Search Results (340)

Introduction: Cannabidiol (CBD) is widely available over the counter for presumed medical and recreational purposes. Despite its non-psychoactive nature, CBD exhibits intrinsic pharmacological activity that may lead to potential adverse drug events (ADEs) and drug–drug interactions (DDI) with common prescription medications through cytochrome P450 inhibition. Due to their largely unregulated nature and widespread advertising, consumers who use CBD products may not be aware of these potential negative drug interactions. The purpose of this study was to determine how frequently patients who use CBD products concurrently take prescription medication with known drug–drug interaction (DDI) potential, and to identify specific therapeutic classes most commonly involved. Methods: In this cross-sectional study, a survey was distributed to patients and family members in the adult and pediatric Emergency Departments of a Level 1 Trauma Center in eastern North Carolina. Respondents reported household CBD use and selected from a list of conditions for which they take prescription medications. Results: Of 681 eligible respondents, 254 (37.3%) reported CBD use in their household (CBDUIH). Among those with CBDUIH, 69.7% reported concurrent use of 1 or more medications with a potential DDI risk. The most common categories of prescriptions were antidepressants (64.4%) and antihypertensives (41.8%), followed by agents for diabetes, hyperlipidemia, and immune disorders. Conclusions: The majority of CBD users in this population are concurrently taking medications with DDI potential, highlighting the need for patient and provider education, and improved labeling of CBD-based products to accurately reflect risks. Further study of clinically significant interactions is needed to determine which medications within these common categories have the most substantial risk of DDI. Full article

Background/Objectives: Transarterial embolization nowadays has a pivotal role in non-operative management strategies of post-traumatic bleeding. Timely control of hemorrhage is critical in trauma care; however, the impact of procedural timing remains underexplored. This single-center study, conducted at a Level II trauma center with 24/7 interventional radiology coverage, evaluated the influence of interval time on embolization outcomes in post-traumatic bleeding patients. Methods: In this retrospective study, 182 trauma patients who underwent embolization between June 2020 and June 2025 were analyzed. Patients were stratified by CT-to-angiography interval time (≤1 h [early, n = 46] and >1 h [delayed, n = 136]). Hemodynamic parameters, laboratory values, transfusion needs, and outcomes were compared and adjusted for baseline differences. Results: Early group patients showed more severe baseline physiology, including hypotension, higher lactates, and lower hemoglobin. No significant differences were found in mortality (2.9% vs. 2.5%), hospital stay (18.7 ± 26.1 vs. 18.1 ± 22.2 days), or transfusion requirements. Embolizations within one hour from CT were associated with significant lactate reduction at 24 h in univariate analysis (p = 0.039), but this was not confirmed in multivariate analysis. Re-embolization (8.7% vs. 1.5%, p = 0.036) and surgical rescue (13.0% vs. 3.7%, p = 0.033) rates were more frequent in the early group. Conclusions: Early embolization improves metabolic parameters in post-traumatic bleeding, especially in patients with greater baseline severity of injuries. These findings support prioritization of early embolization and structured interventional radiology networks for timely procedures. A personalized approach according to baseline injury is required. 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

Objectives: Meniscal integrity is crucial for knee joint stability and the prevention of osteoarthritis (OA) development. Recent studies suggested that mechanical overload and interleukin (IL)-17A may be important intertwined players in meniscal degeneration, but a direct impact of IL-17A on the meniscus has not been investigated. Therefore, the aim of this study was to analyze the effect of IL-17A on meniscal tissue with and without combined mechanical injury (MI). Methods: Meniscal explant disks (1 mm height, 3 mm diameter) were isolated from bovine menisci (preserving the native tibial superficial zone) and exposed to IL-17A [0–100 ng/mL] and/or MI (single compression, 50% strain, strain rate 1 mm/sec). After three days of incubation in a serum-free medium, the proteoglycan release (sGAG; DMMB assay), mRNA level of matrix-degrading enzymes (qRT-PCR), aggrecan degradation (NITEGE immunostaining), and cell death (histomorphometry of nuclear blebbing/apoptosis and condensed nuclei/unspecified cell death) were determined. Statistics: one- and two-way ANOVA with Tukey’s multiple comparisons or Kruskal–Wallis with post hoc testing. Results: IL-17A increased sGAG release in a dose-dependent significant manner. MI also induced the release of sGAG significantly, but the combination with IL-17A showed the highest levels. Both IL-17A and MI individually affected the mRNA levels for ADAMTS4 and MMP-13 slightly, but the combination of both particularly induced a significant increase in mRNA levels. Signals for the ADAMTS4-related aggrecan neoepitope NITEGE were elevated by IL-17A in superficial areas of the excised tissue and by MI in superficial and deeper areas. The combination of both stimuli intensified this signal further. MI increased the number of cells with condensed nuclei significantly and induced apoptosis in a small proportion of cells. IL-17A had no significant impact on the amount of condensed or apoptotic nuclei. Conclusions: Our findings emphasize an interaction between inflammatory cytokine IL-17A signaling and mechanical stress since IL-17A induced matrix degeneration in meniscal tissue, which intensified in combination with a trauma. The latter might create a post-traumatic environment that promotes meniscal degeneration and subsequently osteoarthritis progression. Full article

Background: The management of lateral compression type 1 (LC-1) pelvic fractures remains controversial. Posterior fixation alone has traditionally been practiced without clearly defined indications for supplementary anterior stabilization. Direct comparative evidence between posterior-only and combined anterior–posterior fixation remains scarce. This study evaluated whether institutional criteria reliably identify patients who benefit from additional percutaneous anterior fixation. Methods: A retrospective cohort study was conducted at a level I trauma center and included adults with LC-1 fractures treated exclusively by percutaneous fixation. Combined anterior–posterior fixation was performed when predominant anterior pain and radiographic compromise indicated instability. Primary outcomes were pain trajectory (Numeric Rating Scale), inpatient opioid use, physiotherapy clearance, and ward mobility. Results: Thirty-seven patients were analyzed (combined = 14; posterior-only = 23). Preoperative pain was higher in the combined group (median 7 vs. 6; median difference 1 [95% CI 0 to 2]; p = 0.0036). Postoperatively, pain scores were lower in the combined group at 1–6 weeks (median difference −1 [95% CI −2 to 0]; p < 0.05). Opioid consumption was reduced (193 mg vs. 312 mg; median difference −200 mg [95% CI −280 to −120]; p < 0.001), and physiotherapy clearance occurred earlier (4 vs. 7 days; median difference −3 [95% CI −5 to −1]; p = 0.020). Conclusion: Our current indications to perform combined fixation were associated with favorable early outcomes in pain control and physiotherapy clearance among patients with LC-1 fractures showing anterior compromise. These results support a selective combined approach, though interpretation must remain cautious given the small retrospective cohort. Further prospective studies are warranted to validate these findings and refine patient selection. Full article

Post-traumatic stress disorder (PTSD) is frequently comorbid with persistent depressive disorder (dysthymia), indicating shared neurobiological pathways that influence stress modulation, emotional regulation, and neurohormonal adaptation. This study examines the roles of serum biomarkers—small ubiquitin-like modifier 1 (SUMO1), malondialdehyde (MDA), fractalkine (CX3CL1), and ubiquitin C-terminal hydrolase L1 (UCHL1)—involved in oxidative stress management, neuroimmune regulation, and neuronal proteostasis. In this cross-sectional analysis, biomarker expression was assessed in 92 male trauma-exposed participants aged 19–50 years, divided into three groups: PTSD duration ≤ 5 years (n = 33, median age 34.0 years [IQR 31.0–41.0]), PTSD duration > 5 years (n = 31, median age 36.0 years [IQR 29.5–41.0]), and controls without current or past PTSD (n = 28, median age 33.5 years [IQR 24.3–41.5]). Participants were stratified into younger (19–34 years) and older (35–50 years) cohorts to account for age-related neurobiological variability. Dysthymic symptomatology was evaluated using the Cornell Dysthymia Rating Scale (CDRS), focusing on chronic subthreshold depressive features. Results indicated a significant association between PTSD and elevated dysthymic symptom burden (p < 0.001), with both PTSD subgroups demonstrating mild to moderate CDRS severity compared to euthymic controls. Biomarker analysis revealed phase-dependent alterations: SUMO1 levels were significantly elevated in the ≤5 years PTSD group compared to controls (p = 0.002), suggesting early compensatory neuroprotection, whereas UCHL1 was markedly increased in the >5 years PTSD group (p = 0.015), which is indicative of chronic neuronal damage and proteostatic disruption. No significant differences were observed in MDA or CX3CL1 across groups (p > 0.05). These findings highlight PTSD’s contribution to sustained affective dysregulation, potentially mediated by temporal shifts in oxidative stress and protein homeostasis markers. Clinically, this supports the utility of biomarker profiling for risk stratification, early intervention, and personalized therapeutic strategies, such as targeted modulation of SUMOylation or UCHL1 activity, to enhance neuroresilience and mitigate progression to severe mood disorders. Full article

Background: Fractures of the first and second cervical vertebrae are common in both young and elderly patients. Surgical management of C1–C2 fractures in elderly patients is controversial. The aim of this study is to report the rate of fusion in elderly patients who underwent surgery for C1 or C2 fractures. Methods: A retrospective review of all patients over the age of 65 years old who underwent surgical treatment for C1 or C2 fracture was reported. Visual analog scale (VAS) and neck disability index (NDI) were used to assess patients’ clinical outcome at 1 year follow-up. Cervical spine computer tomography (CT) scans were performed in all cases before surgery and at 1 year follow-up to evaluate the long-term postoperative rate of fusion, according to Lenke fusion grade. Results: From 2019 to 2023, 105 patients with cervical craniocervical junction (CCJ) fracture underwent surgical treatment in our Pisana University Hospital. Among all these, 74 patients (70.5%) were over 65 years old. The mean age of the study population was 76.9 years old (12.2% aged 65–70, 51.4% aged 70–79, and 36.5% over 80). According to the AO Spine Upper Cervical Injury Classification System, 6 (8.1%) patients presented a type II fracture and 68 (91.9%) patients presented a type III fracture. At admission, neurological examination resulted in American Spinal Injury Association (ASIA) E in 97.3% of cases. Over 60% of all patients underwent C1–C2 posterior fixation. Postoperative complications occurred in 12.25% of patients. According to the criteria described by Lenke, a good rate of fusion (A-B grade) was obtained in 71.6% of patients. Conclusions: In elderly patients with CCJ fractures, precision medicine can help identify those at higher risk for complications and guide personalized treatment strategies. Surgical treatment of CCJ fractures in elderly patients, although not always associated with bone fusion, can be performed with an acceptable incidence of mortality and morbidity, allowing rapid mobilization and return to pre-trauma levels of independence. Full article

Background: Optimal energy and protein delivery during the early phase of severe trauma remains unclear. Observational studies frequently contradict the findings of randomized controlled trials, raising concerns about confounding factors. The aim of this study is to assess nutritional adequacy and daily variability in the energy gaps and its impact on outcomes using innovative statistical methods. Methods: Prospective observational study enrolled severely injured patients in the ICU at the Level 1 trauma center between October 2023 to April 2025. To describe the evolution of calorie and protein deficits during the first 10-day ICU stay, we utilized a linear mixed-effects model to estimate each patient’s individual energy gap trajectory. Results: 286 patients were analyzed. Median APACHE II and ISS score was 16.0 (12.0–20.0) and 22.0 (18.0–27.0), respectively. Mortality rate was 35.3%. Patients received 68.3% of prescribed calories and 76.8% of proteins. Admission energy deficit, rate of caloric intake, and their interaction are associated with ICU mortality. Increased day-to-day energy variability was associated with longer duration of mechanical ventilation (HR = 0.55, 95% CI: 0.31–0.99; p = 0.047). Patients who achieved better caloric (HR = 0.68, 95% CI: 0.48–0.98, p = 0.036) and protein (HR = 0.29, 95% CI: 0.09–0.96, p = 0.043) nutrition had a lower hazard of developing nosocomial infection. Conclusions: This study supports the 2023 ESPEN guidelines, showing that achieving the recommended energy and protein intake during the early phase of severe trauma is linked to lower mortality rates, shorter mechanical ventilation time, and reduced risk of nosocomial infections. 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

Background: There are differing opinions in the literature regarding the optimal treatment modality for adolescents with completely displaced, complex clavicle fractures. This study aims to determine outcome differences between surgical and non-surgical treatment for adolescent Z-type clavicle fractures and to ascertain if differences exist in outcomes between the two interventions. Methods: This was a single-center, retrospective chart review performed at a level 1 trauma center. Inclusion criteria included pediatric patients ages 12 to 16 years who presented with a comminuted, displaced clavicle shaft fracture with a comminuted fragment more than 1 cm in length and were treated either operatively or nonoperatively between January 2019 and December 2022. The outcomes were radiographic union status (i.e., union versus non-union versus malunion), follow-up period, shoulder range of motion, return to athletic activities, and patient reported pain level. Results: Of the 24 patients, 11 were treated surgically and 13 non-surgically. Patients who were treated surgically were more likely to be older (mean 1.5 years, p = 0.039) and have a longer follow-up by 9 months average duration compared to the cohort treated non-surgically (p = 0.0009). There was no significant difference between patient reported pain, radiographic union status, return to athletic activity, or shoulder range of motion between the cohorts. The small sample size and retrospective study design limits the statistical power of our results. Conclusions: The decision between treating these complex fractures operatively versus nonoperatively should be left to a lengthy discussion between the surgeon, parents, and the patient. Full article

Background: Open fractures in pediatric patients are uncommon but clinically relevant, often resulting from high-energy trauma or sports-related incidents. This study analyzes the demographic patterns, types of sports, injury mechanisms, treatment strategies, and outcomes in children and adolescents with sports-related open fractures. Methods: In this retrospective study, 74 pediatric patients with sports-related open fractures treated at a level 1 trauma center between 2002 and 2023 were documented. Parameters such as age, sex, fracture location, sport type, treatment modality, complications, and outcomes were evaluated. Results: The cohort included 74 patients, with a mean age of 13 ± 3.6 years. Open fractures of the upper extremity were most common (seen in 34 patients). Moreover, 10 open craniofacial and 27 open nasal fractures represented 50.0% of injuries, mainly in male athletes involved in contact sports. Soccer was the leading injury-related sport (n = 14; 18.9%). Surgical treatment was required in 28 patients (37.8%), most frequently using elastic stable intramedullary nailing, Kirschner wire fixation in the upper extremities or nasal bone reduction. Antibiotics were administered in 46 patients (62.2%), with a mean documented duration of 2.7 ± 3.1 days. An excellent outcome was documented in 95%. Conclusions: Sports-related open fractures in children primarily affect male adolescents in contact sports and involve the upper extremities and facial region. Conservative management is effective in stable, non-displaced and low-grade injuries. Surgical treatment is frequently indicated in open forearm fractures. The implementation of a structured trauma care protocol, incorporating early debridement, definitive treatment, and antibiotics, has been demonstrated to yield a safe and effective treatment outcome with a favorable prognosis for sports-related open fractures in children. Full article

Objectives: Despite the implementation of additional safety measures, motor vehicle collisions (MVCs) still result in significant injuries and fatalities. This study aims to explore the severity of these injuries and the length of hospital stays (LOS) following MVCs. Furthermore, this study will assess how helmet use and alcohol influence trauma outcomes. Methods: This retrospective study from a single center includes 604 patients from 1 January 2016, to 31 December 2024. Patients were identified based on the Abbreviated Injury Scale (AIS) body regions. Descriptive statistics and ANOVA were performed on helmet use and blood alcohol concentration, with significance set at p < 0.01. Results: Mean LOS at the hospital (H) was 13 days, 10.53 h in the ED, and 113.32 h in the ICU. In total, 74.5% of patients were male and 25.5% were female. The mean injury severity score (ISS) was 22.58, with 99.83% representing blunt trauma. The majority of patients (94.21%) arrived with signs of life, with 50.99% patients discharged to home or self-care (routine discharge). A noticeable trend following 2020 showed an increase in ED discharges, and thus ED admissions, compared to years before 2020. Helmet use showed a non-significant trend toward reduced ISS and length of stay. ETOH level and primary payor source were not significantly associated with outcome variables in regression models, though patterns suggest a potential relationship between payor source and ED discharge disposition. Conclusions: This study identifies important clinical trends that merit further investigation. Helmet use may be associated with reduced injury severity and shorter hospital stays, while differences in primary payor source suggest disparities in ED discharge outcomes. These findings underscore the need for further research on payor disposition, helmet use, and ETOH level in MVCs. Full article

Background: Mandibular fractures are often treated with open reduction and internal fixation in order to restore function and anatomy. This study analyzes postoperative complications and outcomes over one year at a high-volume teaching hospital, focusing on fracture types, treatment methods, and the impact of providers’ experience. Methods: This retrospective study included patients 12 years of age or older with mandibular fractures resulting from trauma during a 1-year period, January–December 2022 in a level 1 trauma center. Medical records were reviewed, and patient data was collected. Patients were categorized into 3 groups: Group 1 (surgical treatment), Group 2 (closed treatment, i.e., dental splints, arch bars/eyelets), and Group 3 (observation/soft diet). The results were tabulated, and standard descriptive statistics were used. Results: 141 patients with 223 mandibular fractures met inclusion criteria. Throughout all groups, 18 surgically treated patients (12.7%) and one patient treated with arch bars (0.07%) required additional unintended surgical procedure such as plate removal with/without re-plating, or orthognathic surgery for occlusal correction. Conclusions: The complication rates in this cohort align with the existing literature, though variations may origin from limited sample size, short follow-up and patient comorbidities. The involvement of less experienced surgeons during on-call hours most likely contributed to outcome variability. Despite challenges, most patients had favorable outcomes. Full article

Background/Objectives: Periprosthetic joint infection (PJI) is a challenging problem in orthopedic surgery and is often associated with high morbidity. The treatment becomes even more challenging whenever the microorganism is virulent and/or not widely known as a causative organism on these occasions. This study aims to report on the clinical outcomes of hip hemiarthroplasty prosthetic hip joint infection by an atypical, rare microorganism, Morganella morganii (M. morganii), focusing on morbidity, revisions, and mortality. Methods: This is a retrospective series of four cases of prosthetic joint infections with Morganella morganii, a rare Gram-negative opportunistic facultative anaerobic pathogen, in four patients who received hip hemiarthroplasty for displaced femoral neck fractures at a level 1 trauma center. Clinical notes, laboratory findings, and radiographs were reviewed to extract relevant information regarding the history and outcomes. Results: The patients were four females, with a mean age of 84.27 years at the time of surgery. Two cases (50%) underwent surgical debridement and implant retention, followed by lifelong antibiotic suppression for symptomatic control of persistent wound drainage, and the other two underwent implant removal and resection arthroplasty (one patient) or received an antibiotic spacer (one patient), followed by chronic antibiotic therapy until wound closure. Conclusions: Periprosthetic hemiarthroplasty infection secondary to M. morganii was associated with overall poor outcomes. Antibiotic suppression could be a reasonable option after the surgical debridement or implant removal in M. morganii PJI to control the symptoms. Full article

Objective: The aim of this study was to retrospectively evaluate the results of administering subcutaneous neutral protamine Hagedorn (NPH) insulin every 8 h (NPH-8) versus every 12 h (NPH-12) in critically ill, hyperglycemic trauma patients who required continuous enteral nutrition (EN). Methods: Both groups of patients were given concurrent sliding scale regular human insulin (SSI) with NPH therapy. The evaluation of glycemic control continued for 7 days. Results: A total of 15 patients were given NPH every 8 h (NPH-8), and 19 were given NPH every 12 h (NPH-12). Carbohydrate intake was similar between groups (115 ± 35 vs. 108 ± 37 g/d; p = 0.584). There was no significant difference in average blood glucose (BG) concentration (168 ± 18 vs. 166 ± 17 mg/dL; p = 0.803) or time within a BG target range of 70 to 149 mg/dL (7.5 ± 4.7 vs. 8.1 ± 5.0 h/d; p = 0.678) or 70 to 179 mg/dL (14.5 ± 5.0 vs. 16 ± 5.6 h/d; p = 0.419) or the incidence of Level 1 hypoglycemia (2 patients in each group; p = 1.00) or Level 2 hypoglycemia (1 patient vs. 0 patients, p = 0.441) between the NPH-8 and NPH-12 groups, respectively. However, the NPH-8 group required twice as much total (NPH + SSI) insulin (115 ± 52 vs. 58 ± 33 units/d; p = 0.004). Conclusions: These preliminary data suggest no significant difference between the administration of NPH-8 and NPH-12 based on glycemic control metrics in critically ill hyperglycemic trauma patients given EN. However, these results may be confounded by a selection bias as to who received NPH-8 vs. NPH-12. Further research is required. Full article