Journal of Orthopaedic Trauma最新文献

{"title":"Temporary Reduction Assisting Corridor Constraint Wires for Intramedullary Nailing of Periarticular Fractures: A Technical Trick and Case Series.","authors":"Ryan P Serbin, Calvin Chandler, Benjamin Averkamp, Madeline Rieker, Ziqing Yu, Laurence B Kempton, Joseph R Hsu, Kevin D Phelps","doi":"10.1097/BOT.0000000000002905","DOIUrl":"10.1097/BOT.0000000000002905","url":null,"abstract":"<p><strong>Summary: </strong>Achieving satisfactory alignment during intramedullary nailing of periarticular fractures can be technically challenging due to a combination of deforming forces and the lack of cortical contact by the nail in the articular segment metaphysis allowing malreduction to persist during nail passage. Although blocking screws are described to facilitate reduction, they risk impeding subsequent implant fixation. This article introduces an innovative Temporary Reduction Assisting Corridor Constraint Wires (TRACC-wires) technique to safely correct multiplanar deformities without limiting fixation options. A retrospective case series of 22 patients showed that TRACC-wires effectively facilitated anatomic alignment intraoperatively that was maintained after wire removal. Compared with other methods, advantages include (1) the ability to easily redirect, reposition, or remove (given instant access to the blocking device), (2) malleability of the wires during nail insertion, (3) small bony footprint, and (4) versatility for patient-specific correction. Outcomes support TRACC-wires as a valuable tool for trauma surgeons managing complex periarticular fractures.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"675-679"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348669","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":"Surgical Fixation of Flail Chest Injuries: Reduction and Fixation Options, Tips and Tricks.","authors":"Niloofar Dehghan, Benjamin C Taylor","doi":"10.1097/BOT.0000000000002921","DOIUrl":"10.1097/BOT.0000000000002921","url":null,"abstract":"<p><strong>Summary: </strong>Modern techniques of rib fracture fixation surgery follow the AO principles of fracture reduction, fixation, and appropriate soft tissue handling. Fixation techniques can be performed using anatomic reduction and rigid fixation, or bridge plate fixation for comminuted fractures. Anatomic and nonanatomic plates can be used, although titanium precontoured locking plates are the most commonly used. Other contemporary intra- and extramedullary fixation strategies have also been developed. Intrathoracic fixation is a novel technique, however, limited literature on clinical outcomes currently exists. This article discusses techniques of reduction, fixation, and tips and tricks for surgical fixation of rib fractures.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S21-S26"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983963","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":"Out With the Old and in With the New: \"Flexible\" Syndesmotic Fixation.","authors":"Jan P Szatkowski","doi":"10.1097/BOT.0000000000002896","DOIUrl":"10.1097/BOT.0000000000002896","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12","pages":"672-674"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915128","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":"Anatomy of the Ribs, Sternum, and Costal Margin.","authors":"Douglas R Haase, Humza S Shaikh","doi":"10.1097/BOT.0000000000002919","DOIUrl":"10.1097/BOT.0000000000002919","url":null,"abstract":"<p><strong>Summary: </strong>The ribs, sternum, and costal margin provide a rigid, but flexible chest wall that functions to provide protection to the vital cardiothoracic organs, while also allowing for varying levels of respiration based on physiologic need. The latter function is accomplished through various muscular attachments and rib articulations with both the axial spine posteriorly and the sternum anteriorly. The accessory muscles of inspiration rely on the downward slope and outward curve of each rib, which when contracted move the ribs upward and outward, in turn forcing the sternum anterior and increasing the thoracic volume. Ribs are also classified as true, false, or floating based on their attachment anteriorly to the costal cartilage and sternum. Ribs 1-7 are considered true ribs as their costal cartilage directly articulates with the manubrium and sternum. Ribs 8-10 are considered false ribs because their costal cartilage connects to the cartilage of the immediately superior rib instead of the sternum itself. This complex cartilaginous structure is referred to as the costal margin, which provides attachments for the diaphragm and various abdominal muscles. Although historically thought to be a consistent structure, its variable nature has recently been defined in cadaveric studies. Ribs 11 and 12 are considered floating ribs because they have rudimentary cartilage caps and are not attached to the sternum at all. The sternum comprises the manubrium, body, and xiphoid process. Each component has differing mobility, muscle attachment, and function.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S1-S6"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983911","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":"Timing of Radiographic Healing for Distal Femur Fractures Treated With Intramedullary Nails.","authors":"Dane Brodke, Sai Devana, Adolfo Hernandez, Nathan O'Hara, Cynthia Burke, Jayesh Gupta, Natasha McKibben, Robert O'Toole, John Morellato, Hunter Gillon, Murphy Walters, Colby Barber, Paul Perdue, Graham Dekeyser, Lillia Steffenson, Lucas Marchand, Marshall James Fairres, Loren Black, Erika Roddy, Ashraf El Naga, Matthew Hogue, Trevor Gulbrandsen, Omar Atassi, Thomas Mitchell, Stephen Shymon, Zachary Working, Christopher Lee","doi":"10.1097/BOT.0000000000002915","DOIUrl":"10.1097/BOT.0000000000002915","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to profile modified Radiographic Union Scale for Tibia (mRUST) scores over time in distal femur fractures treated with intramedullary nails and identify predictors of radiographic union timing and delayed progression.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Ten Level I Trauma Centers.</p><p><strong>Patient selection criteria: </strong>The inclusion criteria were patients with distal femur fractures (OTA/AO 33A and 33 C) treated with intramedullary nails, with a minimum follow-up of 1 year or until radiographic union or reoperation. The exclusion criteria were fractures treated with combination nail-plate constructs, pathologic fractures, and patients younger than 18 years old.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was the mRUST score at 3, 6, and 12 months postoperatively. Receiver operating characteristic curve analysis identified the optimal 3-month mRUST score predicting reoperation. Multivariable models were used to identify predictors of radiographic union timing and delayed progression.</p><p><strong>Results: </strong>The study included 155 fractures in 152 patients, with a mean patient age of 51 and a mean follow-up of 17 months. A 3-month mRUST score of ≤8 predicted reoperation with a PPV of 25% and a NPV of 99%. The timing of radiographic union was associated with tobacco use (1.2 months later; P = 0.04), open fracture (1.4 months later; P = 0.04), and the use of topical antibiotics (2.1 months longer; 95% CI, 0.33-3.84; P = 0.02); however, topical antibiotics were at high risk of being confounded by injury severity. Delayed progression to fracture healing, wherein the most rapid radiographic healing occurs more than 3 months postoperatively, was predicted by chronic kidney disease ( P < 0.01).</p><p><strong>Conclusions: </strong>A 3-month mRUST score >8 suggests a very high likelihood of avoiding reoperation for nonunion. Tobacco use and open fractures were associated with a longer time to radiographic union. Chronic kidney disease is associated with a delayed radiographic progression, suggesting a need for adjusted expectations and management strategies in these patients.</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":"661-667"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348670","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":"Is the Orthopaedic Trauma Association-Open Fracture Classification Better Than the Gustilo-Anderson Classification at Predicting Fracture-Related Infections in the Tibia?","authors":"Philip Khoury, Nina Hazra, Anthony DeMartino, Kevina Birungi-Huff, Gerard P Slobogean, Robert V O'Toole, Nathan N O'Hara","doi":"10.1097/BOT.0000000000002907","DOIUrl":"10.1097/BOT.0000000000002907","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate and compare the predictive ability of the Orthopaedic Trauma Association-Open Fracture Classification (OTA-OFC) and the Gustilo-Anderson classification systems for fracture-related infections (FRI) in patients with open tibia fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged 16 years or older with an operatively treated open tibia fracture (OTA-AO 41, 42, and 43) between 2010 and 2021.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was FRI. The OTA-OFC and the Gustilo-Anderson classifications were compared in their ability to predict FRI.</p><p><strong>Results: </strong>Eight hundred ninety patients (mean age, 43 years [range, 17 to 96]; 75% men) with 912 open tibia fractures were included. In total, 142 (16%) had an infection. The OTA-OFC was not significantly better at predicting FRI than the Gustilo-Anderson classification (area under the curve, 0.66 vs. 0.66; P = 0.89). The Gustilo-Anderson classification was a stronger predictor of FRI than any single OTA-OFC domain, explaining 72% of FRI variance. Only the addition of the OTA-OFC wound contamination domain to Gustilo-Anderson significantly increased the variance explained (72% vs. 84%, P = 0.04). Embedded contamination increased the risk of FRI by approximately 10% as the risk of FRI with embedded contamination was 16% for type I or type IIs, 26% for type IIIAs, 45% for type IIIBs, and 46% for type IIICs.</p><p><strong>Conclusions: </strong>The more complex OTA-OFC system was not better than the Gustilo-Anderson classification system in predicting FRIs in patients with open tibia fractures. Adding embedded wound contamination to the Gustilo-Anderson classification system significantly improved its prognostic ability.</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":"655-660"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108449","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":"Pleural Space Management in Thoracic Trauma.","authors":"Erin E Devine, Joseph D Forrester","doi":"10.1097/BOT.0000000000002923","DOIUrl":"10.1097/BOT.0000000000002923","url":null,"abstract":"<p><strong>Summary: </strong>Thoracic injuries are common, occurring in up to 60% of polytrauma patients and represent 25% of trauma deaths. Thoracic trauma frequently involves injury to the pleural space resulting in hemothorax and pneumothorax-effective management of the pleural space is essential. Reviewed in this article is management of the pleural space in chest wall trauma (including pneumothorax and hemothorax), and chest tube placement, indications for video-assisted thoracoscopic surgery, management, and complications.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S27-S32"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983939","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":"Using an Intraoperative Stress Examination to Direct Treatment in Posterior Femoral Head Fracture-Dislocations.","authors":"David A Zuelzer, Lunden Ryan, Ryan Mayer, Tyler Pease, Stephen Warner, Jon Eastman, Raymond D Wright, Milton L C Routt","doi":"10.1097/BOT.0000000000002912","DOIUrl":"10.1097/BOT.0000000000002912","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the results of a treatment algorithm incorporating an examination under anesthesia (EUA) performed intraoperatively after fixation of the femoral head through a Smith-Petersen approach to determine the need for posterior wall or capsule repair.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Two Level 1 trauma centers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;All acute, traumatic femoral head fractures from posterior hip dislocations treated at participating centers over a 5-year period from 2017 to 2022. Injuries were classified according to the Pipkin system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The primary outcome was the result of intraoperative EUA performed after femoral head fixation to determine the need for Kocher-Langenbeck exposure for posterior wall and/or capsule fixation. The secondary outcomes included rates of avascular necrosis, heterotopic bone formation, late instability, and conversion to total hip arthroplasty (THA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 63 men and 22 women with a mean age of 32.5 (range 18-71) years were studied. Seventy-nine of 85 (92.9%) patients had a stable EUA after fixation of the femoral head through a Smith-Petersen approach. Six (6/85, 7.1%) underwent an additional Kocher-Langenbeck approach for posterior wall or capsule fixation. This included 1 Pipkin I, 1 Pipkin II, and 4 Pipkin IV injuries. Of the Pipkin IV injuries, 51/55 (92.7%) had stable EUA and did not require fixation of their posterior wall. This included seven patients with wall involvement &gt;20%. Five patients were excluded because of planned fixation of their posterior wall based on preoperative imaging. Of patients with at least 6 months follow-up, 16 of 65 (26.4%) developed radiographic evidence of avascular necrosis and 21 of 65 (32.3%) evidence of heterotopic bone formation. Seven out of 65 (10.8%) were converted to THA over the study period. When comparing patients with a single exposure and those with additional KL exposure, it was found that they did not vary in their rate of avascular necrosis (27.1% vs. 0.0%, P = 0.3228), heterotopic ossification formation (30.5% vs. 50.0%, P = 0.3788), or conversion to THA (10.2% vs. 16.7%, P = 0.510).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study found residual posterior hip instability after femoral head fixation in patients with and without posterior wall fractures after posterior dislocations. The results of this study support the use of an EUA after femoral head fixation to identify residual posterior hip instability in all femoral head fractures from posterior hip dislocations, regardless of Pipkin type. Use of the Smith-Petersen exposure remains a viable surgical option and may be improved with the incorporation of an EUA after femoral head fixation. For Pipkin IV injuries with posterior wall fractures with indeterminate stability, an EUA acc","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"641-647"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108451","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":"Embracing a New Horizon in Orthopaedic Surgery: Chest Wall Injury and the Surgical Stabilization of Rib and Sternum Fractures.","authors":"Peter A Cole","doi":"10.1097/BOT.0000000000002916","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002916","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"Si"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983927","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 Patterns and Surgical Approaches.","authors":"Humza S Shaikh, Douglas R Haase","doi":"10.1097/BOT.0000000000002920","DOIUrl":"10.1097/BOT.0000000000002920","url":null,"abstract":"<p><strong>Summary: </strong>Effective management of bony and cartilaginous thoracic injury is a vital part of the care of the polytraumatized patient. Commonly because of high-energy accidents including motor vehicle collisions and falls, these patients routinely require multidisciplinary care and surgical intervention. As our understanding of unstable chest wall injuries and pulmonary sequelae of the injury grows, it is imperative that injury patterns and surgical approaches become familiar to the orthopaedic trauma-trained surgeon. Common rib fracture patterns and muscle-sparing surgical approaches are detailed, with the goal of restoring chest wall stability to improve the mechanics of respiration and pain control in these challenging patients.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S15-S20"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983933","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}