Trauma Care, Volume 5, Issue 2 (June 2025) – 6 articles

Introduction: The anatomy of the distal tibiofibular joint (DTFJ) has been demonstrated to influence the radiological outcome of reduction with syndesmotic screw fixation in the course of ankle fracture treatment. The objective of this study was to describe the anatomy of the DTFJ and to analyze the effect of incisura anatomy on syndesmotic stabilization with suture button systems (SBS), also in the context of their flexible nature of fixation. Materials and Methods: Forty-four (21 females, 23 males) consecutive postoperative bilateral computed tomography scans after stabilization of the DTFJ by SBS in the course of operative treatment of unstable ankle fractures were retrospectively analyzed. The anatomy of the DTFJ was evaluated by examining the following parameters: depth of the tibial incisura (DI), rotation of the incisura (ROI), Nault talar dome angle (NTDA), Leporjärvi clear space (LCS), anterior tibiofibular distance (antTFD), and fibula engagement (FE). The side-to-side (Δ) of LCS, NTDA, and antTFD, which analyzed the reduction result, were correlated with DI, FE, ROI, and NTDA, as well as the transverse offset (TO), reflecting the flexible nature of fixation. Results: Patients with slight overtightening (ΔLCS > −1 mm) showed a fibula that protruded less into the incisura on the native side (smaller FE) compared to symmetrical reduced patients and to patients with slight diastasis (p < 0.05). There was no relationship between the parameters describing the anatomy of the incisura and parameters assessing the parameter of the “flexible nature of fixation” (rs < 0.300). Regarding the anatomical parameters, it was observed that there were inter-individual differences of more than 4 mm (p > 0.05). Conclusions: The considerable inter-individual anatomical variability of the DTFJ was confirmed. The morphological configuration of the incisura has no impact on the immediate radiological reduction result after SBS stabilization of the DTFG, as determined by CT. The extent of the flexible nature of fixation is also not affected by the morphology of the incisura. Stabilization of the DTFJ can be performed regardless of the anatomical configuration. Full article

Background/Objectives: Childhood trauma has a documented impact on development, and may also affect functioning and well-being in transition-age youth (TAY). There is a need to explore approaches, such as trauma-informed care (TIC), to enhance the services provided during the transition to adulthood. The objective of this scoping review was to explore the extent of the literature on the potential of TIC for supporting TAY. Methods: We focused on initiatives grounded in TIC to support TAY between the ages of 14 and 25 who have histories of trauma. The search strategy involved nine databases and the gray literature. The titles, abstracts, and full text were screened in duplicate by reviewers, and then data were extracted. Results: A total of 19 references were included and classified into three categories: (1) importance of TIC to support TAY (k = 5); (2) description of TIC initiatives (k = 6); and (3) evaluation of TIC initiatives supporting TAY (k = 2). Seven references were classified into more than one category. The references documented 10 TIC models or initiatives, half of which were evaluated and showed promising results. Important components of TIC initiatives supporting TAY included staff training and support; collaborative and multidisciplinary work; systemic changes; addressing trauma and its impacts; and a strength-based and youth-focused approach. Conclusions: The review emphasizes the importance of acknowledging and responding to trauma and its impact in TAY and advances the core components of TIC in the context of the TA, including its systemic nature. Although we cannot conclude that TIC is effective in supporting the TA at the moment—given that the literature is still in its early stages—the review shows that it is at least promising. Limitations, as well as future lines of work are discussed. Full article

Background and Introduction: Race-based social rejection has been found to predict post-traumatic stress and depression symptoms, consistent with previous studies that have shown the negative mental health effects of racism, as well as social rejection in general. While racial identity has been noted as a protective factor among African Americans, the role it plays in the context of race-based social rejection is less clear. Methods: This study examines the relationships among self-reported race-based social rejection, hypothesized protective factors, and negative psychological outcomes among a sample of 230 low-income, urban African American men and women. Results: Multiple regression analyses revealed that racial identity did not moderate the race-based social rejection–depression relationship. However, it exacerbated post-traumatic stress symptoms in the face of race-based social rejection. Discussion: These results suggest that when one perceives such rejection, identifying strongly with one’s group may amplify post-traumatic stress by triggering collective instances of racial trauma. Conclusions: The role of racial identity highlights the unique nature of racial trauma, involving the interplay of individual and social facets, particularly among those who highly identify with their racial group, and call for collective and creative solutions. Full article

Objectives: this study aimed to compare the admission volume and characteristics of patients with traumatic orthopaedic injuries before, during, between, and after the COVID-19 lockdowns in metropolitan Victoria, Australia. Methods: A multi-centre, registry-based cohort study with an interrupted time series analysis was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) for patients with a date of injury from January 2017 to June 2022. Weekly admission volume, injury event characteristics, and in-hospital outcomes were analysed before, during, between, and after the two periods of COVID-19 lockdowns in metropolitan Melbourne (i.e., five periods). Results: During the first week of lockdown in Victoria (L1), the number of weekly orthopaedic trauma admissions declined by 24% relative to the preceding week, IRR 0.76 (95%CI 0.67, 0.87). However, the volume of admissions during the subsequent lockdown (L2) approximated pre-COVID levels. An immediate increase in orthopaedic trauma admissions occurred during the intermission (time between lockdowns) and post-COVID periods by 33% and 20%, respectively, compared to the preceding week. During periods of lockdown, patients were older (61 versus 58 years old), and a higher proportion were injured at home (38% versus 28%); fewer due to motor vehicle collisions (8% versus 11%). The pattern of injury by intent, body region injured, injury severity, and in-hospital mortality were unchanged. Conclusions: the impact of COVID-19 lockdowns on the volume and characteristics of hospitalised orthopaedic trauma was not uniform across consecutive lockdowns, but favoured injuries that occurred at home. Full article