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Introduction: Patients sustaining pulmonary contusion (PC) have a higher risk of complications and long-term respiratory difficulty. Computed tomography (CT) scans have a high sensitivity for PC. However, since PC develops over time, CT scans made directly post-trauma may underestimate the full extent of PC. This creates a need to better define in which PC-patients complications are more likely. The aim of this systematic review was to identify different classification systems of PC, and investigate the association between amount of PC and in-hospital outcomes., Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies reporting a classification system for PC after blunt thoracic trauma based on a CT scan were included. Outcomes were classification method of PC and the relation between classification and pulmonary complications and in-hospital outcomes., Results: Twenty studies were included. Total number of patients ranged from 49 to 148,140 patients. The most common classification system used was calculating the percentage of contused lung volume. Other classification methods were based on Blunt Pulmonary Contusion score-6 and -18, Abbreviated Injury Score and Thoracic Trauma Severity scores. Worse outcomes were generally associated with between > 18 to > 24% contusion volume., Discussion: The heterogeneity of currently available literature makes comparing classification methods challenging. The most common classification of PC was based on volumetric analysis. Calculating a percentage of PC as part of the total volume allows for the highest level of segmentation of lung parenchyma as compared to using BPC-6, BPC-18, or AIS. Contusion volume exceeding 18-24% was generally associated with worse outcomes., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: This study aims to review complications and union rates of ballistic femoral neck fractures when compared to their blunt counterparts. We hypothesize that gunshot injuries to the femoral neck may have higher rates of complications (nonunion, avascular necrosis [AVN], and implant failure) as a result of increasing comminution and disruption to the already tenuous blood supply through the femoral neck., Methods: Following the Institutional Review Board approval, a retrospective chart review was performed identifying femoral neck fractures at a single level 1 trauma center from 2018 to 2023. Inclusion criteria were age 16-45 years old with intracapsular femoral neck fractures. Exclusion criteria were absence of radiographic and clinical follow-up beyond 6 weeks, prior femur fractures, pathologic fractures, or primary surgery of total hip arthroplasty. Garden classification and Pauwels angle were reported. Clinical union was defined as the absence of pain with ambulation in the absence of radiographic changes. Radiographic union was defined using the validated Radiographic Union Score for Hip (RUSH) scoring system. Complication rates (deep and superficial infection, failure of fixation, and AVN) and subsequent surgery were recorded., Results: After exclusion, 12 ballistic and 16 blunt femoral neck fractures met inclusion criteria and were reviewed. The ballistic cohort had significant more Garden I fractures than the blunt cohort (4 [33%] vs. 0 [0%]), and significantly fewer Garden IV fractures than the blunt cohort (2 [17%] vs. 9 [56%]). Despite different Garden classification types of fracture patterns, the Pauwels angle between the two cohorts was similar (51° ballistic vs. 60° blunt, p = 0.16). The overall nonunion rate was 24.1%. Nonunion rates were similar between the two cohorts (3, 25% ballistic vs. 4, 25% blunt, p = 0.99). The mean final RUSH score between the two cohorts was similar (20.1 ballistic vs. 23.4 blunt [p = 0.05]). The total complication rate was 31% (9/28) consisting of 7 nonunions and 2 malunions across both cohorts., Conclusion: The current study found no difference in the union rates between blunt and ballistic femoral neck fractures. Although comparing these fractures using traditional classification systems (Garden and Pauwels) are difficult due to the inherent differences in mechanism and the applicability of these tools, both groups presented with high rates of nonunion and complications. We believe the similar RUSH scores and complication rates in both cohorts show these fractures fundamentally behave similarly and remain challenging injuries to manage with ORIF., Competing Interests: Declarations Conflict of interest The authors have no relevant financial or nonfinancial interests to disclose. The authors have no competing interests to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: The impact of major trauma is long lasting. Although polytrauma patients are currently identified with the Berlin polytrauma criteria, data on long-term outcomes are not available. In this study, we evaluated the association of trauma classification with long-term outcome in blunt-trauma patients., Methods: A trauma registry of a level I trauma centre was used for patient identification from 1.1.2006 to 31.12.2015. Patients were grouped as follows: (1) all severely injured trauma patients; (2) all severely injured polytrauma patients; 2a) severely injured patients with AIS ≥ 3 on two different body regions (Berlin-); 2b) severely injured patients with polytrauma and a physiological criterion (Berlin+); and (3) a non-polytrauma group. Kaplan-Meier survival analysis was performed to estimate differences in mortality between different groups., Results: We identified 3359 trauma patients for this study. Non-polytrauma was the largest group (2380 [70.9%] patients). A total of 500 (14.9%) patients fulfilled the criteria for Berlin + definition, leaving 479 (14.3%) polytrauma patients in Berlin- group. Berlin + patients had the highest short-term mortality compared with other groups, although the difference in cumulative mortality gradually plateaued compared with the non-polytrauma patient group; at the end of the 10-year follow up, the non-polytrauma group had the greatest mortality due to the high number of patients with traumatic brain injury (TBI)., Conclusion: Excess mortality of polytrauma patients by Berlin definition occurs in the early phase (30-day mortality) and late deaths are rare. TBI causes high early mortality followed by increased long-term mortality., Competing Interests: Declarations. Ethics approval and consent to participate: This was a retrospective register study. The HUH scientific review board accepted the study (HUS/221/2017). According to Finnish legislation, consent from patients is not needed for a register study of this type. Data for the register were gathered by patient medical chart review. Consent for publication: All authors have read the final draft of the manuscript and give consent for publication. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Splenorrhaphy was once used to achieve splenic preservation in up to 40% of splenic injuries. With increasing use of nonoperative management and angioembolization, operative therapy is less common and splenic injuries treated operatively are usually high grade. Patients are often unstable, making splenic salvage unwise. Modern surgeons may no longer possess the knowledge to perform splenorrhaphy., Methods: The records of adult trauma patients with splenic injuries from September 2014 to November 2018 at an urban level I trauma center were reviewed retrospectively. Data including American Association for the Surgery of Trauma splenic organ injury scale, type of intervention, splenorrhaphy technique, and need for delayed splenectomy were collected. This contemporary cohort (CC) was compared to a historical cohort (HC) of splenic injuries at a single center from 1980 to 1989 (Ann Surg 1990; 211: 369)., Results: From 2014 to 2018, 717 adult patients had splenic injuries. Initial management included 157 (21.9%) emergent splenectomy, 158 (22.0%) angiogram ± embolization, 371 (51.7%) observation, and only 10 (1.4%) splenorrhaphy. The HC included a total of 553 splenic injuries, of which 313 (56.6%) underwent splenectomy, while splenorrhaphy was performed in 240 (43.4%). Those who underwent splenorrhaphy in each cohort (CC vs HC) were compared., Conclusion: The success rate of splenorrhaphy has not changed. However, splenorrhaphy now involves only electrocautery with topical hemostatic agents and is used primarily in low-grade injuries. Suture repair and partial splenectomy seem to be "lost arts" in modern trauma care.