. Retrospective data were extracted from hospital records of patients who had TBI test ordered in the ED. Test results and subsequent clinical care pathway data (CT order, CT scan result, admission or discharge) were analysed. Data was available for 460 mTBI patients (median age 43, 54
