Multiple trauma: early fixation of torso injuries: METHODS: A retrospective analysis of 1005 patients with ISS scores >18 for multiple fractures of the thoracolumbar spine, pelvis, acetabulum, and femur was performed to compare postoperative complications, mortality, and resource utilization for early (<24h) or late (>24h) fixation. RESULTS: ISS scores, age, and number of combined thoracic and abdominal injuries differed between the two groups. After controlling for confounding factors, it was found that patients with early fixation had lower rates of blood transfusion, days in the ICU, ventilator use, length of stay, number of pneumonia episodes, acute respiratory failure syndrome and sepsis than those with late fixation. Point: Patients with high-energy multiple injuries who are adequately resuscitated benefit more from early immobilization, and adequate resources to ensure that early immobilization is possible should be advocated for patients with such multiple injuries. Postoperative complications of pelvic ring injuries and arterial embolization: METHODS: A retrospective analysis of 121 patients treated with pelvic vascular embolization for pelvic ring injuries was performed to analyze their short-term complications. RESULTS: A total of 11 patients presented with 19 associated complications, including gluteal muscle necrosis (6 cases), incisional dehiscence (5 cases), deep infection (4 cases), erectile dysfunction (2 cases), superficial infection (1 case) and bladder necrosis (1 case). All cases with complications underwent percutaneous (4 cases) or incisional (7 cases) treatment of the fracture. Those with complications were mostly patients treated with non-selective vascular embolization. KEY POINT: This study suggests a higher complication rate in patients with pelvic ring fractures that require surgical stabilization of the pelvic ring and vascular embolization therapy. Surgeons and imaging physicians need to work together to balance the risks and benefits of different treatments to reduce the risk of complications. Incisional infections after pelvic and acetabular fracture surgery: METHODS: This was a case-matched controlled study. The experimental group was 17 patients with deep infections treated surgically for pelvic fractures and the control group was 80 patients without deep infections. Risk factors for deep infection were determined by comparison. RESULTS: High ISS scores (>16), obesity (BMI >30), and obesity combined with preoperative leukocytosis were associated with a significant increase in incisional infections. Unrelated factors recorded included preoperative fever, leukocytosis, other organ infections, open injuries at other sites, and blood transfusion. Preoperative vascular embolization also significantly increased the rate of incisional infection. Key points: ISS>16, obesity, and preoperative vascular embolism are risk factors for the development of deep infections in pelvic and acetabular surgical treatments. Extra attention should be paid to the corresponding patients and prompted. Severe foot and ankle injuries: METHODS: A case group of 182 cases from the Lower Extremity Evaluation Program included foot and ankle injuries. The prognosis of patients treated with standard below-knee amputation and limb preservation was compared over two years. The impact of free soft tissue transfer and ankle fusion was also analyzed. RESULTS: There were no differences between limb preservation and amputation on scores of overall condition, physical fitness, psychological, and disease impact on image. However, regression analysis showed that among limb-preserving patients, those treated with additional free flaps and ankle fusion performed worse psychosocially and overall than limb-preserving patients and below-knee amputees who did not undergo these additional treatments. The best overall performance and psychosocial scores were seen in limb-preserving patients who did not require flap grafting and joint fusion, but the difference was not significant. Management of nonhealing, infected wounds Prediction of nonhealing tibial fractures: METHODS: Fifty-six patients with tibial fractures treated with intramedullary nailing who did not heal completely at three months postoperatively were analyzed, and three traumatologists assessed whether each fracture would heal using patient imaging data. RESULTS: The diagnostic accuracy of the 3 physicians was 74%, the sensitivity was 62%, and the specificity was 77%. KEY POINT: Experienced physicians can accurately predict whether a fracture will heal at 3 months after intramedullary nailing of a tibial fracture. The authors concluded that in this group of patients, it is not necessary to wait until 6 months before considering the option of secondary surgery for nonunion of the fracture. The use of lidocaine in VSD: METHODS: The methodology of this study was a randomized, double-blind, controlled trial. The effects on patient pain and anesthetic requirements were compared between the two groups using topical lidocaine and blank saline during VSD treatment. RESULTS: Patients using lidocaine had a mean of 2.4 fewer postoperative pain scores and a mean of 1.7 mg less postoperative opioid use than the control group. KEY POINT: Pretreatment with topical lidocaine reduces pain and pain medication use in patients with VSD. Diagnosis of preoperative infection in patients with nonhealing fractures: METHODS: A retrospective study of 95 patients with nonhealing fractures. The usefulness of performing a complete blood count, CRP, ESR, leukocytes, or bone scan for the diagnosis of infection was evaluated. RESULTS: Infection was eventually confirmed in 31.5% of patients with nonhealing fractures. Excluding bone scan, the predictive accuracy of infection was 19.6%, 18.8%, 56.0%, and 100% for 0, 1, 2, and 3 of the above tests, respectively. ESR and CRP were independent predictors of infected fracture nonunion. Point: Routine serologic tests can accurately predict the risk of infection for nonhealing fractures; leukocyte and bone scan tests are not recommended. Treatment strategy for aseptic fracture nonunion: METHODS: To compare the surgical outcomes of 87 patients with a preoperative diagnosis of aseptic fracture nonunion after one-stage revision and intraoperative positive and negative bacterial cultures. RESULTS: Among patients with a preoperative diagnosis of nonunion of aseptic fractures, the probability of a positive intraoperative bacterial test was 28.7% and their rate of second-stage surgery (28%) was higher than that of negative patients (6.4%; p=0.01). KEY POINT: Phase I revision therapy can be used in patients with a preoperative diagnosis of nonunion of aseptic fractures. Secondary surgery was also not necessary in 74% of patients with positive intraoperative bacterial cultures. Bone marrow injection for nonunion of tibial fractures: METHODS: Eleven patients with nonunion or delayed fracture healing after ORIF treatment of distal tibial metaphysis fractures were treated with 40-80 ml of autologous bone marrow injection. RESULTS: Nine patients had fracture healing within 6 months of injection treatment, and six of them had long-term follow-up with significant improvement. KEY POINT: Percutaneous bone marrow injection is an effective treatment for patients with non-healing or delayed healing distal tibial fractures with complete or stable fixation.