Journal of Orthopaedic Trauma最新文献

{"title":"Defining Percentiles for Cases Performed During Accreditation Council for Graduate Medical Education Accredited Orthopaedic Trauma Training.","authors":"Jason Silvestre, Jaimo Ahn, Michael J Weaver, Mitchel B Harris, Kristoff R Reid, Langdon A Hartsock","doi":"10.1097/BOT.0000000000003046","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003046","url":null,"abstract":"<p><strong>Objectives: </strong>Accrediting bodies in orthopaedic trauma education are adopting case minimum requirements to enhance orthopaedic trauma fellowship training. This study defined case volume percentiles during Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic trauma fellowship training.</p><p><strong>Methods: </strong>This was a retrospective cohort study of orthopaedic trauma fellows graduating from ACGME-accredited programs (2018-2023). Percentiles for reported case volumes were calculated across ACGME-defined case categories. Variability was defined as fold-differences between the 90th and 10th percentiles of orthopaedic trauma fellows by case volume. Annual trends in reported case volumes were analyzed with linear regression. Sensitivity analyses were performed to identify potential case minimum requirements.</p><p><strong>Results: </strong>There were 117 orthopaedic trauma fellows included in this study, which represented all ACGME-accredited fellows from 2018 to 2023. Mean annual reported case volume did not change significantly over the study period (505 ± 126 to 558 ± 106, 10.5% increase, P=0.176). Pediatric cases accounted for a minority of cases (1.2%). Reported cases were mostly in pelvis / hip (n=123, 25%), femur / knee (n=100, 20%), and leg / ankle (n=86, 17%). Variability in reported case volumes between the 90th and 10th percentiles was greatest in fasciotomy (20.5-fold), debridement (8.4-fold), and external fixation (5.8-fold). The tenth and thirtieth percentiles of ACGME-accredited orthopaedic trauma fellows reported a total of 343 and 431 cases, respectively.</p><p><strong>Conclusions: </strong>Analysis of reported case volumes from ACGME-accredited orthopaedic trauma fellows suggest performance of 343 and 431 cases to achieve tenth and thirtieth percentiles, respectively. Understanding areas of case volume variability can assist future fellows and faculty improve operative training experiences during orthopaedic trauma fellowship training.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal Interlocking Screw Backout in New-Generation Retrograde Femoral Nails.","authors":"Adam N Musick, Robert K Wagner, Kameron M Kraus, Wyatt G S Southall, Austin T Gregg, Thomas J Policicchio, Maaz Muhammad, Stephen T Duncan, David C Landy, Arun Aneja","doi":"10.1097/BOT.0000000000003043","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003043","url":null,"abstract":"<p><strong>Objectives: </strong>To compare distal interlocking screw backout rates between two new-generation retrograde femoral nails: the DePuy Synthes RFN-Advanced Retrograde Femoral Nail (RFNA) and the Stryker T2 Alpha Femur Retrograde Nail (T2 Alpha).</p><p><strong>Methods: </strong>Design: Retrospective comparative study.</p><p><strong>Setting: </strong>Three Level 1 Trauma Centers.</p><p><strong>Patient selection criteria: </strong>Patients aged ≥18 years who underwent operative fixation with the RFNA or T2 Alpha for a diaphyseal or distal femur fracture (OTA/AO 32-33) between November 2022 and August 2024 with a minimum follow-up of 3 months.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was the distal interlocking screw backout rate. Secondary outcomes included time to backout and reoperation rates for screw removal. Outcomes were compared between the RFNA and T2 Alpha.</p><p><strong>Results: </strong>A total of 103 patients (median age 59 years [IQR: 38-73], 61% female) were included, comprising 63 OTA/AO 32 and 40 OTA/AO 33 fractures, with 24 treated with the RFNA and 79 with the T2 Alpha. Backout rates were higher in the RFNA group (38% [95% CI: 20-59%] vs. 5.1% [95% CI: 1.6-13%], p<0.001). Stratified by fracture location, backout rates remained higher in the RFNA group for both diaphyseal (6/20 [30%] vs. 1/43 [2.3%], p=0.003) and metaphyseal fractures (3/4 [75%] vs. 3/36 [8.3%], p=0.008). Time to backout was earlier in the RFNA group (5 weeks [IQR: 3-6] vs. 19 weeks [IQR: 14-31], p=0.013). Reoperation rates for screw removal were higher in the RFNA group (21% vs. 0%, p<0.001). The median follow-up for the overall cohort was 27 weeks (IQR: 18-41).</p><p><strong>Conclusions: </strong>The RFNA was associated with a higher rate of distal interlocking screw backout, an earlier time to backout, and an increased reoperation rate for screw removal compared to the T2 Alpha. These findings can guide surgeons in implant selection and highlight the need for solutions to mitigate distal interlocking screw backout in the RFNA.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor Tranexamic Acid and Heterotopic Ossification Formation Following Elbow Surgery: A Prospective Randomized Controlled Trial.","authors":"Erez Avisar, Ahmad Essa, Ryan Paul, Eric Kachko, Oded Rabau, Rom Mattan, Jonathan Persitz","doi":"10.1097/BOT.0000000000003031","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003031","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interobserver Reliability of the Modified Radiographic Union Score (mRUST) for Tibial and Femoral Fractures.","authors":"Dominik Deppe, Matteo Gabriele, Manuel Giovanni Mazzoleni, Alejandro Ordas-Bayon, Andrea Fidanza, Yuriy Rozhko, Ekin Kaya Şimşek, Eran Keltz, Georg Osterhoff, Philipp Damm, Georg N Duda, Marko Leskovar, Stefan Zachow, Adam Trepczynski, Mark Heyland","doi":"10.1097/BOT.0000000000003032","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003032","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the reliability of the modified Radiographic Union Score for Tibial fractures (mRUST) as a reliable tool for monitoring lower limb fractures (Femur, Tibia) treated with various modalities (Nail, Plate).</p><p><strong>Methods: </strong>Design: Retrospective analysis.</p><p><strong>Setting: </strong>Single center academic hospital in Germany.</p><p><strong>Patient selection criteria: </strong>Adult patients (≥18 years) with extra-articular long bone fractures of the lower extremities treated surgically between January 2005 and April 2022, requiring radiographs in two perpendicular planes and at least one follow-up visit, were included. Exclusion criteria were critical clinical conditions, inability to consent, joint articulation fractures, inadequate documentation, or insufficient imaging quality.</p><p><strong>Outcome measures and comparisons: </strong>Six international investigators (five orthopedic surgeons, one radiologist) independently assessed fracture line and callus growth per cortex (mRUST) at individualized follow-up timepoints based on clinical practice. To evaluate inter-rater reliability, intraclass correlation coefficients (ICC) were calculated for the overall dataset, and for subsets of rated images, that were defined based on anatomical location (femur/tibia), treatment type (plate/nail fixation), and treatment combinations across locations.</p><p><strong>Results: </strong>A total of 166 patients (63 femur fractures, 103 tibia fractures; 32.5% female, mean age 43.4 (18-84)) with 1,136 follow-up timepoints were analyzed. Overall inter-rater reliability for mRUST was good (ICC 0.77), consistent across fixation methods (nail/plate fixation, 0.79) and anatomical locations (tibia, 0.78; femur, 0.81). Cortex-specific reliability varied, with highest agreement for the medial cortex (0.70-0.74) and lowest for the posterior cortex (0.65-0.74).</p><p><strong>Conclusions: </strong>The mRUST (radiographic score) demonstrated reliability for monitoring fracture healing in the femur and tibia, irrespective of fixation method, supporting its use as a generalizable tool across lower limb fractures.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Has the impact of surgical timing on postoperative heterotopic ossification following elbow fractures been clearly evaluated?","authors":"Shuhao Bi, Baojian Zhang, Yanqun Liu","doi":"10.1097/BOT.0000000000003030","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003030","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine use of autograft is not necessary for treatment of humeral shaft nonunions and anticipated nonunions after failed nonoperative treatment.","authors":"Erika Roddy, Jonah Hebert Davis, Reza Firoozabadi, David Barei","doi":"10.1097/BOT.0000000000003028","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003028","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if the use of autogenous bone graft is necessary for the treatment of humeral shaft nonunions after initial nonoperative management.</p><p><strong>Design: </strong>Retrospective.</p><p><strong>Setting: </strong>Level 1 academic trauma center.</p><p><strong>Patient selection criteria: </strong>All skeletally mature patients undergoing nonunion repair of a humeral shaft fracture (AO/OTA 12A, 12B, 12C) after initial nonoperative management of the acute fracture.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was osseous union. Failure of nonunion repair was defined by lack of osseous union within 365 days from surgery and/or return to the operating room for additional attempts to promote union. Secondary outcomes included complications including infection, radial nerve palsy, and donor site morbidity.</p><p><strong>Results: </strong>Seventy-two patients were included in the final cohort. Thirty-eight patients (53%) were female, and the average age was 51 (SD 18, range 17, 83). Two patients (3%) developed a recalcitrant nonunion, both of which healed after a second procedure consisting of revision compression plating. The use of bone autograft was uncommon overall in this cohort (4 patients, 6%). Bone morphogenic protein, bone allograft, or demineralized bone matrix was used in 12 patients (17%). The remaining 56 patients (78%) were treated with compression plating alone. Compression was generated through multiple techniques including use of the articulated tensioning device, a pull screw with a verbrugge clamp, lag screw application, and compression generated via eccentric drilling through the plate. There were no differences in terms of patient demographics, fracture or injury characteristics between the groups that received autograft and those who did not (p>0.05). Use of autograft or other biologic supplementation was not associated with a statistically significant increase in union rate, 100% versus 97% (p=1.00). In the four patients who underwent autogenous bone grafting, there were no reported donor site complications.</p><p><strong>Conclusions: </strong>For humeral shaft fractures initially treated nonoperatively that went on to nonunion or anticipated nonunion, the union rate for compression plating alone was comparable to the union rate noted in the literature after treatment with bone autograft and compression plating. These results suggest that routine use of bone autograft may be unnecessary in the treatment of humeral shaft nonunions.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infrapatellar vs suprapatellar nailing for fractures of the tibia (INSURT study): A multicentered randomized controlled trial.","authors":"David J Cinats, Darius Viskontas, Trevor Stone, Bertrand Perey, Farhad Moola, Dory Boyer, H Michael Lemke, Kelly Apostle, Alan J Johnstone","doi":"10.1097/BOT.0000000000003029","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003029","url":null,"abstract":"<p><strong>Objectives: </strong>To compare suprapatellar and infrapatellar tibial nail insertion approaches on post-operative knee pain.</p><p><strong>Methods: </strong>Design: Randomized controlled trial.</p><p><strong>Setting: </strong>Multi-centered academic level 1 trauma centers.</p><p><strong>Patient selection criteria: </strong>Included were all patients 18 to 65 years of age with nailing OTA/AO type 42 and 43A fractures amenable to and indicated for repair with reamed intramedullary nailing.</p><p><strong>Outcome measures and comparisons: </strong>Patients were randomized to receive a tibial intramedullary nail through either a suprapatellar or infrapatellar approach. The primary outcome was the visual analog scale (VAS) for knee pain after kneeling for 60 seconds. The study was designed to have 80% power to detect a 1.6-point difference in the VAS for pain on kneeling, which was considered clinically significant. Secondary outcomes included the Aberdeen Kneeling Test (AKT) and Aberdeen Standing Test (AST) (objective measures of weight-bearing capacity while kneeling and standing), Lysholm score, EQ-5D score, and Work Productivity and Activity Impairment Questionnaire (WPAI). The outcomes were recorded at 6 weeks, 4 months, 6 months, one year, and two years post-operatively.</p><p><strong>Results: </strong>254 patients were randomized with 128 patients randomized to suprapatellar nailing and 117 patients randomized to infrapatellar nailing. 96 patients (68.8% male) in the suprapatellar group (mean age 42.4 years, range 18-60 years) and 93 patients (69.2% male) in the infrapatellar group (mean age 38.8 years, range 19-52 years) completed 2-year follow-up. The VAS after kneeling for 60 seconds in the suprapatellar group was lower than the infrapatellar group at 6 weeks (4.1 vs 5.2 p=0.012), 4 months (2.8 vs 4.1 p=0.0003), 6 months (2.2 vs 3.2 p=0.0041), and one year (1.4 vs 2.7 p=0.0021) post-operatively and was statistical significant but not clinically significant. The AKT demonstrated that patients who underwent suprapatellar nailing could bear significantly more weight through their operative knee compared to the infrapatellar treatment group at 6 weeks (36% vs 27% p=0.0004), 4 months (45% vs 41% p=0.0012), 6 months (47% vs 43% p=0.001), one year (49% vs 45% p=0.0007), and two years (50% vs 46% p=0.001) post-operatively.</p><p><strong>Conclusions: </strong>There was no clinically significant difference between suprapatellar and infrapatellar nailing in terms of VAS knee pain or PROMs. Patients in the suprapatellar cohort could bear more weight through their operative knee up to and including 2 years post-surgery. Patients should be counseled on the ability to kneel and the nail insertion method when considering nail insertion technique.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury-associated anemia and iron homeostasis following orthopaedic trauma: a prospective observational study of 844 patients.","authors":"Danielle F Peterson, Natasha S McKibben, Victoria R Duke, Catherine E Hutchison, Chih Jen Yang, Colby Curtis, Karalynn Lancaster, Talia Trapalis, Dongseok Choi, Joseph J Shatzel, Graham J Dekeyser, Darin M Friess, Martin A Schreiber, Joseph E Aslan, Karina Nakayama, Nick J Willett, Zachary M Working","doi":"10.1097/BOT.0000000000003027","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003027","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the incidence of injury-associated anemia and functional iron deficiency following operative fracture care.</p><p><strong>Methods: </strong>Design: Prospective cohort study.</p><p><strong>Setting: </strong>Level 1, academic trauma center.</p><p><strong>Patient selection criteria: </strong>All operative fracture patients who presented between April 2022 and August 2023 were screened.</p><p><strong>Outcome measure and comparisons: </strong>Laboratory tests for anemia were performed on post-operative day one including complete blood count, serum iron, total iron binding capacity (TIBC), percent transferrin saturation (TSAT), transferrin, and ferritin levels. Values were enumerated to capture the previously unknown incidence of injury-associated anemia.</p><p><strong>Results: </strong>844 patients were screened following operative fracture management (mean: 52 years (SD 22), 58% male). Injury-associated anemia was present in 94.7% (median hemoglobin: 10.0 [IQR: 8.5 - 11.1]) of the 844 eligible patients; 72.5% of patients with anemia did not reach transfusion requirements (hgb <7.0). Only 33% (270/800) received an ICD-10 diagnosis code for anemia during the hospital admission. Functional iron deficiency was present in 80.9% of eligible patients, while 94.5% demonstrated derangements in body iron stores. Ferritin levels were >50 ng/mL in 89.8% of patients overall and 96.9% in patients with all other iron studies low. Patients with fractures in multiple extremities demonstrated 52% higher odds of elevated ferritin levels than patients with isolated fractures after controlling for transfusions and sex (adjusted OR 1.52, 95%CI: 1.06-2.17, p=0.02).</p><p><strong>Conclusion: </strong>The incidence of injury-associated anemia and functional iron deficiency was exceedingly common following operative orthopaedic trauma. Ferritin was more likely to be normal or high even when all other iron values were low, indicating that iron may become sequestered and unavailable for replenishing blood cell volume. Improving documentation of perioperative anemia after trauma and directing future research to counteract both anemia and functional iron deficiency may benefit most orthopaedic trauma patients.</p><p><strong>Level of evidence: </strong>Prognostic Level 1.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Reoperation in Induced Membrane Technique for Acute Traumatic Bone Loss.","authors":"Lillia Steffenson, Alex Roszman, Cameron Wallace, Taylor Corbin Kot, Clay Spitler, Patrick Bergin, Michael Githens, Justin Haller","doi":"10.1097/BOT.0000000000003024","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003024","url":null,"abstract":"<p><strong>Objectives: </strong>To identify patient, injury, and surgical characteristics associated with success or failure of Masquelet's induced membrane technique (IMT) for acute traumatic bone loss.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Four Level 1 Academic Trauma Centers.</p><p><strong>Patients selection criteria: </strong>Patients acutely treated with IMT for AO/OTA 32, 33, and 41-43 fractures with bone loss at four Level 1 trauma centers between 2010-2020.</p><p><strong>Outcome measure and comparisons: </strong>Primary outcome was fracture union with comparison between union after initial two stage IMT versus patients who underwent reoperation to promote union or experienced treatment failure defined as: amputation, implant dependent, or persistent nonunion. Variables of interest included demographic variables, injury characteristics, and differences in surgical management (definitive fixation construct, autograft source, use of graft adjuvants).</p><p><strong>Results: </strong>130 fractures with defects were treated with IMT, including 72 tibial fractures and 58 femoral fractures with an average defect length of 6.4cm. Average age of patients was 40 years (range 16 to 68 years) and 65 percent of patients were male. Demographic characteristics including age, sex, BMI, tobacco and alcohol use were not significantly different among treatment outcomes (p >.05). Initial success after two stage IMT was 57.7% (75/130) and 82% (107/130) after subsequent reoperation. Increasing defect length was associated with failure of IMT (mean 5.4 vs 8.3cm, p=.03). Deep infection after stage 2 surgery was associated with reoperation to promote union and treatment failure (p<.01).</p><p><strong>Conclusions: </strong>In this study of acute traumatic bone loss, shorter defect length and absence of infection were significantly associated with success of IMT. Meanwhile fixation construct and autograft choice were not associated with treatment outcome.</p><p><strong>Level of evidence: </strong>III retrospective comparative cohort series.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost of Orthopaedic Trauma Surgery is Weakly Associated with Industry Payments to Surgeons.","authors":"Harsh Wadhwa, Gavin Touponse, Guan Li, Julius A Bishop, Corinna C Zygourakis","doi":"10.1097/BOT.0000000000003021","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003021","url":null,"abstract":"<p><strong>Objective: </strong>To examine the relationship between industry payments to surgeons and total cost of orthopaedic trauma surgery. Secondarily, to investigate the relationship between surgeon industry payments and operating room cost, length of stay, 30-day mortality, and 30-day readmission.</p><p><strong>Methods: </strong>Design: Retrospective cross-sectional database study with minimum 30-day follow-up.</p><p><strong>Setting: </strong>20% sample of Medicare beneficiaries from January 2006 to December 2015 from the Medicare database.</p><p><strong>Patient selection criteria: </strong>Medicare-insured patients undergoing orthopaedic trauma surgery identified by CPT codesOutcome Measures and Comparisons: The primary outcomes were the risk-adjusted relationship between amount of industry payments to surgeons and the total and operating costs. The secondary outcomes were the risk-adjusted relationships between amount of industry payments to surgeons and hospital length of stay, mortality, and readmission.</p><p><strong>Results: </strong>99.9% of orthopaedic trauma surgeons (n=9,023) received industry payments. Median patient age was 82 (IQR: 15), 73.2% female, 91.5% White, and with multiple comorbidities (CCI median [IQR] 6 [4]). After multivariable risk adjustment, for each $1,000 increase in surgeon industry payments, total and operating room cost of cases increased by $2.25 and $1.26 (0.003% and 0.008% of total cost), respectively (p<0.001). The median industry payment was $607.72 compared to the mean of $12,070.84 indicating a highly right-skewed distribution of payments. Amount of industry payments were not associated with length of stay (p=0.18), 30-day mortality (p=0.094) or readmission (p=0.59) after orthopaedic trauma surgery. Total and operating room cost was approximately $8,920 (17.8%) and $1,481 (14.2%) higher for surgeons receiving the highest 5% of industry payments (p<0.001). These surgeons generally practiced in large urban areas (51.7%; p<0.001), in hospitals with higher number of beds (median 398; p<0.001), with higher wage index (0.96; p<0.001).</p><p><strong>Conclusions: </strong>and Relevance: While most orthopaedic trauma surgeons received industry payments, a minority of surgeons received the majority of payments. Although industry payments may lead to conflicts for some surgeons, these conflicts affect only a small proportion of the cost of fracture care.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}