Complex Injury Patterns Research Articles

Aucune différence dans les résultats cliniques et radiologiques après la fixation de fractures transversales de la rotule avec une fixation par une bandelette ou un cerclage métallique : une étude comparative rétrospective

IntroductionSeveral surgical techniques have been proposed for the treatment of patellar fractures. The aim of this study is to compare the clinical efficacy and complication rates of treatment using suture tape circumferential cerclage (STCC) and metallic wire circumferential cerclage (MWCC) for the surgical treatment of displaced transverse patellar fractures (TPFs). HypothesisThe hypothesis is that the use of the suture tape would be associated with a significantly lower rate of re-peration than metallic cerclage but no differences in other clinical outcomes. Patients and methodsA retrospective comparative analysis of the clinical outcomes of consecutive patients undergoing fixation of TPFs with either MWCC or STCC between January 2017 and December 2018 was undertaken. All patients underwent evaluation with standardised radiographs at one, three, and six months after surgery to determine rates of union, non-union, loss of fixation and malunion. All patients underwent a final clinical evaluation at 18 months post-operatively to evaluate clinical scores and complications. ResultsA total of 26 patients were included in the study. Thirteen patients underwent STCC and 13 underwent MWCC. There were no complications in the STCC group. In the MWCC group, one patient underwent hardware removal at two months post-operatively due to painful prominence. There was no significant difference in reoperation rates between the STCC and MWCC groups (p=1). There were no cases of non-union, malunion or loss of reduction throughout the series. At the final clinical follow-up of 18 months, there were no significant differences in KSS, KOOS or Böstman scores between the groups. ConclusionNo significant differences were identified when comparing the clinical outcomes of fixation of AO/OTA 34C1/2 fractures with suture tape or metallic cerclage fixation concerning re-operation rates, union rates, loss of fixation and functional outcome measures. These results cannot be extrapolated to more complex injury patterns or surgical techniques in which prominence of implanted material is more likely. Level of evidenceIII.

No difference in clinical and radiological outcomes following fixation of transverse patella fractures with either suture tape or metallic cerclage: A retrospective comparative study

IntroductionSeveral surgical techniques have been proposed for the treatment of patellar fractures. The aim of this study is to compare the clinical efficacy and complication rates of treatment using suture tape circumferential cerclage (STCC) and metallic wire circumferential cerclage (MWCC) for the surgical treatment of displaced transverse patellar fractures (TPFs). HypothesisThe hypothesis is that the use of the suture tape would be associated with a significantly lower rate of re-operation than metallic cerclage but no differences in other clinical outcomes. Patients and methodsA retrospective comparative analysis of the clinical outcomes of consecutive patients undergoing fixation of TPFs with either MWCC or STCC between January 2017 and December 2018 was undertaken. All patients underwent evaluation with standardised radiographs at one, three, and six months after surgery to determine rates of union, non-union, loss of fixation and malunion. All patients underwent a final clinical evaluation at 18 months postoperatively to evaluate clinical scores and complications. ResultsA total of 26 patients were included in the study. Thirteen patients underwent STCC and 13 underwent MWCC. There were no complications in the STCC group. In the MWCC group, one patient underwent hardware removal at 2 months postoperatively due to painful prominence. There was no significant difference in re-operation rates between the STCC and MWCC groups (p=1). There were no cases of non-union, malunion or loss of fixation throughout the series. At the final clinical follow-up of 18months, there were no significant differences in KSS, KOOS or Böstman scores between the groups. ConclusionNo significant differences were identified when comparing the clinical outcomes of fixation of AO/OTA 34C1/2 fractures with suture tape or metallic cerclage fixation concerning re-operation rates, union rates, loss of fixation and functional outcome measures. These results cannot be extrapolated to more complex injury patterns or surgical techniques in which prominence of implanted material is more likely. Level of evidenceIII.

Team Approach: Spinopelvic Dissociation.

Spinopelvic dissociation is a complex and variable injury pattern that requires an integrated, multidisciplinary team including orthopaedic trauma and spine surgeons. Protocols and efficient channels of communication should be in place at tertiary Level-I trauma centers to ensure appropriate and timely treatment of patients with spinopelvic dissociation. Patients with spinopelvic dissociation may present with acute neurological deficits and impending cauda equina syndrome, necessitating urgent, coordinated care. Lumbopelvic fixation with sacroiliac screws yields a stable, multiplanar construct that connects the spine to the pelvis and allows for early mobilization.

Cervical Spine Injuries with Acute Traumatic Spinal Cord Injury: Spinal Surgery Adverse Events and Their Association with Neurological and Functional Outcome.

Monocenter case-control study. Effects of spinal surgical adverse events (SSAE) on clinical and functional outcome, length of stay, and treatment costs after traumatic cervical spinal cord injury (SCI). Traumatic SCI is a challenge for primary care centers because of the emergency setting and complex injury patterns. SSAE rates of up to 15% are reported for spine fractures without SCI. Little is known about SSAE after traumatic SCI and their outcome relevance. Acute traumatic cervical SCI patients were enrolled from 2011 to 2017. Cases with and without SSAE were compared regarding neurological recovery, functional outcome, secondary complications, mortality, length of stay, and treatment costs. Adjusted logistic regression and generalized estimating equation models were calculated for the endpoints ASIA impairment scale (AIS)-conversion and dysphagia. All analyses were run in the total and in a propensity score matched sample. At least one SSAE occurred in 37 of 165 patients (22.4%). Mechanical instability and insufficient spinal decompression were the most frequent SSAE with 13 (7.9%) or 11 (6.7%) cases, respectively. The regression models adjusted for demographic, injury, and surgery characteristics demonstrated a reduced probability for AIS-conversion related to SSAE (OR [95% CI] 0.14 [0.03-0.74]) and additionally to single-sided ventral or dorsal surgical approach (0.12 [0.02-0.69]) in the matched sample. Furthermore, SSAE were associated with higher risk for dysphagia in the matched (4.77 [1.31-17.38]) and the total sample (5.96 [2.07-17.18]). Primary care costs were higher in cases with SSAE (median (interquartile range) 97,300 [78,200-112,300]) EUR compared with cases without SSAE (52,300 [26,700-91,200]) EUR. SSAE are an important risk factor after acute traumatic cervical SCI with impact on neurological recovery, functional outcome, and healthcare costs. Reducing SSAE is a viable means to protect the limited intrinsic capacity for recovery from SCI.Level of Evidence: 4.

Floating elbow, an uncommon clinical entity: A case report

Floating elbow is an uncommon complex injury pattern with varied functional outcomes. The term is used to describe combined fractures of humerus and forearm bones in the same extremity. It could occur in children and adults. We describe a 49 years old right – handed male farmer who fell off a moving motorbike into a ditch, sustaining a closed injury to the right upper extremity. Radiographs showed right humeral shaft fracture, comminuted fracture of radial head, fracture of proximal 3rd of Ulna and dislocation of the 5th Metacarpo-phalangeal joint. He had plate and screw fixation of both humerus and ulna fractures, K wire fixation of 5th MP joint and excision of radial head. All fractures united but he has residual stiffness of the fingers and limited forearm rotation 6 months postoperatively. No Neurological sequel.

Finger injuries with a focus on ligamentous structures

Ligamentous lesions of the fingers are common everyday injuries and usually the result of distortion or overloading. Numerous examination methods are available for dedicated radiological diagnosis of sometimes complex injury patterns. To review radiological diagnosis of the ligamentous structures of the finger joints including the presentation of anatomical, biomechanical and therapeutic aspects. Presentation of the anatomy and biomechanics as well as the most common trauma mechanisms of the ligamentous structures. Review of the literature, discussion of recent work and diagnostic expert recommendations. The most relevant ligamentous structures are collateral ligaments, pulley ligaments, volar plates and tendons. The goal of radiologic diagnosis is to accurately define the injury pattern and to differentiate between simple and complicated ligamentous lesions. In unclear cases, magnetic resonance imaging (MRI) has become standard for further diagnostics, which may allow depiction of ligamentous structures in submillimetre resolution. Today, differential diagnosis includes all radiological modalities, which ensures the determination of an adequate therapy and prevention of sequel at ahigh standard.

Localization of Brachial Plexopathies Using a Novel Diagnostic Program.

Background: Assessing the extent and specific location of brachial plexus injuries can be difficult given the variety of mechanisms of injury and anatomic complexity of the plexus. We developed a program to accurately assess the location of a patient's neurologic injury based on electromyographic data. Purpose: We sought to test our hypothesis that the location of traumatic brachial plexopathies could be accurately assessed with a novel program that processed electromyogram (EMG) and mechanism of injury data. Methods: This retrospective diagnostic cohort study was carried out with a novel diagnostic algorithm developed with the Python programming language. The program accepts user input of muscles demonstrating decreased motor unit recruitment, positive sharp waves, or fibrillation potentials. The testing data set was derived from a registry of brachial plexus injuries treated at our center. The primary outcome was the percent concordance of the algorithm's diagnosis with the surgical diagnosis. Results: Ninety-five cases met the inclusion criteria. Median time from injury onset to EMG examination was 4 months; median time from EMG examination to surgery was 1.2 months. The program diagnosis matched the surgical diagnosis in 92 out of 95 (97%) of cases, including cases with multilevel injuries and additional peripheral nerve injuries. Conclusion: This program accurately localized brachial plexopathies in nearly all cases, including those involving polytrauma or complex patterns of injury. This algorithm may be valuable as an aid to complete electrodiagnostic examinations, a diagnostic adjunct when planning treatment of severe plexus palsies, or an educational tool.

Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?

Traumatic bladder injuries are commonly associated with pelvic fractures. While the majority of intraperitoneal bladder injuries are surgically repaired, extraperitoneal bladder injuries (EBIs) can be managed nonoperatively in the absence of complex injury patterns such as bladder neck injury or presence of bone spicules in the bladder. Concern for pelvic hardware contamination is one of the most common reasons for repairing EBIs at the time of orthopedic interventions for pelvic fracture (usually open reduction and internal fixation). However, given the inconsistent and limited evidence, practice patterns are different and largely depend on surgeon preferences and institutional management. In this review, we explore the roots for this concern and summarize the current evidence on risk of pelvic hardware infection with nonoperative management of EBIs.

Diagnostics and Invasive Techniques in the Treatment of Chest Trauma

Chest Trauma is a complex injury pattern whose diagnostics and therapy demand everything from an emergency response team. Chest trauma subsumes thoracic injuries in all facets from the bounce mark of a seat belt to fatal rollover trauma with contusion or disruption of organs located in the thorax. Possible causes comprise blunt or penetrating trauma, as well as decelerations, chemical and thermal damage. Sonographic assessment according to a protocol plays a major role in diagnosis of underlying conditions and treatment indications. Therapeutic management may include invasive emergency techniques: Decompression of a tension pneumothorax is a fundamental life-saving intervention. Pericardiocentesis seldomly is necessary or possible in order to drain a cardiac tamponade. In case of traumatic cardiac arrest and under defined circumstances, resuscitative thoracotomy may be indicated. The out-of-hospital management may require transfusion of blood components. As with all procedures, which are performed seldomly but under emergency conditions, invasive techniques require clear communication, precise structured working procedures and especially continuous training, team briefing, and debriefing.

Gunshot Injuries in American Trauma Centers: Analysis of the Lethality of Multiple Gunshot Wounds

Trauma center care and survival have been improving over the past several years. However, yearly firearm-related deaths have remained near constant at 33 000. One challenge to decreasing gunshot mortality is patients presenting with complex injury patterns from multiple gunshot wounds (GSWs) made possible by high-caliber automated weapons. Our study analyzes outcomes of trauma patients of firearms using the National Trauma Databank (NTDB). We conducted a retrospective review of the NTDB from the years 2003-2015 for patients with penetrating injuries. We separated patients into groups based on stab wounds, single GSW, and multiple GSW. We performed multivariate logistic regression analyses in which we adjusted for demographics and injury severity. Overall, 382 376 patients presenting with penetrating injuries were analyzed. Of those 167 671 had stab, 106 538 single GSW, and 57 819 multiple GSW injuries. Crude mortality was 1.97% for stab wounds, 13.26% for single GSW, and 18.84% for multiple GSW. Adjusted odds ratio (OR) compared with 2003 demonstrates a trend toward decreased mortality for stab wounds (OR range of 0.48-0.69, P < .05 for years 2010-2015). A similar trend was demonstrated in single GSW injuries (OR 0.31-0.83, P < .01 for years 2005-2015). Conversely, multiple GSW injuries did not follow this trend (OR 0.91-1.36 with P > 0.05 for each year). In contrast to significant improvement in survival in patients with a single GSW injury since 2003, multiple GSW injuries still pose a challenge to trauma care. This warrants further investigation into the efficacy of legislature, and the lack thereof, as well as future preventative measures to this type of injury.

Surgical Management of Thoracolumbar Burst Fractures: Surgical Decision-making Using the AOSpine Thoracolumbar Injury Classification Score and Thoracolumbar Injury Classification and Severity Score.

The management of thoracolumbar burst fractures is controversial with no universally accepted treatment algorithm. Several classification and scoring systems have been developed to assist in surgical decision-making. The most widely accepted are the Thoracolumbar Injury Classification and Severity Score (TLICS) and AOSpine Thoracolumbar Injury Classification Score (TL AOSIS) with both systems designed to provide a simple objective scoring criteria to guide the surgical or nonsurgical management of complex injury patterns. When used in the evaluation and treatment of thoracolumbar burst fractures, both of these systems result in safe and consistent patient care. However, there are important differences between the 2 systems, specifically in the evaluation of the complete burst fractures (AOSIS A4) and patients with transient neurological deficits (AOSIS N1). In these circumstances, the AOSpine system may more accurately capture and characterize injury severity, providing the most refined guidance for optimal treatment. With respect to surgical approach, these systems provide a framework for decision-making based on patient neurology and the status of the posterior tension band. Here we propose an operative treatment algorithm based on these fracture characteristics as well as the level of injury.

The ‘outside to inwards’ approach in the spaghetti wrist

•The 'spaghetti wrist' is a complex injury pattern.•Emptying the forearm and carpal tunnel permits repair accurate repair of volar structures working from deep to superficial.•This pragmatic approach permits better anatomical appreciation and sequence of repair.

Bilateral Suprascapular Nerve Injury and Novel Technique of Nerve Transfers for Restoration of External Rotation: Case Report

Complex brachial plexus and peripheral nerve injuries can be challenging to evaluate and treat, especially in the face of novel pathology. To describe the diagnosis of bilateral suprascapular nerve injury, the unique surgical anatomy, and the novel use of a distal nerve transfer to re-establish external rotation. To the best of our knowledge, bilateral suprascapular nerve injury has not previously been reported. The authors describe the physical examination and electrodiagnostic and imaging work-up for elucidating complex injury patterns and present a procedure for reinnervating the infraspinatus muscle. A 48-yr-old man presented with profound, right-sided, partial brachial plexus injury incurred 5 mo earlier in a motorcycle accident. Imaging demonstrated atrophy and severe edema within the bilateral supraspinatus and infraspinatus muscles. Needle electromyography depicted no motor units and insertional activities in bilateral infraspinatus muscles, consistent with bilateral suprascapular nerve injury. Along with brachial plexus repair, the patient underwent transfer of a distal branch of the spinal accessory nerve to the inferolateral branch of the suprascapular nerve to the infraspinatus muscle. At 16 mo, he had recovered strong restoration of shoulder external rotation. Systematic evaluation can assist in defining complex pathology, particularly with previously unreported types. In this case, predominant injury was inflicted upon the branch innervating the infraspinatus. Highly focal nerve transfers can achieve substantial restoration of external rotation.

Identifying Homogeneous Patterns of Injury in Paediatric Trauma Patients to Improve Risk-Adjusted Models of Mortality and Functional Outcomes.

Injury is a leading cause of morbidity and mortality in the paediatric population and exhibits complex injury patterns. This study aimed to identify homogeneous groups of paediatric major trauma patients based on their profile of injury for use in mortality and functional outcomes risk-adjusted models. Data were extracted from the population-based Victorian State Trauma Registry for patients aged 0–15 years, injured 2006–2016. Four Latent Class Analysis (LCA) models with/without covariates of age/sex tested up to six possible latent classes. Five risk-adjusted models of in-hospital mortality and 6-month functional outcomes incorporated a combination of Injury Severity Score (ISS), New ISS (NISS), and LCA classes. LCA models replicated the best log-likelihood and entropy > 0.8 for all models (N = 1281). Four latent injury classes were identified: isolated head; isolated abdominal organ; multi-trauma injuries, and other injuries. The best models, in terms of goodness of fit statistics and model diagnostics, included the LCA classes and NISS. The identification of isolated head, isolated abdominal, multi-trauma and other injuries as key latent paediatric injury classes highlights areas for emphasis in planning prevention initiatives and paediatric trauma system development. Future risk-adjusted paediatric injury models that include these injury classes with the NISS when evaluating mortality and functional outcomes is recommended.

Complications in Posterior Cruciate Ligament Injuries and Related Surgery.

Posterior cruciate ligament (PCL) injury, especially in isolation, is a less frequent injury than injury to the anterior cruciate ligament and other ligaments of knee. In addition, the complex injury patterns involving the PCL, the technically demanding nature of surgical treatments, the anatomic proximity to vital neurovascular structures and the controversy surrounding optimal management of PCL injuries, make these injuries and their treatment potentially prone to more complications. This chapter will review the common complications of PCL injuries and related surgery.

Peri- and Postoperative Pain Management in Multiple Ligament Knee Surgery in the Hospital and Ambulatory Surgery Center Setting

The multiligament knee injury presents as a complex injury pattern that has substantial potential to cause long-term disability. Patients who sustain this injury pattern experience significant pain not only immediately following injury but also throughout the perioperative and postoperative period. Treating pain with major orthopaedic procedures is challenging but technical success of a surgical repair becomes trivial when pain is not effectively managed. This article will (1) provide an outline of the types of pain most often sustained in the multiligament knee injury, (2) outline the phases of pain management for this injury, and (3) provide an overview of persistent postoperative pain. The principles of multimodal analgesia in combination with effective regional anesthesia and attentive intraoperative management can position patients for successful rehabilitation and recovery.

Combat Vascular Trauma Management for the General Surgeon

This review focuses on the initial management and stabilization of complex vascular injuries for the general surgeon within the combat zone. Recent conflicts in Iraq, Afghanistan, and Syria demonstrate that general surgeons are responsible for the initial surgical management of combat-related vascular trauma in damage control scenarios. These injuries display a more complex injury pattern and often require different management strategies than seen in civilian trauma. Vascular trauma in combat settings is often accompanied by a multitude of life- and limb-threatening injuries. Definitive repair operations are often deferred for initial damage control surgery and resuscitation. Resultant strategies to restore perfusion and control bleeding are determined by the patient’s underlying physiology and frequently require the use of vascular shunts, ligation, primary anastomosis, or interposition grafting. While general surgeons in the combat zone are not typically responsible for definitive repair during initial damage control surgery, proper initial surgical management in the far-forward setting with an intimate understanding of future repair strategies remains critical aspects in assuring optimal definitive treatment.

PhaseI/II interim analysis of extracorporeal mesenchymal Stromal cell therapy (SBI-101 Therapy) in subjects with acute kidney injury

Background & Aim Acute kidney injury (AKI) involves damage to renal epithelial cells, podocytes, and vascular beds that manifests into a self-perpetuating immune response and peripheral organ dysfunction. Such a complex injury pattern requires a multifaceted therapeutic to address the systemic, immune-mediated inflammation that underpins much of the morbidity and mortality of AKI. Mesenchymal stromal cells (MSCs) are a unique source of secreted factors that modulate an inflammatory response and enhance the repair of injured tissue. SBI-101 contains allogeneic human MSCs inoculated into a hollow-fiber hemofilter for the treatment of patients with severe dialysis dependent AKI . SBI-101 is designed to restore balance to the immune system by reprograming the molecular and cellular components of blood in patients with severe organ injury. In the initial cohort analyzed, patients were randomized to receive SBI-101 (250 × 106 cells) or sham control up to 24 hours of treatment. The primary objective of the study is to assess the safety and tolerability of SBI-101. Exploratory analyses were performed to characterize the effect of SBI-101 on circulating inflammatory biomarkers. Methods, Results & Conclusion Twelve subjects received active treatment and four received sham control (3:1). Overall, we observed a heterogeneous population with multiple etiologies leading to AKI. No differences were observed between groups in age, gender, BMI, rate and number of TEAEs and/or SAEs. Mortality was consistent with historical rates in treated group. Incidence of circuit discontinuations was similar in both groups, with length of treatment shorter with SBI-101 due to earlier clotting. Analysis of clinical biomarker data was performed on the Per Protocol set. Exploratory biomarkers were measured to characterize the pharmacodynamic effects of SBI-101. Samples were collected for the measurement of immune cell populations, kidney injury biomarkers, and biomarkers of inflammation (blood or urine) at pre dose, conclusion of treatment, days 1, 3, 7, 14, 21, and 28 post-treatment with SBI-101 or sham control. Results showed that SBI-101 exposes immune cells to a concentrated compartment of MSC factors (such as IL-6 and TGFb) and that MSCs were licensed to differing extents based on the inflammatory profile of each patient. A trend towards an overall anti-inflammatory effect was observed in dosed subjects relative to sham for both molecular and cellular markers of inflammation.

Frequency and management of complex facial fractures-an oral and maxillofacial surgical assessment

The treatment of facial fractures is an integral part of the oral and maxillofacial surgical treatment spectrum. In the case of complex fractures that involve multiple levels of the facial skeleton associated with severe concomitant injuries, an individual and interdisciplinary treatment approach is needed, which requires the infrastructure of anational trauma center. The aim of this study was to analyze the incidence and management of patients with complex facial fractures and considering the concomitant injury pattern. A retrospective analysis of patients with complex facial fractures during the years 2009-2015 admitted to the emergency surgical department of anational trauma center was carried out. The identification of appropriate patient cases was based on the International Statistical Classification of Diseases and Related Health Problems (ICD) coding of electronic patient data. Only patients with at least acombination of mandibular and midfacial fractures (2-level fractures) were considered. Patients with mainly dentoalveolar fractures and simple nasal bone fractures were not included. The evaluation of the electronic medical records included the etiology, fracture pattern, associated severe injuries on the basis of the injury severity score (ISS), treatment regimen as well as the length of the hospital stay. In the 7‑year study period, 3382 patients were identified with facial fractures. Of these, 128 patients (3.78%) presented with acomplex fracture pattern with acombination of mandibular fractures and fractures of the midface. The majority of these patients (n = 92) had less severe concomitant injuries (ISS ≤ 16), while 36patients showed severe concomitant injuries (ISS > 16). The incidence of a3-level fracture involving the mandible, midface and anterior skull base was only 0.47% and could be detected in 16patients, of which 10 were classified as polytrauma (ISS > 16). The incidence of complex fractures of the facial skeleton was comparatively low with almost 4%. More than one in four patients with complex injury patterns of the facial skeleton exhibited severe concomitant life-threatening injuries, necessitating an interdisciplinary management with the specialized infrastructure of anationwide trauma center.

Does skeletal maturity affect pediatric pelvic injury patterns, associated injuries and treatment intervention?

IntroductionPediatric pelvic injuries are rare. Due to anatomic differences of the immature pelvis, different injury patterns may occur as compared to adults. The purpose was to analyze the effect of skeletal maturity on pediatric pelvic injury pattern, associated injuries, and treatment intervention. Patients and MethodsNinety children with a pelvic injury receiving treatment at a private orthopaedic practice in association with a Level One Teaching Trauma Center, between March 2002 and June 2011, were retrospectively analyzed. Skeletal maturity was determined as closed triradiate cartilage. Forty-one (46%) were skeletally immature and 49 (54%) were skeletally mature. Mean age was 11.5 years (2–16). Fractures were 23 A2, 1 A3, 4 B1, 44 B2, 16 B3, and 2 C2 according to OTA/AO classification. OTA B and C fractures were 26 LC1 (lateral-compression), 20 LC2, 10 LC3, 4 APC1 (anterior-posterior-compression), 5 APC2, and 1 VS (vertical-shear) injury according to Young and Burgess. Treatment of the pelvic injury was operative in 28 (31%) and non-operative in 62 (69%) of children. Mechanism of injury, Injury Severity Score (ISS), deaths, and associated injuries were recorded. ResultsMore complex and unstable injuries occurred in skeletally mature vs. immature children (p = 0.014). Skeletally mature children had a significantly higher rate of operative intervention (p = 0.009). The ISS in skeletally mature children was higher 25 (1–66) than in skeletally immature children 17 (4–43) (p = 0.013). 84% (41) skeletally mature and 78% (32) skeletally immature children sustained associated injuries. Twenty-two% (11) of all skeletally mature children sustained urinary tract injuries, but only 7% (3) of all skeletally immature children (p = 0.049). DiscussionSkeletally mature children are more likely to sustain more complex injury patterns with a higher rate of operative treatment, to have a higher rate of associated injuries, and to have a higher ISS than immature patients. Level of EvidenceRetrospective comparative study, Level III.