Journal of Orthopaedic Trauma最新文献

{"title":"The Effects of a Stepped-Care Mental Health Program on Trauma Recidivism at a Level 1 Trauma Center.","authors":"Gabriella A Rivas, Juliette Gammel, Kola George, Kenneth J Ruggiero, Tatiana Davidson, Hannah C Espeleta, Langdon Hartsock, Kristoff Reid","doi":"10.1097/BOT.0000000000002929","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002929","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to analyze the effects of a stepped-care mental health program (TRRP) on trauma recidivism at a single institution.</p><p><strong>Methods: </strong>Designs: Retrospective review.</p><p><strong>Setting: </strong>single Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Trauma activation patients presenting at a single Level 1 trauma center between 2017-2021 were selected. Data on demographics, mechanism of injury, readmissions, and TRRP participation were recorded.</p><p><strong>Outcome measures and comparisons: </strong>Main outcomes included recidivism rates, risk factors for re-presentation, and determining if a change in readmission risk existed after participation in TRRP.</p><p><strong>Results: </strong>4,484 patients were included, with a mean age of 44.8 years. 65.9% were males and 34.1% were female. 14.2% (637/4,484) patients presented to the same institution having experienced an unrelated traumatic incident after their index injury. 75.6% patients identified by TRRP participated in at least one TRRP service. Patients who did not participate in TRRP were statistically significantly more likely to be recidivists (15.6%) compared to those who did (10.9%, p<0.001). Multivariable binary logistic regression analysis demonstrated statistically significant associations between increased trauma recidivism and being unmarried, Black/African American race, no use of seatbelts, alcohol intoxication at index injury, history of depression, alcohol use disorder, smoking, and government insurance (p≤0.024). The multivariable regression model predicted a decrease in trauma recidivism by 33% in privately insured patients (p=0.002), by 33% after participation in TRRP (p<0.001), and by 18% after participation in each additional step of the TRRP program (p<0.001).</p><p><strong>Conclusions: </strong>Results demonstrate reduced rates of trauma recidivism with involvement of the Trauma Resilience and Recovery Program. While programs focused solely on psychosocial interventions may be sufficient to reduce the risk of subsequent traumatic events, further development of trauma rehabilitation programs should address both the psychosocial consequences of traumatic injuries as well as re-injury and readmission prevention.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622378","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":"Tibial Malalignment is an Independent Predictor of Nonunion After Intramedullary Nailing of Tibial Shaft Fractures.","authors":"Abraham Goch, Kathleen Healey, Nicolas Zingas, Michael Raffetto, Natasha McKibben, Caroline Benzel, David J Stockton, Nathan N O'Hara, Gerard P Slobogean, Jason W Nascone, Robert V O'Toole","doi":"10.1097/BOT.0000000000002932","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002932","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the relationship between postoperative alignment and nonunion in patients with tibial shaft fractures treated with intramedullary nailing.</p><p><strong>Methods: </strong>Design: Retrospective case-control study.</p><p><strong>Setting: </strong>Single academic trauma center.</p><p><strong>Patients selection criteria: </strong>Adult patients with closed or open tibial shaft fractures (42A-C) treated with intramedullary nailing from 2007 to 2018.</p><p><strong>Outcomes measures and comparisons: </strong>Case patients with nonunion were compared to control patients with radiographic evidence of healing in terms of the postoperative tibial alignment measured in the coronal and sagittal planes.</p><p><strong>Results: </strong>Of the 192 included patients (median age, 38 years; 76% male), 51 patients had a nonunion, and 141 patients had united fractures and served as the control group. A strong association between postoperative tibial malalignment in one plane and nonunion (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.1 to 8.3; P = 0.03) was demonstrated. This association was even greater for malalignment in both coronal and sagittal planes (OR, 5.7; 95% CI, 2.1 to 16.1; P < 0.001) after controlling for confounders.</p><p><strong>Conclusion: </strong>After controlling for confounding factors, postoperative malalignment in the coronal or sagittal plane was associated with significantly increased odds of tibial shaft nonunion after intramedullary nailing.</p><p><strong>Level of evidence: </strong>Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622381","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":"Are Drains Associated With Infection After Operative Fixation of High-Risk Tibial Plateau and Pilon Fractures?","authors":"Adam Boissonneault, Robert V O'Toole, Roman Hayda, J Spence Reid, Cyrus Caroom, Anthony Carlini, Arman Dagal, Renan Castillo, Madhav Karunakar, Paul Matuszewski, Robert Hymes, Nathan N O'Hara","doi":"10.1097/BOT.0000000000002933","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002933","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the association between closed suction drainage and postoperative infection in patients with tibial plateau or pilon fractures. Secondarily, this study assessed if intrawound vancomycin powder modified the association of closed surgical drains with infection.</p><p><strong>Methods: </strong>Design: Secondary analysis of the Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial (VANCO) trial.</p><p><strong>Setting: </strong>36 academic trauma centers.</p><p><strong>Patient selection criteria: </strong>All patients with high-risk tibia fractures (OTA/AO classification 41B/C or 43B/C) from the VANCO trial were considered. Closed suction drains were placed based on the treating surgeon's discretion. Patients were randomly assigned to received 1-gram intrawound vancomycin powder in the surgical wound at definitive fixation or the standard infection prevention protocol at each center.Outcome Measures and Comparisons: Deep surgical site infection (SSI) within 6 months. Comparisons were made between patients treated with and without drains. Subgroup analysis also examined the effect of drains in patients with and without intrawound vancomycin powder.</p><p><strong>Results: </strong>Of the 978 study patients, 197 (20%) were treated with drains. Deep infection rates did not significantly differ between patients with or without surgical drains (8% versus 8%, p=0.88). However, intrawound vancomycin powder significantly modified the association of surgical drains on deep SSI (interaction p=0.048). Specifically, patients with drains but no vancomycin powder had the highest deep infection rate (13%; 95% CI, 6% to 19%). When vancomycin powder was used in addition to a drain, deep SSI rates were reduced by 10% (95% CI, 2% to 17%, p=0.01).</p><p><strong>Conclusions: </strong>This study suggests that closed suction drains after operative fixation of high-risk tibia fractures may not be associated with deep infection in general. However, a secondary analysis raises the possibility that drains are associated with reduced deep infection rates if topical vancomycin powder is used but associated with increased infection rates if vancomycin powder is not used.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622374","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":"The Use Of External Beam Radiation Therapy For Heterotopic Ossification Prophylaxis After Surgical Fixation Of Acetabular Fractures: A Randomized Controlled Trial.","authors":"Adam Boissonneault, Nathan N O'Hara, Gerard P Slobogean, Anna Meyer, Michael Maceroli, Marcus F Sciadini, Jason W Nascone, Mark J Gage, Jolinta Lin, Sheela Hanasoge, Jay Shelton, Zaker Rana, Mark Mishra, Robert V O'Toole","doi":"10.1097/BOT.0000000000002931","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002931","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the effect of external beam radiation (XRT) on preventing severe heterotopic ossification (HO) after acetabular surgery.</p><p><strong>Methods: </strong>Design: Randomized controlled trial.</p><p><strong>Setting: </strong>Two level I academic trauma centers.</p><p><strong>Patient selection criteria: </strong>Patients with an acetabular fracture (OTA/AO type 62) surgically treated through a posterior or combined anterior and posterior approach.Outcome Measures and Comparisons: Radiographic HO was determined using Brooker Classification at the last follow-up. The primary outcome was severe HO (Brooker class III-IV). The secondary outcome was any HO (Brooker class I-IV). The incidence of radiographic HO was compared between patients that did and did not undergo postoperative XRT. The results were analyzed in both an intention-to-treat (randomized to XRT) and as-treated (received XRT) basis.</p><p><strong>Results: </strong>Severe HO occurred in 3 of 54 (6%) patients randomized to XRT and 9 of 50 (18%) patients randomized to no XRT (odds ratio (OR) 0.24, 95% confidence interval (CI) 0.05 to 0.94; p=0.05). Any HO occurred in 10 (19%) patients assigned to XRT and 17 (34%) patients in the no XRT control group (OR 0.39; 95% CI 0.13 to 1.05; p =0.07).</p><p><strong>Conclusions: </strong>The findings of this dual-center randomized controlled trial suggest that XRT after acetabular surgery significantly reduced the odds of severe HO compared to patients that did not receive XRT. These results can help guide shared decision-making between surgeons and patients regarding the use of XRT for HO prophylaxis.</p><p><strong>Level of evidence: </strong>Level I, therapeutic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604997","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":"Cast-OFF 2: one week versus three to five weeks of plaster cast immobilization for non-or minimally displaced distal radius fractures, a stepped wedge cluster randomized controlled trial.","authors":"Marcel A N de Bruijn, Emily Z Boersma, Lysanne van Silfhout, Laura A van Ginkel, Tjarda N Tromp, Erik van de Krol, Michael J R Edwards, Vincent M A Stirler, Erik Hermans","doi":"10.1097/BOT.0000000000002930","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002930","url":null,"abstract":"<p><strong>Objectives: </strong>Implementation of one week of cast immobilization followed by gradually increasing wrist mobilization for non- or minimally displaced DRF and comparison of the functional outcomes and pain scores with the usual care (three to five weeks of cast immobilization).</p><p><strong>Methods: </strong>Design: A randomized stepped wedge cluster design, prospective cohort.</p><p><strong>Setting: </strong>Academic and peripheral hospitals in level 1, 2, and 3 trauma centers.</p><p><strong>Patient selection criteria: </strong>All patients between 18 and 85 years old with an isolated non- or minimally and nonreduced DRF were eligible for inclusion. Participating hospitals were randomized to transition from usual care (three to five weeks of cast immobilization) to one week of cast immobilization, following the stepped wedge design.</p><p><strong>Outcome measures and comparisons: </strong>Patient characteristics, secondary dislocation, surgical treatment, visual analog scale (VAS), Patient Rated Wrist Evaluation (PRWE), Patient Reported Outcomes Measurement Information System Pain Interference (PROMIS-PI), Pain Catastrophizing Scale 4 (PCS-4), and patient satisfaction were compared between control, and intervention group at week 1, 3-5, 6, month 3, 6, and 12. A difference around 11 points on the PRWE scale was considered clinically significant.</p><p><strong>Results: </strong>402 patients were included (control n=197 vs intervention n=205, 267/135, female/male). There were no differences in age (53.7 ± 18.6 vs 53.3 ± 19.5, P = 0.27), sex (66% vs 67% female, P 0.44), dominant hand fractured (44% vs 53%, P 0.39), and type of fracture (39% vs 41% extra-articular, P = 0.44) After six weeks, the PRWE score showed no clinically significant differences (-4.5 [CI -12.9, 4.02], P = 0.30). No significant differences were observed for function, pain scores, and patient satisfaction between groups (all P > 0.05). Furthermore, there was no significant difference in secondary dislocation rate (control 1.5% vs intervention 1.0%, p=0.32, P = 0.32) and operation rate (control 1.5% versus 1.5% intervention P = 0.92).</p><p><strong>Conclusions: </strong>This study compared one week of cast immobilization followed by gradually increasing wrist mobilizationto the usual care of three to five weeks for nonreduced DRF. No clinically significant differences in function, pain scores, patient satisfaction, secondary dislocation, and operations were observed. Therefore, one week of plaster immobilization can be safely recommended for the non- or minimally displaced and nonreduced DRF treatment.</p><p><strong>Level of evidence: </strong>Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546048","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":"Hardware Removal After Lisfranc ORIF Results in Improved Physical Function.","authors":"Oliver Sroka, Megan Campbell, Tyler Thorne, Justin Haller, David Rothberg, Thomas Higgins, Lucas Marchand","doi":"10.1097/BOT.0000000000002927","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002927","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to investigate whether HWR after Lisfranc ORIF resulted in significant impact via PROMIS physical function (PF) and pain intensity (PI) scores.</p><p><strong>Methods: </strong>Design: Retrospective cohort.</p><p><strong>Setting: </strong>Level-1 trauma center.</p><p><strong>Patient selection criteria: </strong>Adult patients with isolated Lisfranc injuries who were treated via ORIF between 2002-2023 that had PROMIS PF and PI scores through 6 months follow-up were included. Patients were excluded if they received index treatment other than ORIF or underwent secondary surgical intervention prior to HWR. A sub analysis was performed at 1 year follow- up.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes were PROMIS PF and PI scores. The Wilcoxon signed-rank test compared differences between PROMIS scores within the HWR group. The Wilcoxon ranked-sum test compared differences between HWR vs no HWR. Distributive MCID was calculated using the 0.5 SD method.</p><p><strong>Results: </strong>There were 482 patients (489 feet) identified with isolated Lisfranc injuries. Seventy-seven feet underwent ORIF followed by HWR. Thirty feet underwent ORIF without HWR. The average age of the no HWR group was 45.8 (18.0-81.3) versus the HWR group which was 38.7 (18.3-74.1) (p=0.053). Nineteen (63.3%) were female in the no HWR group compared to 33 (42.9%) in the HWR group (p=0.084). HWR occurred an average of 4.43 months after ORIF. Patients who underwent HWR had a statistically significant increase in average PF scores (39.7 to 45.9, p<0.001) at their standard 6 week (1.5 month) postoperative visit. HWR patients had a non-significant decrease in average PI scores (56.5 to 53.9, p=0.24). Compared to those with retained hardware, the HWR group demonstrated a statistically significant net improvement in PF and PI scores from surgery, with an average improvement of 5.6 and 1.7, respectively (P=0.002, 0.008).</p><p><strong>Conclusions: </strong>Patients experienced significant improvement in PROMIS PF scores for Lisfranc ORIF at 6 weeks after HWR. Compared to patients with retained hardware, they also experienced significant improvement in PROMIS PF and PI scores.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468162","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":"Inability to Remove Locking Screws from the Femoral Neck System due to Stripping of the Screwdriver within the Locking Screw Head.","authors":"Jung-Wee Park, Yong-Han Cha, Jin-Woo Kim, Hong-Seok Kim, Jae-Hwi Nho, Byung-Woong Jang, Jung-Taek Kim, Jin-Kak Kim, Tae-Young Kim, Ki-Choul Kim, Young-Kyun Lee","doi":"10.1097/BOT.0000000000002926","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002926","url":null,"abstract":"<p><strong>Objectives: </strong>The purposes of this study were to investigate the frequency of screwdriver stripping in the head of the locking screw that attaches to the side plate to the femur shaft among the patients who underwent implant removal after Femoral Neck System (FNS) for femoral neck fracture, to determine the risk factors for locking head screw stripping in FNS treatment of femoral neck fracture, and to suggest a surgical tip that removes FNS, which is difficult to remove due to screw stripping.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Eight Urban tertiary referral academic hospitals.</p><p><strong>Patient selection criteria: </strong>Included were patients with OTA/AO 31-B1, 31-B2, and 31-B3 femoral neck fractures who underwent surgical fixation with FNS from Nov 2019 to Feb 2023.</p><p><strong>Outcome measures and comparisons: </strong>The frequency of locking head screw stripping of FNS during the implant removal was evaluated.</p><p><strong>Results: </strong>Among the 47 patients (18 (38%) men and 29 (62%) women) who met the inclusion criteria with average age of 59.2 years (range, 28 to 94 years), 13 (27.7%) experienced screwdriver stripping in the head of the distal locking screw during FNS removal surgery. A higher BMI showed a borderline significant association with the stripping in the adjusted model (OR = 1.233; 95% CI: 0.988-1.539; p = 0.064). No other variables showed significant association with the stripped locking head screw (p>0.05).</p><p><strong>Conclusions: </strong>Stripping of the screwdriver within the head of the distal locking screw occurred in over one quarter of cases. While a higher BMI demonstrated a borderline significant association, none of the other variables examined showed a statistically significant relationship with the stripped locking head screw.</p><p><strong>Levels of evidence: </strong>Level III (retrospective cohort study).</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406494","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":"Outpatient Upper Extremity Fracture Surgery Is Associated with Increased Post-operative Emergency Department Visits.","authors":"Jonathan Lans, Clay B Beagles, Ian T Watkins, Aron Lechtig, Rohit Garg, Neal C Chen","doi":"10.1097/BOT.0000000000002925","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002925","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine if outpatient upper extremity fracture surgery was associated with increased post-operative ED visits and identify related risk factors.</p><p><strong>Methods: </strong>Design: Retrospective cohort.</p><p><strong>Setting: </strong>This multi-center study was conducted within a single academic institution, encompassing two level 1, two level 2, and one level 3 trauma center.</p><p><strong>Patient selection criteria: </strong>All patients >18 years of age that underwent upper extremity fracture surgery from 2015-2021 were included.</p><p><strong>Outcome measures and comparisons: </strong>Risk factors for postoperative ED visit that were investigated included age, sex, tobacco use, alcohol abuse, psychiatric diagnosis, Elixhauser comorbidity score, race, location of upper extremity fracture, surgical setting (inpatient vs. outpatient), upper extremity block, surgical specialty, and Area Deprivation Index. Variables with a p<0.1 in bivariate analysis were included in a multivariable logistic regression to determine factors associated with a postoperative ED visit at 30 and 90-days.</p><p><strong>Results: </strong>A total of 6,315 patients with an average age of 51±19 years were identified of which 52% were female and 65% had outpatient surgery. Post-operatively, 188 patients (3.0%) presented to the ED within 30 days and 304 (4.8%) presented within 90 days. Thirty-seven percent of ED visits were directly related to the procedure, most commonly for pain (20%), cast issues (4.3%), and swelling (3.9%). At 30 days postoperatively, 2.8% of patients who underwent surgery in an outpatient setting and 3.4% of those who underwent inpatient surgery returned to the ED, with these rates increasing to 4.4% and 5.6%, respectively, by 90 days. In multivariable analysis, outpatient surgery (OR:1.5, p=0.030), tobacco use (OR:2.1, p<0.001), higher Elixhauser Comorbidity scores (OR:1.2, p<0.001), non-White race (OR:1.9, p<0.001) elbow fractures (OR:1.8, p=0.016), and hand fractures (OR: 1.6, p=0.046) were associated with 30-day ED visits.</p><p><strong>Conclusions: </strong>Outpatient surgery was associated with increased rate of 30-day ED visits. Patients that smoke, had increased number of comorbidities or were non-White presented to the ED more frequently.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372082","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":"Lower Extremity Trauma is Associated With an Increased Rate of New Mental Disorder Diagnosis and Suicide Attempt.","authors":"Julianna E Winter, Jacob S Budin, Bela P Delvadia, Arjun Verma, William F Sherman, K Chandra Vemulapalli, Olivia C Lee","doi":"10.1097/BOT.0000000000002874","DOIUrl":"10.1097/BOT.0000000000002874","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the risk of developing a new mental disorder diagnosis within 2 years of lower extremity fracture.&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 cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;National insurance claims database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Patients between 18 and 65 years with lower extremity, pelvis, and acetabular fractures without prior mental disorders as defined using International Classification of Diseases, 9th and 10th revision diagnosis codes were included. Mental disorders evaluated included alcohol use disorder, generalized anxiety disorder, bipolar disorder, major depressive disorder, drug use disorder, panic disorder, posttraumatic stress disorder, and suicide attempt.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The individual lower extremity fracture cohorts were matched 1:4 with nonfracture controls. The specific groups of interest were pelvis fractures, acetabulum fractures, proximal femur fractures, femoral shaft fractures, distal femur fractures, patella fractures, tibia plateau fractures, tibia shaft fractures, ankle fractures, pilon fractures, calcaneus fractures, and Lisfranc fractures. Rates of mental disorders after primary lower extremity fractures within 2 years were compared using multivariable logistic regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, the 263,988 patient-fracture group was 57.2% female with an average age of 46.6 years. Compared with controls with no fracture, patients who sustained pelvis, acetabulum, proximal femur, femoral shaft, distal femur, patella, tibia plateau, tibia shaft, pilon, calcaneus, or Lisfranc fracture had a statistically significantly increased risk of being diagnosed with a queried mental disorder within 2 years of fracture. When comparing all fracture patients by location, those suffering from fractures proximal to the knee joint, including pelvis fractures [OR: 1.51, 95% confidence interval (CI): 1.39-1.64] and proximal femur fractures [odds ratio (OR): 1.36, 95% CI: 1.26-1.47], demonstrated greater risk of developing any of the queried mental disorders compared with fractures distal to the knee, including ankle fractures (OR: 0.99, 95% CI: 0.95-1.03) and pilon fractures (OR: 1.05, 95% CI: 0.81-1.36). When comparing specific fracture patients with patients without fracture by mental disorder, patients demonstrated an increased risk of suicide attempt following fracture of the pelvis, acetabulum, femoral shaft, distal femur, and calcaneus, as well as patients sustaining a Lisfranc fracture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;There is an increased risk of being diagnosed with a new mental disorder following lower extremity trauma in patients without prior mental disorder diagnosis compared with matched individuals without a lower extremity fracture. Among the fractures studied, those that were more proximal, such as pelvis and proximal femur fractures, c","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"547-556"},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759339","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":"Heritable Thrombophilia and Increased Risk for Venous Thromboembolism Despite Thromboprophylaxis After Pelvis or Acetabulum Fracture.","authors":"Nihar S Shah, Sarah N Pierrie, Julie Agel, Reza Firoozabadi, H Claude Sagi","doi":"10.1097/BOT.0000000000002865","DOIUrl":"10.1097/BOT.0000000000002865","url":null,"abstract":"<p><strong>Objectives: </strong>Individuals with pelvic and acetabular fractures are at high risk of venous thromboembolism (VTE). The purpose of this study was to determine whether serum markers for thrombophilia and rapid thromboelastography (r-TEG) values correlate with increased VTE risk among patients with pelvic and acetabular fractures.</p><p><strong>Methods: </strong>.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Two urban academic level 1 trauma centers.</p><p><strong>Patient selection criteria: </strong>Adult patients with isolated pelvis and/or acetabulum fractures (OTA/AO 61 and 62) treated surgically placed on a standardized VTE chemoprophylaxis regimen with enoxaparin over a 5-year period were included.</p><p><strong>Outcome measures and comparisons: </strong>Serum r-TEG, coagulation laboratory values, and markers for heritable thrombophilia were drawn postoperatively and after completion of a 6-week course of enoxaparin. The primary outcome was VTE event (either deep venous thrombosis or pulmonary embolism) diagnosed using a Duplex ultrasound, chest computed tomography angiogram, or lung ventilation-perfusion ordered based on clinical suspicion of a VTE event. Laboratory markers and values were then compared between patients who went on to have a VTE event and those who did not and patients with and without markers of thrombophilia.</p><p><strong>Results: </strong>One hundred thirty-three adult patients with isolated operative pelvic and/or acetabular fractures were enrolled in this study. The average age of patients at time of injury was 48.3 years (range 18-91). Sixty-seven percent of patients in the study were (n = 90) males. Sixty-three percent of patients (n = 84) completed both clinical and laboratory follow-up. Forty-one percent of patients (n = 54) had 1 or more markers of heritable thrombophilia. Twelve percent (n = 10) of patients who completed follow-up were diagnosed with VTE. Age, sex, and smoking status were not associated with VTE. Patients who developed VTE had a higher body mass index (P = 0.04). Having more than 1 marker of heritable thrombophilia (P = 0.004) and an r-TEG mean amplitude greater than 72 mm postoperatively was positively associated with VTE (P = 0.02).</p><p><strong>Conclusions: </strong>Among patients treated surgically for isolated pelvic and acetabular fractures who received enoxaparin prophylaxis, the presence of more than 1 marker of heritable thrombophilia or r-TEG mean amplitude value greater than 72 mm postoperatively was associated with an increased risk of VTE.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 10","pages":"521-526"},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348671","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}