Journal of Orthopaedic Trauma最新文献

{"title":"What is the Rate of Occult Vessel Abnormalities in High-Energy Tibial Plateau Fractures (OTA/AO 41)?","authors":"Douglas Zhang, Jennifer Eurich, Lauren Pitz-Goncalves, Gregory Schimizzi, Mary Kate Erdman, Anthony Christiano","doi":"10.1097/BOT.0000000000003215","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003215","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the rate of occult vascular abnormalities in high-energy tibial plateau fractures using Computed Tomography Angiography (CTA).</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Prospective Cohort Study.</p><p><strong>Setting: </strong>Single Academic Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Adult subjects with a tibial plateau (OTA/AO 41) fracture, without clinical indication for CTA, that underwent knee-spanning external fixation were prospectively enrolled.</p><p><strong>Outcome measures and comparisons: </strong>Following external fixation, subjects underwent CTA to evaluate fracture morphology and the vascular tree. Fisher's exact test was utilized to determine correlations between arterial abnormalities and wound complications in patients with ≥90 days of follow-up.</p><p><strong>Results: </strong>Twenty-six subjects with 27 high-energy tibial plateau fractures were enrolled. Subjects were predominantly male (n=16, 61.5%) with a mean age of 45.1±13.3 years. All patients had a blunt injury mechanism resulting in mostly closed (n=25, 92.6%) bicondylar (n=22, 81.5%) tibial plateau fractures. CTA demonstrated non-atherosclerosis vascular abnormalities in three patients (11.5%). Two had disrupted flow in the popliteal artery, and one had disrupted flow in the anterior tibial artery. No subjects required vascular intervention. Atherosclerosis was appreciated in six (26.9%) subjects. One of three subjects (33%) with non-atherosclerosis vascular abnormalities had wound complications. Four of 24 subjects (16.7%) without non-atherosclerosis vascular abnormalities had wound complications. There was no significant correlation between non-atherosclerosis vascular abnormalities and wound complications (abnormality present: 33.3% wound complication rate vs. no abnormality: 16.7%, p=0.47).</p><p><strong>Conclusions: </strong>Non-atherosclerotic vascular abnormalities on CTA were found in approximately a tenth of high-energy tibial plateau fractures. In this cohort, vascular abnormalities were not associated with wound complications. CTA is likely not necessary in tibial plateau fracture patients without clinical indications for CTA.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839385","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":"Author's Response Re: Methodological concern regarding the multivariable analysis of rare implant breakage events.","authors":"Noelle L Van Rysselberghe, Michael J Gardner","doi":"10.1097/BOT.0000000000003221","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003221","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839299","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":"A Dual-Implant Approach to Vancouver C Femur Fractures: Improved Outcomes with Retrograde Nail and Lateral Plate Fixation Compared to Lateral Locked Plating.","authors":"Brendan E Page, M Kareem Shaath, Griffin R Rechter, Bader A Nasir, Timothy J Baker, Jon P Yawman, Elizabeth Jacobs, Joshua R Langford, George J Haidukewych","doi":"10.1097/BOT.0000000000003218","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003218","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare lateral locked plating (LLP) to a combined treatment approach utilizing a retrograde intramedullary nail (rIMN) alongside a minimally invasive lateral locked periprosthetic plating system (PPS) (Smith & Nephew; Memphis, TN) in the management of Vancouver C periprosthetic femoral fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective chart review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single, academic, Level-1 Trauma center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;All adult patients who underwent fixation of a Vancouver C periprosthetic femur fracture (AO/OTA Type 32C [IVC/D]) with a rIMN and PPS (NP Group) or LLP (LLP group) between 2019 and 2025 with follow-up to union, reoperation, or a minimum of one year were included. Patients in the NP group were recommended to fully bear weight immediately while patients in the LLP group were recommended to remain non-weight bearing for 8 weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The primary outcome was fracture union. Secondary outcomes included implant failure, infection, and alignment immediately postoperatively and at final follow-up. Primary and secondary outcome measures were compared between the NP and LLP groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 52 patients were included. 31 in the NP group (68% female, mean age 79 years (range, 67 - 99)) and 21 in the LLP group (67% female, 69 years (range, 53 - 85)), (p = 0.54 for sex, p = 0.26 for age). In both groups, the lateral plate extended proximal to the hip prosthesis by at least 3 screw holes. There were no differences when comparing body mass index, diabetes, smoking status, mechanism of injury, or fracture classification between groups (p &gt; 0.05). In the NP group the mean immediate aLDFA was 82 degrees range (79-87 degrees) compared to 80 degrees (range 79 - 87 degrees) at final follow-up (p = 0.37; 95% CI -5.08 to 12.9). In the LLP group the mean immediate aLDFA was 80 degrees (range, 63 - 87 degrees), compared to 82 degrees (range 69 - 87 degrees) at final follow-up (p = 0.43; 95% CI, -5.35 to 2.37). There was no difference in alignment both immediately postoperatively and at final follow-up between groups (p = 0.20 and 0.45, respectively). There were 2 reoperations (6%) in the NP group, both a removal of a loose interlocking screw. There were 3 reoperations (14%) in the LLP group, all nonunions without implant failure that were revised to nail-plate constructs and subsequently achieved union. There was no difference in reoperation between groups (p = 0.68). There were 0 nonunions in the NP group compared to 3 (14%) in the LLP group (p = 0.03). There were no cases of implant failure or infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Retrograde nail/plate combination demonstrated a high union rate when treating Vancouver C periprosthetic femur fractures. When compared to lateral locked plating alone which does not facilitate immediate weig","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839322","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":"Non-tobacco nicotine dependence is associated with increased fracture risk in adolescents and young adults.","authors":"Jeffrey Zhang, Yoli Meydan, Bryan Chen, James Barsi","doi":"10.1097/BOT.0000000000003220","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003220","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether non-tobacco nicotine dependence (NTND) in adolescents and young adults is associated with an increased risk of new-onset fractures over a medium and long term follow up.</p><p><strong>Methods: </strong>Design: retrospective cohort query of TriNetX network.</p><p><strong>Setting: </strong>Multi-center study conducted using de-identified electronic health records from the TriNetX network of participating healthcare organizations.</p><p><strong>Patient selection criteria: </strong>Adolescents and young adults (≤21 years) were included if they had a diagnosis of NTND between June 1, 2005, and June 1, 2020. Exclusions: any prior tobacco use, environmental tobacco exposure, tobacco use disorder, pre-existing bone/joint pathology (e.g., osteoporosis, osteoarthritis, osteogenesis imperfecta, malignant neoplasms of bone/cartilage), or prior fracture. NTND patients were propensity score matched 1:1 with controls without any documented nicotine or tobacco use.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was incident fracture after the most recent eligible clinical encounter documented between June 1, 2005, and June 1, 2020. Fracture risk was assessed over a fixed 5-year period following the index date and across the longest available follow-up in TriNetX. Risk ratios (RR) and 95% confidence intervals (CI) were calculated. Kaplan-Meier survival analysis was used to estimate hazard ratios (HR) for time-to-event comparison.</p><p><strong>Results: </strong>The matched cohort was comprised of 10,576 patients per group with an average age at index of 19.4 + 1.7 years. The NTND group was comprised of 44.9% males and 54.7% females while the control group was comprised of 44.7% males and 55.0% females. At 5 years, fracture incidence was 1.1% in the NTND group and 0.5% in controls (RR, 2.1; 95% CI, 1.5 - 2.9; p < 0.001). Over the extended follow-up, fracture incidence was observed to be 2.0% in NTND group and 1.0% in the control group (RR, 1.9; 95% CI, 1.5-2.4; p < 0.001). Over the extended follow-up, the elevated fracture risk in NTND group when compared to controls was confirmed time-to-event analysis (HR, 1.9; 95% CI, 1.5-2.4).</p><p><strong>Conclusions: </strong>Non-tobacco nicotine dependence was associated with a two-fold increased risk of fracture among adolescents and young adults (RR, 2.1; 95% CI, 1.5-2.9 at 5 years; RR, 1.9; 1.5-2.4 over an extended follow up period). It is suggested by these findings that skeletal health consequences should be considered when evaluating the long-term impact of nicotine use in youth.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839304","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":"Preoperative Proton Pump Inhibitor Use Was Associated With Increased Risk of Revision Surgery and Impaired Bone Healing Following Pelvic Fracture Fixation: A Retrospective Cohort Study.","authors":"Joshua Wang, Emmerson McGowan, Keenan Horani, John C Hagedorn","doi":"10.1097/BOT.0000000000003219","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003219","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between preoperative proton pump inhibitor (PPI) use and postoperative outcomes following pelvic fracture fixation.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>TriNetX Research Network, a federated database of electronic medical records from approximately 103 healthcare organizations.</p><p><strong>Patient selection criteria: </strong>Adult patients aged 18 years and older who underwent surgical fixation of pelvic fractures between 2000 and 2023 were identified. All operatively managed pelvic fracture types were included, encompassing OTA/AO classifications 61A-C; however, specific fracture classification was not available within the database. Patients were stratified into cohorts based on preoperative PPI use.</p><p><strong>Outcome measures and comparisons: </strong>Postoperative outcomes, including sepsis, revision surgery, hardware removal, nonunion, and malunion, were compared between patients with and without preoperative PPI use at 90 days and 2 years following surgery.</p><p><strong>Results: </strong>Before matching, 2,648 patients were included in the preoperative PPI cohort and 7,655 patients in the control cohort. After propensity score matching, 2,403 patients remained in each cohort. The mean age was 44.0 ± 17.3 years in the PPI cohort and 43.7 ± 17.0 years in the control cohort, with 37.3% and 38.6% female patients, respectively. At 90 days postoperatively, preoperative PPI use was associated with increased risks of sepsis (RR 1.48, 95% CI 1.07-2.06, p=0.017), deep vein thrombosis (RR 1.58, 95% CI 1.11-2.23, p=0.010), revision surgery (RR 1.69, 95% CI 1.28-2.22, p<0.001), and hardware removal (RR 1.58, 95% CI 1.20-2.08, p<0.001). At 2 years, preoperative PPI use remained associated with increased risk of revision surgery (RR 1.66, 95% CI 1.27-2.15, p<0.001), as well as nonunion (RR 1.71, 95% CI 1.10-2.65, p=0.015) and hardware removal (RR 1.17, 95% CI 1.01-1.36, p=0.039). No other significant differences were observed.</p><p><strong>Conclusions: </strong>Preoperative PPI use was associated with increased risks of both short-term complications and long-term adverse outcomes following pelvic fracture fixation, including higher rates of sepsis, nonunion, malunion, and revision surgery.</p><p><strong>Level of evidence: </strong>Level III, Prognostic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839390","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":"Blood Culture Testing in Fracture-Related Infections: Low Yield and Lack of Concordance with Deep Tissue Pathogens.","authors":"Lauren A Merrell, Sara J Solasz, Abhishek Ganta, Sanjit R Konda, Kenneth A Egol","doi":"10.1097/BOT.0000000000003214","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003214","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the concordance between blood culture isolates and intraoperative deep tissue cultures in patients with confirmed fracture-related infection (FRI).</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective Cohort Study.</p><p><strong>Setting: </strong>Academic Medical Center.</p><p><strong>Patient selection criteria: </strong>This Institutional Review Board-approved study included patients 18 years and older diagnosed with a confirmed FRI according to the FRI Consensus Group criteria who, at time of irrigation and debridement (I&D), underwent deep tissue culture (TC) as well as concurrent blood culture (BC) testing (in the Emergency Department or inpatient setting). The decision to perform BC testing was left to the discretion of the initial treating providers at the time of this presentation.</p><p><strong>Outcome measures and comparisons: </strong>Microbiological data were reviewed from the electronic medical record. Infections were classified as monomicrobial (either gram-positive or gram-negative), polymicrobial, or culture negative. Pathogen concordance between blood and intraoperative tissue cultures was analyzed.</p><p><strong>Results: </strong>84 patients were included with both intraoperative deep TC and concurrent BC. This cohort had a mean age of 56.2 ± 20.3 years and consisted of 33 females (39.3%). BC were never ordered by the orthopedic surgeon. Microbial analysis of deep tissue specimens identified 29 gram-positive infections, 18 gram-negative infections, 33 polymicrobial infections, and 4 culture-negative cases. Of the 84 BC analyzed, 69 (82.1%) were culture-negative and 15 (17.9%) were culture-positive. BC results were discordant with their respective TC isolates in 76 of 84 (90.4%) cases. This discordance in 76 cases was driven by negative BC in the setting of positive TC (69/76, 90.8%), while a smaller proportion reflected growth of different organisms in BC compared to TC (7/76, 9.2%). Concordance was observed in only 8 of 84 (9.6%) cases, in which BC identified at least one pathogen sampled from TC. BC yielded negative culture results 17 times as often as TC. McNemar's test revealed a highly significant difference in culture-positivity rates (χ2=65, p<0.0001), while Cohen's Kappa for agreement was 0.022, indicating minimal agreement between BC and TC results.</p><p><strong>Conclusions: </strong>These results suggest that blood cultures were part of some workflows for patients presenting with infections, but they did not reflect the true bony pathogens nor contribute meaningful diagnostic information in most cases of confirmed fracture-related infection (FRI) according to the FRI Consensus Group criteria. While blood culture testing is important in the evaluation of systemic infection from, it does not provide orthopedic surgeons with information that informs the management or treatment of the FRI itself.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839331","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":"Do computerized tomography images influence surgeons' estimates of posterior tilt angle or treatment preference for minimally displaced femoral neck fractures?","authors":"Soroush Shabani, Nathan N O'Hara, Ryan C Ross, Julien Wier, Jordan Gasho, Sheila Sprague, Gerard P Slobogean, Joseph T Patterson","doi":"10.1097/BOT.0000000000003186","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003186","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if axial computerized tomography (CT) images compared with radiographs of minimally displaced femoral neck fractures in older adults change surgeons' estimates of posterior tilt or treatment preference for internal fixation versus arthroplasty.</p><p><strong>Methods: </strong>Design: A survey was developed from the clinical vignettes, injury radiographs of anteroposterior (AP) pelvis and lateral hip, and CT pelvis axial images of 10 patients randomly selected from 50 patients with minimally displaced femoral neck fractures enrolled in a clinical trial. Survey respondents estimated femoral neck fracture posterior tilt angle (0-90°) and stated their treatment preference on a scale of 100% for internal fixation to 100% for arthroplasty based on the radiographs, then again after viewing the CT images of the same patient.</p><p><strong>Setting: </strong>The survey was administered electronically using REDCap and distributed by email between 15 June and 15 July 2025.</p><p><strong>Patient selection criteria: </strong>The survey was distributed to a convenience sample of attending orthopaedic surgeons with hip fracture call experience nonrandomly selected from email contacts of colleagues, acquaintances, and extramural research collaborators located in North America, South America, and Europe. Neither fellowship training nor practice setting were requirements for participation.</p><p><strong>Outcome measures and comparisons: </strong>The mean differences in posterior tilt estimates and treatment preferences between radiographs and CT were estimated using linear mixed-effects models.</p><p><strong>Results: </strong>Complete survey responses were received from 69 of 98 participants (70.4% response rate). Posterior tilt estimates were 6° greater based on CT versus radiographs (95% confidence interval [CI], 4-7°; p<0.0001). CT images significantly changed treatment preferences by 20% more in favor of arthroplasty (95% CI, 14-26%; p<0.0001).</p><p><strong>Conclusions: </strong>Axial CT images significantly changed orthopaedic surgeons' estimates of posterior tilt and treatment preferences in favor of arthroplasty for minimally displaced femoral neck fractures compared to radiographs.</p><p><strong>Level of evidence: </strong>Prognostic Level V.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839313","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":"Periprosthetic Femur Fractures: The Screw-in-Washer Technique for Bicortical Small Fragment Screw Fixation Through Large Fragment Plates. A Technical Trick and Case Series.","authors":"Ahmed Nageeb Mahmoud, Daniel S Horwitz","doi":"10.1097/BOT.0000000000003223","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003223","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839348","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":"Modified CT Sagittal Angle Measure: Accuracy in Determining Hip Stability for Posterior Wall Acetabulum Fractures and Observer Reliability and Agreement Among Inexperienced Observers.","authors":"Todd Jaeblon, Colin Harrington, Umar Khan, Katherine Clark, Shane Kaplan, Patrick McGlone, Nick Panarello, Sneh Talwar, Brent J Bauer","doi":"10.1097/BOT.0000000000003217","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003217","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To describe modifications to the original CT sagittal angle measure (SAM) for predicting hip stability after posterior wall acetabular fractures (PWF), and to assess modified sagittal angle measure (mSAM) accuracy and resident agreement and accuracy with the mSAM relative to examination under anesthesia (EUA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective review of prospectively collected data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Academic Level 2 Trauma Center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Results of a modification of the sagittal CT based PWF measurement (mSAM) and gold standard exam under anesthesia (EUA) were collected and evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Patients with PWFs (AO/OTA 62A.1) requiring an EUA from June, 2017, through July, 2025 were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The accuracy of mSAMs by the lead author and residents in predicting hip stability was quantified by sensitivity, specificity, positive predictive value, and negative predictive value using EUA, performed by fellowship trained orthopaedic surgeons, as the reference standard. A receiver operating characteristic (ROC) curve analysis was used to determine whether mSAM reproduced the published SAM threshold angles most closely associated with hip stability, using EUA as the reference standard. Modified SAM reliability and agreement was assessed with intraclass correlation coefficients (ICC) after measurements in two rounds, separated by one month. Resident agreement for mSAM in predicting hip stability after PWF was compared with their agreement for the axial CT-based percentage of posterior wall fracture (PPWF) measurement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mSAM sensitivity and specificity for predicting hip stability from 84 subjects (male: 65 [77%]; median age: 35.0 years [range: 17-75] years) was 97.7% and 100.0%, respectively (95% CI 87.7-99.9%, 91.4-100%). ROC analysis identified the optimal mSAM thresholds of ≥71° for instability, and ≤70° for stability. Resident measurements of mSAM resulted in 100.0% sensitivity and 94.4% specificity for predicting stability in round 1 (95% confidence interval [CI] 91.6-100.0%, 72.7-99.9%) and 100.0% sensitivity and specificity in round 2 (95% CI 91.6 -100%, 81.5-100.0%). Interrater reliability for mSAM was good in round 1 (ICC = 0.83, 95% CI 0.70-0.93) and round 2 (ICC = 0.86, 95% CI 0.74-0.95). Intrarater reliability was good for two residents and excellent for four (range 0.79-0.99). Interrater reliability for PPWF was good (ICC = 0.78, 95% CI 0.62-0.91).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Optimal mSAM measures predictive of hip instability were ≥71° and ≤70° for stability following PWF. The mSAM demonstrated good to excellent intrarater reliability among residents, and the intraclass correlation coefficient was higher than the PPWF measure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;Level III, Dia","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839288","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":"Outcomes of Primary Repair of Heel Pad Degloving Injuries.","authors":"Erika Roddy, David Dalstrom, Bruce Sangeorzan, Stephen Benirschke, Stephanie Vu, Kari Keys, Reza Firoozabadi","doi":"10.1097/BOT.0000000000003216","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003216","url":null,"abstract":"<p><strong>Objectives: </strong>To report the outcomes of patients with heel pad degloving injuries, and to identify patient, injury, or treatment factors associated with successful repair.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single level 1 academic trauma center.</p><p><strong>Patient selection criteria: </strong>All patients admitted with an acute heel pad degloving injury between 2005-2024 were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was successful repair of a heel pad degloving injury. Univariate analysis was performed to examine risk factors for primary repair failure.</p><p><strong>Results: </strong>Fifty-eight patients with acute heel pad degloving injuries were included, of whom fifty were male with average age of 35 years (range 6-69, SD 17). Forty patients were treated with an attempt at primary repair, three were treated primarily with a flap, and 15 were treated with primary amputation. Primary repair was successful in 15 patients (38%). Repair method (suture alone, augmentation with k-wires, incisional wound vac) was not associated with repair success (p>0.05 for all). Of the patients with failed primary repair, 6 underwent secondary amputation, while 19 underwent attempted salvage with a flap (13), skin graft (5), or dermal substitute (1). Of the 19 with attempted salvage, 10 (53%) had complications including persistent ulceration, infection, and/or wound breakdown. Two of this cohort underwent secondary amputation. No patients in the successful primary repair group underwent later amputation.</p><p><strong>Conclusions: </strong>The rate of success after attempted primary repair of heel pad degloving injuries was 38% in this series. The rate of secondary amputation was 20%. Augmenting primary repair with suture anchors or k-wires, or addition of a wound vac, was not significantly associated with improved success rates in univariate analysis, although these findings are limited by the retrospective nature of the study. Skin and soft tissue necrosis was the reason for failure of primary repair in all cases. Future studies may consider using techniques such as indocyanine green angiography to assess heel pad perfusion and identify patients at risk for failure of primary repair. Finally, although complication rates after failed primary repair were high, ultimately most limbs that underwent secondary flap reconstruction were able to be salvaged.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839382","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}