Trauma Care, Volume 5, Issue 4 (December 2025) – 7 articles

Background/Objectives: Early diagnosis and surgical intervention are critical in upper extremity (UE) compartment syndrome to prevent irreversible muscle necrosis or amputation. Despite its prevalence, there remains limited literature guiding surgical management or predictors of complications. This study aims to characterize risk factors and outcomes following UE fasciotomies. Methods: A 14-year (2010–2024) retrospective review was conducted of adult patients undergoing fasciotomies for UE compartment syndrome at a level 1 trauma center. Exclusion criteria included age <18 years, incomplete records, or fasciotomies not performed for compartment syndrome. Data collected include demographics, injury mechanism, presenting symptoms, and diagnostic methods. Intraoperative details obtained include incision type, number of interventions, closure method, presence of muscle necrosis, and amputation. Results: Fifty-five patients (58 extremities) met the inclusion criteria (median age 42 years; 85% male). Mechanisms included fractures (29.3%), prolonged pressure (“found-down”) (25.9%), vascular injuries (13.8%), ballistic trauma (8.6%), crush (6.9%), and other (15.5%). Common symptoms were pain (72.4%), paresthesias (48.3%), and motor dysfunction (43.1%). Isolated fasciotomy incisions included volar forearm (41.4%), hand (8.6%), dorsal forearm (3.4%), and upper arm (1.7%), with the remaining being combinations thereof. Among the 40 total volar forearm fasciotomies, none developed postoperative dorsal forearm muscle necrosis. Muscle necrosis (19%) was associated with pallor (p = 0.05) and pulselessness (p < 0.001). A prolonged pressure mechanism was associated with increased muscle necrosis (p = 0.02) and amputation (p < 0.001). Meanwhile, the fracture mechanism was associated with decreased muscle necrosis (p < 0.001) and higher DPC rates (p < 0.001). Conclusions: Pain, paresthesias, and motor dysfunction were most common symptoms in UE compartment syndrome; pallor and pulselessness correlated with muscle necrosis, indicating advanced compartment syndrome. The prolonged pressure mechanism was associated with greater muscle necrosis and amputation, while fracture-related mechanisms were associated with decreased muscle necrosis and higher DPC rates. Full article

External fixation is widely used in trauma care for managing bone and soft tissue injuries. These devices are often associated with psychological challenges and are often not followed up with sufficient psychological support for the patient. The specific psychological impact of external fixation following traumatic injuries remains underexplored. This scoping review aimed to synthesize the current literature on the psychological impact of external fixation in trauma patients. A systematic search of CINAHL, Cochrane Library, PsycInfo, PubMed, Scopus, Google Scholar, and EBSCO identified ten studies (2006–2024), from the USA, Europe, Asia, and Oceania to be included based on inclusion criteria of using the device for traumatic injuries (excluding limb lengthening procedures) and assessing psychological outcomes using validated tools. Data extracted included injury type, fixator application, survey type, and mental health outcomes. Common measures included HADS, SF-36/SF-12, PedsQL, CRIES-13, EQ-5D-5L, and patient-reported questionnaires. The findings showed that elevated psychological distress was greatest during early recovery (~1 month). Body image concerns were frequently reported with the fixator in place; however, partial recovery of mental health scores was seen by 12–24 months. These findings emphasize the need for additional research and a greater integration of mental health resources in trauma care protocols involving external fixation. Full article

Background: Quality of life is a foundational component of overall health and is negatively impacted by post-traumatic stress disorder (PTSD). In the last decade, acupuncture treatment has become a popularized treatment option for PTSD, especially for Veterans. Research evidence is needed to provide support for acupuncture as a treatment for PTSD which leads to an enhanced quality of life. Objectives: This paper investigated the changes in health-related quality of life in Veterans with combat PTSD who enrolled in a 5-year randomized (two-arm, parallel-group, prospective, single-blinded) clinical trial, completing either a control (Sham) or acupuncture (Verum) treatment (N = 93). Methods: Health-related quality of life was measured by the Veterans RAND 12-item Health Survey (VR-12). Paired t tests between and among participants’ differences were calculated for the Verum acupuncture group, Sham acupuncture group, and Total group. Results: Veterans who completed acupuncture treatment in either randomized arm (Verum and Sham) had a self-perceived improvement in quality of life when assessing physical and mental health symptoms. Specifically, those who were randomized and completed Verum acupuncture treatment reported the greatest improvement in mental health quality of life. Conclusions: Study results support prior foundational findings that acupuncture has a positive effect on self-reported quality of life by reducing PTSD symptoms in Veterans with combat PTSD, with Verum acupuncture eliciting the greatest improvement on mental health symptoms. Full article

Aim: This study aims to assess the relationship between the time-to-CT and outcomes in trauma patients presenting to a regional Australian hospital. Method: This study is a retrospective analysis of prospectively collected data to review the relationship between time-to-CT and the outcomes of mortality, length of stay, and intrahospital transfer for trauma patients presenting to a single regional Australian hospital between January 2000 and July 2022. Results: There were 127 trauma patients who met the inclusion criteria during the study period. Comparing patients who had a CT performed within 1 h of arrival to patients those who had a CT performed more than 1 h after arrival, there was no statistically significant difference in mortality rate (8.0% vs. 7.7%, p = 1.000), and no statistically significant difference in length of stay (4.5 days vs. 3 days, p = 0.496). Increased age was associated with an increased risk of mortality while First Nations people were found to have a shorter length of stay within hospital. Conclusions: In this cohort study, the time-to-CT was not predictive of increased mortality risk in trauma patients presenting to a regional hospital. The time-to-CT in this regional hospital was comparable to published data from level I trauma centres in Australia. What does this paper add to the literature? This paper is the first to look at the impact of time-to-CT in the regional Australian setting. Full article

Background: Fractured ribs remain a significant cause of morbidity and are associated with severe injuries requiring several healthcare resources and may be associated with prolonged hospital stays that may require an ICU facility. In our facility, we have a high burden of patients sustaining rib fractures, and we aim to compare management options, outcomes, and factors associated with mortality from a single center. Methods: A retrospective review was performed on patients who presented with rib fractures at a Level 1 Trauma facility in Johannesburg, undergoing medical or surgical management. The study included data from 1 July 2011 until 31 December 2020. All patients were identified using the Medibank database. STATA Version 18 software was used for all data analysis. A p-value of <0.05 was considered statistically significant. Injuries were subdivided according to the Abbreviated Injury Severity score as follows, Mild = AIS Grade I–II, Moderate = AIS Grade III, Severe AIS Grade IV–V. Results: There was a total of 940 patients. The median age was 45 (IQR: 34–55) years, with 22% female patients in a cohort of 940. The mechanism of injury was blunt in 96%. Most patients (93%) fractured 3/> ribs. Only 4.6% sustained a flail chest. The median SBP was 126 mmHg (IQR:109–144), and the pulse rate was 91 (IQR: 79–108) beats per minute. The mean Injury Severity Score (ISS) and New Injury Severity Score (NISS) were 17 (IQR: 10–29) and 22 (IQR: 14–34), respectively. The most common associated injuries were chest trauma in 42%, combined abdominal and pelvic trauma in 35%, and severe extremity trauma in 37%. The mortality rate was 17% (159/940). Most patients required medical and supportive management, with only 8% undergoing rib plating (76/940). The mean length of stay was 14 days (IQR: 6–25). Statistically significant factors associated with mortality were rib fractures 3≥, flail chest, higher ISS, severe head, neck, chest, abdomen and pelvis injuries (p-value 0.001) and severe extremity injury (p-value 0.006). Conclusions: Rib fractures remain a common pathology in the trauma population, and these patients can have significant associated injuries. With an appropriate multidisciplinary approach, our study found an 83% survival rate, and only 8% of patients requiring surgical intervention. Poor outcomes in patients are directly linked to the number of ribs involved, the injury severity score, associated injuries, and advanced age. Full article

Post-traumatic lymphedema (PTL) is a chronic and often under-recognized sequela of soft tissue trauma, leading to persistent swelling, functional impairment, and increased risk of infection. While lymphedema is traditionally associated with oncologic interventions, growing evidence highlights the significant burden of PTL in trauma patients. This review provides a comprehensive analysis of the current understanding of PTL, including epidemiology, risk factors, pathophysiology, diagnostic modalities, and treatment strategies. PTL often occurs after high-impact musculoskeletal injuries (such as open fractures with significant soft tissue loss) or burns (especially if deep or circumferential). This risk is increased if injury occurs at critical areas of increased lymphatic density (such as anteromedial leg, medial knee, medial thigh, medial elbow, or medial arm). Advances in imaging techniques, including indocyanine green lymphography and magnetic resonance lymphangiography, have improved early detection and classification of PTL. Management approaches range from conservative therapies, such as complete decongestive therapy (CDT), to surgical interventions, including lymphaticovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and vascularized lymph vessel transfer (VLVT)/lymph-interpositional-flap transfer (LIFT). We report on our experience with two patients. At our center, we diagnose and stage PTL with ICG lymphography and trial CDT for 6 months. If there is no significant improvement, we recommend LVA. If there is insufficient improvement after 12 months, we recommend LIFT/repeat LVA/VLNT. We also treat open fractures with significant soft tissue defects with LIFT, as prophylaxis against PTL. PTL remains an underdiagnosed condition, necessitating increased awareness and intervention to prevent long-term disability. Full article

Objective: There is scarce reporting of radial head fracture epidemiology and patient characteristics beyond age and sex. This study aimed to describe demographic, socioeconomic, and injury pattern characteristics for people sustaining a radial head fracture admitted to trauma centers over a 15-year period. Methods: Analysis of Victorian Orthopaedic Trauma Outcomes Registry data was conducted to describe the demographic and case characteristics of patients with radial head fractures admitted to collaborating hospitals. Cohort and case characteristics were compared by center type (Level 1 vs. other trauma centers). Results: A total of 991 cases with a unilateral radial head fracture were recorded over 15 years, with 827 admitted to Level 1 trauma centers and 164 admitted to other centers. The mean age at time of injury was 48.7 years (SD 19.7), with male predominance (n = 621, 62.7%). Most patients resided in major cities (n = 824, 85.2%), were treated under the universal healthcare system (n = 546, 56.1%), and had no Charlson Comorbidity Index conditions (n = 738, 74.5%). A higher proportion of patients managed at Level 1 centers were male (65.7% vs. 47.6%), younger (mean 47.7 vs. 53.7 years), living in major cities (86.6% vs. 78.5%), and working prior to injury (71.3% vs. 57.1%). Over 85% of the cohort sustained concomitant injuries, with Level 1 centers receiving a higher proportion of multiple injury cases (87.8% vs. 73.2%). Elbow dislocations constituted the largest proportion of concomitant injuries (n = 257, 25.9%). Conclusions: This study has provided new insights into the demographic characteristics, comorbidity status, and associated injuries of radial head fracture populations admitted to Level 1 and other trauma centers, using long-established registry data. Full article