Journal of Orthopaedic Trauma最新文献

{"title":"Projected Lifetime Salary Compensation Between Academic and Non-Academic Careers in Orthopaedic Trauma Surgery.","authors":"Jason Silvestre, Anthony J Minerva, Benjamin A Jacques, Kristoff R Reid, Langdon A Hartsock, Michael J Weaver, Mitchel B Harris, Jaimo Ahn","doi":"10.1097/BOT.0000000000003306","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003306","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the projected lifetime salary compensation of orthopaedic trauma surgeons in academic versus non-academic practice settings.</p><p><strong>Methods: </strong>This was a net present value (NPV) financial analysis and Monte Carlo simulation. Data were obtained for academic and non-academic orthopaedic trauma surgeons in the 2025 American Medical Group Association (AMGA) and Medical Group Management Association (MGMA) salary surveys. Lifetime salary compensation assuming different career lengths, discount rates, and career trajectories were compared between academic and non-academic practices.</p><p><strong>Results: </strong>Compensation per wRVU was consistently lower (range, 20.5%-23.5%) in academia across MGMA percentile benchmarks. With MGMA benchmarks, academic practice had lower lifetime salary compensation than non-academic practice for fixed salaries at the 25th percentile ($10.6 million vs $13.9 million, 23.7% lower), at the 50th percentile ($13.7 million vs $16.6 million, 17.5% lower), and at the 75th percentile ($18.4 million vs $19.7 million, 6.6% lower). Academic orthopaedic trauma surgeons required 4 to 24 additional years based on MGMA benchmarks and 5 to 8 additional years based on AMGA benchmarks to reach parity in lifetime salary compensation with non-academic orthopaedic trauma surgeons.</p><p><strong>Conclusions: </strong>Academic orthopaedic trauma practice was associated with lower lifetime salary compensation than non-academic practice. The gap was driven by lower compensation per wRVU and not by differences in clinical productivity.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194555","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":"Trends in Orthopaedic Trauma Research: A 30-Year Analysis of Orthopaedic Trauma Association Annual Meeting Abstracts, 1996-2025.","authors":"Griffin R Rechter, Davis T Hedbany, Joshua R Langford, Astrid Casin, George J Haidukewych, M Kareem Shaath","doi":"10.1097/BOT.0000000000003305","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003305","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize 30-year trends in the topics of abstracts presented at the Orthopaedic Trauma Association (OTA) Annual Meeting.</p><p><strong>Methods: </strong>All OTA Annual Meeting abstracts from 1996 through 2025 were identified from the OTA online abstract archive. Two independent reviewers classified each abstract into 1 of 22 primary topic categories and recorded non-exclusive secondary research themes. Each category's annual proportion of abstracts was compared across 3 eras (1996-2005, 2006-2013, and 2014-2025), and its temporal trend across calendar years was assessed.</p><p><strong>Results: </strong>A total of 5,213 abstracts were included. From 1996-2005 to 2014-2025, the proportion of abstracts increased for hip and proximal femur trauma (7.7% to 14.4%; r = +0.79, P < 0.001), the most represented anatomic region in 2014-2025, and for health-systems research (12.6% to 19.1%; r = +0.64, P < 0.001). Geriatric (3.6% to 7.1%; r = +0.59, P < 0.001), arthroplasty for trauma (2.1% to 4.1%; r = +0.52, P = 0.003), and periprosthetic fracture (0.6% to 1.3%; r = +0.43, P = 0.018) themes also increased. Proportions declined for midfoot/hindfoot (6.3% to 1.8%; r = -0.75, P < 0.001), spine (3.3% to 0.7%; r = -0.74, P < 0.001), and pediatric trauma (5.4% to 1.9%; r = -0.66, P < 0.001). The proportion of randomized controlled trials did not change significantly (7.8%, 9.9%, and 5.4%; r = -0.21, P = 0.26).</p><p><strong>Conclusions: </strong>Over 30 years, the proportion of Orthopaedic Trauma Association Annual Meeting abstracts addressing hip and proximal femur trauma, health-systems research, geriatric care, arthroplasty for trauma, and periprosthetic fractures increased, whereas the proportions addressing spine, pediatric, and midfoot/hindfoot trauma declined. The hip and proximal femur trauma category became the most represented anatomic region by 2014-2025, and the proportion of randomized controlled trials did not change significantly over the study period.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194501","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 Prospective Randomized Trial to Assess Early versus Delayed Weight Bearing Following Operatively Treated Ankle Fractures in the United States.","authors":"William T Obremskey, Kristin R Archer, Greg E Gaski, Ida Leah Gitajn, Roman M Natoli, Clay A Spitler, Joseph F Levy, Richard E Thompson, Elizabeth Wysocki, Lisa Reider","doi":"10.1097/BOT.0000000000003299","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003299","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the safety of early versus delayed weight bearing and effectiveness for improving return-to-work following ankle fracture repair.</p><p><strong>Methods: </strong>Design: Prospective randomized study.</p><p><strong>Setting: </strong>19 United States Trauma Centers.</p><p><strong>Patient selection criteria: </strong>Adult patients (≥18 years) with ankle fracture (OTA/AO 44 A, B or C) undergoing surgical fixation were included. Open Gustilo-Anderson (G-A) Type IIIB, IIIC, syndesmotic injuries with fixation, and injuries with arterial impaction that surgeons felt unsafe to weight were excluded.</p><p><strong>Outcome measures and comparisons: </strong>The co-primary outcomes were (1) non-inferiority of early versus delayed weight bearing for reoperation for complications of hardware failure, non-union, loss of reduction, infection, or fusion; and (2) gated superiority of early versus delayed weight bearing for time to return-to-work, both within 365 days of randomization. Reoperation and time to return-to-work was compared between patients assigned to early (2 weeks post-operatively) versus delayed (6 weeks post-operatively) weight bearing.</p><p><strong>Results: </strong>The modified intent to treat sample included 418 patients enrolled between January 2020 through October 2023; 214 early (mean age: 47; SD (15) range (18-84); 35% male); 204 delayed (mean age: 43; SD (15); 36% male). Reoperation for complication occurred in 5 early (2.3%, 95% Confidence Interval (CI): 0.3%, 4.4%), and 7 delayed patients (3.4%, 95% CI: 0.9%, 5.9%). Median time to return-to-work (95% CI) was 54 (42, 77) days and 69 (47, 89) days for the early and delayed groups, respectively. Early weight bearing was non-inferior to delayed weight bearing for reoperation (difference in complication free survival (early - delayed): 1.5 percentage points; 90% two sided CI: -1.7%, 4.8% which excluded the non-inferiority tolerance of -5.0%) and not superior for return-to-work (Hazard Ratio 1.1, 95% CI: 0.8, 1.6, p=0.475).</p><p><strong>Conclusions: </strong>Trial findings add to the growing evidence demonstrating the safety of early weight bearing after fixation of bimalleolar and trimalleolar ankle fracture without syndesmotic disruption, a key concern for both clinicians and patients. However, no statistically significant benefit of earlier return-to-work was found.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182602","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":"Comparison of novel anterior fixation method, W-plate, versus superior parasymphyseal plating in anterior posterior compression type III pelvic ring injuries: a biomechanical study.","authors":"Brandi Ann Krieg, Todd Baldini, Christopher Orear, Keenan Masami Onodera, Nicholas Jerome Tucker, Adam Schlauch, Justin E Hellwinkel, Nathaniel Elliot Schaffer, Cyril Mauffrey","doi":"10.1097/BOT.0000000000003304","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003304","url":null,"abstract":"<p><strong>Objectives: </strong>To compare stiffness, displacement, and load to failure (LTF) patterns of a novel anterior pelvic plating technique, W-plating, to superior parasymphyseal plating (SPSP) in anterior posterior compression type III (APC III) pelvic ring injuries in a biomechanical model.</p><p><strong>Methods: </strong>Twelve fourth generation composite pelves with induced APC III injuries stabilized with posterior screw fixation and either W-plating or SPSP were stressed via the Instron machine under single leg stance (SLS) axial load and external rotation (ER) load. Motion was analyzed at the pubic symphysis (PS) and sacroiliac joints (SIJ). PS and SIJ displacement, rotation, and stiffness were compared between the W-plate and SPSP groups under simulated stressed conditions. T-test was used to compare means and significance was set at p<0.05. Unadjusted p-values were reported alongside effect sizes (Cohen's d) and 95% confidence intervals (CI) to provide additional context regarding the magnitude and potential biomechanical relevance of the observed differences.</p><p><strong>Results: </strong>The W-plate demonstrated less inferior PS displacement than the SPSP under SLS with a large observed effect size (0.5 ± 0.4 mm vs 1.2 ± 0.5 mm, respectively, Cohen's d = 1.47). Average PS displacement also demonstrated a large effect size favoring the W-plate construct (Cohen's d = 1.07), though statistical significance was not reached (0.3 ± 0.3 mm vs 0.7 ± 0.3 mm respectively, p = 0.07). There were no significant differences in stiffness in the SLS for the W-plate versus SPSP (98.9 ± 11.2 vs 105 ± 6.6 N/mm, respectively, p = 0.6) or in ER (4.4 ± 2.2 v 3.1 ± 1.6, respectively, p = 0.3). When loaded to failure, the W-plate and the SPSP both failed at the posterior fixation with no significant difference between groups (1411± 221 v 1545 ± 225 N, respectively p = 0.4).</p><p><strong>Conclusions: </strong>In a biomechanical analysis of induced APC-III pelvic ring injury, W-plating performed similarly to SPSP in stiffness, displacement, and LTF. W-plating for anterior pelvic ring fixation was found to be biomechanically similar to SPSP with potentially increased resistance to anterior ring displacement.</p><p><strong>Level of evidence: </strong>V.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148689","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":"Mechanical Failure and Revision Risk Following Transition from PFNA to TFNA: A Single-Center Cohort Study of 1,970 Patients.","authors":"Ilai Ben Zoor, Itay Fogel, Snir Balziano, Ben Goldstein, Yosif Mansor, Alon Friedlander, Yosef Sourogeon, Dan Prat","doi":"10.1097/BOT.0000000000003303","DOIUrl":"10.1097/BOT.0000000000003303","url":null,"abstract":"<p><strong>Objectives: </strong>To compare implant mechanical failure, cut-out rate, and time to failure between two cephalomedullary nail designs following an institutional transition.</p><p><strong>Methods: </strong>Design: Retrospective consecutive cohort study.</p><p><strong>Setting: </strong>Single Level I trauma center, Israel.</p><p><strong>Patient selection criteria: </strong>Patients aged >65 years with acute OTA/AO 31A fractures (subtypes 31A1-31A3) treated with a short cephalomedullary nail with helical blade fixation, either the Proximal Femoral Nail Antirotation (PFNA) or the Trochanteric Fixation Nail-Advanced (TFNA), between January 2018 and May 2025 were included. Implant type was determined solely by an institutional transition from PFNA to TFNA in March 2023 for logistical reasons rather than surgeon preference.</p><p><strong>Outcome measures and comparisons: </strong>Implant mechanical failure, cut-out rate, time to failure, body mass index (BMI), and Tip-Apex Distance (TAD) were compared between groups. Mortality within the early revision-risk window was compared between groups to exclude survival bias.</p><p><strong>Results: </strong>The PFNA cohort comprised 1,388 patients (mean age 83.1 years, range 65-102; 986 females [71.0%]) and the TFNA cohort 582 patients (mean age 82.9 years, range 65-107; 407 females [69.9%]); baseline demographics were comparable (age, p=0.691; sex, p=0.626). Orthopedic follow-up was 63.9% for the TFNA cohort versus 61.0% for the PFNA cohort (p=0.24), with a shorter maximum observation period for TFNA (TFNA 26 vs. PFNA 88 months).TFNA was associated with a five-fold increase in implant mechanical failure relative to PFNA (TFNA 1.6% vs. PFNA 0.3%; RR=5.36, 95% CI 1.66-17.3; p=0.005), primarily driven by a four-fold increase in cut-outs (1.2% vs. 0.3%; RR=4.18, 95% CI 1.23-14.2; p=0.027). Failures occurred earlier with TFNA (median 80.0 vs. 244.0 days; p=0.027). Among cut-outs, OTA/AO subtype distribution did not differ (31A1: TFNA 57.1% vs. PFNA 50.0%; no 31A3 in either group; p=1.00); TFNA patients had a higher BMI (median 23.9 vs. 20.1 kg/m 2 ; p=0.024), but mean TAD did not differ (TFNA 24.6 vs. PFNA 21.1 mm; p=0.37). Mortality within the revision-risk window did not differ (TFNA 7.2% vs. PFNA 8.8%; p=0.24).</p><p><strong>Conclusions: </strong>The transition to the Trochanteric Fixation Nail-Advanced (TFNA) was associated with five-fold higher mechanical failure and four-fold higher cut-out rates than the Proximal Femoral Nail Antirotation (PFNA) with earlier failures suggesting reduced mechanical stability of the TFNA during early fracture healing. Heightened vigilance is warranted when using TFNA, particularly in patients with higher body mass index early postoperatively.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148117","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":"Headless Compression Screws May Reduce Symptomatic Hardware After Medial Malleolus Fixation: A Comparative Cohort Study.","authors":"Griffin R Rechter, Joshua R Langford, M Kareem Shaath, Timothy B Baker, Brendan E Page, Jonathan Yawman, George J Haidukewych","doi":"10.1097/BOT.0000000000003301","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003301","url":null,"abstract":"<p><strong>Objectives: </strong>To compare rates of medial-sided symptomatic hardware, hardware removal, and fracture union following medial malleolus fixation using partially threaded, headless compression screws versus traditional partially threaded, headed screws.</p><p><strong>Methods: </strong>Design: Retrospective cohort.</p><p><strong>Setting: </strong>Single, academic, Level I trauma center.</p><p><strong>Patient selection criteria: </strong>Skeletally mature patients who underwent operative fixation of a medial malleolus fracture [OTA/AO 44A-C] between 2021 and 2025 and had a minimum of 3 months follow-up were included.</p><p><strong>Outcome measures and comparisons: </strong>Demographics, injury characteristics, and surgical management was collected for the headless and headed screw cohort. The primary outcome was medial-sided symptomatic hardware. Secondary outcomes included removal of hardware from the medial malleolus, medial malleolus fracture union, and infection of the medial aspect of the ankle. A comparison between the medial malleolus screw type used was undertaken.</p><p><strong>Results: </strong>Of 306 patients, 195 (63.7%) received headed screws (mean age 56.0 years, range 18-92; 72.3% female; mean follow-up 15.1 months) and 111 (36.3%) received headless compression screws (mean age 51.0 years, range 18-95; 58.6% female; mean follow-up 13.2 months). Symptomatic hardware occurred in 34.8% of patients in the headed screw group compared with 20.7% in the headless screw group (p = 0.01), corresponding to an absolute risk reduction of 14.1%. Hardware removal rates did not differ between groups (30.8% vs 23.4%, p = 0.17). There were no differences in nonunion (3.6% vs 3.6%, p = 0.99) or infection rates (4.6% vs 5.4%, p = 0.97). On multivariable analysis, headless screw fixation was independently associated with a decreased likelihood of symptomatic hardware (odds ratio 0.55, 95% CI 0.32-0.96, p = 0.04). No independent association was observed between screw type and hardware removal.</p><p><strong>Conclusions: </strong>Headless compression screws may be associated with a lower rate of symptomatic hardware at a mean of one year following medial malleolus fixation without compromising fracture healing or increasing infection risk. The lower observed incidence of symptomatic implants may suggest a clinically meaningful benefit of implant selection in this subcutaneous anatomic region.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148173","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":"Measuring Knee Alignment Following Distal Femur Fracture Surgery: A Novel Deep Learning Approach.","authors":"Daniel E Pereira, Sundeep Chakladar, Noah J Harrison, Brian D Rust, Mitchel R Obey, Christopher M McAndrew, Marschall B Berkes, Jenna L Wilson","doi":"10.1097/BOT.0000000000003300","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003300","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether a machine learning-based system can accurately measure coronal knee alignment parameters from routine postoperative radiographs following surgical fixation of distal femur fractures.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Single-center academic orthopedic trauma practice.</p><p><strong>Patient selection criteria: </strong>Adult patients 50 years of age or older who underwent surgical fixation of low-energy OTA/AO 33A and 33C distal femur fractures (including periprosthetic fractures) between November 2020 and December 2024 were retrospectively identified.</p><p><strong>Outcome measures and comparisons: </strong>A machine learning-based automated alignment assessment system was trained to identify standard radiographic landmarks, including the femoral intercondylar notch, femoral condyles, tibial spines, and tibial plateaus, and automatically calculate commonly used coronal alignment parameters including joint line convergence angle (JLCA), anatomic femorotibial angle (aFTA), anatomic lateral distal femoral angle (aLDFA), and anatomic medial proximal tibial angle (aMPTA). Automated measurements were compared with manual measurements annotated by a trained observer and validated by an orthopedic surgeon.</p><p><strong>Results: </strong>A total of 287 postoperative AP knee and distal femur radiographs were obtained as part of routine postoperative care and randomly divided into training and testing datasets for model development and validation. The cohort was 78.0% female with a mean age of 72.3 years (range: 50 to 97 years). Automated measurements demonstrated strong agreement with surgeon-validated measurements. Mean absolute error was 1.1° for JLCA (range: 0.0° to 3.5°), 1.5° for aFTA (range: 0.0° to 4.4°), 1.0° for aLDFA (range: 0.0° to 3.1°), and 2.3° for aMPTA (range: 0.1 to 6.4°). Pearson correlation coefficients ranged from 0.4 to 1.0, and Bland-Altman analysis demonstrated minimal systematic bias, with 95% of differences falling within a clinically acceptable range of ±5°.</p><p><strong>Conclusions: </strong>Automated alignment assessment utilizing a machine learning-based system using routine postoperative radiographs provided accurate measurements in distal femur fracture patients and may serve as a practical adjunct for longitudinal surveillance in orthopedic trauma practice.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127802","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":"Dynamic Interfragmentary Compression Through a Tibial Intramedullary Nail Compared to Backslapping Alone: A Biomechanical Analysis.","authors":"Brittany E Haws, J Daniel Thompson, Jonathan P Yawman, Jana M Davis, Nina Suh, James A Blair","doi":"10.1097/BOT.0000000000003293","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003293","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the amount of interfragmentary compression obtained in a transverse tibia fracture model with backslapping alone (BS) versus the intramedullary nail's dynamic internal compression (IC) mechanism and if that compression is maintained after loading.</p><p><strong>Methods: </strong>A transverse diaphyseal tibia synthetic fracture model was used. Specimens were allocated to four groups (n=5/group) that received one of two intramedullary nails (A or B) and obtained compression either with the IC device or with BS alone. Specimens underwent sinusoidal loading for 135,000 cycles of 700N @3Hz to simulate three months of weightbearing. Interfragmentary pressure measurements were measured at initial compression, procedure completion (pre-cycling) and after loading (post-cycling). Compression at each stage was compared between BS and IC groups as well as between stages. Outcomes were also compared between Nails A and B.</p><p><strong>Results: </strong>There was significantly greater initial (1097N vs 167N, p<0.001) and pre-cycling (391N vs 103N, p<0.001) compression generated with IC compared to BS. The IC group also maintained greater compression than the BS group post-cycling (377N vs 75N, p<0.001). Both groups experienced significant loss of compression between initial and pre-cycling timepoints and during the cycling process (p<0.05 for all). On subanalysis, Nail B was able to generate significantly more initial compression than Nail A with the IC device (1523N vs 382N, p=0.001) and maintain it post-cycling (412N vs 205N, p=0.032). Conversely, Nail A was able to generate and maintain significantly more compression than Nail B at all three time-points with the BS technique (p<0.05 for all).</p><p><strong>Conclusions: </strong>Intramedullary IC devices generated and maintained greater interfragmentary fracture compression than traditional BS techniques alone. However, some compressive force was lost after loading regardless of compression technique utilized. Differences in compressive force were observed between nail manufacturers with both techniques, which may suggest that nail geometry and instrumentation may contribute to fracture compression.</p><p><strong>Level of evidence: </strong>V.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111176","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 Following Early Weight Bearing in Syndesmotic Injuries: A Randomized Controlled Trial.","authors":"Mubinah Khaleel, Elizabeth Durante, Sam Hawkins, James P Stannard, Gregory J Della Rocca, Brett Crist, James L Cook, Kyle Schweser","doi":"10.1097/BOT.0000000000003296","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003296","url":null,"abstract":"<p><strong>Objectives: </strong>To compare outcomes of early weight bearing (EWB) at 2-weeks versus delayed weight bearing (DWB) at 6-weeks following operative ankle fracture fixation with syndesmotic stabilization.</p><p><strong>Methods: </strong>Design: Prospective randomized controlled clinical trial.</p><p><strong>Setting: </strong>Single Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Adult patients with operative rotational ankle fractures (OTA/AO 44A-C) and an intraoperative finding of syndesmotic injury following fracture fixation between September 2019 and September 2022 were included. All underwent dynamic syndesmotic stabilization utilizing a single suture button. Exclusion criteria were fibular fractures not amenable to length-stable fixation (e.g., Maisonneuve injuries), neuropathic diabetes, body weight ≥147.4 kg (325 lbs), imprisonment, pregnancy, lactation, end-stage renal disease, cognitive dysfunction, or polytrauma.</p><p><strong>Outcome measures and comparisons: </strong>Maintenance of syndesmotic reduction at 1 year comparing immediate postoperative and 1-year CT scans of both ankles was the primary outcome. Secondary outcomes: pain (VAS), surgical satisfaction (SSQ-8), functional scores (AAOS Foot and Ankle), ankle range of motion, and complications.</p><p><strong>Results: </strong>106 patients were enrolled: 40 underwent syndesmotic fixation and were randomized. 16 patients (mean age 41 (21-80), 9 female, 7 male) randomized to EWB and 23 (mean age 43 (23-85), 12 female, 11 male) to DWB completed the study. Fracture types included lateral malleolar (OTA/AO 44A), bimalleolar and bimalleolar equivalent (OTA/AO 44B), and trimalleolar (OTA/AO 44C) fractures, with similar distribution between groups (p=0.96). EWB group had significantly higher pain scores (4.6 ± 2.8 vs 2.8 ± 2.3, p = 0.039) at the 2-week visit compared to DWB. At 1 year, dorsiflexion in the EWB group was significantly higher (14.2° ± 3.9° vs 7.7° ± 4.4°) than the DWB (p = 0.017). No significant difference in syndesmotic malreduction (p>0.99), loss of reduction (p>0.89), PROs, development of arthritis (p>1.0) or complication rates (p>0.37) at any other timepoint.</p><p><strong>Conclusions: </strong>Early weight bearing at 2-weeks was noninferior to delayed weight bearing at 6-weeks following rotational ankle fracture fixation with a syndesmotic injury stabilized with flexible fixation.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111207","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 Association Between Serum Inflammatory Markers and Pathogen Profile in Confirmed Fracture-related Infection.","authors":"Abhishek Ganta, Lauren A Merrell, Natalie H Vu, Sara J Solasz, Sanjit R Konda, Kenneth A Egol","doi":"10.1097/BOT.0000000000003292","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003292","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine whether serum inflammatory markers, Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP), varied according to pathogen profile in patients with confirmed fracture-related infection (FRI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective Cohort Study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single, multi-site urban academic institution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Patients treated between January 2011 and July 2024 were included if they met FRI Consensus Group criteria for confirmed FRI, underwent surgical irrigation and debridement with intraoperative deep tissue sampling, and had ESR (mm/hr) or CRP (mg/L) values documented within 7 days of operative debridement. Cases were classified into four mutually exclusive pathogen groups: gram-positive (GP) monomicrobial, gram-negative (GN) monomicrobial, polymicrobial (PM), and culture-negative (CN).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;ESR (reference range: 0-22 mm/hr) and CRP (reference range: &lt;5.1 mg/L) were compared across pathogen groups, with direct comparison of gram-positive versus gram-negative infections. Receiver operating characteristic (ROC) analysis evaluated each marker's discriminatory ability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 359 patients meeting inclusion criteria, 331 had ESR and 343 had CRP values available. Gram-positive monomicrobial infections were identified in 143 (39.8%), patients (median [IQR] age: 49.0 [35-64], 71.3% male), gram-negative in 69 (19.2%) patients (median [IQR] age: 54.5 [39-65], 44.9% male), polymicrobial in 114 (31.8%) patients (median [IQR] age: 46.8 [37-65], 64.0% male) and culture-negative in 33 (9.2%) patients (median [IQR] age: 65.0 [39-69], 30.3% male). Baseline demographics were similar across groups (median age: 46.8-65.0, median BMI 26.4-27.5, median CCI 0-0; all p&gt;0.05), except for sex distribution, with male sex most common in gram-positive infections (71.3%, p&lt;0.001). ESR did not differ significantly across pathogen groups (median 53.0 GP, 57.0 GN, 45.0 PM, 48.5 CN mm/hr, p=0.728). CRP differed significantly across groups (median 17.4 GP, 7.0 GN, 14.0 PM, 10.8 CN mg/L, p=0.013); post hoc analysis identified gram-positive versus gram-negative as the only significant pairwise difference, with CRP approximately 2.5-fold greater in gram-positive than gram-negative infections (median 17.4 vs 7.0 mg/L, adjusted p=0.012). ROC analysis demonstrated modest ability of CRP to discriminate gram-positive from gram-negative FRIs (AUC=0.634, sensitivity 72.5%, specificity 49.2%), while ESR demonstrated no meaningful discrimination (AUC=0.482).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;ESR did not differ by pathogen profile in confirmed FRI. CRP was significantly higher in gram-positive infections, with a median value approximately 2.5-fold greater than gram-negative infections. However, the modest AUC and poor specificity indicate CRP cannot reliably classify pathogen t","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111161","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}