Journal of Orthopaedic Trauma最新文献

{"title":"Clinical trial of a new continuous compartment pressure monitoring to aid in the diagnosis of Acute Compartment Syndrome.","authors":"Mohammed Ali Balhareth, Kate Vaile, Prism Schneider, Allan Liew, Jeremy Hall, Pierre Guy, Abdel-Rahman Lawendy, Job Doornberg, Ruurd Jaarsma, Ross Leighton","doi":"10.1097/BOT.0000000000002980","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002980","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate a new compartment pressure monitor reporting continuous pressures and its contribution to Acute Compartment Syndrome (ACS) diagnosis.</p><p><strong>Methods: </strong>Design: Multicenter, non-randomized, prospective study.</p><p><strong>Setting: </strong>Six Level-I Trauma Centers.</p><p><strong>Patient selection criteria: </strong>Enrolled were patients with acute long bone fractures (OTA 11-13, 2R, 2U, 31-33, and 41-43) where the Micro Electric Mechanical Sensor (MEMS) device was inserted either pre- or post-operatively into the compartment most likely to develop ACS, as deemed by the surgeon. Intracompartmental pressures (ICP) were continuously measured for up to 18 hours (as indicated by the FDA and Health Canada); clinical signs were simultaneously assessed for canonical compartment syndrome signs.</p><p><strong>Outcome measures and comparisons: </strong>The primary measurement outcomes were ease of use, accuracy, and safety of the device across all participating sites. Ease of use was assessed through surveys completed by surgeons, which evaluated their confidence in the device's functionality and usability. Accuracy was determined by analyzing patient outcomes, using surgical findings and clinical resolution as the gold standards, to assess whether the device's results corresponded to true positive and true negative cases of compartment syndrome. Feasibility was defined as the device's ability to integrate into the clinical workflow, operate reliably under typical conditions, and provide actionable data for ACS diagnosis. The secondary outcomes included continuous intracompartmental pressure (ICP) measurements and their diagnostic value. Sensitivity and specificity were evaluated by comparing continuous ICP data with clinical assessments based on the \"6 P's\" (pain, pallor, paresthesia, pulselessness, poikilothermia, and paralysis) to determine their combined utility in diagnosing ACS.</p><p><strong>Results: </strong>A total of 100 patients, 68 males and 32 females with an average age of 42 years old (17-80 years old), were enrolled. All of the patients had suffered a fracture, 25 proximal tibias (OTA/AO-41), 40 midshaft tibias (OTA/AO42), 13 distal tibias (OTA/AO43), 11 forearms (OTA/AO 2R.2U), 6 femurs (OTA/AO31-33), 5 humerus (OTA/AO 11-13). Eighty-nine patients received the MEMS device post-operatively and 11 patients pre-operatively. 93% of participating surgeons reported confidence in the device's function and ease of use. Pressures were measured on average for 16h36 (3h-18h). No complications were reported. Post-operative ICPs (25.4 mmHg) were higher (p =0.0462) on average than pre-operative ICPs (18.9 mmHg). Patients that did not develop Compartment Syndrome had their post-operative pressures trend down after 4 hours (23.8mmHg). Sensitivity and specificity analyses of ICP alone, delta P alone, pressure trends alone, or a combination of the three metrics were conducted using patient outcomes","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803205","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":"Risk Factors and Infection Presentation of Gram-Negative Fracture Related Infections.","authors":"Elizabeth M Benson, Robert W Rutz, Austin C Atkins, Karen J Carter, Evan G Gross, Matthew Yeager, Joseph P Johnson, Clay A Spitler","doi":"10.1097/BOT.0000000000002981","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002981","url":null,"abstract":"<p><strong>Objective: </strong>To assess factors associated with gram-negative (GN) fracture related infections (FRIs) and the impact of GN infections in treatment and outcomes in FRIs.</p><p><strong>Methods: </strong>Design: Retrospective cohort.</p><p><strong>Setting: </strong>Single Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>All patients with extremity FRIs between 2013-2020.</p><p><strong>Outcome measures and comparisons: </strong>A univariate analysis of FRI bacteriology was conducted in two manners. Two group analysis compared Any GN (AGN) to Gram-positive (GP) only (GPO) FRIs . Three group analysis compared Gram-negative only (GNO) vs. GPO vs. Polymicrobial GN including GP (PGN) FRIs.</p><p><strong>Results: </strong>299 patients met inclusion criteria. The mean age was 45.59 (18-92), and 187 (62.5%) were male. 76 (25%) patients had a GN microbe on intraoperative culture. In the AGN vs. GPO comparison, there were more male GN FRI patients (AGN=74% vs. GPO=59%, p=0.02). Cardiovascular disease was less common in AGN FRI patients (AGN=17% vs. GPO=30%, p=0.028). Multisystem trauma (AGN=67% vs. GPO=50%, p=0.014), external fixation (AGN=50%, vs. GPO=33%, p=0.014), skin grafting (AGN=27% vs. GPO=15%, p=0.045) and flap coverage (AGN=32% vs. GPO=16%, p=0.011) were more common in the AGN FRI. AGN FRI patients had more sinus tracts on presentation (AGN=42% vs. GPO=27%, p=0.013) and higher rates of amputation (AGN=15% vs. GPO=6%, p=0.021. Nonunion rates did not differ between the groups (AGN=20% vs. GPO=22%, p=0.731). Total number of reoperations needed for infection clearance was similar between AGN (3.5 +/-2.7) and GPO (2.9 +/-2.5) FRIs (p=0.068). The 3-group comparison was performed between the following groups (GNO, GPO, PGN). Post-hoc analysis of the 3-group analysis demonstrated PGN infections had no significant differences from GNO FRI in regard to injury characteristics (lower extremity, polytrauma), surgical characteristics (external fixation, flap coverage) and sinus tract formation.</p><p><strong>Conclusion: </strong>Male sex, multi-system trauma, external fixation, and need for flap coverage or skin graft were associated with gram negative FRIs. Nonunion rates were similar between Gram-negative vs. Gram-positive only or Gram-negative vs. polymicrobial including Gram-negative FRIs. In comparison to patients with Gram-positive only FRI, any Gram-negative FRI led to a higher rate of amputation.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803250","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":"Distal Interlock Backout in the RFN-Advanced Retrograde Femoral Nailing System (RFNA) in Femur Fractures: Short Term Outcome Analysis.","authors":"Doriann M Alcaide, Nigel Blackwood, Rodney Arthur, David A Patch, Robert W Rutz, Clay A Spitler","doi":"10.1097/BOT.0000000000002979","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002979","url":null,"abstract":"<p><strong>Objective: </strong>To examine rate of distal screw backout in patients treated with the DePuy Synthes Retrograde Femoral Nail Advanced (RFNA) system.</p><p><strong>Methods: </strong>Design: Retrospective.</p><p><strong>Setting: </strong>Single Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Adults with type 32 and 33 AO/OTA femur fractures that underwent fixation between 2021 and 2024 with the RFNA. Patients were included only if they had healed fractures or demonstrated distal screw backout regardless of follow up.</p><p><strong>Outcome measures and comparisons: </strong>Demographics, injury characteristics, fixation construct, complications such as rates of reoperation, interlock fracture, implant removal, distal screw backout ≥ 5mm and reoperation to promote bone healing were analyzed. Characteristics of patients with and without distal screw backout ≥ 5mm were compared.</p><p><strong>Results: </strong>A total of 101 patients underwent fixation with RFNA for femur fractures. The mean patient age was of 40.4 (18-83), 62.4% were males, and mean BMI was 29.2. The average follow up was 281 days (27-1041 days). Motor vehicle accident was the most common mechanism of injury(48.5%). Fractures consisted of 77.2% AO/OTA type 32 and 22.8% type 33. Nine cases (8.9%) had screw backout (mean 15.5mm (5-31mm)). Among these 55.6% were OTA/AO 32 and 44.4% were OTA/AO 33.No cases had multiple screws backout. The mean time for diagnosis of screw backout was 73.3 days (25-180 days). Five of nine cases with backout underwent a reoperation for screw removal due to symptomatic prominence. There was a 5.0% reoperation rate to promote bone healing, a 5.0% surgical site infection rate, and a 3.0% interlock fracture rate. Excluding patients with supplemental fixation, 4 patients (5.7%) had distal screw backout with 2 undergoing removal of screw and all achieving union. No significant differences in age (37.5 vs 35.6; p=0.821), BMI (31.5 vs 29.4; p=0.607), weight bearing status (WBAT 75% vs 66.7%;p=0.134) or distance from fracture to screw (121 mm vs 132 mm; p=0.804) were observed between patients with and without backout.</p><p><strong>Conclusion: </strong>When used for treating distal femoral and femoral shaft fractures, the Depuy Synthes RFNA showed a 8.9% rate for distal interlock screw backout ≥ 5mm and a 5% reoperation rate for removal of distal screw backout.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780337","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":"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":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective cohort series.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Multi-hospital academic institution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;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 (&lt;50% and &gt;50%) and 2) only MRI ITE 50% or greater.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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 &lt;50% MRI ITE and 56 (69%) patients had ≥50% MRI ITE. The presence of CL on CT corresponded to any MRI ITE (&lt;50% and &gt;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%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;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}