Injury (INJURY)

Publisher: Institute of Accident Surgery, Elsevier

Journal description

Injury is an established, internationally renowned academic journal focusing on the rapidly evolving fields of trauma and accident surgery. The journal encourages the exchange of information among all members of the accident and emergency trauma team. Topics covered by Injury include trauma systems and management; surgical procedures; epidemiological studies; surgery (of all tissues); resuscitation; biomechanics; rehabilitation; anaesthesia; radiology and wound management. Regular features include original research papers; review papers; case reports; book reviews; ideas and innovations detailing novel and effective solutions to surgical problems; calendar of courses and worldwide meetings. The journal publishes a series of special supplements documenting the work of AO/ASIF Research, Development and Clinical Studies.

Current impact factor: 2.46

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 2.462
2012 Impact Factor 1.931
2011 Impact Factor 1.975
2010 Impact Factor 2.269
2009 Impact Factor 2.383
2008 Impact Factor 1.946
2007 Impact Factor 1.509
2006 Impact Factor 1.067
2005 Impact Factor 0.919
2004 Impact Factor 0.742
2003 Impact Factor 0.511
2002 Impact Factor 0.408
2001 Impact Factor 0.39
2000 Impact Factor 0.363
1999 Impact Factor 0.261
1998 Impact Factor 0.326
1997 Impact Factor 0.257
1996 Impact Factor 0.326
1995 Impact Factor 0.146
1994 Impact Factor 0.128
1993 Impact Factor 0.134
1992 Impact Factor 0.254

Impact factor over time

Impact factor

Additional details

5-year impact 2.35
Cited half-life 6.70
Immediacy index 0.33
Eigenfactor 0.02
Article influence 0.68
Website Injury website
Other titles Injury
ISSN 0020-1383
OCLC 1715915
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Pre-print allowed on any website or open access repository
    • Voluntary deposit by author of authors post-print allowed on authors' personal website, or institutions open scholarly website including Institutional Repository, without embargo, where there is not a policy or mandate
    • Deposit due to Funding Body, Institutional and Governmental policy or mandate only allowed where separate agreement between repository and the publisher exists.
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months .
    • Set statement to accompany deposit
    • Published source must be acknowledged
    • Must link to journal home page or articles' DOI
    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: The aim of this study was to explore how family members perceive and support young people with traumatic physical injury during the acute phase of hospital care. Methods: This study forms part of the qualitative explanatory follow-up phase of a mixed methods study. The paper reports on family members’ experiences of providing support to young people 16-24 years admitted with major traumatic injury to an Australian Level 1 Trauma Centre. Semi-structured in-depth interviews with family members were conducted and transcribed verbatim. Data were managed using NVivo software, and thematically analysed. Findings: Family support was determined by how family members perceived the injury. Driven by a need to protect the injured young person, family members sought to control potential emotional impacts of injury, creating a buffer between the young person and other people including healthcare professionals. Family members safeguarded the psychological well-being of the young person, in an attempt to facilitate their transition back to independence. Conclusion: This study identifies iterative changes in family relationships and emotional and practical support provided by family members during the initial injury trajectory, extending understandings of the broader burden of injury. Key elements of family stress theory offer a useful framework for the development of anticipatory guidance for clinicians that are responsive to the emotional needs of patients and families, supporting the need for a family-centred care approach to managing major traumatic injury in young people.
    Injury 03/2015; DOI:10.1016/j.injury.2015.03.030
  • Injury 03/2015; DOI:10.1016/j.injury.2015.02.026
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present a case of intra-corpus spongiosal pseudoaneurysm causing massive urethral bleeding during penile erection after straddle injury in a 42-year-old man. A pseudoaneurysm of bulbar artery was located in the corpus spongiosum. To the best of our knowledge, our report is the first known case of a rare cause of massive urethral bleeding only during penile erection: a pseudoaneurysm of the corpus spongiosum from straddle injury.
    Injury 03/2015; DOI:10.1016/j.injury.2015.02.027
  • Injury 03/2015; DOI:10.1016/j.injury.2015.03.007
  • Injury 03/2015; DOI:10.1016/j.injury.2015.03.008
  • [Show abstract] [Hide abstract]
    ABSTRACT: Respiratory neuromuscular impairment severity is known to predict weaning outcome among patients with cervical spinal cord injury; however, the impact of non-neuromuscular complications remains unexplored. This study was to evaluate possible neuromuscular and non-neuromuscular factors that may negatively impact weaning outcome. From September 2002 to October 2012, acute traumatic cervical spinal cord injury patients who had received mechanical ventilation for >48h were enrolled and divided into successful (n=54) and unsuccessful weaning groups (n=19). Various neuromuscular, non-neuromuscular factors and events during the intensive care unit stay were extracted from medical charts and electronic medical records. Variables presenting with a significant difference (p<0.2) between these two groups were included in the univariate analysis. Following univariate analysis, those significantly different variables (p<0.05) were subjected to multivariate logistic regression to identify independent predictors of unsuccessful weaning. Compared to successful weaning patients, unsuccessful weaning patients were older; more often had high level of cervical spinal cord injury (C1-3), lower pulse rates, and lower Glasgow Coma Scale score on admission, higher peak blood urea nitrogen, lower trough albumin, and lower trough blood leukocyte counts. Furthermore, unsuccessful weaning patients had a higher incidence of pneumonia, acute respiratory distress syndrome, shock and acute kidney injury during the intensive care unit stay. Multivariate logistic regression analysis revealed acute kidney injury and high level of cervical spinal cord injury were independent risk factors for failure of weaning. Importantly, patients with both risk factors showed a large increase in odds ratio for unsuccessful weaning from mechanical ventilation (p<0.001). The presence of acute kidney injury during the intensive care unit stay and high level of cervical spinal injury are two independent risk factors that synergistically work together producing a negative impact on weaning outcome. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Injury 03/2015; DOI:10.1016/j.injury.2015.02.025
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hospital admission rates for a number of conditions have been linked to variations in the weather. It is well established that trauma workload displays significant seasonal variation. A reliable predictive model might enable targeting of high-risk groups for intervention and planning of hospital staff levels. To our knowledge there have been no systematic reviews of the literature on the relationship between weather and trauma workload, and predictive models have thus far been informed by the results of single studies.
    Injury 03/2015; DOI:10.1016/j.injury.2015.03.016
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: 30-day mortality is routinely used to assess proximal femoral fracture care, though patients might remain at risk for poor outcome for longer. This work has examined the survivorship out to one year of a consecutive series of patients admitted for proximal femoral fracture to a single institution. We wished to quantify the temporal impact of fracture upon mortality, and also the influence of patient age, gender, surgical delay and length of stay on mortality from both cardiorespiratory and noncardiorespiratory causes. Patients and methods: Data were analysed for 561 consecutive patients with 565 fragility type proximal femoral fractures treated surgically at our trauma unit. Dates and causes of death were obtained from death certificates and also linked to data from the Office of National Statistics. Mortality rates and causes were collated for two time periods: day 0–30, and day 31–365. Results: Cumulative incidence analysis showed that mortality due to cardiorespiratory causes (pneumonia, myocardial infarction, cardiac failure) rose steeply to around 100 days after surgery and then flattened reaching approximately 12% by 1 year. Mortality from non-cardiorespiratory causes (kidney failure, stroke, sepsis etc.) was more progressive, but with a rate half of that of cardiorespiratory causes. Progressive modelling of mortality risks revealed that cardiorespiratory deaths were associated with advancing age and male gender (p < 0.001 for both), but the effect of age declined after 100 days. Non-cardiorespiratory deaths were not time-dependent. Conclusion: We believe this analysis extends our understanding of the temporal impact of proximal femoral fracture and its surgical management upon outcome beyond the previously accepted standard (30 days) and supports the use of a new, more relevant timescale for this high risk group of patients. It also highlights the need for planning and continuing physiotherapy, respiratory exercises and other chest-protective measures from 31 to 100 days.
    Injury 02/2015; 46:358 - 362.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The optimal treatment for avulsion-type greater tuberosity fractures is yet to be determined. Three fixation methods are tested: tension band with #2 wire suture (TB), double-row suture bridge with anchors (DR), and simple transosseous fixation with braided tape (BT). Twenty-four porcine proximal humeri were randomised into three groups: TB, DR and BT. A standardised greater tuberosity (GT) osteotomy was performed at 90° to the humeral diaphysis axis. A mechanical testing machine was used to simulate supraspinatus contraction. The force required to produce 3mm and 5mm displacement, as well as complete failure was measured with an axial load cell. Also, three cycles of shoulder flexion/extension with 25N of supraspinatus contraction were performed. Maximum GT fragment translation and rotation amplitude during one cycle were measured. During supraspinatus contraction, DR and BT groups (p<0.05) were superior to TB group for both displacements. The BT technique had the strongest maximal load to failure (BT=466N; DR=386N; TB=320N). For the flexion/extension, DR and BT groups had less displacement and rotation than TB group (anterio-posterior displacement: BT=2.0mm, DR=1.9mm, TB=5.8mm; anterio-posterior angular displacement: BT=1.4°, DR=1.0°, TB=4.8°). No significant difference was observed between DR and BT groups, except for the medio-lateral rotation favouring the DR group. In conclusion, BT and DR are good fixation methods to treat displaced avulsion-type greater tuberosity fractures. They have similar mechanical properties, and are stronger and more stable that the TB construct. Potential advantages of the BT over the DR may be a lower cost and easier surgery. Basic science study (LEVEL II). Copyright © 2015 Elsevier Ltd. All rights reserved.
    Injury 02/2015; DOI:10.1016/j.injury.2015.02.007
  • [Show abstract] [Hide abstract]
    ABSTRACT: The accuracy and maintenance of syndesmosis reduction are essential when treating ankle fractures with accompanying syndesmosis injuries. The primary aim of this study was to compare syndesmosis screw and TightRope fixation in terms of accuracy and maintenance of syndesmosis reduction using bilateral computed tomography (CT). Single centre, prospective randomised controlled clinical trial; Level of evidence 1. This study (, NCT01742650) compared fixation with TightRope(®) (Arthrex, Naples, FL, USA) or with one 3.5-mm tricortical trans-syndesmotic screw in terms of accuracy and maintenance of syndesmosis reduction in Lauge-Hansen pronation external rotation, Weber C-type ankle fractures with associated syndesmosis injury. Twenty-one patients were randomised to TightRope fixation and 22 to syndesmotic screw fixation. Syndesmosis reduction was assessed using bilateral CT intraoperatively or postoperatively, and also at least 2 years after surgery. Functional outcomes and quality of life were assessed using the Olerud-Molander score, a 100-mm Visual Analogue Scale, the Foot and Ankle Outcome Score, and the RAND 36-Item Health Survey. Grade of osteoarthritis was qualified with follow-up cone-beam CT. According to surgeons' assessment from intraoperative CT, screw fixation resulted in syndesmosis malreduction in one case whereas seven syndesmosis were considered malreduced when TightRope was used. However, open exploration and postoperative CT of these seven cases revealed that syndesmosis was well reduced if the ankle was supported at 90˚. Retrospective analysis of the intra- and post-operative CT by a radiologist showed that one patient in each group had incongruent syndesmosis. Follow-up CT identified three patients with malreduced syndesmosis in the syndesmotic screw fixation group, whereas malreduction was seen in one patient in the TightRope group (P=0.33). Functional scores and the incidence of osteoarthritis showed no significant difference between groups. Syndesmotic screw and TightRope had similar postoperative malreduction rates. However, intraoperative CT scanning of ankles with TightRope fixation was misleading due to dynamic nature of the fixation. After at least 2 years of follow-up, malreduction rates may slightly increase when using trans-syndesmotic screw fixation, but reduction was well maintained when fixed with TightRope. Neither the incidence of ankle joint osteoarthritis nor functional outcome significantly differed between the fixation methods. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Injury 02/2015; DOI:10.1016/j.injury.2015.02.004
  • [Show abstract] [Hide abstract]
    ABSTRACT: The relatively high complication rate after fixation of olecranon fractures has led to an increasing application of anatomically pre-contoured locking plate systems. The purpose of the present study was to conduct a biomechanical comparison of olecranon osteosyntheses by applying the Olecranon VA-LCP and the 3.5mm LCP Hook Plate (LCP, locking compression plate) to an unstable fracture model under high-cycle loading conditions. After creating an unstable fracture (Schatzker type B), osteosynthesis was performed on eight pairs of fresh-frozen cadaveric ulnae by application of either the Olecranon VA-LCP (Synthes, Solothurn, Switzerland) or the 3.5mm LCP Hook Plate (Synthes, Solothurn, Switzerland). Loading (50,000 alternating loads, cyclic and sinusoidal 10-300N) was conducted by application of tensile load with the elbow in 90° flexion to simulate the tensile strength of the triceps brachii. For statistical analysis, angular displacement in the region of the humeral trochlea was taken as a measure of olecranon dislocation. In Group 1 (Olecranon VA-LCP), a median angular displacement of 0.36° (minimum 0.10°; maximum 0.80°) was observed after 500 alternating loads. In Group 2 (3.5-mm LCP Hook Plate), the medial displacement was 0.80° (minimum 0.13°; maximum 2.72°). The difference was nonsignificant (p=0.128). The mean value for angular displacement in Group 1 after 50,000 cycles was 0.80° (minimum 0.31°; maximum 1.99°), whereas in Group 2 a mean angular displacement of 2.02° (minimum 0.71°; maximum 6.40°) was recorded. The difference was statistically significant (p=0.017). In Group 2, implant failure in the form of proximal plate pullout occurred in one construct after 756 cycles. A significantly higher biomechanical stability can be achieved in the fixation of unstable olecranon fractures by application of the Olecranon VA-LCP rather than the 3.5mm LCP Hook Plate. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Injury 02/2015; DOI:10.1016/j.injury.2015.02.010
  • [Show abstract] [Hide abstract]
    ABSTRACT: Elderly patients with a hip fracture represent a large proportion of the trauma population; however, little is known about outcome differences between different levels of trauma care for these patients. The aim of this study is to analyse the outcome of trauma care in patients with a hip fracture within our inclusive trauma system. Retrospective cohort study. Data were collected from the electronic patient documentation of patients, with an isolated hip fracture (aged ≥60), admitted to a level I or level II trauma centre between January 2008 and December 2012. Main outcomes were time to operative treatment, complications, mortality, and secondary surgical intervention rate. A total of 204 (level I) and 1425 (level II) patients were admitted. Significantly more ASA4 patients, by the American Society of Anesthesiologists (ASA) classification, were treated at the level I trauma centre. At the level II trauma centre, median time to surgical treatment was shorter (0 days; IQR 0-1 vs 1 day; IQR 1-2; P<0.001), which was mainly influenced by postponement due to lack of operation room availability (14%, n=28) and co-morbidities (13%, n=26) present at the level I trauma centre. At the level II trauma centre, hospital stay was shorter (9 vs 11 days; P<0.001) and the complication rate was lower (41%; n=590 vs 53%; n=108; P=0.002), as was mortality (4%; n=54 vs 7%; n=15; P=0.018). Secondary surgical intervention was performed less often at the level II trauma centre (6%; n=91vs 12%; n=24; P=0.005). However, no differences in secondary surgical procedures due to inadequate postoperative outcome or implant failure were observed. The clinical pathway and the large volume of patients at the level II centre resulted in earlier surgical intervention, lower overall complication and mortality rate, and a shorter length of stay. Therefore, the elderly patient with a hip fracture should ideally be treated in the large-volume level II hospital with a pre-established clinical pathway. However, complex patients requiring specific care that can only be provided at the level I trauma centre may be treated there with similar operative results. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Injury 02/2015; DOI:10.1016/j.injury.2015.02.015
  • Injury 01/2015; 46:S13-S17. DOI:10.1016/S0020-1383(15)70005-7
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Pre-hospital triage is an intricate part of any mass casualty response system. However, in settings where no such system exists, it is not known if hospital-based disaster response efforts are beneficial. This study describes in-hospital disaster response management and patient outcomes following a mass casualty event (MCE) involving 200 victims in a lower-middle income country in South Asia. Methods We performed a single-center, retrospective review of bombing victims presenting to a trauma center in the spring of 2013, after a high energy car bomb leveled a residential building. Descriptive analysis was utilized to present demographic variables and physical injuries. Results A disaster plan was devised based on the canons of North-American trauma care; some adaptations to the local environment were incorporated. Relevant medical and surgical specialties were mobilized to the ED awaiting a massive influx of patients. ED waiting room served as the triage area. Operating rooms, ICU and blood bank were alerted. Seventy patients presented to the ED. Most victims (88%) were brought directly without prehospital triage or resuscitation. Four were pronounced dead on arrival. The mean age of victims was 27 (±14) years with a male preponderance (78%). Penetrating shrapnel injury was the most common mechanism of injury (71%). Most had a systolic blood pressure (SBP) >90 with a mean of 120.3 (±14.8). Mean pulse was 90.2 (±21.6) and most patients had full GCS. Extremities were the most common body region involved (64%) with orthopedics service being consulted most frequently. Surgery was performed on 36 patients, including 4 damage control surgeries. All patients survived. Conclusion This overwhelming single mass-casualty incident was met with a swift multidisciplinary response. In countries with no prehospital triage system, implementing a pre-existing disaster plan with pre-defined interdisciplinary responsibilities can streamline in-hospital management of casualties.
    Injury 01/2015; 46(1):156-161. DOI:10.1016/j.injury.2014.08.029
  • Injury 01/2015; 46:S24-S27. DOI:10.1016/S0020-1383(15)70007-0
  • Injury 01/2015; 46:S2-S7. DOI:10.1016/S0020-1383(15)70003-3
  • Injury 01/2015; 46:S1. DOI:10.1016/S0020-1383(15)70002-1