Module
6: Musculoskeletal Injuries
Segment 4: Patient Transport & Orthopedic Injury Management
References labeled PEDS contain a pediatric element or primary focus.
Topic: Transport/interfacility transfer
- Lichtenberger PM, Peer MF, Lindtner RA, et al. Helicopter vs. ground-based transfer for emergency interhospital transportation: A time and cost-efficiency analysis across varying transfer distances. Injury. 2025;56(7):112359. doi: 10.1016/j.injury.2025.112359 https://pubmed.ncbi.nlm.nih.gov/40349570/.
- Lin S, Nolan B, Dashi G, et al. The relative importance of clinical factors in initiating interfacility transfer of major trauma patients: A discrete choice experiment. Trauma. 2021;25(1):17-22. doi: 10.1177/14604086211031744 https://journals.sagepub.com/doi/abs/10.1177/14604086211031744.
- National Health Services. Framework to support inter-hospital transfer of critical care patients. Vol. PAR1215. 2021:4. 9 May 2021. https://www.england.nhs.uk/wp-content/uploads/2021/12/B1215-framework-to-support-inter-hospital-transfer-of-critical-care-patients.pdf.
- Trenga-Schein N, Zonies D, Cook M. Goals of care are rarely discussed prior to potentially futile trauma transfer: Is it okay to say “No”? J Trauma Acute Care Surg. 2024;96(4):583-588. doi: 10.1097/ta.0000000000004215 https://pubmed.ncbi.nlm.nih.gov/37981716/.
Topic: Pelvis: definitive management
- Abo-Elsoud M, Awad MI, Abdel Karim M, et al. Internal fixator vs external fixator in the management of unstable pelvic ring injuries: A prospective comparative cohort study. World J Orthop. 2023;14(7):562-571. doi: 10.5312/wjo.v14.i7.562 https://pubmed.ncbi.nlm.nih.gov/37485427/.
- Addevico F, Altomare M, Mezzadri U, et al. Enhancing pelvic fracture care: The impact of extraperitoneal pelvic packing on definitive orthopaedic treatment. Injury. 2025;doi: 10.1016/j.injury.2025.112207 https://pubmed.ncbi.nlm.nih.gov/39929088/.
- Artigue M, Schroeppel T, Sheehan B, et al. Does pelvic angioembolization increase pelvic ischemic complications? A multicenter American Association for the Surgery of Trauma study. J Am Coll Surg. 2025;241(5):773-782. doi: 10.1097/xcs.0000000000001477 https://pubmed.ncbi.nlm.nih.gov/40470836/.
- Asselin E, Fouré G, Conté M, et al. Pelvic embolization in severely traumatized patients in hemorrhagic shock with pelvic fractures without contrast extravasation on the initial CT scan: A retrospective comparative study between three French centers. Injury. 2026;57(6):113273. doi: 10.1016/j.injury.2026.113273 https://pubmed.ncbi.nlm.nih.gov/41980477/.
- Bal B, Rudin D, Zdravkovic V, et al. Short-term mobility in low-energy pelvic ring fractures after conservative treatment. Injury. 2024;55(11):111770. doi: 10.1016/j.injury.2024.111770 https://pubmed.ncbi.nlm.nih.gov/39142220/.
- Coccolini F, Ceresoli M, McGreevy DT, et al. Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry. Updates Surg. 2020;72(2):527-536. doi: 10.1007/s13304-020-00735-4 https://pubmed.ncbi.nlm.nih.gov/32130669/.
- Coleman M, Bergner C, Carver TW. Risk factors for fracture-related infections after low-velocity gunshot fractures to the pelvis. Injury. 2024;55(11) doi: 10.1016/j.injury.2024.111918 https://pubmed.ncbi.nlm.nih.gov/39341050/.
- Dahill M, McArthur J, Roberts GL, et al. The use of an anterior pelvic internal fixator to treat disruptions of the anterior pelvic ring: a report of technique, indications and complications. Bone Joint J. 2017;99-b(9):1232-1236. doi: 10.1302/0301-620x.99b9.Bjj-2016-1025.R2 https://pubmed.ncbi.nlm.nih.gov/28860405/.
- Fridling J, Ebadinejad A, Cobar J, et al. Bilateral versus unilateral arterial embolization in pelvic trauma: A ReCONNECT study. J Surg Res. 2026;321:423-428. doi: 10.1016/j.jss.2026.03.032 https://pubmed.ncbi.nlm.nih.gov/41926800/.
- Halawi MJ. Pelvic ring injuries: Surgical management and long-term outcomes. J Clin Orthop Trauma. 2016;7(1):1-6. doi: 10.1016/j.jcot.2015.08.001 https://pubmed.ncbi.nlm.nih.gov/26908968/.
- Johansen C, Mejia V, Scrushy M, et al. Clinical and radiographic predictors for angiography in pelvic trauma: An analysis of 1703 patients. Injury. 2024;55(11):111772. doi: 10.1016/j.injury.2024.111772 https://pubmed.ncbi.nlm.nih.gov/39146611/.
- Knowlton LM, Sauaia A, Moore EE, et al. Does preperitoneal packing increase venous thromboembolim risk among trauma patients? A prospective multicenter analysis across 17 level I trauma centers. J Trauma Acute Care Surg. 2024;97(5):791-798. doi: 10.1097/ta.0000000000004416 https://pubmed.ncbi.nlm.nih.gov/39443838/.
- Kumbhare C, Meena S, Kamboj K, et al. Use of INFIX for managing unstable anterior pelvic ring injuries: A systematic review. J Clin Orthop Trauma. 2020;11(6):970-975. doi: 10.1016/j.jcot.2020.06.039 https://pubmed.ncbi.nlm.nih.gov/33191998/.
- Kwon J, Allison-Aipa T, Zakhary B, et al. Comparison of timing of definitive pelvic fixation in pelvic fracture treated with preperitoneal pelvic packing or angioembolization. J Am Coll Surg. 2025;241(1):87-95. doi: 10.1097/xcs.0000000000001354 https://pubmed.ncbi.nlm.nih.gov/39932248/.
- McDonald JC, Kent S, LeRoy T, et al. Prevalence of pelvic CT angiography (CTA) and angiographic embolization in geriatric patients with pelvic ring fractures presenting to two level I trauma centers. Injury. 2024;55(11):111767. doi: 10.1016/j.injury.2024.111767 https://pubmed.ncbi.nlm.nih.gov/39168011/.
- McDonogh JM, Lewis DP, Tarrant SM, et al. Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2022;92(5):931-939. doi: 10.1097/ta.0000000000003528 https://pubmed.ncbi.nlm.nih.gov/34991126/.
- Mi M, Kanakaris NK, Wu X, et al. Management and outcomes of open pelvic fractures: An update. Injury. 2021;52(10):2738-2745. doi: 10.1016/j.injury.2020.02.096 https://pubmed.ncbi.nlm.nih.gov/32139131/.
- Migliorini F, Cocconi F, Schipper I, et al. Arterial angioembolisation versus pre-peritoneal pelvic packing in haemodynamically unstable patients with complex pelvic fractures: a meta-analysis. Eur J Trauma Emerg Surg. 2023;doi: 10.1007/s00068-023-02389-4 https://pubmed.ncbi.nlm.nih.gov/37962595/.
- Mikdad S, van Erp IAM, Moheb ME, et al. Pre-peritoneal pelvic packing for early hemorrhage control reduces mortality compared to resuscitative endovascular balloon occlusion of the aorta in severe blunt pelvic trauma patients: A nationwide analysis. Injury. 2020;51(8):1834-1839. doi: 10.1016/j.injury.2020.06.003 https://pubmed.ncbi.nlm.nih.gov/32564964/.
- Murata M, Aoki M, Hagiwara S, et al. Successful endovascular therapy in an elderly patient with severe hemorrhage caused by traumatic injury. Open Med (Wars). 2018;13:203-207. doi: 10.1515/med-2018-0031 https://pubmed.ncbi.nlm.nih.gov/29845120/.
- Patel M, McGwin G, Spitler C. Longer time to surgery for pelvic ring injuries is associated with increased systemic complications. J Trauma Acute Care Surg. 2025;98(6):921-926. doi: 10.1097/ta.0000000000004547 https://pubmed.ncbi.nlm.nih.gov/39924685/.
- Roszman AD, John DQ, Patch DA, et al. Management of open pelvic ring injuries. Injury. 2023;54(4):1041-1046. doi: 10.1016/j.injury.2023.02.006 https://pubmed.ncbi.nlm.nih.gov/36792402/.
- Sasagawa T. Treatment of unstable pelvic ring injury with a dual internal anterior subcutaneous fixator using spinal instrumentation called “dual INFIX”: A case report. J Orthop Case Rep. 2021;11(7):33-36. doi: 10.13107/jocr.2021.v11.i07.2304 https://pubmed.ncbi.nlm.nih.gov/34790599/.
- Scheyerer MJ, Zimmermann SM, Osterhoff G, et al. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures. BMC Res Notes. 2014;7(1):133. doi: 10.1186/1756-0500-7-133 https://pubmed.ncbi.nlm.nih.gov/24606833/.
- Shaath MK, Garrett C, Pattisapu N, et al. Obstetricians are likely to elect for cesarean section in women with retained pelvic implants: a radiographic survey study. Eur J Orthop Surg Traumatol. 2023;doi: 10.1007/s00590-023-03803-8 https://pubmed.ncbi.nlm.nih.gov/38133652/.
- Steer R, Balendra G, Matthews J, et al. The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic ring injuries in major trauma patients, complications and outcomes. SICOT J. 2019;5:22. doi: 10.1051/sicotj/2019019 https://pubmed.ncbi.nlm.nih.gov/31250805/.
- Stevens NM, Tejwani NC. Damage-control orthopedics or early total care: What you need to know. J Trauma Acute Care Surg. 2024;96(5):694-701. doi: 10.1097/ta.0000000000004250 https://pubmed.ncbi.nlm.nih.gov/38227676/.
- Stevenson AJ, Swartman B, Bucknill AT. Percutaneous internal fixation of pelvic fractures. Unfallchirurg. 2017;120(Suppl 1):10-18. doi: 10.1007/s00113-016-0225-x Perkutane interne Fixation bei Beckenfrakturen. https://pubmed.ncbi.nlm.nih.gov/27659309/.
- Vaidya R, Nasr K, Feria-Arias E, et al. INFIX/EXFIX: Massive open pelvic injuries and review of the literature. Case Rep Orthop. 2016;2016:9468285. doi: 10.1155/2016/9468285 https://pubmed.ncbi.nlm.nih.gov/27493818/.
- Vaidya R, Tonnos F, Nasr K, et al. The anterior subcutaneous pelvic fixator (INFIX) in an anterior posterior compression type 3 pelvic fracture. J Orthop Trauma. 2016;30 Suppl 2:S21-2. doi: 10.1097/bot.0000000000000583 https://pubmed.ncbi.nlm.nih.gov/27441929/.
- Wignakumar T, Brameier DT, Leland CR, et al. Is percutaneous pelvic fixation becoming more prevalent among new orthopaedic trauma surgeons? - Trends in pelvic ring fixation. Injury. 2026;57(3):112960. doi: 10.1016/j.injury.2025.112960 https://pubmed.ncbi.nlm.nih.gov/41547086/.
- Yin Y, Luo J, Zhang R, et al. Anterior subcutaneous internal fixator (INFIX) versus plate fixation for pelvic anterior ring fracture. Sci Rep. 2019;9(1):2578. doi: 10.1038/s41598-019-39068-7 https://pubmed.ncbi.nlm.nih.gov/30796253/.
- Zhang D, Zhang GZ, Peng Y, et al. Pelvic packing or endovascular interventions: Which should be given priority in managing hemodynamically unstable pelvic fractures? A systematic review and a meta-analysis. Surg Open Sci. 2024;19:146-157. doi: 10.1016/j.sopen.2024.03.016 https://pubmed.ncbi.nlm.nih.gov/38721524/.
Topic: Femur: definitive management
- Cenzer IS, Tang V, Boscardin WJ, et al. One-year mortality after hip fracture: Development and validation of a prognostic index. J Am Geriatr Soc. 2016;64(9):1863-8. doi: 10.1111/jgs.14237 https://pubmed.ncbi.nlm.nih.gov/27295578/.
- Coimbra BC, Kwon J, Zakhary B, et al. Damage control does not offer a survival advantage and increases the risk of serious complications compared with early total care in severely injured patients with femoral shaft fractures. J Trauma Acute Care Surg. 2025;98(6):907-914. doi: 10.1097/ta.0000000000004594 https://pubmed.ncbi.nlm.nih.gov/40107976/.
- Fletcher J, Morello V, Gurbanov E, et al. Age matters: Elevated mortality and distinct injury patterns in elderly (>75 years) patients with high-energy pelvic ring injuries. Injury. 2026;57(2) doi: 10.1016/j.injury.2025.112963 https://pubmed.ncbi.nlm.nih.gov/41418384/.
- Jensen KO, Prediger B, Könsgen N, et al. Initial surgical management of injuries to the lower extremities in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline update. Eur J Trauma Emerg Surg. 2024;50(6):3329-3350. doi: 10.1007/s00068-024-02662-0 https://pubmed.ncbi.nlm.nih.gov/39500775/.
- Khurana A, Quencer K, Saini A, et al. Endovascular interventions in the management of acute extremity trauma: a narrative review. Ann Transl Med. 2021;9(14):1197. doi: https://pubmed.ncbi.nlm.nih.gov/34430638/.
- Kursad Bayraktar M, Akdas Tekin E. Headless cannulated screw and external fixator in the treatment of type C distal femur fractures: Effect of early mobilization on clinical outcomes. Acta Orthop Belg. 2023;89(1):122-127. doi: 10.52628/89.1.11119 https://pubmed.ncbi.nlm.nih.gov/37294995/.
- Mahesan H, Perumal R, Vasudeva N, et al. Management and outcomes of open pelvic injury -a retrospective analysis of 30 patients. Injury. 2025;doi: 10.1016/j.injury.2025.112658 https://pubmed.ncbi.nlm.nih.gov/40840317/.
- Reinhard J, Schindler M, Straub J, et al. Timing in orthopaedic surgery - Rethinking traditional myths with a critical perspective. Injury. 2025;56(3):112165. doi: 10.1016/j.injury.2025.112165 https://pubmed.ncbi.nlm.nih.gov/39879862/.
- Stahel PF, Kaufman AM. Contemporary management of open extremity fractures: What you need to know. J Trauma Acute Care Surg. 2024;97(1):11-22. doi: 10.1097/ta.0000000000004288 https://pubmed.ncbi.nlm.nih.gov/38374531/.
- Steinfeld E, Horst K, Ansems K, et al. Optimal timing of stabilization and operative technique for extremity fractures in polytrauma patients: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2025;51(1):27. doi: 10.1007/s00068-024-02762-x https://pubmed.ncbi.nlm.nih.gov/39827327/.
- Travis LM, Blanc NK, Hinchberger V, et al. Risk factors for postoperative infection after non-elective femur fracture fixation in pediatric patients. Injury. 2026;57(8) doi: 10.1016/j.injury.2026.113381 https://pubmed.ncbi.nlm.nih.gov/42208193/. Peds
- Zagorac S, Lesic A, Bumbasirevic M. A case of acute bilateral femur fracture with vascular injury. J Acute Dis. 2016;5(1):86-89. doi: 10.1016/j.joad.2015.07.009 https://www.sciencedirect.com/science/article/pii/S2221618915000931?via%3Dihub.
Topic: Ortho care interventions
- Cast care. American Academy of Orthopaedic Surgeons; 2019. Accessed 2022. https://orthoinfo.aaos.org/globalassets/pdfs/cast-care.pdf.
- Drugeon B, Rickard CM, Buetti N, et al. Myths glorify what reality neglects: Efficacy and safety of chlorhexidine gluconate. Curr Infect Dis Rep. 2025;27(1):14. doi: 10.1007/s11908-025-00865-z https://doi.org/10.1007/s11908-025-00865-z.
- Hadeed A, Werntz RL, Varacallo M. External fixation principles and overview. StatPearls. StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK547694/.
- Hickland P, Wilson D, Mullan C, et al. Circular frame management of distal tibial fractures; 15 years of practice in a tertiary referral unit. Injury. 2025;56(12):112808. doi: 10.1016/j.injury.2025.112808 https://pubmed.ncbi.nlm.nih.gov/41101040/.
- Horowitz ME, Talsania A, Grando K, et al. Evaluating the efficacy of disinfecting agents against Staphylococcus aureus on external fixator devices. Injury. 2026;57(10):113606. doi: 10.1016/j.injury.2026.113606 https://pubmed.ncbi.nlm.nih.gov/42632351/.
- Ktistakis I, Guerado E, Giannoudis PV. Pin-site care: Can we reduce the incidence of infections? Injury. 2015;46 Suppl 3:S35-9. doi: 10.1016/s0020-1383(15)30009-7 https://pubmed.ncbi.nlm.nih.gov/26458298/.
- Nguyen P, Pokrzywa C, Figueroa J, et al. Predictive factors for the application of pelvic binders in the prehospital setting. Prehosp Emerg Care. 2023:1-12. doi: 10.1080/10903127.2023.2213316 https://pubmed.ncbi.nlm.nih.gov/37171847/.
- Rizos J, Hebert-Seropian S, Buckley R. Do we try to salvage too many traumatic limb injuries with reconstruction and flaps when we should be doing more amputations? Injury. 2024;55(6) doi: 10.1016/j.injury.2024.111489 https://pubmed.ncbi.nlm.nih.gov/38460479/.
- Royal College of Nursing. Guidance on pin site care. 2022. https://www.rcn.org.uk/Professional-Development/publications/guidance-on-pin-site-care-uk-pub-009-907.
- Sáenz-Jalón M, Sarabia-Cobo CM, Roscales Bartolome E, et al. A randomized clinical trial on the use of antiseptic solutions for the pin-site care of external fixators: Chlorhexidine-alcohol versus povidone-iodine. J Trauma Nurs. 2020;27(3):146-150. doi: 10.1097/jtn.0000000000000503 https://pubmed.ncbi.nlm.nih.gov/32371731/.
- Scott S. Orthopaedic trauma surgery: when to operate? Injury. 2026;57(4):113148. doi: 10.1016/j.injury.2026.113148 https://pubmed.ncbi.nlm.nih.gov/41843999/.
- Serlis A, Sgardelis P, Vampertzis T, et al. Complex limb injuries: Limb salvage versus amputation—A mini review and meta-analysis. Adv Orthop. 2025;2025:2884802. doi: 10.1155/aort/2884802 https://pubmed.ncbi.nlm.nih.gov/39950183/.
- Smadi Z, Lingam S, Muwalla R, et al. Weight on the fixation: The influence of body mass index on lower extremity fracture fixation outcomes. Injury. 2025;56(12):112864. doi: 10.1016/j.injury.2025.112864 https://pubmed.ncbi.nlm.nih.gov/41197500/.
- Trompeter A. Weightbearing instructions after orthopaedic injury or surgery. Injury. 2025;56(6):112329. doi: 10.1016/j.injury.2025.112329 https://pubmed.ncbi.nlm.nih.gov/40250091/.