Journal of Bone and Joint Surgery, American Volume最新文献

{"title":"Intraneural Ganglion Cysts Arising from the Hip Joint as Rare Causes of Sciatic Neuropathy: A Case Series of 13 Patients Treated with Hip Arthroscopy.","authors":"Chan-Woo Park, Sang Jin Jeong, Jae Soon Kim, Seung-Jae Lim, Youn-Soo Park","doi":"10.2106/JBJS.24.00737","DOIUrl":"https://doi.org/10.2106/JBJS.24.00737","url":null,"abstract":"<p><strong>Background: </strong>Sciatic neuropathy can result from pressure, injury, or inflammation around the sciatic nerve. In rare instances, sciatic neuropathy is caused by an intraneural ganglion cyst (IGC) originating from the hip joint. However, an effective treatment modality for this condition has not yet been established. The purpose of the present study was to evaluate the clinical and radiographic outcomes of hip arthroscopy for the treatment of IGCs involving the sciatic nerve.</p><p><strong>Methods: </strong>We reviewed the records on a consecutive series of hip arthroscopy procedures that had been performed by a single surgeon for the treatment of sciatic IGCs between July 2016 and February 2022. Thirteen Asian patients (13 hips) with symptomatic sciatic neuropathy were included. During arthroscopic surgery, IGCs were decompressed by enlarging their periarticular connection. Magnetic resonance imaging (MRI) and electrodiagnostic evaluation were routinely performed. The visual analog scale (VAS) for pain and modified Harris hip score (mHHS) were used for clinical evaluations. The mean age at the time of surgery was 57 years (range, 23 to 72 years), and the mean duration of follow-up was 41 months (range, 24 to 87 months).</p><p><strong>Results: </strong>The mean VAS score decreased from 8.3 preoperatively to 1.9 at the latest evaluation (p < 0.001). Satisfactory pain relief was reported by 12 patients (92%), including 9 patients (69%) who had complete remission. Four of the 6 patients with sensory impairment and 3 of the 4 patients with motor weakness reported complete recovery. The mean mHHS improved from 51.5 to 94.1 (p < 0.001). In MRI comparisons, the mean largest diameter and length of IGCs decreased from 2.6 to 0.5 cm (p < 0.001) and from 6.8 to 0.6 cm (p < 0.001), respectively. IGCs completely disappeared on MRI in 9 patients (69%). The latest electrodiagnostic studies confirmed improvement in all 12 patients with preoperative abnormalities. One patient (8%) with symptomatic recurrence was successfully treated with revision arthroscopic decompression.</p><p><strong>Conclusions: </strong>In patients with sciatic neuropathy, the possibility of IGCs arising from the hip should be considered. Our findings suggest that arthroscopic hip surgery is a less-invasive and more-effective treatment for relieving neuropathic pain and neurological deficits associated with sciatic IGCs.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PGE2 Ameliorates Aging-Aggravated Rotator Cuff Muscle Atrophy.","authors":"Longqiang Shu, Xin Wang, Haoyuan Wang, Yang Tang, Chongyang Wang, Yao Zhang","doi":"10.2106/JBJS.24.00866","DOIUrl":"https://doi.org/10.2106/JBJS.24.00866","url":null,"abstract":"<p><strong>Background: </strong>The aging-related escalation of muscle degeneration impacts the structure and function of rotator cuff muscles, contributing to spontaneous and tear-induced muscle atrophy. This study investigated how prostaglandin E2 (PGE2), a regulator of muscle regeneration, influences muscular structure and mitochondrial function in aged mice by using SW033291 to inhibit PGE2 degradation, revealing potential therapeutic pathways for mitigating rotator cuff muscle deterioration.</p><p><strong>Methods: </strong>A total of 20 young (5 to 6-month-old) and 100 aged (18 to 20-month-old) female C57BL/6J mice were divided into 2 groups: the first group included young, aged, and aged+SW033291 subgroups and was used to study sarcopenia, and the second group consisted of tear, tear+repair, and tear+repair+SW033291 subgroups and was used to examine the outcomes following a rotator cuff tear (RCT). Tissue staining, muscle mass assessments, functional assays, and mitochondrial function tests were performed.</p><p><strong>Results: </strong>Rotator cuff muscle degeneration was observed in the setting of natural aging and in the setting of an RCT. These conditions together worsened muscle atrophy and fatty infiltration into the muscle, with the aged tear group demonstrating a decrease in muscle mass from a mean and standard deviation of 45.45 ± 4.04 to 25.18 ± 1.82 mg (p < 0.001) and a reduction in fiber cross-sectional area (CSA) from 1,697.3 ± 108.4 to 1,263.0 ± 56.8 μm2 (p < 0.001). This was linked to increased 15-prostaglandin dehydrogenase (15-PGDH) activity and a reduction in PGE2 levels in the aged tear group (from 2.897 ± 0.177 to 1.873 ± 0.179 ng/g muscle; p < 0.001). SW033291 treatment increased the level of PGE2, reversing muscle atrophy by mitigating mitochondrial dysfunction in both models, as demonstrated by a muscle mass of 33.50 ± 3.05 mg and a CSA of 1,423.6 ± 81.3 μm2 in the presence of both conditions.</p><p><strong>Conclusions: </strong>These findings support the hypothesis that elevated PGE2 levels can improve muscle health by reversing mitochondrial dysfunction, offering a strategy to combat sarcopenia and to enhance rotator cuff repair.</p><p><strong>Clinical relevance: </strong>Large or massive RCTs are associated with muscle atrophy, a higher retear rate, and suboptimal surgical outcomes, especially in elderly patients. This study showed that the occurrence of rotator cuff muscle degeneration and muscular mitochondrial dysfunction in both the natural aging and RCT mouse models was mitigated by enhanced PGE2 levels. This finding demonstrates the efficacy of the application of a 15-PGDH inhibitor and suggests a possible new therapeutic approach.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immobilization Time for Conservative Treatment of Distal Radial Fractures in Elderly Patients: A Randomized Controlled Trial.","authors":"A Sala-Pujals, A Portes Chiva, J Chillon Soria, D Valverde Vilamala, E Dominguez Font, A Pardo Pol","doi":"10.2106/JBJS.24.01480","DOIUrl":"10.2106/JBJS.24.01480","url":null,"abstract":"<p><strong>Background: </strong>The management of distal radial fractures (DRFs) in elderly patients remains controversial. Although conservative treatment with cast immobilization is widely accepted, the optimal duration for immobilization is unclear. This study aimed to compare pain control, functional outcomes, and complication rates between 4-week and 6-week immobilization periods in elderly patients treated nonoperatively for displaced DRFs.</p><p><strong>Methods: </strong>A single-center randomized controlled trial was conducted, including 150 patients who were ≥65 years of age and had displaced DRFs. Patients were randomized into 2 groups: 4-week immobilization and 6-week immobilization. Pain was assessed using a visual analog scale (VAS) at 10 days after removing the cast and then at 3, 6, and 12 months after injury. Functional outcomes were measured using the Patient-Rated Wrist Evaluation (PRWE) and QuickDASH (the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire) at 3, 6, and 12 months. Radiographs were reviewed for malunion, and complications and range of motion were also evaluated.</p><p><strong>Results: </strong>In the 135 patients analyzed, no differences were observed in pain or functional outcomes between the 2 groups at any time point. VAS scores 10 days after the cast removal were similar (3.87 for the 4-week immobilization group and 4.00 for the 6-week group; p = 0.67), as were PRWE scores (14.18 for the 4-week group and 15.51 for the 6-week group; p = 0.686) and QuickDASH scores (15.46 for the 4-week group and 17.86 for the 6-week group; p = 0.449) after 1 year. The malunion rates were 29.9% in the 4-week group and 32.8% in the 6-week group (p = 0.85), and there were no significant differences in complications or range of motion between groups.</p><p><strong>Conclusions: </strong>A 4-week immobilization period provided equivalent pain control, functional outcomes, and complication rates as a 6-week immobilization period in elderly patients with displaced DRFs treated nonoperatively. Therefore, a shorter immobilization period may be safely recommended for treating these fractures.</p><p><strong>Level of evidence: </strong>Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1628-1635"},"PeriodicalIF":4.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future Is Mobile: Pilot Validation Study of Apple Health Metrics in Orthopaedic Trauma.","authors":"Dane J Brodke, Brian M Shear, Haley Demyanovich, Vivian Li, Alice Bell, David Okhuereigbe, Nelson F SooHoo, Gerard P Slobogean, Robert V O'Toole, Nathan N O'Hara","doi":"10.2106/JBJS.24.00842","DOIUrl":"https://doi.org/10.2106/JBJS.24.00842","url":null,"abstract":"<p><strong>Background: </strong>Surgeons often lack objective data on patient functional outcomes, particularly as compared with the patient's baseline. The present study aimed to determine whether gait parameters recorded on Apple iPhones provided longitudinal mobility data following lower-extremity fracture surgery that matched clinical expectations. We hypothesized that iPhones would detect the mobility changes of injury and early recovery, correlate with patient-reported outcome measures, and differentiate nonunion.</p><p><strong>Methods: </strong>This cross-sectional study included 107 adult patients with lower-extremity fractures who owned iPhones and had at least 6 months of follow-up. Participants shared Apple Health data and completed Patient Reported Outcomes Measurement Information System (PROMIS) surveys. The primary outcome was the daily step count. Four other gait-related parameters were analyzed: walking asymmetry, double support, walking speed, and step length. Mixed-effects models compared mobility parameters at pre-injury, immediate post-injury, and 6-months post-injury time points. Correlations between mobility parameters and PROMIS surveys were assessed. A mixed-effect model evaluated the relationship between step count recovery and surgery for nonunion.</p><p><strong>Results: </strong>There was a 93% reduction in daily step count from the pre-injury period to the immediate post-injury period (95% confidence interval [CI], -94% to -93%). Other gait parameters also showed increased impairment from pre-injury to post-injury. At 6 months, step count improved sixfold relative to the immediate post-injury period but remained 52% below baseline (95% CI, -55% to -49%). PROMIS Physical Function correlated moderately with step count (r = 0.42; 95% CI, 0.25 to 0.57) and weakly with other gait parameters. Patients with a known nonunion had a 55% slower recovery of step count than those without a nonunion (95% CI: 44% to 66%).</p><p><strong>Conclusions: </strong>Apple Health mobility parameters captured changes in mobility following lower-extremity fracture and throughout the subsequent recovery period. These metrics distinguished between patients with and without nonunions, demonstrating their potential usefulness as objective, real-world functional outcome measures. These \"digital biomarkers\" may aid clinical decision-making and research and could be utilized for the early identification of patients at risk for poor outcomes.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's Important (Arts & Humanities): In the Stillness of the Spine.","authors":"Kefu Chen","doi":"10.2106/JBJS.25.00203","DOIUrl":"https://doi.org/10.2106/JBJS.25.00203","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Option for Engaging Patients in Their Recovery: Commentary on an article by Brian M. Shear, MD, et al.: \"Predicting Post-Fracture Recovery with Smartphone Mobility Data. A Proof-of-Concept Study\".","authors":"Julie Agel","doi":"10.2106/JBJS.25.00216","DOIUrl":"https://doi.org/10.2106/JBJS.25.00216","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"107 11","pages":"1289"},"PeriodicalIF":4.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescents with Osteochondritis Dissecans of the Femoral Condyle Present with High Rates of Corresponding Coronal Malalignment.","authors":"V Claire Clark, Benjamin L Johnson, Charles W Wyatt, Bayley N Potter, Philip L Wilson, Henry B Ellis","doi":"10.2106/JBJS.24.00220","DOIUrl":"10.2106/JBJS.24.00220","url":null,"abstract":"<p><strong>Background: </strong>Osteochondritis dissecans of the knee (KOCD) may be a source of pain in active, skeletally immature patients. An association between the condylar lesion location and lower-extremity coronal plane malalignment has been established, but clinical implications have been poorly understood. This study aimed to confirm the high rate of malalignment in KOCD and variation in demographic characteristics, presentation features, and disease severity between those with and without malalignment.</p><p><strong>Methods: </strong>Prospectively collected clinical, demographic, and radiographic data were obtained, and standard standing alignment measurements were evaluated from an institutional KOCD cohort. Alignment was defined as whether the mechanical axis passed between the condyles (neutral), the lateral femoral condyle (valgus), or the medial femoral condyle (varus). Comparative analysis was performed between KOCD lesions in each condyle presenting with or without malalignment. The Fisher exact test or chi-square test was used to analyze categorical variables, and the t test or Mann-Whitney U test was used to analyze continuous variables.</p><p><strong>Results: </strong>This study examined 187 knees (156 patients, with a mean age of 12.9 years, 36.4% female); 66.3% had medial femoral condyle (MFC) lesions. Malalignment was found in 47.6% of all KOCD cases and 45.9% of skeletally immature cases. Twenty-nine (23.4%) of 124 MFC KOCD cases were in varus knees, and 42 (66.7%) of 63 lateral femoral condyle (LFC) KOCD cases were in valgus knees. MFC KOCD cases that presented in varus knees were more likely in Black or African American patients (p = 0.008) and had a larger lesion size, with a coronal width of 16.6 mm compared with MFC KOCD cases not in varus knees at 14.1 mm (p = 0.008). Similar differences were found in LFC KOCD cases presenting in valgus knees, which represented nearly all LFC KOCD cases in Black or African American patients (91.7%; p = 0.05) and had a larger lesion size, with a sagittal width of 20.8 mm compared with 16.4 mm for LFC KOCD cases not in valgus knees (p = 0.006).</p><p><strong>Conclusions: </strong>Nearly one-half of knees with KOCD in skeletally immature patients may be in coronal malalignment and, thus, candidates for guided growth. Malalignment corresponding to the involved compartment was common and was present in two-thirds of lateral lesions. When malalignment placed the weight-bearing axis within the involved compartment, lesions were larger and more advanced. Thus, consideration should be given to addressing malalignment found during evaluations.</p><p><strong>Level of evidence: </strong>Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1188-1199"},"PeriodicalIF":4.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring Sleep-Breathing Disorders in Patients with Idiopathic Scoliosis.","authors":"Erwei Feng, Junduo Zhao, Wenhao Cao, Yang Jiao, Haoyu Cai, Zhen Wang, Xu'an Huang, Yi Xiao, Jianxiong Shen","doi":"10.2106/JBJS.24.00867","DOIUrl":"10.2106/JBJS.24.00867","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic scoliosis (IS) is the most common spinal deformity and is often accompanied by abnormal respiratory function.</p><p><strong>Methods: </strong>This study investigated the correlations among radiographic parameters, pulmonary function tests, and sleep-breathing monitoring in patients with IS. The clinical data of patients with IS admitted to our hospital for scoliosis surgery between January 2020 and March 2022 were retrospectively collected. Radiographic measurements, including scoliosis and thoracic malformation parameters, were performed. Pulmonary function measurements and sleep-breathing monitoring results were collected for correlation analysis.</p><p><strong>Results: </strong>Overall, 19.8% of the 81 participants were diagnosed with obstructive sleep apnea. The sleep-breathing monitoring results showed a significant correlation between the main thoracic curvature and the lowest oxygen saturation (SpO 2 ) (r = -0.233; p = 0.036). The degree of thoracic kyphosis significantly correlated with FEV1/FVC (forced expiratory volume in 1 second/forced vital capacity) and FEV1. FEV1 was significantly correlated with the oxygen desaturation index (ODI) (r = -0.242; p = 0.03), as was FVC.</p><p><strong>Conclusions: </strong>In this study, 19.8% of the patients with thoracic IS had obstructive sleep apnea. In patients with IS, the severity of pulmonary function decline and SpO 2 during sleep-breathing correlated with the severity of thoracic scoliosis, whereas the decline in pulmonary function correlated with the ODI during sleep-breathing.</p><p><strong>Level of evidence: </strong>Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1245-1254"},"PeriodicalIF":4.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's Important: The Green Whistle.","authors":"Hong Jing Lee","doi":"10.2106/JBJS.24.01339","DOIUrl":"10.2106/JBJS.24.01339","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1276"},"PeriodicalIF":4.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Factors That Affect Operating Room Start Time for Pediatric Femoral Shaft Fractures.","authors":"Emi Schwab, Shanika De Silva, Kristin Livingston","doi":"10.2106/JBJS.24.01031","DOIUrl":"10.2106/JBJS.24.01031","url":null,"abstract":"<p><strong>Background: </strong>The operating room start time (ORST) for pediatric femoral fractures is a health-care quality metric used for hospital rankings and accreditation. Factors affecting ORST remain unclear. This study aimed to evaluate the demographic and clinical factors associated with gold-standard (early) ORST (<18 hours) versus delayed ORST (≥18 hours) for pediatric femoral fractures.</p><p><strong>Methods: </strong>A retrospective review was conducted of 216 pediatric patients with a femoral shaft fracture admitted to the emergency department (ED) at a pediatric Level-I trauma hospital from 2021 to 2023. Patient demographic and clinical data were analyzed to identify significant factors associated with ORST. Immediate postoperative outcomes were compared across ORST groups.</p><p><strong>Results: </strong>In multivariable models, race, ED admission time, comorbidities, and surgery type affected ORST (p < 0.05). Compared with White patients, patients of other racial or ethnic groups, including Hispanic, Black, Asian, and multiracial patients, had 2.4 times higher odds of delayed ORST. Compared with midnight to 6 a.m. ED admissions, the odds of delayed ORST were 6.6 times higher for ED admissions between 6 a.m. and noon and 9.2 times higher for ED admissions between noon and 6 p.m. Patients with comorbidities were 4.7 times more likely to experience delayed surgery compared with healthy patients. Patients who underwent open reduction and internal fixation (ORIF) were 2.5 times as likely as patients who underwent closed reduction (CR) with a spica cast to have delayed ORST. Delayed ORST was associated with longer hospital stay (median, 71 hours) compared with early ORST (median, 41 hours), but not with immediate complications.</p><p><strong>Conclusions: </strong>ED admission time, race, method of transfer, comorbidities, and procedure type were associated with ORST for pediatric femoral fractures. Longer ORST led to a disproportionately longer hospital stay.</p><p><strong>Level of evidence: </strong>Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1180-1187"},"PeriodicalIF":4.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12118612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}