Journal of Orthopaedic Trauma最新文献

{"title":"Technical Trick: Dual Plating with Medial Twist Plate of Distal Femur Fractures.","authors":"Hunter B Yancey, Madeline C Smith, Nicholas A Andring, Mattie E Raiford, Sharon Babcock, Jason J Halvorson, Holly T Pilson, Eben A Carroll","doi":"10.1097/BOT.0000000000002978","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002978","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657413","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":"Utility of Pelvis CT to Assess Occult Intertrochanteric Extension of Greater Trochanteric Fractures.","authors":"Meghan A Moriarty, Dimitri G Stefanov, Randy M Cohn, Michael S Brown, Daniel M Walz, Pamela J Walsh","doi":"10.1097/BOT.0000000000002973","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002973","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if CT differences of bone density between the injured and non-injured femora in patients with greater trochanteric fractures can be used to identify intertrochanteric extension.</p><p><strong>Methods: </strong>Design: Retrospective cohort series.</p><p><strong>Setting: </strong>Multi-hospital academic institution.</p><p><strong>Patient selection criteria: </strong>Included were patients over a 7-year period (1/2014-12/2021) with greater trochanteric fractures (OTA/AO 31A1.1) without evident intertrochanteric extension on CT that also underwent pelvis MRI to assess for occult intertrochanteric extension.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome measures were CT findings of intertrochanteric curvilinear density (CL) and subtrochanteric bone density (ST) in the injured femur in patients with greater trochanteric fractures. CT findings (CL and ST) were compared to the patient's MRI, which was the reference standard for occult intertrochanteric fractures. The MRI determined presence of occult intertrochanteric extension (MRI ITE) and if present, MRI determined fracture extension into the intertrochanteric region, were categorized as 1) less than 50% or 2) 50% or greater. Descriptive statistics, sensitivity, specificity and inter-rater reliability were calculated assessing the presence of the CT findings of CL and ST, compared to reference standard MRI ITE. Sensitivity and specificity for CL and ST were calculated for 1) any degree of MRI ITE (<50% and >50%) and 2) only MRI ITE 50% or greater.</p><p><strong>Results: </strong>Eighty-one patients (54 females, 27 males, mean age 82, range 54-102) were included. Fourteen (17%) patients had no MRI ITE, 11 (14%) patients had <50% MRI ITE and 56 (69%) patients had ≥50% MRI ITE. The presence of CL on CT corresponded to any MRI ITE (<50% and >50%) with sensitivity of 55.2%, specificity 100%, PPV 100%, and NPV 31.8%. In patients with MRI ITE 50% or greater only and CL presence, specificity was 92% and sensitivity was 62.5%. Presence of ST on CT was associated with any MRI ITE with sensitivity of 34.3%, specificity 100%, PPV 100% and NPV 24.1%. Patients with MRI ITE 50% or greater and ST presence, specificity was 96% and sensitivity was 39%.</p><p><strong>Conclusions: </strong>In patients with apparent isolated greater trochanteric fractures, the presence of curvilinear intertrochanteric and subtrochanteric density in the medullary bone in the injured femur on pelvis CT was highly predictive of intertrochanteric extension. Patients with these CT findings in the injured femur on pelvis CT can be assumed to have intertrochanteric extension and treated accordingly, obviating the need for MRI. The absence of the curvilinear intertrochanteric and subtrochanteric densities did not rule-out possible intertrochanteric extension, and MRI can be further considered in this population.</p><p><strong>Level of evidence: </strong>Diagnostic Level I","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657391","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":"Pin-site related outcomes after temporary staging external fixator pin placement using the self-drilling pin insertion technique.","authors":"Tyler J Moon, Andrew J Moyal, Kira L Smith, Elika Fanaeian, Michael B Suponcic, Brian Weatherford, John K Sontich, Joshua K Napora, George Ochenjele","doi":"10.1097/BOT.0000000000002977","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002977","url":null,"abstract":"<p><strong>Objectives: </strong>To report on pin-related complications in patients who underwent temporary staging external fixation using a self-drilling pin insertion technique.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single tertiary referral level one trauma center.</p><p><strong>Patient selection criteria: </strong>Adult patients were included who underwent temporary spanning external fixation of the lower extremity (AO/OTA 32, 33, 41, 42, 43, 44, 81, 82, 83, 84, and 85 fractures) using self-drilling and self-tapping pins placed using the self-drilling technique (Stryker Hoffman External Fixation System, Kalamazoo, MI, USA) between August 1st, 2015, and December 31st, 2022, with minimum follow up of 90 days. The self-drilling technique included use of a soft tissue sleeve for pin protection in the femur and tibia, release of the tourniquet if inflated, and full speed insertion with the final turns completed by hand. Irrigation of the pin-bone interface was not typically used.</p><p><strong>Outcome measures: </strong>Outcome measures included pin-site infection, pin loosening, loss of reduction in external fixator, and deep infection of the primary surgical site.</p><p><strong>Results: </strong>265 patients were included with a mean follow-up of 556 days. Mean age was 50 years (range 18-86 years). 155 patients (59%) were male. 1154 total pins were placed: 289 (25%) in the femur (one metaphyseal), 527 (46%) in the tibia (12 metaphyseal), 161 (14%) transfixion pins in the calcaneus, and 171 (15%) in the midfoot/forefoot. 7 patients (2.6%) developed a pin site infection. The infection rate for the total number of pins placed was 7/1154 (0.6%). 1 patient sustained a loss of reduction in the external fixator and 3 pins were noted to be loose at the time of definitive fixation (two in the tibial diaphysis and one in the 1st metatarsal shaft). 35/265 (13.2%) patients developed deep fracture related infection or septic nonunion in the post-operative period, none of which were associated with prior pin site infection.</p><p><strong>Conclusions: </strong>The self-drilling technique for temporary external fixator pin insertion in the present study demonstrated low rates of pin site infection, pin loosening, and loss of reduction.</p><p><strong>Level of evidence: </strong>Level III Therapeutic Study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630571","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":"What is the rate and timing of salvage surgery after operative treatment of talus fractures?","authors":"Erika Roddy, William Hannay, Bilal Khilfeh, Kira Newell, David Dalstrom, Bruce Sangeorzan, Stephen Benirschke, Reza Firoozabadi","doi":"10.1097/BOT.0000000000002975","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002975","url":null,"abstract":"<p><strong>Objectives: </strong>To report on the short-term, mid-term, and long-term rates of salvage treatment after operative treatment of talus fractures.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Level one trauma center.</p><p><strong>Patient selection criteria: </strong>All patients with a talus fracture (AO/OTA 81.1-81.3) treated surgically at a level one trauma center between 2008 and 2018 were eligible for inclusion.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was conversion to salvage treatment, defined as conversion to arthroplasty, arthrodesis, or amputation.</p><p><strong>Results: </strong>A total of 343 patients with operatively treated talus fractures were identified. One hundred and twenty eight patients were reached by telephone for long-term follow-up. Two hundred and twenty two (65%) were men. The mean age was 35 (SD 10, range 14-70). There were 195 (57%) talar neck fractures, 113 talar body fractures, 5 talar head fractures, and 30 lateral process fractures. The mean duration of follow-up was 5 years. Twenty-four patients (7%) underwent 24 salvage procedures. The rate of salvage was 1% (95% CI 0-3%) at 1 year, 3% (95% CI 1-6%) at 2 years, 10% (95% CI 6-15%) at 5 years, 13% (95% 9-20%) at 10 years, and 15% (10-22%) at 16 years. All salvage procedures occurred within 11 years, and 80% occurred within 5 years of injury. In multivariate cox analysis, the presence of higher Hawkins type as well as the presence of AVN with collapse (HR 4.67 (95% CI 1.82, 11.99, p=0.001)) and arthritis (HR 5.70 (95% CI 1.25, 25.78, p=0.024) remained predictive of conversion to salvage treatment.</p><p><strong>Conclusions: </strong>The rate of salvage surgery was 15% at 16 years after operative treatment of talus fractures. The highest risk of conversion to salvage treatment was within the first 5 years. The presence of a neck or body fracture, higher Hawkins classification, development of AVN with collapse, and arthritis were associated with increased risk of conversion to salvage treatment.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630573","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":"Treatment of Incompletely Displaced Femoral Neck Fractures Using Trochanteric Fixation Nail-Advanced(TFNA) in Patients over 50 years of Age.","authors":"Jee Young Lee, Gyu Min Kong","doi":"10.1097/BOT.0000000000002976","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002976","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze the outcomes of patients with femoral neck fractures aged 50 years or older treated with Trochanteric Fixation Nail-Advanced (TFNA; DePuy Synthes, Paoli, PA) to determine the stability of fracture fixation and the effectiveness of the treatment.</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>Patients aged 50 years or older who underwent fixation with TFNA helical blade for femoral neck fractures (OTA/AO 31-B) and were followed for more than 1 year were included.</p><p><strong>Outcome measures and comparisons: </strong>Radiological examinations were evaluated to determine bone union, femoral neck shortening, development of avascular necrosis (AVN) of the femoral head, and breakage of metal fixation. A comparison was made between patients with femoral neck shortening (>5 mm) and those without (<5 mm).</p><p><strong>Results: </strong>A total of 45 patients were included in this study. The mean age of the patients was 70.2 (50-89) years, and 68.9% were females. No early postoperative complications, such as postoperative infection, deep vein thrombosis, or pulmonary embolism, were observed. All patients achieved bone union within 23 weeks. The average femoral neck shortening was 2.6 mm (0-16.8), with femoral neck shortening >5 mm observed in 7 patients (15.6%). Significant femoral neck shortening was observed in patients with displaced fractures compared to non-displaced fractures (p=0.006). One patient developed AVN of the femoral head. No metal fixation failure was observed.</p><p><strong>Conclusions: </strong>In patients aged 50 years or older, TFNA fixation for non-displaced femoral neck fractures demonstrated relatively minimal femoral neck shortening and a low complication rate, indicating that it is an effective technique for treating these fractures. However, for displaced fractures, surgeons should be mindful of the potential for excessive neck shortening and carefully select the surgical method.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630572","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":"High failure rates in comminuted patella fractures (AO/OTA 34-C3) fixed with an isolated new patella specific 2.7 mm variable angle locking plate.","authors":"Wayne Hoskins, Rown Parola, Charles Gusho, Jaime L Bellamy, Abdulai Bangura, Gregory Della Rocca, Kyle Schweser, Steven DeFroda, Brett Crist, Douglas Haase","doi":"10.1097/BOT.0000000000002972","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002972","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the outcomes of comminuted patella fractures fixed with a new patella-specific 2.7mm variable angle (VA) locking plate in isolation versus when augmentation of fracture fixation is applied with the plate.</p><p><strong>Methods: </strong>Design:Retrospective.</p><p><strong>Setting: </strong>Academic Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>All acute comminuted patella fractures (AO/OTA 34-C3; complete displaced or undisplaced articular, frontal/coronal multifragmentary fractures) in adult patients primarily treated with a new patella-specific 2.7 mm VA locking plate (Synthes, Paoli, PA) between January 2021 and February 2024 at a single academic center were reviewed and divided in those fixed with the patella plate alone and those with additional bony and/or soft tissue augmentation. Excluded were those with < 90 follow-up, set a priori, unless complications occurred <90 days.</p><p><strong>Outcome measures and comparisons: </strong>Comparison of patient age, sex, BMI, ASA, FRAX score, open fracture, polytrauma involvement, length of follow-up and post-operative protocols was made between groups. The primary outcome measure was loss of fixation. Secondary outcomes were mode of failure and other surgical complications.</p><p><strong>Results: </strong>There were a total of 38 included patients, with no lack of or loss of follow-up, with 20 grouped into patella plate alone, and 18 into patella plate plus augmentation. The plate only group had a higher mean age (63.7 vs. 46.9, p=0.024), with no between-group differences in sex (65% vs. 44% female, p=0.20), BMI (p=0.51), 10-year fracture risk (FRAX) (p=0.06), open fractures (p=0.30), polytrauma involvement (p=0.97), or postoperative weight-bearing (p=0.76) or range of motion (p=0.06) protocols. There were eight failures (40.0%) in the plate-only group, and two failures in the plate with augmentation group (11.1%); (p=0.043). When controlling for known risk factors for osteoporosis and poor bone quality using the FRAX 10-year fracture risk on multivariable regression analysis, plate fixation with fracture augmentation was associated with a lower risk of fixation failure (OR=0.14, 95% CI 0.02-0.75; p=0.036). The plate-only group failed by loss of distal (62.5%, n=5) and proximal fixation (37.5%, n=3). Each of the two failures in the plate plus augmentation group had loss of distal fixation.</p><p><strong>Conclusions: </strong>Treatment of comminuted patella fractures with a new patella-specific 2.7mm VA locking plate has a high failure rate when used in isolation. Augmenting fracture fixation with soft-tissue repair and/or independent fracture fragment fixation may significantly decrease failure rates. In particular, augmentation of the tendon avulsion component to restore the extensor mechanism appears critical.</p><p><strong>Level of evidence: </strong>Therapeutic Level 3.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573292","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":"Expedited Hip Fracture Surgery in Patients on Direct Oral Anticoagulants Does Not Increase Perioperative Blood Loss.","authors":"Juntian Wang, Peter Aldo Giammanco, Paal Nilssen, Julia Stone, Kathleen Breda, Milton Little, Charles Moon, Peter Yim, Carol Lin","doi":"10.1097/BOT.0000000000002974","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002974","url":null,"abstract":"<p><strong>Objectives: </strong>To compare blood loss and transfusion rates in geriatric hip fracture patients on direct oral anticoagulants undergoing surgery ≤ 24 hours from admission (Expedited group) versus 24-72 hours from admission (Delayed group).</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients aged ≥ 65 with a femoral neck, intertrochanteric, or subtrochanteric fracture (AO/OTA 31A, 31B, and 32) on factor Xa inhibitors (apixaban or rivaroxaban) prior to admission from April 2014 to April 2024 were included.Outcome Measures and Comparisons: Primary outcomes were preoperative blood loss (difference between admission hemoglobin (Hgb) and lowest preoperative Hgb), overall blood loss (difference between admission Hgb and lowest postoperative Hgb within four days postop), and transfusion rates. Secondary outcomes were length of stay (LOS) and 90-day complication (cerebrovascular accident, myocardial infarction, deep venous thrombosis, pulmonary embolism, urinary tract infection, gastrointestinal bleed, pneumonia, acute kidney failure, surgical site infection), readmission, reoperation, and mortality rates.</p><p><strong>Results: </strong>The Expedited group (n=67) and Delayed group (n=183) were similar in age (85.2±6.8 years (67-97) vs. 84.4±7.5 years (65-101), p=0.405) and sex (50.7% vs. 37.2% male, p=0.084). The Delayed group had higher preoperative blood loss (1.2±1.3 g/dL vs. 0.80±1.0 g/dL, p=0.003) with no differences in overall blood loss (2.9±.1.7 g/dL vs. 2.9±1.7 g/dL, p=0.881) and transfusion rates (28.4% vs. 25.4%, p=0.634). The Expedited group had a shorter LOS (6.0±5.6 days vs. 7.1±3.3 days, p<0.001). The Delayed group had a higher 90-day complication rate (41.5% vs. 19.4%, p=0.001). The Expedited group did not have higher rates of 90-day readmission (22.4% vs. 25.7%, p=0.593), reoperation (4.5% vs. 3.8%, p=0.730), or mortality (9.0% vs 6.6%, p=0.581).</p><p><strong>Conclusions: </strong>For geriatric hip fracture patients on factor Xa inhibitors, surgery ≤ 24 hours from admission reduced preoperative blood loss without increasing risk for overall bleeding, transfusion, or 90-day complication.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567434","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":"Internal vs external fixation of the anterior ring in unstable pelvic fractures was associated with discharge to home.","authors":"Joseph T Patterson, Ian G Hasegawa, Brandan Sakka, Andrew P Collins, Soroush Shabani, Andrew M Duong, Li Ding, Monica D Wong, Reza Firoozabadi, Joshua L Gary","doi":"10.1097/BOT.0000000000002971","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002971","url":null,"abstract":"<p><strong>Objective: </strong>To determine if anterior internal or definitive external fixation combined with posterior internal fixation of unstable pelvic fractures was associated with frequency of discharge to home.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Two Level 1 Trauma Centers and one academic tertiary referral center.</p><p><strong>Patient selection criteria: </strong>Patients aged ≥16 years with unstable OTA/AO 61B/C pelvis fractures treated with operative fixation of the anterior and posterior pelvic ring by three fellowship-trained orthopaedic trauma surgeons from October 2020 to November 2022.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was the adjusted odds of discharge to home with internal fixation compared with definitive external fixation of the anterior pelvic ring on multivariable analysis considering patient, injury, and treatment characteristics. Secondary outcomes included bivariable associations between anterior fixation type and intensive care unit (ICU) days, ventilator days, hospital length of stay, and hospital charges.</p><p><strong>Results: </strong>Seventy-nine patients (65%) who were treated with internal fixation presented with higher mean Glasgow Coma Scale scores (13.5±3.6 vs 10.5±5.4, p<0.01) than 43 patients treated with definitive external fixation, but were otherwise similar to with regard to age (mean 48.1±19.9 vs 41.2±15.8, range (16-96) vs (19-77), p=0.07), sex (36.7% vs 44.2% female, p=0.42193), mean, body mass index (28.4±6.2 vs 28.7±7.4 kg/m2, p=0.93), any medical comorbidities (50.6% vs 44.2%, p=0.62), substance use ((13.9% vs 27.9%, p=0.09884), insurance type (p=0.97), mean Injury Severity Score (24.8±12.0 vs 29.5±14.0, range 5-57 vs 10-57, p=0.14), pelvis fracture pattern (p=0.12187), and preinjury living environment(p=0.67695). On multivariable analysis, patients treated with internal fixation were more frequently discharged to home (53.2% vs 27.9%, odds ratio 3.39, 95% confidence interval 1.29-9.84, p=0.0198). Patients treated with anterior internal fixation also experienced fewer mean ICU days (6.0±8.8 vs 9.8±16.3, p=0.0213), ventilator days (3.5±8.2 vs 6.9±15.9, p<0.0081), and hospital days (18.7±16.2 vs 31.2±26.7, p<0.01); and incurred less hospital charges ($278,563.29±$261,602.35 vs $580,625.98±$503,067.98, p<0.01).</p><p><strong>Conclusions: </strong>Patients who received anterior and posterior internal fixation of their unstable pelvis fractures were more likely to discharge to home than patients treated with anterior definitive external fixation and posterior internal fixation. Anterior internal fixation was also associated with fewer ICU, ventilator, and hospital days, as well as less hospital charges.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492315","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":"Intraoperative Radiographic Rotational Profile of the Tibia: Technique and Clinical Series.","authors":"Sean P Wrenn, Robert B Ponce, Ridge Maxson, Andres Libos, Vamshi Gajari, Andres F Moreno, Joseph R Cave, Stephen Bigach, Michael A Quacinella, Taylor M Yong, Manish K Sethi, Daniel J Stinner, Robert H Boyce, Amir A Jahangir, Lauren M Tatman, Phillip M Mitchell, William T Obremskey","doi":"10.1097/BOT.0000000000002970","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002970","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468077","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":"Rotational Alignment in tibia diaphyseal fractures with the Suprapatellar Semi-extended Versus Standard Upper Entry Tibial Intramedullary Nailing: A Randomized Controlled Trial (RASPUTIN).","authors":"Viju Daniel Varghese, Jubin Jamshed, Chandy Viruthipadavil John, Madhavi Kandagaddala, Abel Livingston, Jeremy Bliss, Bijesh Yadav","doi":"10.1097/BOT.0000000000002968","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002968","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether suprapatellar or infrapatellar approach makes a difference in the rate of rotational malalignment in tibial diaphyseal fractures treated with intramedullary nailing.</p><p><strong>Methods: </strong>Design: Non inferiority, randomized controlled trial, with 2 arms (Suprapatellar and Infrapatellar approach).</p><p><strong>Setting: </strong>Single centre trial at a Level I trauma centre in South India.</p><p><strong>Patient selection criteria: </strong>Adults presenting with tibial diaphyseal fractures (OTA/AO 42A, B and C, 43A) planned for intramedullary nailing between September 2021 to July 2022.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome compared was the degree of rotational malignment in patients undergoing tibia nailing with Suprapatellar and Infrapatellar approaches. This was done using CT scan in the immediate post-operative period. Secondary outcomes included across the 2 groups were post-operative entry site pain, anterior knee pain (Kujala score), functional scores and union rates.</p><p><strong>Results: </strong>50 patients, 25 in each arm were included and followed up to a period of 1 year. The mean age was 34 (16-67) years (68% male) in the suprapatellar group and 45 (16-72) years (72% male) in the infrapatellar group. The rate of rotational malalignment was 34% with 8 (32%) in the suprapatellar group and 9 (36%) in the infrapatellar group and was independent of approach (P=0.76). The rotational malalignment had no association with knee functional scores (P=0.24). Factors such as location of fracture (P=0.81), mechanism of injury (P=0.76), type of injury (P=0.24) and surgeon seniority (P=0.2) had no association with malrotation. Suprapatellar and infrapatellar groups were similar in terms of knee function (P=0.52), knee (P=0.31) and ankle P=0.23) range of movement and union rates (P=0.84). Entry site pain was found to be significantly less (P=0.021) in the suprapatellar group (6/25) as compared to the infrapatellar group (14/25).This difference persisted at 1 year.</p><p><strong>Conclusions: </strong>Rotational malalignment in tibial diaphyseal fractures treated by intramedullary nailing was independent of the approach used. Entry site pain was less common with suprapatellar approach.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458376","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}