Journal of Orthopaedic Trauma最新文献

{"title":"The Effects of a Stepped-Care Mental Health Program on Trauma Recidivism at a Level 1 Trauma Center.","authors":"Gabriella A Rivas, Juliette Gammel, Kola George, Kenneth J Ruggiero, Tatiana Davidson, Hannah C Espeleta, Langdon Hartsock, Kristoff Reid","doi":"10.1097/BOT.0000000000002929","DOIUrl":"10.1097/BOT.0000000000002929","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to analyze the effects of a stepped-care mental health program (TRRP) on trauma recidivism at a single institution.</p><p><strong>Methods: </strong></p><p><strong>Designs: </strong>Retrospective review.</p><p><strong>Setting: </strong>Single level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Trauma activation patients presenting at a single level 1 trauma center between 2017 and 2021 were selected. Data on demographics, mechanism of injury, readmissions, and TRRP participation were recorded.</p><p><strong>Outcome measures and comparisons: </strong>Main outcomes included recidivism rates, risk factors for representation, and determining whether a change in readmission risk existed after participation in TRRP.</p><p><strong>Results: </strong>Intotal, 4484 patients were included, with a mean age of 44.8 years. 65.9% were men and 34.1% were women. Overall, 14.2% (637/4484) patients presenting to the same institution have experienced an unrelated traumatic incident after their index injury. Overall, 75.6% patients identified by TRRP participated in at least 1 TRRP service. Patients who did not participate in TRRP were statistically significantly more likely to be recidivists (15.6%) than those who did (10.9%, P < 0.001). Multivariable binary logistic regression analysis demonstrated statistically significant associations between increased trauma recidivism and being unmarried, Black/African American race, no use of seatbelts, alcohol intoxication at index injury, history of depression, alcohol use disorder, smoking, and government insurance ( P ≤ 0.024). The multivariable regression model predicted a decrease in trauma recidivism by 33% in privately insured patients ( P = 0.002), by 33% after participation in TRRP ( P < 0.001), and by 18% after participation in each additional step of the TRRP program ( P < 0.001).</p><p><strong>Conclusions: </strong>Results demonstrate reduced rates of trauma recidivism with involvement of the Trauma Resilience and Recovery Program. Although programs focused solely on psychosocial interventions may be sufficient to reduce the risk of subsequent traumatic events, further development of trauma rehabilitation programs should address both the psychosocial consequences of traumatic injuries and reinjury and readmission prevention.</p><p><strong>Level of evidence: </strong>Therapeutic 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":"e1-e8"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622378","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":"Inability to Remove Locking Screws From the Femoral Neck System Due to Stripping of the Screwdriver Within the Locking Screw Head.","authors":"Jung-Wee Park, Yong-Han Cha, Jin-Woo Kim, Hong-Seok Kim, Jae-Hwi Nho, Byung-Woong Jang, Jung-Taek Kim, Jin-Kak Kim, Tae-Young Kim, Ki-Choul Kim, Young-Kyun Lee","doi":"10.1097/BOT.0000000000002926","DOIUrl":"10.1097/BOT.0000000000002926","url":null,"abstract":"<p><strong>Objectives: </strong>The purposes of this study were to investigate the frequency of screwdriver stripping in the head of the locking screw that attaches to the side plate to the femur shaft among the patients who underwent implant removal after femoral neck system (FNS) for femoral neck fracture, to determine the risk factors for locking head screw stripping in FNS treatment of femoral neck fracture, and to suggest a surgical tip that removes FNS, which is difficult to remove due to screw stripping.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Eight Urban tertiary referral academic hospitals.</p><p><strong>Patient selection criteria: </strong>Included were patients with Orthopedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen 31-B1, 31-B2, and 31-B3 femoral neck fractures who underwent surgical fixation with FNS from November 2019 to February 2023.</p><p><strong>Outcome measures and comparisons: </strong>The frequency of locking head screw stripping of FNS during the implant removal was evaluated.</p><p><strong>Results: </strong>Among the 47 patients (18 (38%) men and 29 (62%) women) who met the inclusion criteria with an average age of 59.2 years (range, 28-94 years), 13 (27.7%) experienced screwdriver stripping in the head of the distal locking screw during FNS removal surgery. A higher body mass index showed a borderline significant association with the stripping in the adjusted model (odds ratio = 1.233; 95% confidence interval: 0.988-1.539; P = 0.064). No other variables showed significant association with the stripped locking head screw ( P > 0.05).</p><p><strong>Conclusions: </strong>Stripping of the screwdriver within the head of the distal locking screw occurred in over one-quarter of cases. While a higher body mass index demonstrated a borderline significant association, none of the other variables examined showed a statistically significant relationship with the stripped locking head screw.</p><p><strong>Levels 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":"63-67"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406494","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":"Cast-OFF 2: One Week Versus 3-5 Weeks of Plaster Cast Immobilization for Non- or Minimally Displaced Distal Radius Fractures-A Stepped Wedge Cluster Randomized Controlled Trial.","authors":"Marcel A N de Bruijn, Emily Z Boersma, Lysanne van Silfhout, Laura A van Ginkel, Tjarda N Tromp, Erik van de Krol, Michael J R Edwards, Vincent M A Stirler, Erik Hermans","doi":"10.1097/BOT.0000000000002930","DOIUrl":"10.1097/BOT.0000000000002930","url":null,"abstract":"<p><strong>Objectives: </strong>Implementation of 1 week of cast immobilization followed by gradually increasing wrist mobilization for non- or minimally displaced distal radius fracture (DRF) and comparison of the functional outcomes and pain scores with the usual care (3-5 weeks of cast immobilization).</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>A randomized stepped wedge cluster design, prospective cohort.</p><p><strong>Setting: </strong>Academic and peripheral hospitals in levels 1, 2, and 3 trauma centers.</p><p><strong>Patient selection criteria: </strong>All patients between 18 and 85 years old with an isolated non- or minimally and nonreduced DRF were eligible for inclusion. Participating hospitals were randomized to transition from usual care (3-5 weeks of cast immobilization) to 1 week of cast immobilization, following the stepped wedge design.</p><p><strong>Outcome measures and comparisons: </strong>Patient characteristics, secondary dislocation, surgical treatment, visual analog scale, Patient Rated Wrist Evaluation (PRWE), Patient Reported Outcomes Measurement Information System Pain Interference, Pain Catastrophizing Scale 4, and patient satisfaction were compared between control and intervention group at weeks 1, 3-5, 6, months 3, 6, and 12. A difference around 11 points on the PRWE scale was considered clinically significant.</p><p><strong>Results: </strong>Four hundred two patients were included (control n = 197 vs. intervention n = 205, 267/135, female/male). There were no differences in age (53.7 ± 18.6 vs. 53.3 ± 19.5, P = 0.27), sex (66% vs. 67% female, P = 0.44), dominant hand fractured (44% vs. 53%, P = 0.39), and type of fracture (39% vs. 41% extra-articular, P = 0.44). After 6 weeks, the PRWE score showed no clinically significant differences (-4.5 [confidence interval -12.9 to 4.02], P = 0.30). No significant differences were observed for function, pain scores, and patient satisfaction between groups (all P > 0.05). Furthermore, there was no significant difference in secondary dislocation rate (control 1.5% vs. intervention 1.0%, P = 0.32) and operation rate (control 1.5% vs. 1.5% intervention, P = 0.92).</p><p><strong>Conclusions: </strong>This study compared 1 week of cast immobilization followed by gradually increasing wrist mobilization to the usual care of 3-5 weeks for nonreduced DRF. No clinically significant differences in function, pain scores, patient satisfaction, secondary dislocation, and operations were observed. Therefore, 1 week of plaster immobilization can be safely recommended for the non- or minimally displaced and nonreduced DRF treatment.</p><p><strong>Level of evidence: </strong>Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"82-89"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546048","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":"Consolidation of the Anteromedial Aspect of the Tibia Is Inferior to the Other Areas in the Reconstruction of Critical-Sized Bone Defect of the Tibial Shaft Using the Induced Membrane Technique: An Analysis of 111 Serial Computed Tomography of 37 Patients.","authors":"Whee Sung Son, Eic Ju Lim, Beom-Soo Kim, Wonseok Choi, Jae-Woo Cho, Jong-Keon Oh","doi":"10.1097/BOT.0000000000002928","DOIUrl":"10.1097/BOT.0000000000002928","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the consolidation quality between the anteromedial aspect of regenerated bone (AMRB) and the other areas of regenerated bone (TORB) following the induced membrane technique (IMT) for managing critical-sized tibial shaft bone defects, and determine the factors affecting consolidation quality in the AMRB.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective comparative study.</p><p><strong>Setting: </strong>Academic Level I trauma center.</p><p><strong>Patients selection criteria: </strong>Included were patients who underwent IMT with only an intramedullary nail for tibial shaft segmental defects and serial computed tomography immediately, 6 months, and 1 year postoperatively.</p><p><strong>Outcome measures and comparisons: </strong>Comparison were made of regenerative bone volume, density, and corticalization between AMRB and TORB.</p><p><strong>Results: </strong>This study enrolled 37 patients with a mean age of 47.7 years (range 20-79). Twenty-eight (75.7%) patients were men. Postoperatively, the AMRB exhibited significantly more negative volumetric change than TORB at 0-1 year (-20.01% ± 25.59% vs. -13.32% ± 22.48%, P = 0.028), less positive density change 0-6 months (+197.84 ± 107.95 vs. +290.14 ± 131.74 Hounsfield unit (HU), P < 0.001) and 0-1 year (+377.51 ± 150.71 HU vs. +455.48 ± 135.04 HU, P < 0.001), and lower corticalization rate in 1 year (49.77% ± 29.42% vs. 82.27 ± 19.73%, P < 0.001). Significant factors included fracture-related infection (FRI) ( P = 0.047 and P = 0.048 at 0-6 months and 0-1 year, respectively) and longer defect length ( P = 0.032 and P = 0.020) for the negative volumetric AMRB changes; older age ( P = 0.004 and P = 0.016) for the AMRB negative density changes; higher percentage of mixed recombinant human bone morphogenetic protein-2 in graft material ( P = 0.013 in 0-6 months) for the AMRB positive density change; FRI ( P = 0.024) for the inferior corticalization rate of the AMRB; FRI ( P = 0.026 in 0-1 year), longer defect length ( P = 0.017 in 0-6 months), and higher mixed demineralized bone matrix percentage ( P = 0.010 in 0-1 year) for the difference in density change between the AMRB and TORB; higher mixed demineralized bone matrix percentage ( P = 0.023) for the difference between the AMRB and TORB in corticalization rates.</p><p><strong>Conclusions: </strong>The tibial shaft's anteromedial aspects demonstrated significantly inferior consolidation after IMT, especially in terms of volume at 6 months, density at 6 months and 1 year, and corticalization at 1 year postoperatively.</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":"46-56"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950494","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":"Are Drains Associated With Infection After Operative Fixation of High-Risk Tibial Plateau and Pilon Fractures?","authors":"Adam Boissonneault, Robert V O'Toole, Roman Hayda, J Spence Reid, Cyrus Caroom, Anthony Carlini, Arman Dagal, Renan Castillo, Madhav Karunakar, Paul E Matuszewski, Robert Hymes, Nathan N O'Hara","doi":"10.1097/BOT.0000000000002933","DOIUrl":"10.1097/BOT.0000000000002933","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the association between closed suction drainage and postoperative infection in patients with tibial plateau or pilon fractures. Secondarily, this study assessed whether intrawound vancomycin powder modified the association of closed surgical drains with infection.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Secondary analysis of the Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial (VANCO).</p><p><strong>Setting: </strong>Thirty-six academic trauma centers.</p><p><strong>Patient selection criteria: </strong>All patients with high-risk tibia fractures Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO classification 41B/C or 43B/C) from the VANCO trial were considered. Closed suction drains were placed based on the treating surgeon's discretion. Patients were randomly assigned to receive 1-gram intrawound vancomycin powder in the surgical wound at definitive fixation or the standard infection prevention protocol at each center.</p><p><strong>Outcome measures and comparisons: </strong>Deep surgical site infection (SSI) within 6 months. Comparisons were made between patients treated with and without drains. Subgroup analysis also examined the effect of drains in patients with and without intrawound vancomycin powder.</p><p><strong>Results: </strong>Of the 978 study patients, 197 (20%) were treated with drains. Deep infection rates did not significantly differ between patients with or without surgical drains (8% vs. 8%, P = 0.88). However, intrawound vancomycin powder significantly modified the association of surgical drains on deep SSI (interaction P = 0.048). Specifically, patients with drains but no vancomycin powder had the highest deep infection rate (13%; 95% confidence interval, 6%-19%). When vancomycin powder was used in addition to a drain, deep SSI rates were reduced by 10% (95% confidence interval, 2%-17%, P = 0.01).</p><p><strong>Conclusions: </strong>This study suggests that closed suction drains after operative fixation of high-risk tibia fractures may not be associated with deep infection in general. However, a secondary analysis raises the possibility that drains are associated with reduced deep infection rates if topical vancomycin powder is used but associated with increased infection rates if vancomycin powder is not used.</p><p><strong>Level of evidence: </strong>Therapeutic 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":"75-81"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Single-Stage and Dual-Stage Approaches for Nonunion Repair in the Absence of Evident Infections.","authors":"Rajul Gupta, Andrew Burkhart, Tyler Barnes, Michael Beltran, Richard Laughlin, Henry Claude Sagi","doi":"10.1097/BOT.0000000000002936","DOIUrl":"10.1097/BOT.0000000000002936","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to determine if routine dual-stage nonunion repair (DSR) surgery leads to better outcomes than single-stage nonunion (SSR) repair surgery in fracture nonunions without evident clinical or laboratory signs of infection.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective comparison study.</p><p><strong>Setting: </strong>Level 1 Trauma Center affiliated with an academic teaching hospital.</p><p><strong>Patient selection criteria: </strong>Skeletally mature patients diagnosed with fracture nonunion between June 2013 and January 2022 were included. Patients with previous nonoperative treatment, definitive external fixation, previous or current diagnosis of fracture-related infection, or <12 months of follow-up were excluded.</p><p><strong>Outcome measures and comparison: </strong>Patient characteristics and details of the primary and the revision surgery were recorded. Comparison of the primary outcome measures, fracture-related infection, recalcitrant nonunion, and implant failures was performed between SSR and DSR groups.</p><p><strong>Results: </strong>A total of 113 patients met the eligibility criteria. Eighty-six patients (mean age 44.8 years, range 17-80 years, 64% men) underwent SSR, while 27 patients (mean age 50.8 years, range 21-77 years, 52% men) underwent DSR. Seventy-six percent underwent SSR and 24% underwent DSR. Baseline characteristics were similar between groups (open fractures, P = 0.918; smoking, P = 0.86; lower limb fractures, P = 0.238; diabetes, P = 0.503; erythocyte sedimentation rate, P = 0.27; C-reactive protein, P = 0.11; age, P = 0.11; Charlson comorbidity index, P = 0.06) except for a higher rate of DSR in cases initially treated elsewhere ( P = 0.015) and in obese patients ( P = 0.044). Bone grafting was more frequent in DSR using plates ( P = 0.030). No significant differences were observed in subsequent infections (6.97% vs. 7.41%, P = 0.939), persistent nonunion (28.2% vs. 14.81%, P = 0.169), or implant failure (19.76% vs. 22.22%, P = 0.782) between SSR and DSR.</p><p><strong>Conclusions: </strong>No difference was found in infection, recalcitrant nonunion, and implant failure between SSR and DSR for nonunions without overt signs of infection. The study challenges the routine use of DSR, questions the necessity of subjecting patients to 2 surgical procedures, and advocates for a more judicious approach in the absence of overt fracture-related infection in a fracture nonunion.</p><p><strong>Level of evidence: </strong>Therapeutic 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":"41-45"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983908","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":"Evaluating the Severity Spectrum: A Hierarchical Analysis of Complications During Hip Fracture Admission Associated With Mortality.","authors":"Christopher J Pettit, Carolyn F Herbosa, Abhishek Ganta, Steven Rivero, Nirmal Tejwani, Philipp Leucht, Sanjit R Konda, Kenneth A Egol","doi":"10.1097/BOT.0000000000002909","DOIUrl":"10.1097/BOT.0000000000002909","url":null,"abstract":"<p><strong>Objectives: </strong>To determine which in-hospital complications after the operative treatment of hip fractures are associated with increased in-patient, 30-day, and 1-year mortality.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>A single academic medical center and a Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>All patients who were operatively treated for hip fractures (Orthopaedic Trauma Association/AO 31A, 31B and Vancouver A, B, and C periprosthetic fractures) at a single center between October, 2014, and June, 2023.</p><p><strong>Outcome measures and comparisons: </strong>Occurrence of an in-hospital complication was recorded. Cohorts were based on mortality time points (during admission, 30 days, and 1 year) and compared with patients who were alive at those time points to determine which in-hospital complications were most associated with mortality. Correlation analysis was performed between patients who died and those who were alive at each time point.</p><p><strong>Results: </strong>A total of 3134 patients (average age of 79.6 years, range 18-104 years and 66.6% women) met inclusion for this study. The overall mortality rate during admission, 30 days, and 1 year was found to be 1.6%, 3.9%, and 11.1%, respectively. Sepsis was the complication most associated with increased in-hospital mortality (odds ratio [OR] 7.79, 95% confidence interval [CI], 3.22-18.82, P < 0.001) compared with other in-hospital complications. Compared with other in-hospital complications, stroke was the complication most associated with 30-day mortality (OR 7.95, 95% CI, 1.82-34.68, P < 0.001). Myocardial infarction was the complication most associated with 1-year mortality (OR 2.86, 95% CI, 1.21-6.77, P = 0.017) compared with other in-hospital complications.</p><p><strong>Conclusions: </strong>Postoperative sepsis, stroke, and myocardial infraction were the 3 complications most associated with mortality during admission, 30-day mortality, and 1-year mortality, respectively, during the operative treatment of hip fractures.</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":"8-13"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108448","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":"Unplanned Postoperative Emergency Department Visits After Upper Extremity Fracture Surgery.","authors":"Jonathan Lans, Clay B Beagles, Ian T Watkins, Aron Lechtig, Rohit Garg, Neal C Chen","doi":"10.1097/BOT.0000000000002925","DOIUrl":"10.1097/BOT.0000000000002925","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine whether outpatient upper extremity fracture surgery was associated with increased postoperative emergency department (ED) visits and identify related risk factors.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>This multicenter study was conducted within a single academic institution, encompassing two Level 1, two Level 2, and one Level 3 trauma centers.</p><p><strong>Patient selection criteria: </strong>All patients >18 years of age who underwent upper extremity fracture surgery from 2015 to 2021 were included.</p><p><strong>Outcome measures and comparisons: </strong>Risk factors for postoperative ED visit that were investigated included age, sex, tobacco use, alcohol abuse, psychiatric diagnosis, Elixhauser comorbidity score, race, location of upper extremity fracture, surgical setting (inpatient vs. outpatient), upper extremity block, surgical specialty, and Area Deprivation Index. Variables with a P < 0.1 in bivariate analysis were included in a multivariable logistic regression to determine factors associated with a postoperative ED visit at 30 and 90 days.</p><p><strong>Results: </strong>A total of 6315 patients with an average age of 51 ± 19 years were identified of whom 52% were women and 65% had outpatient surgery. Postoperatively, 188 patients (3.0%) presented to the ED within 30 days and 304 (4.8%) presented within 90 days. Thirty-seven percent of ED visits were directly related to the procedure, most commonly for pain (20%), cast issues (4.3%), and swelling (3.9%). At 30 days postoperatively, 2.8% of patients who underwent surgery in an outpatient setting and 3.4% of those who underwent inpatient surgery returned to the ED, with these rates increased to 4.4% and 5.6%, respectively, by 90 days. In multivariable analysis, outpatient surgery (odds ratio [OR]: 1.5, P = 0.030), tobacco use (OR: 2.1, P < 0.001), higher Elixhauser comorbidity scores (OR: 1.2, P < 0.001), non-White race (OR: 1.9, P < 0.001), elbow fractures (OR: 1.8, P = 0.016), and hand fractures (OR: 1.6, P = 0.046) were associated with 30-day ED visits.</p><p><strong>Conclusions: </strong>Outpatient surgery was associated with increased rate of 30-day ED visits. Patients who smoke, had increased number of comorbidities, or were non-White presented to the ED more frequently.</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":"22-27"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372082","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":"Interdisciplinary Opportunities for Orthopaedic and Thoracic.","authors":"Thomas W White","doi":"10.1097/BOT.0000000000002924","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002924","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"Sii-Siii"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983937","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}