{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:05:06Z","timestamp":1790654706322,"version":"4.1.0"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003417","name":"Deutsche Gesetzliche Unfallversicherung","doi-asserted-by":"publisher","award":["FR-0316"],"award-info":[{"award-number":["FR-0316"]}],"id":[{"id":"10.13039\/501100003417","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Secondary lymphedema is a very common clinical issue with millions of patients suffering from pain, recurrent skin infections, and the constant need for a decongestive therapy. Well- established because of oncologic procedures, secondary lymphedema is also a well-known phenomenon after trauma. However, precise epidemiological data of posttraumatic lymphedema upon severe extremity injuries are rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In the present study, we analyzed a patient cohort of 223 individuals who suffered closed fractures of the upper and lower extremity between 2016 and 2020. All of them simultaneously had a soft tissue injury, of 2nd and 3rd grade according to Tscherne classification. Typical symptoms of lymphedema were recorded in a retrospective cohort analysis through patient anamnesis and compared with documented clinical examination findings. Previous illnesses and trauma-specific characteristics were determined from patient files.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of all patients, 36% showed symptoms of secondary lymphedema and 8,5% reported recurrent skin infections, indicating severe lymphedema. Furthermore, comparing patients with and without lymphedema, additional trauma-associated parameters, such as total number of surgeries, degree of soft tissue damage, localization of the fracture in lower extremity, related to lymphedema progress could be identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>According to these data, posttraumatic secondary lymphedema has even in closed fractures, especially of the lower extremity, a highly underestimated clinical prevalence. Further prospective studies are required to validate these findings, identify high-risk groups, and guide early prophylactic and therapeutic interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0337756","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T18:22:54Z","timestamp":1765477374000},"page":"e0337756","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Limb swelling consistent with posttraumatic lymphedema after closed upper and lower extremity fractures: A retrospective cohort study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2265-725X","authenticated-orcid":true,"given":"Felix","family":"Reinkemeier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Wallner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Drysch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja Verena","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flemming","family":"Puscz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxi","family":"von Glinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas Armin","family":"Schildhauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Lehnhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bjo\u0308rn","family":"Behr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes Maximilian","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"pone.0337756.ref001","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/01.sap.0000257149.42922.7e","article-title":"Lymphedema","volume":"59","author":"AG Warren","year":"2007","journal-title":"Ann Plast Surg"},{"issue":"5","key":"pone.0337756.ref002","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s10147-005-0518-5","article-title":"Treatment of 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A report of one case of Stewart-Treves syndrome","volume":"66","author":"M Sandsmark","year":"1977","journal-title":"Ann Chir Gynaecol Suppl"},{"issue":"7","key":"pone.0337756.ref022","article-title":"Risk Factors for Lymphedema after Thigh Sarcoma Resection and Reconstruction","volume":"8","author":"P Wu","year":"2020","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"10","key":"pone.0337756.ref023","doi-asserted-by":"crossref","first-page":"2604","DOI":"10.1016\/j.bjps.2021.03.014","article-title":"Lymph-interpositional-flap transfer (LIFT) based on lymph-axiality concept: Simultaneous soft tissue and lymphatic reconstruction without lymph node transfer or lymphatic anastomosis","volume":"74","author":"T Yamamoto","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0337756","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T18:22:58Z","timestamp":1765477378000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0337756"}},"subtitle":[],"editor":[{"given":"Farina Binti","family":"Mohamad Yusoff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":23,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0337756","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,11]]}}}