Fat-fluid level on standing lateral knee radiographs as a reliable indicator of occult intra-articular knee fractures in acute trauma evaluation.

Effective pain management in prehospital settings remains a significant challenge, particularly for patients with acute trauma. This report examines the complexities of conducting prehospital pain studies, focusing on two clinical trials as case studies. The first trial implemented a novel two-step informed consent process, which, despite its innovation, faced logistical challenges and introduced biases favoring the enrollment of less severely injured patients. The second study, conducted under the federal regulatory pathway for Exception from Informed Consent (EFIC), successfully addressed consent challenges but restricted enrollment to severely injured patients to meet EFIC regulatory requirements. Both studies excluded women of childbearing age due to concerns about fetal safety. These limitations underscore the urgent need for regulatory revisions to expand research with alteration of informed consent, enabling the development of new interventions for prehospital pain management.

Fishing is a widely practiced recreational activity that offers psychological, physical, and social benefits, but it also poses risks such as acute trauma and chronic overuse injuries. This narrative review aims to (1) synthesize current evidence on the musculoskeletal disorders, psychological outcomes, and environmental factors associated with recreational and sport fishing; (2) identify the physical, mental, and social health benefits reported across different angling disciplines; (3) characterize acute and chronic injury risks, including overuse syndromes and environment-related hazards; and (4) highlight gaps in the literature to guide future research directions in public health, rehabilitation, and preventive medicine. Materials and Methods: A narrative review was conducted in accordance with SANRA guidelines. A structured search of PubMed, Scopus, Web of Science and Google Scholar identified studies published between 2000 and 2025. Eligible sources included population surveys, clinical studies, therapeutic angling programs, epidemiological reports, and case studies addressing physical, psychological, or injury-related outcomes in recreational or sport fishing. Studies on commercial or occupational fishing were excluded. Evidence was synthesized thematically across benefit and risk domains. A total of 565 records were identified across four databases (PubMed, Scopus, Web of Science, Google Scholar). After screening, duplication, and full-text assessment, 41 studies met the eligibility criteria and were included in the narrative synthesis. The evidence indicates significant psychological benefits of fishing, including reductions in stress, improved mood, and clinically meaningful decreases in Post-Traumatic Stress Disorder (PTSD) symptoms reported in therapeutic fly-fishing programs. Musculoskeletal outcomes were more heterogeneous: chronic conditions such as low back pain and repetitive strain injuries of the shoulder, elbow, and wrist were commonly reported among regular anglers, particularly in physically demanding disciplines. Ice and sea fishing were associated with distinct environmental risks, including hypothermia, frostbite, and rare but documented fatal incidents. The results of this narrative review highlight the therapeutic potential of both recreational and sport fishing. However, they also point to the need for greater awareness of the risk of injury and environmental hazards associated with this type of fishing.

ABSTRACTFahr's disease is a rare idiopathic neurodegenerative disorder characterized by symmetrical calcifications in the basal ganglia and cerebellar dentate nuclei. Although it may present with diverse neuropsychiatric symptoms, a significant number of cases remain asymptomatic and are only identified incidentally through neuroimaging performed for unrelated medical issues. We present a case of a 43‐year‐old woman who was brought to the emergency department following a high‐impact motor vehicle accident. Brain CT, performed as part of trauma assessment, revealed extensive findings consistent with severe traumatic brain injury, including cerebral edema, contusions, cisternal compression, and skull base fractures. Incidentally, bilateral symmetrical calcifications were noted in the basal ganglia and dentate nuclei—findings unrelated to acute trauma. Subsequent metabolic and endocrine evaluation ruled out secondary causes, confirming a diagnosis of Fahr's disease. This case highlights the diagnostic importance of incidental neuroimaging findings in the acute trauma setting. Although often overshadowed by life‐threatening injuries, such calcifications warrant further evaluation to distinguish Fahr's disease from secondary calcification due to metabolic or infectious etiologies. Recognizing Fahr's disease is essential, as it carries implications for long‐term neurological surveillance, genetic counseling, and family screening. It is worth mentioning that there is ongoing controversy regarding the most appropriate terminology for this condition, including terms such as Primary Familial Brain Calcification (PFBC) and Primary Bilateral Brain Calcification (PBBC), each of which has its own advantages and limitations. In conclusion, incidental detection of Fahr's disease during emergency neuroimaging emphasizes the need for clinical vigilance and a thorough diagnostic approach, even in critical care settings.

Traumatic spinal cord injury (TSCI) is a traumatic disease of the central nervous system that places a heavy burden on families and society. MicroRNAs (miRNAs) are intimately related to the pathophysiological processes of TSCI. This study aimed to investigate the diagnostic performance of miR-18a-3p and its molecular mechanism in TSCI. The 218 patients with acute spinal trauma were classified according to the ASIA criteria into a normal group (n = 68), an incomplete SCI (ISCI) group (n = 85), and a complete SCI (CSCI) group (n = 65). Serum samples from participants were used to evaluate the role of miR-18a-3p in clinical diagnosis. The levels of miR-18a-3p were detected by RT-qPCR. ROC curve analysis evaluated the diagnostic performance of miR-18a-3p for TSCI. PC12 cells, which was a cell line widely used in vitro neuronal models, were treated with 5µg/mL LPS for 12h to simulate an inflammatory environment. Cell viability and apoptosis were assessed via CCK-8 assays and flow cytometry. Inflammatory cytokine levels were measured by ELISA. miR-18a-3p target sites were predicted using the TargetScan database. Target relationships were validated through dual-luciferase reporter assays. Compared with the Normal group, the levels of miR-18a-3p were approximately 0.4-fold higher in ISCI patients and approximately 0.7-fold higher in CSCI patients. ROC curve analysis revealed that miR-18a-3p had good diagnostic value for TSCI. It also distinguished between ISCI and CSCI patients. Additionally, the content of miR-18a-3p in patient serum had positive correlations with inflammatory cytokines (TNF-α, IL-1β, and IL-6). DLST was a target site of miR-18a-3p. In cell models, transfection with miR-18a-3p inhibitor enhanced cell viability and the levels of SOD and GSH. Meanwhile it suppressed proliferation, inflammatory factors and MDA levels. si-DLST attenuated the effects of the miR-18a-3p inhibitor. miR-18a-3p may be a potential diagnostic marker for TSCI. Mechanistically, downregulated miR-18a-3p inhibits apoptosis, inflammation and oxidative stress by negatively modulating DLST, thereby mitigating the progression of TSCI.

A BSTRACT A more well-known adverse effect of severe acute head or neck trauma that tends to occur in patients in auto accidents is traumatic cerebral hemorrhage. Hemiplegia, paraplegia, entire paralysis, or extreme conditions that lead to coma can all be linked to it. We document a male patient, who had acute left-sided hemiplegia at presentation.

Dear Editor,Armed conflicts unfolding along and near Europe’s borders have generated an extraordinary humanitarian response and a justifiable focus on acute trauma care...

Background: Minimally invasive spine surgery (MISS) has become increasingly common, but there are barriers to its adoption in acute trauma. To investigate these barriers, clinical data on preoperative factors and outcomes were compared between patients undergoing percutaneous and open spinal trauma procedures. Methods: In this retrospective cohort study of the National Trauma Data Bank, we analyzed trauma patients nationwide who underwent spine procedures from 2017 to 2023. Using International Classification of Diseases, Tenth Revision codes, index procedures classified as “open”, “percutaneous/MISS”, or “converted.” Comorbidities, demographic data, and adverse events were analyzed and compared between groups. Results: Of the 187,382 patients included, 13.2% underwent MISS. Open surgery correlated with males, older patients, and major comorbidities, including diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease. MISS correlated with smoking and greater injury severity. Except for surgical site infections, all adverse events were more prevalent following open procedures. Conclusion: From 2017 to 2023, traumatic spinal surgery increased significantly, and the percentage approached percutaneously procedures increased from 11.7% to 15.2%, while adverse events were more common after open surgery.

Sports head impacts have been associated with both acute and long-term brain trauma. While wearable sensors provide valuable biomechanics insight, most studies focus on single sports, and the variability in sensor methodologies limits cross-sport comparisons. Our objectives were to conduct a multisport comparison and clustering of head impact biomechanics features implicated in brain injury risk. We uniformly processed a multisport dataset gathered using instrumented mouthguards containing direct head impacts in men's football, men's hockey, women's rugby, and women's soccer. We statistically compared directional and resultant peak kinematics, impulse durations, and impact directionality metrics. Then, we applied unsupervised k-means and t-distributed stochastic neighbour embedding (t-SNE) models to examine clustering in impact magnitude and frequency features. Statistically significant cross-sport differences were found in all biomechanical features. Men's football exhibited the highest resultant median peak kinematics, while women's soccer showed lowest median resultant kinematics. However, directional comparisons revealed unexpected trends such as women's soccer impacts exhibiting high sagittal kinematics relative to other sports. Clustering analyses grouped impacts into low and high magnitude/frequency clusters that transcended sport boundaries, with only women's soccer impacts demonstrating tight clustering patterns due to consistent heading biomechanics. We uniquely curated a standardized dataset for multisport head impact biomechanics comparisons. Cross-sport differences in under-investigated biomechanical features such as directional peak kinematics may need to be further examined for potential sport-specific injury risk considerations. Despite substantial gameplay differences, we found interesting shared biomechanical patterns across sports, warranting joint analyses to inform implications in protective equipment design and injury prevention strategies.

To evaluate selected acute phase proteins (APPs) in 61 cats (mainly stray, domestic shorthair aged 2 months to 17 years, 39 males and 22 females) presented with acute trauma at the university teaching hospital of XXX. Serum amyloid A (SAA), haptoglobin (Hp), ceruloplasmin (Cp) and albumin were compared to APPs in a population of healthy cats with similar demographic data and in cats with trauma considering demographic data, trauma type and localization (craniofacial and/or vertebral and/or appendicular, thoracic, abdominal and localized, multiple or polytrauma), anti-inflammatory treatment, outcome (survival to discharge or death). APPs were correlated to age, rectal temperature, body-weight, total leukocyte, neutrophil, band neutrophil and lymphocyte count, total protein, albumin/globulin ratio, base excess and hospitalization duration. In cats with acute trauma, SAA and Hp median concentrations were significantly higher than in healthy control cats (90.5 versus 0.6 mg/mL and 130.7 versus 58.8 mg/dL, respectively, P<0.0001) and showed, respectively, a median 150-fold increase and 2.2-fold increase with respect to healthy cats. Albumin was significantly lower in cats with trauma compared to healthy cats (3.4 versus 3.8 g/dL, respectively, P<0.0001) and in cats with vertebral trauma compared to cats with other trauma localizations. SAA showed a significantly positive correlation with length of hospitalization (r=0.488, P=0.0003) in 50 surviving cats, while albumin showed a significantly negative correlation (r=-0.426, P=0.0020) in addition to a negative correlation with band neutrophils (r=-0.329, P=0.0097). In 15 cats with trauma in which APPs were also evaluated at discharge, SAA was significantly lower than at admission. Acute trauma in cats is associated with significant increases in SAA and Hp and decreases in albumin. Testing SAA and albumin in cats with acute trauma may provide a useful prognostic indicator of length of hospitalization, but no evaluated APPs are of prognostic value for survival.

The ability of advanced practice allied health-led clinics to comprehensively manage acute upper limb trauma has limited evaluation. This study aimed to evaluate the safety, requirement for specialist escalation, patient satisfaction, and patient outcomes of an allied health-led upper limb fracture clinic. Eligible outpatients referred to Orthopaedics with acute upper limb fractures were diverted to and managed by the allied health led Advanced Practice Hand Clinic (APHC) between August 2020 and August 2022. Patients were excluded if they did not complete treatment, were referred with chronic conditions, or simple fractures not requiring specialist care. Demographic, diagnostic, service delivery, patient satisfaction and clinical outcome data were collected as part of usual care. Descriptive statistics were used to analyse the data. Three hundred and twelve patients were eligible, aged median (IQR) 23 (13-47)years, 38% female, and 28% were clinical scaphoid fractures. Wait time for care was 7 (4-11)days. No adverse events were noted. Most (n = 289, 93%) patients completed APHC treatment, with most (88%, 254/289) not requiring orthopaedic consultation. Few (7%, 23/312) patients were returned for orthopaedic management. QuickDASH scores were significantly improved at discharge (4.6 (0-9.1)) compared to initial appointment (48.9 (31.8-57.3), p < 0.001, n = 72). Most patients (98%-100%) were satisfied with wait times, seeing a hand therapist, and with their treatment received. The APHC safely managed patients with acute upper limb trauma in lieu of Fracture Clinic, reduced reliance on Orthopaedic services, provided good functional outcomes and achieved high levels of patient satisfaction.

Emergency departments (EDs) frequently serve individuals who have experienced acute or cumulative trauma. While trauma-informed care (TIC) offers a framework to support healing and psychological safety, little is known about how nurses implement these principles in high-acuity emergency settings. This study explored how emergency nurses understand, deliver, and emotionally navigate trauma-informed care in the context of a tertiary hospital in Saudi Arabia. A qualitative phenomenological design was employed. Seventeen registered nurses from the emergency department of King Faisal university Hospital participated in in-depth, semi-structured interviews. Data were analyzed thematically using Braun and Clarke's six-phase framework and managed with NVivo 14 software. Four interrelated themes were identified: (1) Holding Emotional Space in Clinical Chaos-nurses created micro-moments of psychological safety amid trauma and time pressure; (2) Systemic Misalignment with Trauma-Informed Values-organizational structures constrained relational care; (3) Protective Empathy and Adaptive Strategies-nurses developed emotional boundaries and grounding rituals to sustain compassion; and (4) The Accumulated Emotional Toll-ongoing exposure to trauma resulted in moral injury and emotional exhaustion, countered by reflection and peer support. Trauma-informed care in emergency settings is relational, emotionally taxing, and often constrained by systemic factors. Institutions must invest in trauma-informed systems, staff supports, and educational infrastructure to sustain ethical, emotionally attuned care in acute environments. Patients were not directly involved in this study, which focused on healthcare provider perspectives. Findings may inform institutional strategies to enhance patient-centered, trauma-informed practice.

Introduction Proximal humeral fractures are increasingly common, particularly among older people, whereas the prognosis of surgical treatments for these fractures remains substantially uncertain. In China, where the ageing population is rapidly growing, high-quality prospective data on surgical outcomes, complications and cost-effectiveness are lacking. To address this gap, we propose to initiate a prospective, multicentre cohort study on surgical treatment for proximal humeral fractures in China—Cohort of Acute Shoulder Trauma (CAST) study.Methods and analysisThe CAST is a multicentre, prospective cohort study enrolling patients with acute proximal humeral fractures undergoing surgical treatments at eight hospitals in China between May 2024 and December 2029. Patients can receive any of the surgical treatment methods which include percutaneous Kirschner wire fixation, external fixation, open reduction and internal fixation using locking plates or intramedullary nails, suture anchors and shoulder arthroplasty. We will collect patient-reported outcome measures (Quick Disabilities of the Arm, Shoulder and Hand), Constant-Murley, American Shoulder and Elbow Surgeons, EuroQol 5-Dimension and Visual Analogue Scale), physical examination results, imaging assessments (based on X-rays, ultrasound, CT and MRI scans), laboratory tests (including inflammatory cytokines) and data on medical costs. We will follow patients at 1 day, and at 1 month, 3 months, 6 months, 12 months and 24 months postoperatively. The planned sample size is 1500 patients.Ethics and disseminationThe study protocol has been approved by the Ethics Committee of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University (Approval No. 2024-ky-104(K)). Written informed consent will be obtained from all participants. Findings from the CAST study will be disseminated through peer-reviewed journals and academic conferences.Study registration numberChiCTR2500109651.

Regional Anesthesia and Analgesia for Acute Trauma Patients.

Tendon injury, resulting from repetitive strain or acute trauma, often leads to pain, reduced mobility, and impaired healing due to the limited regenerative capacity of tendon tissue. Adipose-derived stem cells (ADSCs) exosomes show therapeutic promise, though their mechanisms are unclear. We demonstrated that ADSC-Exos delivers miR-212-5p to tendon-derived stem cells (TDSCs), thereby enhancing their proliferation, migration, and tenogenic differentiation. miR-212-5p directly suppresses forkhead box protein O1 (FOXO1) by binding to its 3′UTR. This downregulation relieves transcriptional repression of protein phosphatase 1A (PP1A), thereby increasing its expression and leading to dephosphorylation and activation of Yes-associated protein 1 (YAP1) signaling. In vivo, ADSC-derived exosomal miR-212-5p promotes tendon repair in male C57BL/6 mice by downregulating FOXO1 and activating YAP1 signaling. Taken together, these findings demonstrate that ADSC-derived exosomal miR-212-5p promotes tendon repair by downregulating FOXO1 to modulate the PP1A/YAP1 axis, highlighting a exosome-based regulatory mechanism and suggesting potential therapeutic targets for tendon injury management.

Circular external fixation provides trauma surgeons with a powerful and versatile tool in the management of complex fractures. It is particularly valuable when internal fixation is not feasible because of soft tissue compromise, active infection, or extensive bone loss. This article outlines the fundamental principles of the Ilizarov method with a practical focus on biomechanical rationale, frame construction techniques, and postoperative care essential to achieving successful union. Integrating clinical experience and recent literature, this guide promotes broader application of circular fixation in both acute trauma and limb salvage settings.

Disorders of the extensor mechanism of the wrist and hand are frequently encountered in clinical practice and observed more commonly than pathologies affecting the flexor system. When unrecognized or inadequately treated, these conditions may lead to substantial functional impairment and suboptimal clinical outcomes. Extensor tendon pathologies encompass a wide range of etiologies, such as repetitive overuse, acute trauma, inflammatory arthropathies, and degenerative tendinopathies. Accurate diagnosis depends on a thorough clinical evaluation, supported by high-resolution imaging. Ultrasound and magnetic resonance imaging are particularly useful for assessing tendon structure, surrounding soft tissues, and dynamic abnormalities. This review offers an updated overview of extensor tendon disorders of the wrist and fingers, focusing on their underlying causes and key imaging findings on magnetic resonance imaging and ultrasound to support an accurate and efficient diagnosis by radiologists.

Glycocalyx shedding as a clinical biomarker in critical illness.

Understanding traumatic injuries and suicide risk: A conceptual exploration for the emergency department.

Arthroscopic Approach to Deltoid Injuries.