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

{"title":"A Hip New Standard: Improving Osteoporosis Care with Inpatient Administration of IV Zoledronate.","authors":"Naomi M Turner, Marissa Song Mayeda, Bryanna De Lima, Darin Friess, Yee-Cheen Doung, Kathleen Drago","doi":"10.2106/JBJS.24.00766","DOIUrl":"10.2106/JBJS.24.00766","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis continues to be underdiagnosed and inadequately treated in older hip-fracture patients. Our aim was to improve the rate of osteoporosis treatment with IV bisphosphonate therapy in eligible patients admitted for hip-fracture surgery.</p><p><strong>Methods: </strong>The present study was designed as a quality improvement initiative using Plan-Do-Study-Act (PDSA) cycles at an academic medical center in Portland, Oregon, over 2.5 years. A protocol was developed (1) to administer IV zoledronate on postoperative day 2 to inpatients aged ≥50 years who underwent surgery for a low-energy hip fracture and (2) to formally diagnose osteoporosis during admission. The protocol was introduced across 3 care settings in a stepped-wedge manner. Outcome measures were the percentage of inpatient zoledronate administered to eligible patients and formal documented diagnosis of osteoporosis. Balance measures included fever after administration and hospital length of stay (LOS). Measures were assessed through quarterly chart review and tracked via control charts.</p><p><strong>Results: </strong>The rate of zoledronate administration significantly increased from 34.5% (29 of 84) to 74.6% (53 of 71) following the second PDSA cycle (p < 0.001). Documented osteoporosis diagnosis also significantly improved from 51.0% (53 of 104) to 85.7% (96 of 112) following the second PDSA cycle (p < 0.001). No significant differences were shown for hospital LOS, and 1 of 82 patients had medical work-up for post-infusion acute phase reaction after administration.</p><p><strong>Conclusions: </strong>This initiative was effective at improving osteoporosis diagnosis and treatment among older hip-fracture patients at our institution. Protocol development for administrating inpatient zoledronate after hip fracture is a reliable way to predictably offer bone health care and secondary-fracture prevention to hip-fracture patients and can be adapted and implemented at other institutions.</p><p><strong>Level of evidence: </strong>Diagnostic 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":"709-716"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416793","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":"Prevalence of Cataractous Changes in the Eyes and Chronic Inflammatory Changes in the Hands Among Spine Surgeons.","authors":"Yasukazu Hijikata, Kazuta Yamashita, Natsuko Hatsusaka, Tatsuo Nagata, Hiroko Kitamura, Koichi Morota, Satoru Matsuzaki, Koichi Nakagami, Go Hitomi, Tomoko Kuriyama, Munehiko Kowatari, Koichi Chida, Hiroshi Sasaki, Takashi Moritake","doi":"10.2106/JBJS.24.00433","DOIUrl":"10.2106/JBJS.24.00433","url":null,"abstract":"<p><strong>Background: </strong>The impact of radiation exposure on cataracts and hand skin cancer in orthopaedic and spine surgeons remains understudied. This study aimed to investigate the prevalence of cataracts and chronic hand inflammation in orthopaedic and spine surgeons and to assess their association with radiation exposure.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted on orthopaedic and spine surgeons attending the 38th Annual Meeting of the Neurospinal Society of Japan or the 31st Annual Meeting of the Japanese Society for the Study of Low Back Pain. Cataractous changes were categorized into none, lens micro-opacity, or cataracts and were detailed alongside the prevalence of chronic hand inflammation, which included longitudinal melanonychia and hand eczema. Participants were divided into quartiles according to hand-exposure opportunities in the operating and fluoroscopy rooms in 2022. Prevalence ratios and 95% confidence intervals (CIs) of chronic hand inflammation in the upper quartiles relative to the first quartile were calculated using modified Poisson regression adjusted for potential confounders.</p><p><strong>Results: </strong>The median work experience of the 162 participants was 23 years, and the median number of hand-exposure opportunities was 70 (interquartile range [IQR], 20 to 123) in the operating room and 20 (IQR, 0 to 60) in the fluoroscopy room. The prevalence of cataracts was 20% (32 participants), and the prevalence of cataractous changes, including lens micro-opacity, was 40% (64 participants). Chronic hand inflammation was present in 62 participants (38%), of whom 52 had longitudinal melanonychia and 23 had hand eczema. The adjusted prevalence ratios of chronic hand inflammation relative to the lowest quartile of hand-exposure opportunities in the operating room were 0.91 (0.50, 1.66) for quartile 2, 0.72 (0.41, 1.25) for quartile 3, and 1.56 (0.97, 2.50) for quartile 4. For fluoroscopy room exposure, the adjusted prevalence ratios were 2.31 (1.16, 4.58) for quartile 2, 2.03 (1.00, 4.09) for quartile 3, and 2.94 (1.51, 5.75) for quartile 4.</p><p><strong>Conclusions: </strong>This study highlighted substantial cataractous and chronic hand inflammatory changes in spine surgeons, indicating indirect and direct radiation exposure effects. Therefore, radiation safety and protective measures must be emphasized. Comparative studies with other populations and longitudinal observations are required to better understand the effects of radiation on health.</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":"e25"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449166","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}

{"title":"Outcomes for Younger Patients with Femoral Neck Fractures.","authors":"Boris C Wagner, William M Oliver, Katrina R Bell, Chloe E H Scott, John F Keating, Timothy O White, Nick D Clement, Andrew D Duckworth","doi":"10.2106/JBJS.23.00582","DOIUrl":"10.2106/JBJS.23.00582","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of longer-term outcome data in younger adult patients who undergo fixation for an intracapsular hip fracture. The aims of this study were to evaluate the outcomes for young adult patients undergoing intracapsular hip fracture fixation and to assess factors associated with failure and patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>From 2008 to 2018, 112 consecutive patients ≤60 years of age (mean age, 48 years [range, 20 to 60 years]; 54% male) were retrospectively identified as having undergone fixation of an intracapsular hip fracture. Displaced fractures (n = 81) were more common than nondisplaced or minimally displaced fractures (n = 31). Failure was defined as loss of fixation, nonunion, or osteonecrosis. PROMs that were assessed included the Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimension (EQ-5D) index and Visual Analogue Scale (EQ-VAS), and University of California Los Angeles (UCLA) Activity Scale.</p><p><strong>Results: </strong>Eighty-six patients (77%) had union without evidence of failure, and 26 patients (23%) had a failure, including loss of fixation (6 patients; 5.4%), nonunion (5 patients; 4.5%), and osteonecrosis (16 patients; 14.3%). Overall, 39 patients (35%) required secondary surgery, with hardware removal (21 patients; 18.8%) and total hip arthroplasty (21 patients; 18.8%) being the most frequent procedures. Long-term functional outcomes were obtained for 81 patients (72%) at a mean of 7 years (range, 2.8 to 12.8 years). The median OHS was 47 (interquartile range [IQR], 40-48), the median FJS was 75 (IQR, 49-85), the median EQ-5D index was 1.00 (IQR, 0.77-1.00), and the median EQ-VAS was 90 (IQR, 70-95). The mean UCLA score fell from 6.8 preinjury to 6.0 postinjury (p < 0.001). Compared with the patients who had primary union, those who had a complication had significantly lower median OHS scores (44.5 versus 47, p = 0.008), EQ-5D index scores (0.825 versus 1.00, p = 0.001), EQ-VAS scores (70 versus 90, p = 0.01), and UCLA scores (4.5 versus 6.5, p = 0.001).</p><p><strong>Conclusions: </strong>One in 4 young adult patients undergoing intracapsular hip fracture fixation had a failure. Failure was associated with inferior long-term function and health-related quality of life.</p><p><strong>Level of evidence: </strong>Therapeutic 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":"678-686"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882042","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}

{"title":"Aspirin Is as Effective and Safe as Oral Anticoagulants for Venous Thromboembolism Prophylaxis After Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.","authors":"Zhenghua Hong, Yongwei Su, Liwei Zhang, Hua Luo","doi":"10.2106/JBJS.24.00946","DOIUrl":"10.2106/JBJS.24.00946","url":null,"abstract":"<p><strong>Background: </strong>Joint arthroplasty effectively treats osteoarthritis, providing pain relief and improving function, but postoperative venous thromboembolism (VTE) remains a common complication. This study therefore assessed the effectiveness and safety of aspirin compared with oral anticoagulants (OACs) for VTE prophylaxis after joint arthroplasty.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was performed by searching PubMed, Embase, the Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) up to May 14, 2024, that compared the effect of aspirin versus OACs on VTE prophylaxis in adults undergoing joint arthroplasty. Data extraction followed the PRISMA guidelines. Two independent researchers conducted the literature searches and data extraction. A random-effects model was used to estimate effects. The primary outcome was the incidence of VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE); secondary outcomes included bleeding, wound complications, and mortality.</p><p><strong>Results: </strong>The meta-analysis included 11 RCTs with a total of 4,717 participants (55.1% female) from several continents. The relative risk (RR) of VTE following joint arthroplasty was 1.11 (95% confidence interval [CI], 0.93 to 1.32) for aspirin compared with OACs. Similar results were observed for DVT (RR, 1.12; 95% CI, 0.90 to 1.40) and PE (RR, 1.18; 95% CI, 0.51 to 2.71). There were no significant differences in the risks of bleeding, wound complications, or mortality between patients receiving aspirin and those receiving OACs. Subgroup analyses considering factors such as study region, type of joint surgery, type of VTE detection, year of publication, use of mechanical VTE prophylaxis, aspirin dose, type of OAC comparator, study quality, and funding also found no significant differences in VTE incidence between aspirin and OACs. The overall quality of evidence for VTE and DVT outcomes was high.</p><p><strong>Conclusions: </strong>Based on high-quality evidence from RCTs, aspirin is as effective and safe as OACs in preventing VTE, including DVT and PE, after joint arthroplasty, without increasing complications.</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":"760-770"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005959","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}

{"title":"Molecular Evidence Supporting MEK Inhibitor Therapy in NF1 Pseudarthrosis.","authors":"Nandina Paria, Ila Oxendine, David Podeszwa, Meghan Wassell, Reuel Cornelia, Carol A Wise, Jonathan J Rios","doi":"10.2106/JBJS.24.01007","DOIUrl":"10.2106/JBJS.24.01007","url":null,"abstract":"<p><strong>Background: </strong>Neurofibromatosis type 1 (NF1) is a genetic condition predisposing children to fracture pseudarthroses. MEK inhibitors are U.S. Food and Drug Administration-approved or are under study for the treatment of malignant pathologies associated with NF1. However, their potential to treat pseudarthrosis is largely unknown.</p><p><strong>Methods: </strong>Primary cells cultured from control bone or fracture pseudarthroses from children with NF1 were treated with vehicle or with the MEK inhibitors trametinib or selumetinib. Gene expression was evaluated with use of transcriptome sequencing (RNAseq), and the activation of the downstream signaling pathway was evaluated with use of western blotting. Results were replicated in an independent cohort of patient fracture pseudarthrosis-derived primary cells.</p><p><strong>Results: </strong>Pseudarthrosis samples were reproducibly associated with the reduced expression of gene signatures implicated in osteoblast differentiation, skeletal development, and the formation of the extracellular matrix. The expression of these gene signatures was significantly rescued following treatment with MEK inhibitors and concomitant reduced MEK/ERK (MAPK) pathway activation.</p><p><strong>Conclusions: </strong>Our study identified molecular signatures associated with fracture pseudarthrosis that were rescued with MEK inhibitor treatment.</p><p><strong>Clinical relevance: </strong>MEK inhibitors may promote the healing of fracture pseudarthroses in children with NF1.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763222","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}

{"title":"AOA Critical Issues Symposium: The Development of an Adaptive Learning Platform in Orthopaedics.","authors":"Marc Swiontkowski, Marc Berg, Chris Chiodo","doi":"10.2106/JBJS.24.01406","DOIUrl":"https://doi.org/10.2106/JBJS.24.01406","url":null,"abstract":"<p><strong>Abstract: </strong>Adaptive learning is a powerful educational tool that uses computer algorithms to personalize and streamline an individual's learning experience. These algorithms allow for continual assessment and real-time customization of the delivery of educational content based on a specific learner's knowledge base; such algorithms mimic a 1-to-1 learning model. The current symposium describes the application of adaptive learning to orthopaedics, as well as the development of an online educational platform that utilizes this promising technology.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763220","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":"A Novel, Easy-to-Measure Radiographic Parameter to Assess Spinopelvic Malalignment: The Pelvic Inclination Angle.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee, Seung Woo Suh, Yunjin Nam","doi":"10.2106/JBJS.24.00520","DOIUrl":"https://doi.org/10.2106/JBJS.24.00520","url":null,"abstract":"<p><strong>Background: </strong>Pelvic tilt (PT) is an important sagittal parameter to be restored to the normal range in corrective surgery for spinopelvic malalignment. However, the normal value of PT varies among patients. With the introduction of the pelvic inclination angle (PIA), which is the angle subtended by the vertical axis and the line connecting the anterior pubic tubercle and the anterior superior iliac spine, we aimed to determine whether the PIA could reflect the symptom severity and whether normal PIA values exist.</p><p><strong>Methods: </strong>The study cohort consisted of patients with spinopelvic malalignment (patient group) and normal healthy adults (normal group). In the patient group, correlation analyses were performed to investigate the relationship between the PIA and other sagittal parameters and between the sagittal parameters and patient-reported outcome measures. In the normal group, correlation analysis was performed to assess the relationship between pelvic incidence (PI) and other sagittal parameters. The radiographic parameters were compared according to PI categories.</p><p><strong>Results: </strong>There were 162 patients in the patient group, with a mean age of 71.1 years, and 108 in the normal group, with a mean age of 32.1 years. In the patient group, the PIA strongly correlated with the conventional parameters such as PT, PI-lumbar lordosis mismatch, and T1-pelvic angle. The PIA had weak to moderate correlations with all patient-reported outcome measures, of which the correlation coefficients were similar to or greater than those of other sagittal parameters with patient-reported outcome measures. In the normal group, PI showed moderate to strong correlations with all conventional sagittal parameters except for the PIA, which correlated very weakly with PI. Unlike the other sagittal parameters, the PIA did not significantly differ among the PI categories.</p><p><strong>Conclusions: </strong>The PIA reflected the symptom severity and had a normal value independent of PI. As an alternative to PT, the PIA can be a clinically useful parameter in evaluating and managing patients with spinopelvic malalignment.</p><p><strong>Clinical relevance: </strong>As the PIA is independent of PI, it will be more useful in differentiating between patients with normal spinopelvic alignment and those with spinopelvic malalignment and in reflecting the clinical symptoms of patients with spinopelvic malalignment. In addition, by providing a cutoff value of 13.6°, the PIA can be used as a surgical target or to predict postoperative outcomes.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736060","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":"Addressing Issues of Inclusive Workplace Culture for Women Orthopaedic Surgeons in Academia: A Qualitative Investigation.","authors":"Katherine M Gerull, Amanda M Faust, Carrie N Reaver, Eshan S Sane, Cara A Cipriano, Anna N Miller","doi":"10.2106/JBJS.24.01134","DOIUrl":"https://doi.org/10.2106/JBJS.24.01134","url":null,"abstract":"<p><strong>Background: </strong>The scarcity of women in academic orthopaedics has persisted for decades despite general interest in promoting diversity. Therefore, we aimed to understand what aspects of workplace culture enhance or detract from building an inclusive workplace for women surgeons in academic orthopaedics.</p><p><strong>Methods: </strong>Women orthopaedic surgeons in the United States with a range of training backgrounds, races/ethnicities, academic institutions, subspecialties, and geographic locations were recruited using purposive sampling techniques until thematic saturation was achieved. All women currently hold or previously held an academic position in orthopaedics. Forty-minute virtual semistructured interviews were conducted from December 2023 to April 2024. Data were analyzed using grounded theory methodology to develop a conceptual model of inclusive culture.</p><p><strong>Results: </strong>Of the 35 women approached for participation, 26 (74%) participated. Eighty-one percent were currently in academia, and 19% had left academia; 12% identified as Asian, and 23% identified as Underrepresented in Medicine (URiM). Our model of inclusive workplace culture is built on 2 interrelated pillars: \"supportive structures\" and \"social inclusion.\" The first pillar, supportive structures, is primarily under the direction of department leaders and includes themes of intentional career development, valuing diverse contributions, transparent policies, and building department cohesiveness. The second pillar, social inclusion, relies on all members of an organization. Themes within social inclusion are respect for women, male allyship, women supporting women, and true integration of women surgeons.</p><p><strong>Conclusions: </strong>With intentional effort, orthopaedic departments can create the structures of support necessary to foster women's career success, as well as the social inclusion to encourage their longevity in academia.</p><p><strong>Clinical relevance: </strong>TK.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736088","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":"https://doi.org/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":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-28","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":"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":"https://doi.org/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":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}