Injury

A 57yo woman fell down six stairs at home and suffered a right knee injury. She was otherwise unhurt. She presented to the ER department and was found to have a closed tibial plateau fracture. The orthopedic resident was called and the fracture was splinted. The patient was curious about antibiotic usage and asked if antibiotics would be used during her surgery. The resident knew that there would be preoperative first-generation cephalosporin used but was unsure if there would be any antibiotics placed into the wound at the end of the case.

The utility of using the patient’s native fracture hematoma as an autograft after performing open reduction and internal fixation (ORIF) for fractures is highlighted. The fracture hematoma may be effectively used in closed fractures as a standalone autograft for filling in or around the fracture site, or used in combination with other structural autografts, allografts, or bioceramics to potentially enhance fracture healing. We advocate surgeons to support and consider in their practice the 'Save The Haematoma Campaign

History of present injury - A 62yo woman was walking at the shopping mall when she tripped and fell. She landed on an outstretched hand and had immediate pain and deformity. She was otherwise uninjured. She was seen in the local trauma unit, and the ER doctor did some x-rays and diagnosed a displaced right distal radial fracture. A reduction was attempted and was successful. She had good distal CSM in her hand post-reduction. The ER doctor was uncertain about the treatment definitively, so the orthopedic consultant was paged.

Injuries are a major public health problem, with 713.9 million injuries occurring globally each year [1]. Injured patients can experience serious complications, such as bloodstream infections (BSIs), which may result from damaged skin or organs, poor blood flow to vital organs, long-term use of invasive procedures, such as catheters or mechanical ventilators, and the presence of foreign bodies [2,3].

Large segmental bone defects are characterized by bone defect size greater than 1.5 times the diameter of long bones[1], resulting from high-energy trauma, excision of bone tumors, or debridement of fracture-related infections(FRI)[2]. Reconstruction of large segmental bone defects caused by postoperative extensive FRI necessitates addressing factors such as reconstruction of bone defects, infection control, and early functional recovery[3,4], presenting a significant challenge in the field of trauma orthopedics.

Soft tissue defects around the ankle joint, resulting from trauma, burns, or chronic ulcers, present a significant reconstructive challenge due to their high prevalence and associated economic burden[1,2]. The paucity of local tissue, poor vascularity, and constant mechanical stress often lead to poor wound healing, recurrent breakdown, and suboptimal functional outcomes[3,4,6]. Conventional solutions, such as split-thickness skin grafts (STSGs), are prone to contracture and unstable coverage, while local or free flaps, though robust, involve considerable morbidity, technical complexity, and may result in bulky, poorly contoured reconstructions that hinder ankle mechanics[5,7,10].

Traumatic brain injury (TBI) is the most common neurological disorder with a significant global disease burden, affecting 50-60 million people and costing the global economy $400 billion annually [1]. Early identification and prognostication of patients who will benefit from neurosurgical interventions remain in need of refinement [2], as timely intervention can lower risk of mortality [3] and improve functional outcomes [4].

Major trauma is an important public health problem requiring a specialist response to deal with complex injuries that often affect multiple body systems. In healthcare systems outside New Zealand, specialised and higher-volume trauma centres have better outcomes than non-specialised and lower-volume centres [1–6]. However, New Zealand’s geography poses unique challenges for ensuring timely access to such centres. Stretching almost 1600km north-to-south, New Zealand’s population density is 19 people/km2, placing it in the bottom quartile of the world [7].

Capturing data on long-term recovery and ongoing health service needs of injured patients beyond acute care is challenging in almost every jurisdiction. Road trauma patients have lengthy recovery journeys and often require readmission to hospital and interaction with motor vehicle/workers compensation systems. While trauma registries typically collect data about the prehospital, emergency and initial acute phase of care, data about sub-acute extended stays, rehabilitation care, and subsequent readmissions are not captured, or in-scope, for most trauma registries worldwide.

Healthcare workers involved in invasive hospital-based procedures frequently endure prolonged, maladaptive postures and intense physical demands, placing them at heightened risk for work-related musculoskeletal disorders (WMSDs). Tasks performed with poor ergonomics (e.g., unsupported postures and heavy lifting) expose healthcare workers to intense physical strain, leaving them highly vulnerable to WMSDs [1–8]. A 2023 systematic review of orthopedic procedure posture reported that 41.6% of operating time is spent in slouched positions [8].