Trauma Care, Volume 6, Issue 2 (June 2026) – 7 articles

Background: Despite standardization of treatment for ankle fractures, postoperative complications continue to pose a challenge. Previous studies focused on the association between patient-specific factors and early complications; less is known about fracture- and treatment-related factors. This study aimed to identify independent predictors of early postoperative complications in ankle fractures by including patient, fracture, and treatment-related factors. Methods: This was a retrospective single-center analysis of consecutive patients with surgically treated ankle fractures at a Level 1 trauma center (2013–2019). The main outcome was the time to the occurrence of an early post-operative complication, defined as an event requiring emergency medical consultation within the first 90 days after definitive fracture stabilization, deviating from the hospital’s standard aftercare protocol. Four different Cox regression analyses were performed to identify significant independent risk factors with the best fit. Results: Around 25% of the patients with ankle fractures developed an early postoperative complication. The multivariable Cox regression analysis revealed the following predictors of early complications: diabetes, substance abuse, older age, type of fracture, and insufficient/missing plaster reduction. Conclusion: Nearly one quarter of our patients developed an early postoperative complication. While some of the predictors of early complications cannot be modified, others might serve as targets for improving outcomes and reducing morbidity of ankle fracture surgeries. Full article

Background: While ibuprofen is a widely used non-opioid analgesic with growing evidence in surgical settings, its safety and efficacy in acute burn care remain poorly characterized. This review aims to address this gap. Methods: A systematic search was conducted in accordance with PRISMA-ScR (September 2025) across PubMed, MEDLINE, CENTRAL, CINAHL, and Scopus for original, English-language studies evaluating the safety and/or efficacy of ibuprofen, distinguishable from multimodal regimens, for acute burn analgesia. Results: Of 136 studies, six met inclusion criteria (5 adult, 1 pediatric). Populations primarily consisted of second- and third-degree burns; only two studies included >10% total body surface area (TBSA). Study designs were heterogeneous, all with moderate to high risk of bias, including one retrospective study (oral ibuprofen), two experimental double-blind placebo randomized controlled trials (RCTs) (topical; oral), and three clinical RCTs (intravenous; topical; topical and oral). No study reported associations with increased adverse events; a retrospective study found no increased bleeding risk with perioperative ibuprofen in skin graft patients. Analgesic outcomes were not directly comparable across studies due to heterogeneity. Experimental models found that ibuprofen did not reduce acute burn pain, but attenuated pain within hyperalgesic skin. Among clinical studies, both oral and dressing ibuprofen formulations demonstrated reduced procedural pain. One topical study noted faster wound healing, though this was confounded by less frequent dressing changes. Conclusions: The available studies were insufficient to draw definitive conclusions, limited by sample size, heterogeneity, bias, and exclusion of high-risk patients. Nonetheless, no study reported increased adverse events across diverse ibuprofen protocols. These findings underscore the need for adequately powered, agent-specific trials in clinically representative burn populations to inform evidence-based multimodal compositions amidst growing advocacy for opioid-sparing analgesia. Full article

Background: Renal trauma is a major cause of morbidity and mortality among trauma patients, especially in low- and middle-income countries (LMICs) where penetrating injuries are common. Although international evidence increasingly supports selective non-operative management (SNOM) for haemodynamically stable patients, data from resource-limited settings remain scarce. This study sought to assess the management outcomes of patients with traumatic renal injury at a South African tertiary trauma centre, describing management patterns and outcomes and identifying predictors of in-hospital death. Methods: A retrospective audit was carried out on all consecutive trauma patients presenting with renal injuries at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between July 2021 and June 2024. Patient demographics, injury mechanism and grade, admission physiological parameters, management strategies, complications, and outcomes were documented. Associations with in-hospital mortality were analysed using bivariate methods and Cox proportional hazards regression. Results: Of 161 patients included, 91.3% were male, with a median age of 32 years (interquartile range [IQR] 26–38). Penetrating trauma accounted for 80.1% of cases, predominantly gunshot wounds (GSWs; 49.7%). Most injuries were classified as American Association for the Surgery of Trauma (AAST) grades III–V (74.5%), and 68.3% required surgical intervention, although direct renal procedures were necessary in only 42.7% of operated patients. Nephrectomy accounted for 80.9% of renal-specific surgical interventions (38 of 47 patients who underwent a direct renal procedure). The overall in-hospital mortality rate was 17.4%. On multivariable analysis, admission lactate (hazard ratio [HR] 1.09; 95% confidence interval [CI] 1.00–1.18; p = 0.049), admission creatinine (HR 1.56; 95% CI 1.29–1.89; p < 0.001), and blood product transfusion within 24 h (HR 3.27; 95% CI 1.14–9.41; p = 0.028) were independently associated with mortality in the adjusted model. Conclusions: Admission lactate, creatinine, and early blood transfusion requirements were independently associated with in-hospital mortality in the adjusted model in this high-acuity cohort. These readily available physiological markers may facilitate early identification of high-risk patients in resource-limited settings; however, in the absence of ISS data, these variables may partly reflect the global burden of physiological insult from polytrauma rather than renal-specific predictors of death. A proportion of patients were managed non-operatively; however, given the inherent selection bias in management allocation and the absence of SNOM-specific outcome data stratified by AAST grade, no conclusions regarding the efficacy or safety of non-operative management can be drawn from this descriptive audit. Full article

Background: Recreational motorized vehicles, including all-terrain vehicles (ATVs), dirt and motor bikes, snowmobiles, and e-scooters, are an increasingly recognized source of severe trauma among children. Adult provincial data from Alberta demonstrate high morbidity, mortality, and more than $6 million in acute care costs from ATV-related injuries over a decade; however, pediatric injury patterns remain under-characterized despite rising exposure. Methods: We conducted a retrospective cohort study of pediatric patients presenting with major trauma (Injury Severity Score > 12) to the Stollery Children’s Hospital between December 2019 and June 2023. Recreational motorized vehicle-related cases were analyzed for demographics, injury mechanisms, injury severity, hospital resource utilization, and clinical outcomes. Available Abbreviated Injury Scale data were reviewed descriptively for a subset of ATV-related injuries. Results: Of 345 pediatric major trauma cases, 55 (16%) involved recreational motorized vehicles, accounting for 17% of major blunt trauma presentations. ATVs were the most common mechanism (58%), followed by dirt/motor bikes (23.6%), snowmobiles (14.5%), and e-scooters (3.6%). Patients were predominantly male (72.7%) with a mean age of 13.1 years. Operative intervention was required in 58.2% of cases, 30.9% required pediatric intensive care unit admission, and mortality was 5.5%. Helmet status was incompletely documented; only 36.4% of patients were recorded as wearing helmets. Children from rural regions accounted for 43.6% of injuries. In the ATV subset with available AIS data, head, facial, and extremity injuries were most common, and all patients sustained at least one serious injury (AIS ≥ 3). Conclusions: Recreational motorized vehicles represent a substantial and preventable cause of severe pediatric trauma in Alberta. When contextualized with adult provincial data demonstrating significant mortality and healthcare costs, these findings support strengthened injury-prevention strategies, improved safety enforcement, and evidence-informed policy approaches. Full article

Background: The management of persistent post-concussive symptoms (PPCS) is limited by the absence of objective biomarkers to guide treatment. We examined the early effects of a mild hyperbaric oxygen protocol on serum biomarkers of neuronal injury (neurofilament light chain, NfL), astrogliosis (glial fibrillary acidic protein, GFAP), acute neuronal injury (ubiquitin C-terminal hydrolase L1, UCH-L1), and axonal stability (total tau) in patients with PPCS. Methods: In this single-center, randomized, placebo-controlled trial, we enrolled adults with PPCS lasting from 3 months to 5 years after mild traumatic brain injury. Participants received 40 sessions of either active treatment (≥99% O₂ at 1.5 atmospheres absolute, ATA) or a true chamber placebo (21% O₂ with simulated pressure changes). Serum samples were collected at baseline and 13 weeks after treatment. The primary outcome was the difference between groups in serum NfL levels. Analysis was performed on an intention-to-treat basis using a two-way ANOVA with Šídák’s multiple comparison test. Findings: Of 84 individuals assessed, 20 were randomized (Placebo, n = 9; Intervention, n = 11). Eight from each group received their respective interventions. At 13 weeks, one participant from each group was lost to follow-up, leaving seven per group for analysis. We found no significant differences in serum levels of GFAP, NfL, total tau, or UCH-L1 between the intervention and placebo groups from baseline to 13 weeks. Conclusions: A 40-session mild hyperbaric oxygen protocol at 1.5 ATA did not significantly change serum biomarkers of neuronal injury, astrogliosis, or acute neuronal damage at 13 weeks post-treatment in individuals with PPCS. This early-phase analysis, at the highest point of participant retention, provides no evidence of a treatment effect on these pathophysiological markers. Full article

Background/Objectives: Traumatic injury in adults can result in decreased physical function, reduced health-related quality of life, and persisting mental health problems. Enhanced rehabilitation in the acute setting may support recovery. Although prior reviews have investigated enhanced rehabilitation across multiple care settings, there remains limited emphasis on interventions implemented specifically within the acute phase of care. This narrative review aimed to examine the current evidence evaluating the effect of enhanced rehabilitation delivered by physiotherapy and/or occupational therapy on physical function following traumatic injury. Methods: A systematic search of Ovid MEDLINE, Embase, and CINAHL was conducted to identify experimental and quasi-experimental studies that delivered enhanced unidisciplinary or multidisciplinary rehabilitation immediately following traumatic injury. Key findings from relevant studies were synthesised narratively. Results: Three randomised controlled trials were included. Due to heterogeneity in population presentations, interventions, outcomes, and timing of measurement, qualitative synthesis was not feasible. There was no significant difference in acute length of stay or discharge destination between intervention and control groups. The effect of enhanced rehabilitation on physical function was inconclusive, and the optimal dosage remains unclear due to inadequate reporting. Conclusions: Evidence for enhanced rehabilitation after traumatic injury is limited. Further research is needed to determine the effect of enhanced rehabilitation on physical function in this population. Pragmatic study designs with standardised reporting and patient-centred outcome measures to capture traumatic injury populations are needed to improve synthesis of findings and guide clinical practice. Full article

Background: Firearm injuries are the leading cause of mortality among youth in the United States and legislation is a key strategy in reducing youth firearm injuries and deaths. Maryland recently enacted a stronger child access prevention (CAP) law known as Jaelynn’s Law, which mandates secure firearm storage and imposes stricter penalties for violations. Objectives: The aim of this study was to examine firearm storage practices and beliefs in a pediatric and adult emergency department in Baltimore before and after the implementation of Jaelynn’s Law. Method: This descriptive study recruited 396 adult participants from pediatric and adult EDs at Johns Hopkins Hospital before and after the implementation of Jaelynn’s Law. Participants completed a survey on demographics, firearm ownership, and storage practices. Those with unsafe storage practices were provided educational pamphlets and safe storage devices. Data were analyzed using SPSS Statistics 28, with descriptive statistics, t-tests, and Chi-square analyses used to assess differences pre- and post-law implementation. Results: Of the participants, 29% owned firearms, with 86% of firearm owners having children in the home. Firearms were primarily stored locked and unloaded. No significant differences in storage practices were observed after implementation of Jaelynn’s Law. Participants cited quick access for personal protection as a key barrier to safe storage. Conclusions: We found no significant change in safe storage practices post-implementation of Jaelynn’s Law. Concerns about personal safety continue to be of primary concern and public health campaigns, legislative measures, and community investment are necessary to enhance safety and safe storage compliance. Full article