Journal of Orthopaedic Trauma最新文献

{"title":"A Cadaveric Study: Does Deltoid Ligament Repair Impact the Quality of Syndesmotic Reduction?","authors":"Christopher R Leland, Adam N Musick, Robert K Wagner, Maaz Muhammad, Carla H Lehle, Thomas J Policicchio, Austin T Gregg, Marco T Di Stefano, Michael G Young, Arjun Srinath, Arun Aneja","doi":"10.1097/BOT.0000000000003084","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003084","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the quality of syndesmotic reduction with and without deltoid ligament repair (DLR).</p><p><strong>Methods: </strong>Ten cadaveric ankle specimens underwent baseline computed tomography (CT) imaging in neutral plantarflexion. A fellowship-trained orthopaedic trauma surgeon disrupted the syndesmosis and deltoid ligament of each specimen. The syndesmosis was reduced in neutral plantarflexion by manual hand pressure under direct visualization through an anterolateral approach and stabilized with two 0.062-inch K-wires placed lateral-to-medial in a quadricortical fashion. Postreduction CT imaging was then obtained. K-wires were removed, and DLR was performed using suture anchor fixation. The syndesmosis was again reduced and stabilized using the same technique, followed by a second postreduction CT scan. Four validated measurements were used to evaluate the quality of syndesmotic reduction. All postreduction CT scans were compared to baseline using mixed-effects linear regression to account for the nesting of ankles within donors.</p><p><strong>Results: </strong>Ten cadaveric ankle specimens were obtained from five donors (mean age: 76.8 years [range: 70-83 years], 3 female and 2 male). Postreduction CT imaging demonstrated mean anterior translation of the fibula, both with DLR compared to baseline (6.4±1.1 mm vs. 7.7±1.5 mm, P=0.001) and without DLR compared to baseline (6.4±1.9 mm vs. 7.7±1.5 mm, P<0.001). The fibula was internally rotated following DLR when compared to baseline when evaluating mean rotation ratio (0.3±0.1 vs. 0.4±0.2, P=0.04) but not mean rotation angle (15.4±3.9 degrees vs. 13.3±3.2 degrees, P=0.12). No differences were observed in mean lateral translation with or without DLR compared to baseline (P>0.05). Direct comparison of reductions with and without DLR showed no differences in measures of mean reduction quality (P>0.05).</p><p><strong>Conclusions: </strong>In this cadaveric study, DLR did not significantly improve syndesmotic reduction quality compared to reductions performed without DLR. Relative internal rotation of the fibula was observed after DLR, perhaps due to prevention of talar external rotation and tensioning of the medial side during syndesmotic reduction.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199679","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":"Impact of Time-to-Surgery on Adverse Outcomes for Distal Radius Fractures: A Population-Based Study.","authors":"Jonathan Persitz, Heather Baltzer, Andrew Calzavara, Jesse Wolfstadt, Ryan Paul, Andrea Chan, Samantha Lee, Brandon Zagorski, David R Urbach","doi":"10.1097/BOT.0000000000003086","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003086","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the optimal time window for surgical fixation of acute, isolated distal radius fractures (DRFs) in order to minimize postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective, population-based cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Province-wide analysis using administrative health databases in Ontario, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Adult patients (≥18 years) who underwent surgical fixation for acute, isolated DRFs (OTA/AO 2R3) between 2010 and 2020 were included. Patients with open fractures, polytrauma, neurovascular injury, or fractures marked as urgent were excluded. Wait time to surgery was defined as days from emergency department presentation to operative intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The primary outcome was a composite of complications including any complication or revision surgery within 10 years. Secondary outcomes included infection and revision individually. Wait time to surgery was analyzed both as a continuous variable and as a categorical variable. For the categorical analysis, patients were stratified into seven intervals (0-2, 3-5, 6-9, 10-15, 16-20, 21-25, and 26-30 days). These cut-offs were chosen to provide relatively small, evenly distributed time ranges while maintaining sufficient patient numbers within each group to ensure statistical power and model stability. This approach allowed for meaningful comparisons across the surgical wait-time spectrum while complementing the continuous analysis. Cox multivariable models were used to estimate hazard ratios (HRs), adjusting for demographics, comorbidities, fracture and fixation type, surgeon volume, and hospital type. An instrumental variable analysis using institutional wait times was performed to address confounding by indication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 13,389 patients met inclusion criteria. Patients were predominantly female (71.2%) with a mean age of 55.7 years (Range 18-95). The 0-2 day group served as the reference and demonstrated the highest complication rates. Compared with this group, patients treated within 6-20 days had a significantly lower risk of composite complications, with the greatest benefit observed in the 6-9 day (HR 0.84, 95% CI: 0.73-0.97, P=0.02) and 10-15 day (HR 0.78, 95% CI: 0.67-0.90, P=0.001) subgroups. Infection risk was similarly lowest in the 6-15 day window, with the most favorable outcomes in the 10-15 day subgroup (HR 0.59, 95% CI: 0.41-0.84, P=0.003). Institutional-level analysis showed a 30% lower infection risk for treatment within 6-15 days compared to 1-5 days (HR 0.70, 95% CI: 0.56-0.87, P=0.002). Surgeries delayed &gt;25 days showed a non-significant trend toward worse outcomes (HR 1.10, 95% CI: 0.75-1.32, P=0.88).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Surgical fixation of distal radius fractures within 6-15 days was associated with the lowest observed rates of composite comp","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199710","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 Terrible Triad as a Predictor of Nonunion in Distal Femur Fractures Treated With Lateral Locking Plates: A Retrospective Cohort Study.","authors":"Agraharam Devendra, Asif Imran, Rahul Sutariya, Arunkamal Chandramohan, Purnaganapathi Sundaram Velmurugesan, Perumal Ramesh, Zackariya Mohamed, Jayaramaraju Dheenadhayalan, Shanmuganathan Rajasekaran","doi":"10.1097/BOT.0000000000003088","DOIUrl":"10.1097/BOT.0000000000003088","url":null,"abstract":"<p><strong>Objectives: </strong>To identify risk factors for nonunion in distal femur fractures (DFFs) treated with lateral locking plates (LLPs).</p><p><strong>Methods: </strong>Design : Retrospective cohort study.</p><p><strong>Setting: </strong>Single Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Adult patients with OTA/AO 33A and 33C DFFs treated with LLPs between 2014 and 2019 were included.</p><p><strong>Outcome measures and comparisons: </strong>Nonunion, defined as the need for a subsequent surgical procedure to promote bone healing, was assessed in relation to patient demographics, comorbidities, injury, and fixation characteristics.</p><p><strong>Results: </strong>A total of 298 patients (75.5% male; mean age 43.1 ± 13.7 years) were included. Among these, 166 fractures were classified as OTA/AO type 33A and 132 fractures as type 33C. Open fractures were present in 47.7%, and 72.1% had comminuted fractures. Nonunion occurred at 19.1% (57/298). No significant differences in age, sex, BMI, smoking, or diabetes were observed between union and nonunion groups. Multivariable analysis identified open fracture (OR 3.25; 95% CI 2.10-5.02; p < 0.001), comminution (OR 2.85; 95% CI 1.89-4.31; p < 0.001), and medial void >1 cm (OR 4.50; 95% CI 2.80-7.30; p < 0.001) as independent predictors. Fixation characteristics, including plate material, length, screw configuration, and alignment, were not associated with nonunion. A post hoc composite variable, the \"Terrible Triad,\" combining open fracture, comminution, and medial void >1 cm, was associated with a 36.7% nonunion rate compared to 5.9% without the triad (p < 0.001) and remained an independent predictor (OR 6.5; 95% CI 3.3-12.9; p < 0.001).</p><p><strong>Conclusions: </strong>The distal femur fracture \"Terrible Triad\" (open fracture, comminution, and medial void >1 cm) was a strong independent predictor of nonunion after lateral locked plating. Lateral locked plating fixation characteristics of were not significantly associated with nonunion. Early recognition and targeted management of triad features may improve healing outcomes.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199731","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 Prolonged Tourniquet Application on the Battlefield: Is a Liberal Application Policy Always Justifiable?","authors":"Alona Katzir, Jonathan Krispel, Asaf Acker, Mahmoud Jammal, Rami Mosheiff, Meir Liebergall, Yoram A Weil","doi":"10.1097/BOT.0000000000003089","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003089","url":null,"abstract":"<p><strong>Objectives: </strong>To provide insight into the implications of prolonged tourniquet use on the battlefield, ultimately contributing to the optimization of clinical practices in military and civilian healthcare settings.</p><p><strong>Methods: </strong>Design: Retrospective observational study.</p><p><strong>Setting: </strong>Two academic Level I Trauma Centers.</p><p><strong>Patient selection criteria: </strong>Adults who suffered high-energy battlefield injuries to the limbs on October 7th, 2023, with prolonged battlefield tourniquet application (>4h). Patients who underwent immediate limb amputation upon arrival at the hospital were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Clinical outcomes including hemodynamic status, vascular repairs, rhabdomyolysis, renal injury, infection, nerve injury, amputation, and functional outcomes were reviewed.</p><p><strong>Results: </strong>Eighteen patients (mean age 24 years; range 19-50 years) with 21 high-energy limb injuries and>4h tourniquet application were included (100% male); 9 (42.9%) upper limb injuries, and 12 (57.1%) lower limb injuries. The mean age of the cohort was 24 (SD 8.9, range 19-50). The mean tourniquet time was 5.8h (SD 1.2, range 4-9h). All of the patients (100%) underwent urgent fasciotomies upon arrival. Five patients (27.8%) required vascular repair. Seven patients (38.9%) developed temporary acute kidney injury (AKI), 2 patients (11.1%) required hemodialysis. Eight patients (44.4%) developed bacterial infections and required additional surgical interventions. Of these eight, limb salvage occurred in 6 (33.3%) and the remaining 2 (11.1%) underwent limb amputation. A total of 5 patients (27.8%) ultimately underwent amputation, all of which were lower limb amputations. Sixteen patients (88.9%) sustained lingering nerve injuries. The average Upper Extremity Functional Index (UEFI) score was 40.6 (SD 14.9 range 30-57) and the average Lower Extremity Functional Index (LEFI) was 42.3 (SD 20.1, range 14-68), indicating moderate functional limitation1,2. Longer tourniquet time was associated with a higher complication rate. CPK levels increased with each additional hour, and 100% of the patients requiring hemodialysis had tourniquet time exceeding 6 h. Additionally, 80% of amputation and 75% of infections occurred when tourniquet time exceeded 6 h.</p><p><strong>Conclusions: </strong>In a cohort of 18 patients with 21 high-energy limb injuries, a tourniquet time >4h did not preclude limb salvage, with an overall amputation rate of 23.8%. Tourniquet times exceeding 6 hours were associated with higher rates of complications.</p><p><strong>Level of evidence: </strong>A level IV retrospective study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199761","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":"Impact of Nicotine Dependence on Postoperative Outcomes in Pilon Fracture Open Reduction and Internal Fixation: A Comparative Cohort Analysis.","authors":"Joshua Wang, Brandon N Cambre, Daniel H Cho, Annie L M Dugan, Vishank Panchbhavi, Allen S Wang, Vinod K Panchbhavi","doi":"10.1097/BOT.0000000000003085","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003085","url":null,"abstract":"<p><strong>Objectives: </strong>To examine postoperative complication rates in patients with nicotine dependence compared to non-users to clarify the risks in pilon fracture recovery.</p><p><strong>Methods: </strong>Design: Retrospective cohort analysis.</p><p><strong>Setting: </strong>Data from the TriNetX Health Research Network.</p><p><strong>Patient selection criteria: </strong>Patients aged 18 years or older who underwent open reduction internal fixation (ORIF) for OTA/AO type 43 pilon fractures between 2000 and 2022 were categorized into nicotine-dependent and non-dependent groups.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes included rates of malunion, nonunion, mechanical complications such as internal fixation failure or removal, and need for revision surgery by 2-year follow-up. Secondary outcomes over a 90-day period included wound disruption, infection, sepsis, and thrombotic events. Statistical analysis calculated risk ratios and odds ratios, with significance set at P < 0.05.</p><p><strong>Results: </strong>After propensity score matching (N = 4,371 patients in each cohort), the mean age was 44.4 ± 14.5 years in Cohort 1 and 44.7 ± 15.7 years in Cohort 2. Female patients comprised 34.9% of Cohort 1 and 35.3% of Cohort 2. Nicotine dependence was associated with increased risks of mechanical complications (5.8% vs. 4.4%; P = 0.003), malunion/nonunion (6.3% vs. 4.7%; P = 0.002), wound disruption (4.5% vs. 3.2%; P = 0.002), and a higher infection rate (5.7% vs. 3.7%; P < 0.001). Conversely, the incidence of pulmonary embolism was lower in nicotine users (0.3% vs. 0.7%; P = 0.005).</p><p><strong>Conclusion: </strong>Nicotine dependence showed significantly elevated risk of adverse postoperative outcomes in pilon fracture surgeries, including mechanical failure, wound complications, and infection. However, the incidence of pulmonary embolism was lower among nicotine users. These results underscored an association between preoperative nicotine dependence and postoperative complications.</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":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199670","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 Impact of Reduction on Survivorship and Outcomes Following Locked Plate Fixation of Proximal Humerus Fractures.","authors":"Troy D Bornes, Craig E Klinger, Jeremy F Kubik, Kathryn A Barth, Jelle P van der List, Trenton T Stevens, Kavita Jain, Ze'ev P Drukker, David S Wellman, Dean G Lorich, David L Helfet","doi":"10.1097/BOT.0000000000003090","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003090","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate outcomes of proximal humerus fractures (PHFs) treated with locked plating constructs and assess association between fracture reduction and outcome.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic tertiary care hospital and affiliated Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>All patients treated with proximal humerus locked plating (PHLP) for PHFs (OTA/AO 11A/B/C) by three fellowship-trained orthopaedic traumatologists from 2008-2020 were screened. Patients were excluded for <12-month follow-up, lack of preoperative radiographic imaging, segmental fracture, isolated tuberosity fracture, humeral nailing, and revision surgery as initial procedure at the study institution.</p><p><strong>Outcome measurements and comparisons: </strong>Fracture pattern, reduction, fixation characteristics, and failure were radiographically evaluated. Functional outcomes were assessed using range of motion, ASES score, QuickDASH, Constant score, and SF-12. Survivorship was calculated using the Kaplan-Meier method. Association of variables with failure was assessed.</p><p><strong>Methods: </strong>Among 153 patients treated for PHFs with PHLP, there were 23 OTA/AO A-type, 40 B-type, and 90 C-type fractures. Mean follow-up was 66 months and mean age 59±15 years (68% female). Mean postoperative coronal alignment was 135°, 91% were fixed within 120-150°, and 53% within 130-140°. Sagittal reduction was neutral in 94%. Medial column restoration was achieved in 80%. Survivorship free from revision surgery was 89% at 5-years. Reduction with coronal alignment outside all neutral reduction ranges (120-150°, 125-145°, 130-140°) and sagittal alignment outside neutral were associated with both radiographic failure and revision surgery (p<.05). Preoperative factors associated with failure included female-sex, number of fragments, head-split, fracture-dislocation, valgus coronal alignment, and medial calcar displacement (p<.05). Functional outcomes included overall mean ASES of 81±21, QuickDASH 16±19, Constant 80±18, SF-12 Physical 50±9, SF-12 Mental 53±8, active forward flexion 145±33°, active abduction 140±35°, active external rotation 73±24°.</p><p><strong>Conclusions: </strong>Proximal humerus locked plating demonstrated a survivorship free from revision surgery of 89% free at 5-years and favorable functional outcomes including mean Constant scores of 80. Fracture reduction was associated with outcome. Reduction with coronal and sagittal alignment outside of neutral were associated with radiographic failure and revision surgery. These findings highlight that favorable functional outcomes can be achieved with restoration of the proximal humerus anatomy.</p><p><strong>Level of evidence: </strong>Level IV case series.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199702","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":"Reliability of Intraoperative 3D-Fluoroscopic Imaging in Assessing Acetabular Fracture Reduction.","authors":"Javier Guerrero, Aziz Saade, Margaret Hankins, Cody L Walters, Ruben Tresgallo Pares, Samuel K Simister, Shannon Tse, Rahul Bhale, Gillian L Soles, Ellen Fitzpatrick, Sean T Campbell, Mark A Lee, Augustine M Saiz","doi":"10.1097/BOT.0000000000003091","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003091","url":null,"abstract":"<p><strong>Objectives: </strong>To assess image quality and reliability of intraoperative 3D fluoroscopy in assessing acetabular reduction.</p><p><strong>Methods: </strong>Design: Retrospective chart review.</p><p><strong>Setting: </strong>Academic, level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Adult patients with acetabular fractures involving weight-bearing dome and/or posterior wall (OTA/AO 62A, 62B, 62C) between 2017-2023 with intraoperative 3D fluoroscopy and postoperative computed tomography (CT) included.</p><p><strong>Outcome measures and comparisons: </strong>Gap and step-off measurements made on intraoperative 3D fluoroscopy and postoperative CT by two graders using standardized technique. Assessments of image quality made using a scale of 1 (uninterpretable) to 5 (excellent). Interclass correlation coefficients (ICC) used to compare 3D fluoroscopy to CT and assessed intra/interobserver reliability for 3D fluoroscopy and CT images. Appropriate tests of significance performed.</p><p><strong>Results: </strong>54 patients with mean age of 48.4 ± 21.0 included. 72.2% of patients were male. 56/106 (52.8%) 3D fluoroscopic scans rated as 1/5 or 2/5. All CT images rated 3/5 or higher (p<0.001). 70% of CT measurements made with high confidence while 2.8% of 3D fluoroscopy measurements received this rating (p<0.001). Moderate agreement for gap (ICC=0.518, p<0.01) and step-off (ICC=0.420, p<0.01) when comparing 3D fluoroscopy to CT. CT showed good intra-reliability (ICC=0.747, 0.864; p<0.001) while 3D fluoroscopy showed moderate intra-reliability (ICC=0.638, 0.604; p<0.001). CT showed greater inter-reliability for largest gap (ICC 0.621, p<0.001) compared to fluoroscopy (ICC 0.219, p=0.05).</p><p><strong>Conclusions: </strong>When assessing acetabular fracture reduction involving the weight-bearing dome and/or posterior wall, intraoperative 3D fluoroscopy performed worse than postoperative CT on measures of image quality and confidence in reduction assessment. 3D fluoroscopy showed poor ICC across all views compared to CT and performed worse for interrater reliability. 3D fluoroscopy has limitations when making final acetabular reduction assessments; it may be advisable to acquire postoperative CT.</p><p><strong>Level of evidence: </strong>Level III, diagnostic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199713","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 Nonunion Surgery Following Tibial Plateau Fractures: A Case Series of 28 Patients.","authors":"Austin T Gregg, Carla H Lehle, Robert K Wagner, Sikun Fan, Adam N Musick, Maaz Muhammad, Thomas J Policicchio, Job N Doornberg, Derek Stenquist, Thuan V Ly, Arvind G von Keudell, Arun Aneja","doi":"10.1097/BOT.0000000000003087","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003087","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate outcomes of tibial plateau fracture nonunion surgery, including rates of final radiographic healing, additional surgery, and conversion to total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>Design: Retrospective case series.</p><p><strong>Setting: </strong>Two Level I academic trauma centers.</p><p><strong>Patients: </strong>Adult patients who underwent nonunion surgery following open reduction internal fixation (ORIF) of tibial plateau fractures (OTA/AO 41B-C) between 2000 and 2024 were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was final radiographic healing. Secondary outcomes included additional surgery and conversion to TKA.</p><p><strong>Results: </strong>Twenty-eight patients were included (median age 55 years (IQR: 38-61), 57% male). The median follow-up from the date of the nonunion surgery was 19 months (IQR:13-33). Twenty-one (75%) fractures were classified as Schatzker VI. Nonunion surgery involved revision ORIF in 23 (82%) cases, bone grafting alone (with or without hardware removal) in three (11%) cases, screw augmentation in one (3.6%) patient, and one patient (3.6%) underwent multistage treatment, ending with definitive treatment using an Ilizarov frame for six months. Overall, 54% of patients received bone grafting to address bone defects. Radiographic healing was achieved in 24 patients (86%). All four (14%) patients with a persistent nonunion had Schatzker VI fractures. Of these, three (75%) ultimately underwent conversion to TKA while one had no further surgery until the last follow-up 12.4 months after the initial procedure. Overall, thirteen (46%) patients required additional surgery, of which five (18%) underwent TKA at a median of 3.1 years (IQR: 1.68-6.74).</p><p><strong>Conclusion: </strong>In the current study of patients who underwent tibial plateau fracture nonunion surgery, 86% of patients ultimately achieved radiographic healing, with 71% healed after the index nonunion surgery. Close to half of the patients required additional surgery, with 14% who underwent further procedures to achieve healing, and 18% ultimately required conversion to total knee arthroplasty. These findings can help surgeons counsel patients and guide expectations following surgery for tibial plateau fracture nonunion.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199699","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":"Patient-Reported Outcomes Following Distal Femur Fracture Fixation: A Retrospective Cohort Study of 151 Patients.","authors":"Robert K Wagner, Maarten van Weezenbeek, Marcos R Gonzalez, Maaz Muhammad, Adam N Musick, Austin T Gregg, Carla H Lehle, Thomas J Policicchio, Job N Doornberg, Stein J Janssen, Arun Aneja, Thuan V Ly","doi":"10.1097/BOT.0000000000003081","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003081","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate 6-, 9-, and 12-month Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Global Health Physical (GH-Physical), and Global Health Mental (GH-Mental) scores following operative treatment of distal femur fractures.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Two Level 1 Trauma Centers.</p><p><strong>Patients: </strong>Adult patients treated operatively for a distal femur fracture (AO/OTA 33A or 33C) between 2016 and 2024, with ≥1 PROMIS score available between 3 and 12 months postoperatively were identified. Patients undergoing reoperation for nonunion were excluded.</p><p><strong>Outcome measures and comparisons: </strong>PROMIS scores were determined as estimated marginal means to account for repeated observations. Mixed-effects linear regression was performed to identify factors (e.g., patient, injury, and treatment characteristics, and PROMIS-GH-Mental scores) associated with PROMIS-PF.</p><p><strong>Results: </strong>Overall, 151 patients (median age 69 years [range: 21-84 years]; 66% female) were included. PROMIS-PF scores were 34.8 at 6 months, 36.3 at 9 months, and 37.9 at 12 months (p<0.001). PROMIS-GH-Physical scores were 40.5, 40.9, and 41.3 (p=0.35), and PROMIS-GH-Mental scores were 46.0, 46.6, and 47.2 (p=0.25). In multivariable analysis, female sex (ß: -2.7, p=0.010) and assisted baseline ambulation (ß: -4.1, p<0.001) were associated with worse PROMIS-PF scores, whereas better PROMIS-GH-Mental scores at follow-up (1-unit increase ß: 0.36, p<0.001) and follow-up duration (1-month increase: ß: 0.35, p=0.006) were associated with better scores.</p><p><strong>Conclusions: </strong>PROMIS-PF scores improved over time but remained considerably lower than the US reference population at 12 months (i.e., 38 vs. 50 points). Clinicians should educate patients that, even though their fracture is healing as expected, their physical function will likely remain impaired at 12 months. The current study findings suggest that physical function during recovery from distal femur fractures is more affected by baseline functioning and mental health during follow-up than injury characteristics.</p><p><strong>Level of evidence: </strong>Prognostic Level II.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176100","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":"Comparing Radial Head Fracture Surgical Outcomes in Patients Younger and Older Than Forty.","authors":"Kevin Kooi, Mark Stam, Ingmar Legerstee, Justin Koh, Wen-Chih Liu, Abhiram R Bhashyam","doi":"10.1097/BOT.0000000000003083","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003083","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the results of radial head arthroplasty(RHA) and open reduction internal fixation (ORIF) for radial head fracture treatment based on patient age.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Two academic Level 1 Trauma centers.</p><p><strong>Patient selection criteria: </strong>Included were patients treated with RHA or ORIF for a radial head fracture (OTA/AO 2R1A/B/C) between January 2015 and September 2022.</p><p><strong>Outcome measures and comparisons: </strong>Postoperative surgical outcomes, including reoperations, final elbow range of motion (ROM), and radiographic features were collected. The outcomes of RHA and ORIF in patients above and below 40 years were compared using bivariate and multivariable regression analyses.</p><p><strong>Results: </strong>The study cohort included 161 operative radial head fractures sustained in 160 patients of which 47% were male (n=75). Thirty-two patients were included in the RHA <40 years group (mean age 31 years, standard deviation (SD) 5; 72% were male (n=23)), 96 patients in the RHA ≥40 years group (mean age 60 years, SD 11; 34% were male (n=33)), and 22 patients in the ORIF <40 years group (mean age 27 years, SD 6; 64% were male (n=14)). In patients <40 years old, RHA versus ORIF had comparable flexion-extension (125° versus 128°, p=0.79) prono-supination (145° versus 140°, p=0.16), and reoperation rate (22% versus 14%, p=0.50). Rates of post-traumatic arthritis were higher for RHA versus ORIF in this age group (57% versus 27%, p=0.047), although the follow-up period for radiographic assessment in the RHA <40 years group was slightly longer than the ORIF <40 years group (12.7±10.4 months versus 7.6±4.6 months, p=0.04). When comparing patients ≥40 years old with those <40 years old, outcomes of RHA had comparable flexion-extension (125° versus 125°, p=0.93) prono-supination (145° versus 150°, p=0.07), reoperation rate (22% versus 15%, p=041), and post-traumatic arthritis rate (57% versus 64%, p=0.34). Younger patients exhibited a lower frequency and severity of stem radiolucency than older patients (53% versus 67%, p=0.01).</p><p><strong>Conclusions: </strong>For patients under 40 years, ORIF and RHA yielded comparable outcomes. RHA had a higher risk of post-traumatic arthritis, favoring ORIF for younger patients if technically feasible. Older patients should be aware of the increased risk of stem lucency when undergoing RHA.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124981","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}