Journal of Orthopaedic Trauma最新文献

{"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}

{"title":"Homelessness and The Outcome of Hip Fracture Surgical Management: A Nationwide Study in the US.","authors":"Amir Human Hoveidaei, Kasra Pirahesh, Fatemeh Kanaani Nejad, Amirhossein Ghaseminejad-Raeini, Basilia Onyinyechukwu Nwankwo, Janet D Conway","doi":"10.1097/BOT.0000000000002967","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002967","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate whether people experiencing homelessness (PEH) have more postoperative complications following hemiarthroplasty, total hip arthroplasty (THA), hip open reduction and internal fixation (ORIF), and percutaneous skeletal fixation surgeries following hip fracture in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;A nationwide study in the US using the PearlDiver Patient Records Database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Patients who underwent hemiarthroplasty, THA, ORIF, and percutaneous skeletal fixation surgeries following hip fracture from 2010 to 2022 were included. The CPT codes corresponding to surgical procedures were searched through the database. Then, the housing status was extracted using the corresponding ICD codes for homelessness. Those who did not have ICD codes assigned for homelessness were considered to be housed. PEH were matched with housed patients in a 1:3 ratio based on age, sex, and year of surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;Baseline patient characteristics and comorbidities were accessed through ICD and CPT codes. After matching, the postoperative 30-day and 90-day rates of acute renal failure (ARF), myocardial infarction (MI), respiratory failure, sepsis, venous thromboembolism (VTE), pneumonia, urinary tract infection (UTI), surgical site infection (SSI), and readmission were compared between PEH and housed patients using two models: 1. A Chi-square test 2. A multivariate logistic regression while controlling for The Elixhauser comorbidity index (ECI), obesity, diabetes, alcohol abuse, tobacco use, and drug abuse.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 692,933 housed patients and 2,795 homeless patients (mean age of 59.1 ±11.6 years, 70.0% male) were evaluated. After matching the PEH to housed patients for age, sex, and year of surgery with a 1:3 ratio, a total of 8,382 housed patients (mean age of 59.1 ± 11.6, 70.0% male) were selected for the postoperative complication analysis in comparison with 2,795 PEH. In the Chi-squared analysis, it was observed that rates of postoperative 90-day ARF (1.36 [1.18 - 1.56]), sepsis (1.70 [1.44 - 1.99]), respiratory failure (1.33 [1.16 - 1.52]), UTI (1.37 [1.19-1.58]), pneumonia (1.49 [1.28-1.74]), SSI (2.03 [1.62-2.54]), and readmission (1.60 [1.45-1.77]) were significantly higher among PEH (P&lt;0.001). In the regression model, it was found that homelessness was an independent factor for 90-day SSI (1.47 [1.13-1.91], P=0.004) and UTI (1.21 [1.03-1.43], P=0.022) following surgical management of hip fracture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study found that homelessness was an independent risk factor for surgical complications, including SSIs and UTIs, within 90 days. Additionally, homelessness was associated with higher comorbidity rates, which were linked to increased complications and readmissions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level ","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":"143458316","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":"Posterior Plating versus Anterior to Posterior Screws in Fixation of Posterior Column in Pilon Fractures.","authors":"Mostafa M Baraka, Tamer A Fayyad, Mootaz F Thakeb, Mina A Lamei, Mohamed A Al Kersh","doi":"10.1097/BOT.0000000000002966","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002966","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the results of anterior to posterior screws (AP screws) versus posterior buttress plating in the fixation of posterior columns fractures in pilon injuries, regarding the 1) functional and 2) radiological outcomes and 3) the incidence of complications.</p><p><strong>Methods: </strong>Design: Prospective, randomized clinical trial.</p><p><strong>Setting: </strong>Single Center, Level 1 trauma Center.</p><p><strong>Patient selection criteria: </strong>All patients with two, three and four column fracture according to the four-column classification (OTA/AO 43-C1 and 43-C2) during the study period were eligible for inclusion. Patients were randomized into two groups: direct reduction and fixation by posterior buttress plating (group A) and indirect reduction with fixation by AP screws (group B). Exclusion criteria included pediatric age group with open physis, pathological fractures, open fractures and fractures with neurovascular injuries. The minimum follow up period was 24 months.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was the quality of reduction as evaluated using postoperative plain radiographs and computed tomography (CT). Secondary outcomes included the functional American Orthopaedic Foot and Ankle Society (AOFAS) score and the incidence of complications.</p><p><strong>Results: </strong>30 patients were included, 15 patients were randomized to group A (mean age 42.3 (range 19-65) and 15 patients in group B (mean age 38.0 in group B (range 23-58). The mean follow up was 32 months (24-45 months). Anatomical reduction was achieved in 80% and 26.7% of group A and group B respectively. AOFAS score was significantly higher in group A compared to group B (p=0.03). There was no statistically significant difference between the two groups regarding the time to union and the complication rates (p>0.05).</p><p><strong>Conclusions: </strong>A higher percentage of anatomical reduction was associated with direct reduction and posterior buttress plating compared to indirect reduction and anterior to posterior screws. This was reflected by a significantly higher AOFAS score.</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":"143458362","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 Rapid Escalation of Fractures and Hospital Admissions from Electric Bicycle Injuries in the United States: An Analysis of National Injury Data from 2019 to 2023.","authors":"Nikan K Namiri, Auston R Locke, Niklas H Koehne, Avanish Yendluri, Kyle K Obana, Katrina Nietsch, Jennifer Yu, John J Corvi, Junho Song, Jeremy Podolnick, David A Forsh, Robert L Parisien","doi":"10.1097/BOT.0000000000002965","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002965","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To examine the characteristics, trends, and attributes of fractures sustained by electric bicycle riders and assess the recent healthcare burden in terms of hospital admissions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;National sample of 100 emergency departments (EDs) in the United States (US).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;The National Electronic Injury Surveillance System (NEISS) was queried for ED presentations with fractures related to e-bicycles between January 1st 2019 and December 31st 2023. The clinical narrative associated with each case was reviewed to exclude cases unrelated to fractures sustained by e-bicycle riders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;NEISS data is a probability sample of US hospitals; each observed sample has an associated weight enabling a population estimate for each individual sample. Sample weights were determined by NEISS using factors that influence likelihood of selection such as hospital size and geographic locations. US population projections (weighted cases) of fractures and admissions were obtained by summing the weights of raw, unweighted NEISS sampled injuries. Pearson's chi-squared tests were applied to determine differences in injury characteristics among subjects who were admitted to the hospital and those who were not admitted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 22,432 e-bicycle fractures occurred in the US from 2019 to 2023, which was a weighted population estimate from 520 raw, unweighted NEISS samples. The number of fractures and admissions increased by 2,371% and 3,146% in 2023, respectively, compared to 2019. Collision with a motor vehicle occurred in nearly one-fourth of fractures, and motor vehicle involvement was significantly associated with hospital admission (36.4% v. 25.1%; p=0.01). Overall, 27.7% of e-bicycle fractures were admitted to the hospital. Upper leg fractures had the highest association with admission (90.7% admission rate) but only consisted of 2.7% of all fractures. The most common fracture location in riders aged &lt;18 was the wrist, while the 35-55 age group and &gt;55 age group were most likely to possess upper trunk fractures (cervical spine, thoracic spine, ribs, sternum). The 18-34 age group and 35-55 age group most commonly sustained fractures involving motor vehicles (29.7% and 28.7%, respectively), but the 18-34 age group possessed a significantly higher rate of overall admission among all age groups (p=0.04).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;There has been a substantial increase in fractures and resource utilization as a result of hospital admissions from e-bicycle riding from 2019-2023. The majority of fractures occurred above the waist, although lower extremity injuries more commonly resulted in admission, and riders aged 35-55 sustained the largest proportion of injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;Prognostic Level ","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tibial Malalignment Is an Independent Predictor of Nonunion After Intramedullary Nailing of Tibial Shaft Fractures.","authors":"Abraham Goch, Kathleen Healey, Nicolas Zingas, Michael Raffetto, Natasha McKibben, Caroline Benzel, David J Stockton, Nathan N O'Hara, Gerard P Slobogean, Jason W Nascone, Robert V O'Toole","doi":"10.1097/BOT.0000000000002932","DOIUrl":"10.1097/BOT.0000000000002932","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the relationship between postoperative alignment and nonunion in patients with tibial shaft fractures treated with intramedullary nailing.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective case-control study.</p><p><strong>Setting: </strong>Single academic trauma center.</p><p><strong>Patients selection criteria: </strong>Adult patients with closed or open tibial shaft fractures (42A-C) treated with intramedullary nailing from 2007 to 2018.</p><p><strong>Outcomes measures and comparisons: </strong>Case patients with nonunion were compared with control patients with radiographic evidence of healing in terms of the postoperative tibial alignment measured in the coronal and sagittal planes.</p><p><strong>Results: </strong>Of the 192 included patients (median age, 38 years; 76% male), 51 patients had a nonunion, and 141 patients had united fractures and served as the control group. A strong association between postoperative tibial malalignment in 1 plane and nonunion (odds ratio, 3.0; 95% confidence interval, 1.1-8.3; P = 0.03) was demonstrated. This association was even greater for malalignment in both coronal and sagittal planes (odds ratio, 5.7; 95% confidence interval, 2.1-16.1; P < 0.001) after controlling for confounders.</p><p><strong>Conclusions: </strong>After controlling for confounding factors, postoperative malalignment in the coronal or sagittal plane was associated with significantly increased odds of tibial shaft nonunion after intramedullary nailing.</p><p><strong>Level of evidence: </strong>Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"57-62"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the Top Articles and Authors of the Journal of Orthopaedic Trauma and Bibliometric Comparison of Impact Factors of Orthopaedic Surgery Journals.","authors":"McKenna W Box, Troy Puga, Laurel Marsh, Wrangler Beal, Vinay Chandrasekaran, John T Riehl","doi":"10.1097/BOT.0000000000002964","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002964","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the top 100 cited authors and the top 20 articles in the Journal of Orthopaedic Trauma (JOT) and compare its impact factor to orthopaedic and non-orthopaedic surgery literature.</p><p><strong>Design: </strong>Review.</p><p><strong>Methods: </strong>The Web of Science database was used to determine the top 100 cited authors and top 20 cited articles that originated in JOT from 1995 to the present. The total number of citations for each article and author in first, last, and any author position for publications in JOT, and the location of training and current place of work for each author were gathered. Each author's total number of citations as first author was tallied to determine the top 100 JOT first authors. The Journal Citation Reports database was searched to determine the impact factor (IF) of multiple orthopaedic and non-orthopaedic journals from 1997 to 2023. Yearly IF and yearly IF percent growth were calculated.</p><p><strong>Results: </strong>The number of citations for the top 20 cited articles in JOT ranged from 302 to 787. Of the top 100 JOT first authors by citation number, 93 were orthopaedic surgeons. 65% of these completed a residency in the United States, 61% worked in the United States, and of the authors that work in the United States, 70.5% practice in an academic setting. From 1997 to 2023, JOT's mean yearly IF was 1.6, and the mean yearly IF percent growth was 6.1%. The mean IF for included comparison orthopaedic subspecialty journals was 2.3, with 5.6% mean yearly IF percent growth. JOT's median IF was 1.8 and was second to Injury (IF 1.9) within orthopaedic trauma journals evaluated.</p><p><strong>Conclusions: </strong>This bibliometric analysis shows that JOT's most cited authors are primarily U.S.-trained orthopaedic surgeons in academic environments. JOT has consistently experienced annual growth in its impact factor throughout its almost 30-year history and has one of the highest impact factors of measured orthopaedic trauma journals.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065758","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}