Journal of Orthopaedic Trauma最新文献

{"title":"Diminished Admission to Skilled Nursing Facility Following the Use of Direct Anterior Approach for Treating Femoral Neck Fractures in a Geriatric Population.","authors":"Devon R Pekas, Daniel Griffin, Trevor M Owen","doi":"10.1097/BOT.0000000000003076","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003076","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the effect surgical approach has on discharge disposition following hip hemiarthroplasty (HHA) treatment of femoral neck fractures (FNF) in the geriatric population.</p><p><strong>Methods: </strong>Design: Retrospective comparative cohort.</p><p><strong>Setting: </strong>Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Patients 65 years old and older who had a FNF (OTA/AO 31-B) treated with a HHA via the anterolateral approach (ALA), direct anterior approach (DAA), or posterolateral approach (PLA) between 2/1/2017 and 2/1/2021.</p><p><strong>Outcome measures and comparisons: </strong>Demographics, discharge disposition, operative timing, inpatient outcomes, and postoperative complications were measured. Outcomes were compared with PLA differentiated into PLA1 and PLA2 to correspond with the time periods that ALA and DAA were performed, respectively.</p><p><strong>Results: </strong>277 patients (34 ALA, 101 PLA1, 38 DAA, and 104 PLA2) were included. Patients' age (ALA=79.1 vs. PLA1=78.4 vs. DAA=80.4 vs. PLA2=81.1 years; p = 0.069), sex (ALA=82.4% vs. PLA1=70.3% vs. DAA=71.1% vs. PLA2=75.0%; p = 0.517), and ASA score (ALA=3.1 vs. PLA1=3.1 vs. DAA=3.0 vs. PLA2=3.0; p = 0.953) were similar. Operative time (ALA=72.3 vs. PLA1=74.6 vs. DAA=79.3 vs. PLA2=73.7 minutes; p = 0.232), transfusion rate (ALA=0.0% vs. PLA1=8.0% vs. DAA=5.3% vs. PLA2=4.8%; p = 0.345), 30-day readmission rate (ALA=5.9% vs. PLA1=5.9% vs. DAA=15.8% vs. PLA2=8.7%; p = 0.289), 1-year reoperation rate (ALA=2.9% vs. PLA1=1.0% vs. DAA=0.0% vs. PLA2=3.8%; p = 0.393), and 1-year mortality (ALA=20.6% vs. PLA1=26.7% vs. DAA=31.6% vs. PLA2=30.8%; p = 0.635) were similar. Discharge rates to a skilled nursing facility (SNF) were significantly lower for DAA when compared to ALA (71.1% and 94.1%; p = 0.021).</p><p><strong>Conclusions: </strong>Treatment of FNF with HHA via the DAA resulted in a significantly lower rate of disposition to SNF compared to ALA.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086443","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":"Assessing Inter-rater Reliability of ChatGPT-4 and Orthopaedic Clinicians in Radiographic Fracture Classification.","authors":"Aliyah N Walker, J B Smith, Samuel K Simister, Om Patel, Soham Choudhary, Michael Seidu, David Dallas-Orr, Shannon Tse, Hania Shahzad, Patrick Wise, Michelle Scott, Augustine M Saiz, Zachary C Lum","doi":"10.1097/BOT.0000000000003079","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003079","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the inter-rater reliability of ChatGPT-4 to that of orthopaedic surgery attendings and residents in classifying fractures on upper extremity (UE) and lower extremity (LE) radiographs.</p><p><strong>Methods: </strong>84 radiographs of various fracture patterns were collected from publicly available online repositories. These images were presented to ChatGPT-4 with the prompt asking it to identify the view, body location, fracture type, and AO/OTA fracture classification. Two orthopaedic surgery residents and two attending orthopaedic surgeons also independently reviewed the images and identified the same categories. Fleiss' Kappa values were calculated to determine inter-rater reliability (IRR) for the following: All Raters Combined, AI vs. Residents (AIR); AI vs. Attendings (AIA); Attendings vs. Residents (AR).</p><p><strong>Results: </strong>ChatGPT-4 achieved substantial to almost perfect agreement with clinicians on location (UE: κ = 0.655-0.708, LE: κ = 0.834-0.909) and fracture type (UE: κ = 0.546-0.563, LE: κ = 0.58-0.697). For view, ChatGPT-4 showed consistent fair agreement for both UE (κ = 0.370-0.404) and LE (κ = 0.309-0.390). ChatGPT-4 struggled the most with AO/OTA classification achieving slight agreement for UE (κ = -0.062-0.159) and moderate agreement for LE (κ = 0.418-0.455). IRR for AIR was consistently lower than IRR for AR. For AR comparisons, almost perfect agreement was observed for location (UE: κ = 0.896, LE: κ = 0.912) and fracture type (UE: κ = 0.948, LE: κ = 0.859), while AO/OTA classification showed fair agreement for UE (κ = 0.257) and moderate for LE (κ = 0.517). The p-values for all comparison groups were significant except for LE AO/OTA classification between AI and residents (p = 0.051).</p><p><strong>Conclusions: </strong>Although ChatcGPT-4 showed promise in classifying basic fracture features, it was not yet at a level comparable to experts, especially with more nuanced interpretations. These findings suggest that the use of AI is more effective as an adjunct to the judgment of trained clinicians rather than a replacement for it.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086405","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":"Fracture Table vs. Lateral Positioning for Antegrade Intramedullary Fixation of Femur Fractures (The FLiP Study): The Clinical Outcomes of a Multi-Centre Cluster Randomized Crossover Pilot Study.","authors":"Daniel E Axelrod, Sheila Sprague, Ernesto Guerra-Farfan, Yaiza Garcia-Sanchez, Brad Meulenkamp, Melanie Dodd-Moher, Sofia Bzovsky, Christy Shibu, Gina Del Fabbro, Jodi L Gallant, Thomas Mammen, Herman Johal","doi":"10.1097/BOT.0000000000003077","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003077","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether patient positioning supine on a fracture table (SFT) or laterally on a radiolucent table (LRT) reduced the risk of clinically important femoral malrotation in patients undergoing antegrade intramedullary fixation for femoral shaft fractures.</p><p><strong>Design: </strong>A pilot multicentre, prospective cluster randomized crossover trial.</p><p><strong>Setting: </strong>Three orthopaedic trauma centres.</p><p><strong>Patient selection criteria: </strong>Patients over 18 years of age with femoral shaft fractures (AO/OTA 32-A, 32-B, or 32-C) appropriate for antegrade intramedullary fixation.Outcome Measures and Comparison: The primary clinical outcome was rotational alignment of the operative limb measured through a bilateral postoperative computed tomography (CT) scan, using the uninjured limb as a reference. Secondary clinical outcomes included quality of life, mobility, operative time, fluoroscopy use, need for open reduction, use of reduction adjuncts, associated positioning complications, hospital stay, and ventilator support days.</p><p><strong>Results: </strong>A total of 101 patients were enrolled, with 54 randomized to SFT and 47 randomized to LRT. There were 26 females (48.1%) in the SFT group and 27 females (57.4%) in the LRT group. The mean age was 60.2 years (SD 25.8 years) in the SFT group and 62.7 years (SD 27.6 years) in LRT group. Most fractures resulted from falls (59.3% SFT; 66% LRT), were subtrochanteric (63% SRT; 61.7% LRT), and classified as simple AO/OTA 32-A (53.7% SRT; 53.2% LRT). Femoral malrotation >15° occurred in 20 (37.7%) SFT and 9 (19.1%) LRT participants The odds of femoral malrotation of ≥15° were 2.6 times higher in the SFT group (95% Confidence Interval 1.0 to 6.4; p=0.04). In both groups, patients were more likely to have an external rotation deformity compared to their native anatomy, with external rotation more common in SFT (69.8% versus 59.6%; p=0.17). No secondary outcomes reached statistical significance (P>0.05).</p><p><strong>Conclusions: </strong>In this clinical outcome assessment of patients enrolled in a feasibility trial, patients treated with SFT were more likely to have femoral malrotation after femoral shaft fracture fixation than patients treated with LRT.</p><p><strong>Level of evidence: </strong>Level 2.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086432","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":"Low-energy Distal Femur Fractures in Patients Over 50 years old: Protecting the Femoral Neck Reduces Risk of Subsequent Hip Fracture.","authors":"Mai Nguyen, Micah Christenson, Mike Murphy, T Zach Paull, Vasil Kukushliev, Lindsay Maier, Patrick Mark, Kaden Kunz, Hobie Summers, Joseph Cohen, William Lack","doi":"10.1097/BOT.0000000000003075","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003075","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the rate of subsequent ipsilateral proximal femur fractures after fixation of low energy distal femur fractures among patients ≥ 50 years old and to evaluate whether fixation protecting the femoral neck mitigates the risk of subsequent ipsilateral hip fracture.</p><p><strong>Methods: </strong>Designs: A retrospective comparative study.</p><p><strong>Setting: </strong>Four academic level I trauma centers.</p><p><strong>Patient population: </strong>Included were patients aged 50 years or older treated with open reduction internal fixation of a low energy distal femur fracture (AO/OTA 33 A, B, or C) from 2005 to 2024 without prior proximal femur implant.</p><p><strong>Outcome measures and comparisons: </strong>Patient demographics, comorbidities, injuries, fixation type, and subsequent hip fracture were evaluated and compared based on femoral neck protection.</p><p><strong>Results: </strong>Femoral neck protection was employed for 103 patients (80 women, 77.7%) with median age 77 years (IQR 70 to 84) and was not employed among 517 patients (424 women, 82.0%) with median age 71 years (IQR 63 to 82). Twenty-six subsequent ipsilateral hip fractures occurred. Two were immediately adjacent to prior fixation, and 24 were distant from prior fixation. Subsequent ipsilateral fractures occurred more often without femoral neck protection (26/517, 5.0%) than when the femoral neck was protected (0/103, 0%), p = 0.013. The cumulative rate of hip fracture in the absence of femoral neck protection at 1, 2, 3, and 4 years postoperatively was 2.4%, 4.0%, 5.6% and 7.2%, respectively, while the cumulative rate remained at 0% throughout follow up in the setting of femoral neck protection (log-rank p = 0.031).</p><p><strong>Conclusion: </strong>Patients ≥ 50 years old with low energy distal femur fractures had a clinically significant risk of subsequent ipsilateral hip fracture that increased steadily with time. Fixation protecting the femoral neck during distal femur fracture treatment was associated with a significantly reduced risk of subsequent ipsilateral hip fracture.</p><p><strong>Level of evidence: </strong>Level III, therapeutic study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064969","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":"Modified Subvastus Approach to the Medial Distal Femur: Cadaveric Dissection.","authors":"Michael Trumbo, Bradley Carlson, Derran Bedward, Brian Schneiderman, Joseph Elsissy","doi":"10.1097/BOT.0000000000002990","DOIUrl":"10.1097/BOT.0000000000002990","url":null,"abstract":"<p><strong>Summary: </strong>This review describes a modified technique for the surgical management of a displaced medial femoral condyle fracture in a 22-year-old man after a motorcycle accident. This case involved an open reduction and the use of a medial buttress plate to restore joint congruity and reduce the risk of varus failure. The modified transfascial approach through the VMO muscle belly was used to facilitate ample exposure while safely protecting the neurovascular structures behind the robust adductor fascia. This technique highlights the utility and benefits of the modified transfascial approach compared with the traditional medial subvastus approach when used in medial distal femur fracture fixation.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S11-S12"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033585","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":"Percutaneous Plating of the Medial Distal Femur: Cadaveric Dissection.","authors":"Bradley Carlson, Michael Trumbo, Derran Bedward, Joseph Elsissy, Brian Schneiderman","doi":"10.1097/BOT.0000000000002989","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002989","url":null,"abstract":"<p><strong>Summary: </strong>Percutaneous medial plating of distal femur fractures, particularly comminuted fractures, offers improved biomechanical stability without the soft tissue insult of an open approach. The addition of a medial plate neutralizes the cantilever bending force that arises from the offset between the single lateral locking plate and the femur's anatomical axis. This cantilever bending force has been theorized to be a contributor to the high nonunion rate of distal femur fractures. Although concerns about the proximity of the superficial femoral artery have previously limited widespread adoption of medial plating, there is a considerable medial distal femur safe zone where the superficial femoral artery is not at risk. In cases where supplemental medial fixation would be beneficial and soft tissue or host limitations prevent open instrumentation, percutaneous medial plating is a safe and effective alternative.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S13-S14"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033415","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":"Open Reduction of a Posteriorly Locked Shoulder Dislocation: A Case Example.","authors":"Lea McDaniel, Midhat Patel, Paulo Castaneda, Michael D McKee","doi":"10.1097/BOT.0000000000002988","DOIUrl":"10.1097/BOT.0000000000002988","url":null,"abstract":"<p><strong>Summary: </strong>Posterior shoulder dislocations are uncommon but pose diagnostic and treatment challenges, particularly when locked due to humeral head impaction or soft tissue interference. These cases often necessitate surgical intervention, especially when locked or associated with recurrent instability or bony injuries. Preoperative assessment is vital to confirm the diagnosis and guide surgical planning. The surgical procedure begins with patient positioning and anesthesia, followed by a chosen approach, such as the deltopectoral route. In this case, exposure involved identifying and tenodesing the biceps tendon and performing a lesser tuberosity osteotomy. Reduction of the humeral head is achieved under direct visualization and confirmed with fluoroscopy. Stabilization is performed, and any associated lesions are addressed. Postoperative care involved immobilization and gradual rehabilitation. Consideration of patient age, chronicity, and associated bone loss helped dictate the appropriate intervention.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S3-S4"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033383","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":"Box-and-1 Suture Augmented Transosseous Patellar Tendon Repair.","authors":"Chirag Soni, Joash R Suryavanshi, Anthony Sorkin, Luke A Lopas","doi":"10.1097/BOT.0000000000002984","DOIUrl":"10.1097/BOT.0000000000002984","url":null,"abstract":"<p><strong>Summary: </strong>Patellar tendon ruptures resulting in extensor mechanism disruption are typically treated with surgical repair. This case involved a 53-year-old man with an acute right patellar tendon rupture sustained during a basketball game. This review describes the standard transosseous primary repair using Krackow sutures with a novel box-and-1 suture augmentation technique.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S17-S18"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033533","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: Coronoid Fracture \"Lasso\" Repair Using Arthroscopic Instrumentation in Terrible Triad Injuries With Fixable Radial Head Fractures.","authors":"Andrew S Bi, Carolyn Herbosa, Matthew V Abola, Sanjit R Konda, Jadie De Tolla, Abhishek Ganta","doi":"10.1097/BOT.0000000000002982","DOIUrl":"10.1097/BOT.0000000000002982","url":null,"abstract":"<p><strong>Summary: </strong>A single-stage operative repair of terrible triad injuries through a laterally-based approach using arthroscopic instrument-assisted reduction of the coronoid fracture in cases in which the radial head is deemed appropriate for repair rather than arthroplasty is described in this technical trick. Using an arthroscopic suture lasso, adjustable drill guides, cannulated guide-pins with nitinol shuttling wires, and a suspensory cortical button allow for a more precise and facile technique of \"lasso\" fixation of coronoid fractures and anterior capsular injuries with intact radial heads in terrible triad injuries.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S7-S8"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033469","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":"Minimally Invasive Plate Osteosynthesis for Scapular Fractures.","authors":"Korbinian Perl, Bryan J M van de Wall, Reto Babst, Frank J P Beeres","doi":"10.1097/BOT.0000000000002985","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002985","url":null,"abstract":"<p><strong>Summary: </strong>This procedure demonstrates a 65-year-old man who sustained an injury approximately 2 weeks ago with a displaced multifragmented intra- and extra-articular scapular fracture. It describes the technique of a minimally invasive approach and fixation with the use of mini fragment plating. Indications are a displaced extra-articular scapula body, glenoid neck, and intra-articular fracture of the glenoid. Intraoperative imaging confirms anatomic reduction and stable fixation. Follow-up shows a good functional outcome and return to normal daily life.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S5-S6"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033528","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}