Journal of Orthopaedic Trauma最新文献

{"title":"Interobserver Reliability of the Modified Radiographic Union Score (mRUST) for Tibial and Femoral Fractures.","authors":"Dominik Deppe, Matteo Gabriele, Manuel Giovanni Mazzoleni, Alejandro Ordas-Bayon, Andrea Fidanza, Yuriy Rozhko, Ekin Kaya Şimşek, Eran Keltz, Georg Osterhoff, Philipp Damm, Georg N Duda, Marko Leskovar, Stefan Zachow, Adam Trepczynski, Mark Heyland","doi":"10.1097/BOT.0000000000003032","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003032","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the reliability of the modified Radiographic Union Score for Tibial fractures (mRUST) as a reliable tool for monitoring lower limb fractures (Femur, Tibia) treated with various modalities (Nail, Plate).</p><p><strong>Methods: </strong>Design: Retrospective analysis.</p><p><strong>Setting: </strong>Single center academic hospital in Germany.</p><p><strong>Patient selection criteria: </strong>Adult patients (≥18 years) with extra-articular long bone fractures of the lower extremities treated surgically between January 2005 and April 2022, requiring radiographs in two perpendicular planes and at least one follow-up visit, were included. Exclusion criteria were critical clinical conditions, inability to consent, joint articulation fractures, inadequate documentation, or insufficient imaging quality.</p><p><strong>Outcome measures and comparisons: </strong>Six international investigators (five orthopedic surgeons, one radiologist) independently assessed fracture line and callus growth per cortex (mRUST) at individualized follow-up timepoints based on clinical practice. To evaluate inter-rater reliability, intraclass correlation coefficients (ICC) were calculated for the overall dataset, and for subsets of rated images, that were defined based on anatomical location (femur/tibia), treatment type (plate/nail fixation), and treatment combinations across locations.</p><p><strong>Results: </strong>A total of 166 patients (63 femur fractures, 103 tibia fractures; 32.5% female, mean age 43.4 (18-84)) with 1,136 follow-up timepoints were analyzed. Overall inter-rater reliability for mRUST was good (ICC 0.77), consistent across fixation methods (nail/plate fixation, 0.79) and anatomical locations (tibia, 0.78; femur, 0.81). Cortex-specific reliability varied, with highest agreement for the medial cortex (0.70-0.74) and lowest for the posterior cortex (0.65-0.74).</p><p><strong>Conclusions: </strong>The mRUST (radiographic score) demonstrated reliability for monitoring fracture healing in the femur and tibia, irrespective of fixation method, supporting its use as a generalizable tool across lower limb fractures.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497368","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":"Has the impact of surgical timing on postoperative heterotopic ossification following elbow fractures been clearly evaluated?","authors":"Shuhao Bi, Baojian Zhang, Yanqun Liu","doi":"10.1097/BOT.0000000000003030","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003030","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326005","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":"Routine use of autograft is not necessary for treatment of humeral shaft nonunions and anticipated nonunions after failed nonoperative treatment.","authors":"Erika Roddy, Jonah Hebert Davis, Reza Firoozabadi, David Barei","doi":"10.1097/BOT.0000000000003028","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003028","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if the use of autogenous bone graft is necessary for the treatment of humeral shaft nonunions after initial nonoperative management.</p><p><strong>Design: </strong>Retrospective.</p><p><strong>Setting: </strong>Level 1 academic trauma center.</p><p><strong>Patient selection criteria: </strong>All skeletally mature patients undergoing nonunion repair of a humeral shaft fracture (AO/OTA 12A, 12B, 12C) after initial nonoperative management of the acute fracture.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was osseous union. Failure of nonunion repair was defined by lack of osseous union within 365 days from surgery and/or return to the operating room for additional attempts to promote union. Secondary outcomes included complications including infection, radial nerve palsy, and donor site morbidity.</p><p><strong>Results: </strong>Seventy-two patients were included in the final cohort. Thirty-eight patients (53%) were female, and the average age was 51 (SD 18, range 17, 83). Two patients (3%) developed a recalcitrant nonunion, both of which healed after a second procedure consisting of revision compression plating. The use of bone autograft was uncommon overall in this cohort (4 patients, 6%). Bone morphogenic protein, bone allograft, or demineralized bone matrix was used in 12 patients (17%). The remaining 56 patients (78%) were treated with compression plating alone. Compression was generated through multiple techniques including use of the articulated tensioning device, a pull screw with a verbrugge clamp, lag screw application, and compression generated via eccentric drilling through the plate. There were no differences in terms of patient demographics, fracture or injury characteristics between the groups that received autograft and those who did not (p>0.05). Use of autograft or other biologic supplementation was not associated with a statistically significant increase in union rate, 100% versus 97% (p=1.00). In the four patients who underwent autogenous bone grafting, there were no reported donor site complications.</p><p><strong>Conclusions: </strong>For humeral shaft fractures initially treated nonoperatively that went on to nonunion or anticipated nonunion, the union rate for compression plating alone was comparable to the union rate noted in the literature after treatment with bone autograft and compression plating. These results suggest that routine use of bone autograft may be unnecessary in the treatment of humeral shaft nonunions.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284987","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":"Infrapatellar vs suprapatellar nailing for fractures of the tibia (INSURT study): A multicentered randomized controlled trial.","authors":"David J Cinats, Darius Viskontas, Trevor Stone, Bertrand Perey, Farhad Moola, Dory Boyer, H Michael Lemke, Kelly Apostle, Alan J Johnstone","doi":"10.1097/BOT.0000000000003029","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003029","url":null,"abstract":"<p><strong>Objectives: </strong>To compare suprapatellar and infrapatellar tibial nail insertion approaches on post-operative knee pain.</p><p><strong>Methods: </strong>Design: Randomized controlled trial.</p><p><strong>Setting: </strong>Multi-centered academic level 1 trauma centers.</p><p><strong>Patient selection criteria: </strong>Included were all patients 18 to 65 years of age with nailing OTA/AO type 42 and 43A fractures amenable to and indicated for repair with reamed intramedullary nailing.</p><p><strong>Outcome measures and comparisons: </strong>Patients were randomized to receive a tibial intramedullary nail through either a suprapatellar or infrapatellar approach. The primary outcome was the visual analog scale (VAS) for knee pain after kneeling for 60 seconds. The study was designed to have 80% power to detect a 1.6-point difference in the VAS for pain on kneeling, which was considered clinically significant. Secondary outcomes included the Aberdeen Kneeling Test (AKT) and Aberdeen Standing Test (AST) (objective measures of weight-bearing capacity while kneeling and standing), Lysholm score, EQ-5D score, and Work Productivity and Activity Impairment Questionnaire (WPAI). The outcomes were recorded at 6 weeks, 4 months, 6 months, one year, and two years post-operatively.</p><p><strong>Results: </strong>254 patients were randomized with 128 patients randomized to suprapatellar nailing and 117 patients randomized to infrapatellar nailing. 96 patients (68.8% male) in the suprapatellar group (mean age 42.4 years, range 18-60 years) and 93 patients (69.2% male) in the infrapatellar group (mean age 38.8 years, range 19-52 years) completed 2-year follow-up. The VAS after kneeling for 60 seconds in the suprapatellar group was lower than the infrapatellar group at 6 weeks (4.1 vs 5.2 p=0.012), 4 months (2.8 vs 4.1 p=0.0003), 6 months (2.2 vs 3.2 p=0.0041), and one year (1.4 vs 2.7 p=0.0021) post-operatively and was statistical significant but not clinically significant. The AKT demonstrated that patients who underwent suprapatellar nailing could bear significantly more weight through their operative knee compared to the infrapatellar treatment group at 6 weeks (36% vs 27% p=0.0004), 4 months (45% vs 41% p=0.0012), 6 months (47% vs 43% p=0.001), one year (49% vs 45% p=0.0007), and two years (50% vs 46% p=0.001) post-operatively.</p><p><strong>Conclusions: </strong>There was no clinically significant difference between suprapatellar and infrapatellar nailing in terms of VAS knee pain or PROMs. Patients in the suprapatellar cohort could bear more weight through their operative knee up to and including 2 years post-surgery. Patients should be counseled on the ability to kneel and the nail insertion method when considering nail insertion technique.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284986","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":"Injury-associated anemia and iron homeostasis following orthopaedic trauma: a prospective observational study of 844 patients.","authors":"Danielle F Peterson, Natasha S McKibben, Victoria R Duke, Catherine E Hutchison, Chih Jen Yang, Colby Curtis, Karalynn Lancaster, Talia Trapalis, Dongseok Choi, Joseph J Shatzel, Graham J Dekeyser, Darin M Friess, Martin A Schreiber, Joseph E Aslan, Karina Nakayama, Nick J Willett, Zachary M Working","doi":"10.1097/BOT.0000000000003027","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003027","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the incidence of injury-associated anemia and functional iron deficiency following operative fracture care.</p><p><strong>Methods: </strong>Design: Prospective cohort study.</p><p><strong>Setting: </strong>Level 1, academic trauma center.</p><p><strong>Patient selection criteria: </strong>All operative fracture patients who presented between April 2022 and August 2023 were screened.</p><p><strong>Outcome measure and comparisons: </strong>Laboratory tests for anemia were performed on post-operative day one including complete blood count, serum iron, total iron binding capacity (TIBC), percent transferrin saturation (TSAT), transferrin, and ferritin levels. Values were enumerated to capture the previously unknown incidence of injury-associated anemia.</p><p><strong>Results: </strong>844 patients were screened following operative fracture management (mean: 52 years (SD 22), 58% male). Injury-associated anemia was present in 94.7% (median hemoglobin: 10.0 [IQR: 8.5 - 11.1]) of the 844 eligible patients; 72.5% of patients with anemia did not reach transfusion requirements (hgb <7.0). Only 33% (270/800) received an ICD-10 diagnosis code for anemia during the hospital admission. Functional iron deficiency was present in 80.9% of eligible patients, while 94.5% demonstrated derangements in body iron stores. Ferritin levels were >50 ng/mL in 89.8% of patients overall and 96.9% in patients with all other iron studies low. Patients with fractures in multiple extremities demonstrated 52% higher odds of elevated ferritin levels than patients with isolated fractures after controlling for transfusions and sex (adjusted OR 1.52, 95%CI: 1.06-2.17, p=0.02).</p><p><strong>Conclusion: </strong>The incidence of injury-associated anemia and functional iron deficiency was exceedingly common following operative orthopaedic trauma. Ferritin was more likely to be normal or high even when all other iron values were low, indicating that iron may become sequestered and unavailable for replenishing blood cell volume. Improving documentation of perioperative anemia after trauma and directing future research to counteract both anemia and functional iron deficiency may benefit most orthopaedic trauma patients.</p><p><strong>Level of evidence: </strong>Prognostic Level 1.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248298","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":"Predictors of Reoperation in Induced Membrane Technique for Acute Traumatic Bone Loss.","authors":"Lillia Steffenson, Alex Roszman, Cameron Wallace, Taylor Corbin Kot, Clay Spitler, Patrick Bergin, Michael Githens, Justin Haller","doi":"10.1097/BOT.0000000000003024","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003024","url":null,"abstract":"<p><strong>Objectives: </strong>To identify patient, injury, and surgical characteristics associated with success or failure of Masquelet's induced membrane technique (IMT) for acute traumatic bone loss.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Four Level 1 Academic Trauma Centers.</p><p><strong>Patients selection criteria: </strong>Patients acutely treated with IMT for AO/OTA 32, 33, and 41-43 fractures with bone loss at four Level 1 trauma centers between 2010-2020.</p><p><strong>Outcome measure and comparisons: </strong>Primary outcome was fracture union with comparison between union after initial two stage IMT versus patients who underwent reoperation to promote union or experienced treatment failure defined as: amputation, implant dependent, or persistent nonunion. Variables of interest included demographic variables, injury characteristics, and differences in surgical management (definitive fixation construct, autograft source, use of graft adjuvants).</p><p><strong>Results: </strong>130 fractures with defects were treated with IMT, including 72 tibial fractures and 58 femoral fractures with an average defect length of 6.4cm. Average age of patients was 40 years (range 16 to 68 years) and 65 percent of patients were male. Demographic characteristics including age, sex, BMI, tobacco and alcohol use were not significantly different among treatment outcomes (p >.05). Initial success after two stage IMT was 57.7% (75/130) and 82% (107/130) after subsequent reoperation. Increasing defect length was associated with failure of IMT (mean 5.4 vs 8.3cm, p=.03). Deep infection after stage 2 surgery was associated with reoperation to promote union and treatment failure (p<.01).</p><p><strong>Conclusions: </strong>In this study of acute traumatic bone loss, shorter defect length and absence of infection were significantly associated with success of IMT. Meanwhile fixation construct and autograft choice were not associated with treatment outcome.</p><p><strong>Level of evidence: </strong>III retrospective comparative cohort series.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225777","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":"Cost of Orthopaedic Trauma Surgery is Weakly Associated with Industry Payments to Surgeons.","authors":"Harsh Wadhwa, Gavin Touponse, Guan Li, Julius A Bishop, Corinna C Zygourakis","doi":"10.1097/BOT.0000000000003021","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003021","url":null,"abstract":"<p><strong>Objective: </strong>To examine the relationship between industry payments to surgeons and total cost of orthopaedic trauma surgery. Secondarily, to investigate the relationship between surgeon industry payments and operating room cost, length of stay, 30-day mortality, and 30-day readmission.</p><p><strong>Methods: </strong>Design: Retrospective cross-sectional database study with minimum 30-day follow-up.</p><p><strong>Setting: </strong>20% sample of Medicare beneficiaries from January 2006 to December 2015 from the Medicare database.</p><p><strong>Patient selection criteria: </strong>Medicare-insured patients undergoing orthopaedic trauma surgery identified by CPT codesOutcome Measures and Comparisons: The primary outcomes were the risk-adjusted relationship between amount of industry payments to surgeons and the total and operating costs. The secondary outcomes were the risk-adjusted relationships between amount of industry payments to surgeons and hospital length of stay, mortality, and readmission.</p><p><strong>Results: </strong>99.9% of orthopaedic trauma surgeons (n=9,023) received industry payments. Median patient age was 82 (IQR: 15), 73.2% female, 91.5% White, and with multiple comorbidities (CCI median [IQR] 6 [4]). After multivariable risk adjustment, for each $1,000 increase in surgeon industry payments, total and operating room cost of cases increased by $2.25 and $1.26 (0.003% and 0.008% of total cost), respectively (p<0.001). The median industry payment was $607.72 compared to the mean of $12,070.84 indicating a highly right-skewed distribution of payments. Amount of industry payments were not associated with length of stay (p=0.18), 30-day mortality (p=0.094) or readmission (p=0.59) after orthopaedic trauma surgery. Total and operating room cost was approximately $8,920 (17.8%) and $1,481 (14.2%) higher for surgeons receiving the highest 5% of industry payments (p<0.001). These surgeons generally practiced in large urban areas (51.7%; p<0.001), in hospitals with higher number of beds (median 398; p<0.001), with higher wage index (0.96; p<0.001).</p><p><strong>Conclusions: </strong>and Relevance: While most orthopaedic trauma surgeons received industry payments, a minority of surgeons received the majority of payments. Although industry payments may lead to conflicts for some surgeons, these conflicts affect only a small proportion of the cost of fracture care.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225776","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":"Excellent Results with Low Reoperation Rates After Fixation of Patella Fractures with a New Anatomically Contoured Plating System.","authors":"M Kareem Shaath, Brendan Page, Bader A Nasir, Griffin R Rechter, Astrid Casin, Jon P Yawman, Elizabeth Jacobs, Joshua R Langford, George J Haidukewych","doi":"10.1097/BOT.0000000000003025","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003025","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the clinical and radiographic outcomes of a consecutive series of patellar fractures treated utilizing an anatomically contoured variable-angle patellar plating system (PPS) (Synthes; Paoli, PA).</p><p><strong>Methods: </strong>Design: Retrospective chart review.</p><p><strong>Setting: </strong>Single, academic, Level-1 Trauma center.</p><p><strong>Patient selection criteria: </strong>All adult patients who underwent fixation of a patellar fracture (AO/OTA 34) with the PPS between 2021 and 2024 with a minimum follow-up of 3 months. Post-operatively, full extension was maintained for six weeks.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was fixation failure. Secondary outcomes included range of motion (ROM) at final follow-up, knee pain due to symptomatic implants, infection, and reoperation. Deep infection was defined as a return to the operating room for irrigation and debridement.</p><p><strong>Results: </strong>There was a total of 61 patients with a mean age of 54 years (19-92 years). The cohort consisted of 32 females (52%) with a mean BMI of 27 kg/m2 (18-42 kg/m2). Fifteen patients (25%) had diabetes and 16 patients were smokers (26%). The average follow-up was 7 months (range 3 - 26 months).There were 2 34A1 fractures, 1 34B1 fracture, 16 34C1 fractures, 10 34C2 fractures, and 32 34C3 fractures. There were 6 open fractures (1%), 2 type II and 4 type IIIA.There were 54 (89%) patients who achieved uneventful healing. Seven patients (11%) experienced a postoperative complication. One patient developed a superficial wound infection which resolved with oral antibiotic therapy, 3 patients developed arthrofibrosis necessitating further intervention, 2 patients experienced fixation failure with one requiring revision fixation, and 1 patient developed osteomyelitis and underwent implant removal after fracture union. Of the 3 patients with arthrofibrosis one underwent manipulation under anesthesia, and two underwent arthroscopic lysis of adhesions.</p><p><strong>Conclusions: </strong>The PPS may be utilized to stabilize challenging patellar fractures, leading to reliable union and minimal implant-related complications when associated with a post-operative protocol of full extension maintained for six weeks.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Early versus Delayed Surgical Intervention in Geriatric Acetabular Fractures on Transfusion Requirements.","authors":"Doriann M Alcaide, Travis Fortin, Nigel Blackwood, Matthew T Yeager, Hassan Ghomrawi, Clay A Spitler, Joey P Johnson","doi":"10.1097/BOT.0000000000003023","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine if fixation within 48 hours from injury reduces risk for transfusion in geriatric patients with acetabular fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single Level I Trauma Center (2010-2023).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Patients above 65 years of age with open reduction internal fixation (ORIF) for acetabular fractures (AO/OTA 62) were identified using Current Procedural Terminology codes. Patients managed non-operatively, with closed reduction percutaneous fixation, acute total hip arthroplasty, staged ORIF and patients with operations with any blood loss prior to acetabular ORIF were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The primary outcome was differences in transfusion requirements between patients who had early fixation (within 48 hours) and those who had delayed fixation (after 48 hours). Secondary outcomes included differences in length of stay (LOS), estimated blood loss (EBL), surgical site infection (SSI), and mortality. Logistic regression for likelihood of transfusion during hospitalization and SSI were done and included surgical timing, surgical approach, hemoglobin at admission, TXA administration, preoperative transfusion, and intraoperative transfusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 132 patients included in the study, 86 (65.9%) underwent early fixation and 45 (34.1%) delayed fixation. The early fixation group had an average age of 73.8 (65-89) and the delayed group of 73.4 (65-89) (p=0.797) and both had male majority (63.2% and 73.3%, respectively). Early fixation group had less injuries from high energy trauma (52.3% vs 75.0%;p=0.013) but no difference in injury severity scores (9 vs 11.1;p=0.184) or complex fracture patterns (69.0% vs 68.9%;p=0.993). Patients with early fixation had higher rates of anterior approaches (58.6% vs 35.6%;p=0.042) and shorter surgical time (136 vs 169 min;p=0.013). There was no statistically significant difference in rates of transfusion between early and delayed fixation (62.1% vs 73.3%;p=0.196). Early fixation group had more units of blood during overall hospital stay (5.1 vs 2.4; p=0.003). Early fixation was also associated with shorter LOS (7.1 days vs 13.5 days; p&lt;0.001). There was no significant difference in EBL, SSI or mortality. Surgical timing did not independently influence SSI risk (p=0.913) or likelihood of transfusion (p=0.273) but early fixation increased the volume of units transfused (p=0.0143).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Early fixation was associated with shorter LOS and operative times. Although the overall transfusion rate did not differ significantly between groups, early fixation demonstrated an increased risk for a higher volume of blood transfused among patients requiring transfusions. Surgical timing did not influence risk for SSI or likelihood of transfusion during hospital stay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: ","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216127","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 Semiextended versus Standard Upper Entry Tibial Intramedullary Nailing: A Randomized Controlled Trial (RASPUTIN).","authors":"Jubin Jamshed, Viju Daniel Varghese, Chandy Viruthipadavil John, Madhavi Kandagaddala, Abel Livingston, Jeremy Bliss, Bijesh Yadav","doi":"10.1097/BOT.0000000000002968","DOIUrl":"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></p><p><strong>Design: </strong>Noninferiority, randomized controlled trial, with two arms (suprapatellar and infrapatellar approaches).</p><p><strong>Setting: </strong>Single-center trial at a Level I trauma center 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 and July 2022.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome compared was the degree of rotational malalignment in patients undergoing tibia nailing with suprapatellar and infrapatellar approaches. This was performed using CT scan in the immediate postoperative period. Secondary outcomes assessed across the 2 groups were postoperative entry site pain, anterior knee pain (Kujala score), functional scores, and union rates.</p><p><strong>Results: </strong>Fifty 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 the approach used ( 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 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 with 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 the suprapatellar approach.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"277-282"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","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}