Journal of Orthopaedic Trauma最新文献

{"title":"Three-Dimensional Mapping of Scapular Body, Neck, and Glenoid Fractures.","authors":"Peter A Cole, Lisa K Schroder, Indraneel S Brahme, Claire N Thomas, Lorenz Kuhn, Erich Zaehringer, Andreas Petersik","doi":"10.1097/BOT.0000000000002734","DOIUrl":"10.1097/BOT.0000000000002734","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to report patterns of scapular fractures and define them with a contemporary methodology.</p><p><strong>Methods: </strong>.</p><p><strong>Design: </strong>Retrospective study, 2015-2021.</p><p><strong>Setting: </strong>Single, academic, Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Consecutive patients ≥18 years, presenting with unilateral scapula fracture, with thin-slice (≤0.5-mm) bilateral computed tomography (CT) scans of the entirety of both the injured and uninjured scapulae.</p><p><strong>Outcome measures and comparisons: </strong>Thin-slice (0.5-mm) CT scans of injured and normal scapulae were obtained to create three-dimensional (3D) virtual models. 3D modeling software (Stryker Orthopedics Modeling and Analytics, Stryker Trauma GmbH, Kiel, Germany aka SOMA) was used to create a 3D map of fracture location and frequency. Fracture zones were delineated using anatomic landmarks to characterize fracture patterns.</p><p><strong>Results: </strong>Eighty-seven patients were identified with 75 (86%) extra-articular and 12 (14%) intra-articular fractures. The dominant fracture pattern emanated from the superior lateral border (zone E) to an area inferior to the spinomedial angle (zone B) and was present in 80% of extra-articular fractures. A second-most common fracture line propagated from the primary (most-common) line toward the inferior medial scapular border with a frequency of 36%. Bare zones (with 1 or no fractures present) were identified in 4 unique areas. Furthermore, intra-articular fractures were found to be heterogenous.</p><p><strong>Conclusions: </strong>The 3D fracture map created in this study confirmed that extra-articular scapular fractures occur in certain patterns with a relatively high frequency. Results provide greater insight into scapular fracture locations and may help to study prognosis of injury and improve treatment strategy including operative approaches and surgical tactics.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"e48-e54"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460548","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":"Meniscus Tear Requiring Intraoperative Repair Does Not Influence Midterm Patient-Reported Outcomes in Operatively Treated Tibial Plateau Fractures.","authors":"Eleanor H Sato, Dillon C O'Neill, Lillia N Steffenson, Luke A Myhre, Thomas F Higgins, David L Rothberg, Lucas S Marchand, Justin M Haller","doi":"10.1097/BOT.0000000000002724","DOIUrl":"10.1097/BOT.0000000000002724","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate whether intraoperatively repaired lateral meniscus injuries impact midterm patient-reported outcomes in those undergoing operative fixation of tibial plateau fracture.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Level I trauma center.</p><p><strong>Patient selection criteria: </strong>All patients (n = 207) who underwent operative fixation of a tibial plateau fracture from 2016 to 2021 with a minimum of 10-month follow-up.</p><p><strong>Outcome measures and comparisons: </strong>The Patient-Reported Outcomes Measurement Information System Physical Function, Knee Injury and Osteoarthritis Outcome Score, and the PROMIS-Preference health utility score.</p><p><strong>Results: </strong>Overall, 207 patients were included with average follow-up of 2.9 years. Seventy-three patients (35%) underwent intraoperative lateral meniscus repair. Gender, age, body mass index, Charlson comorbidity index, days to surgery, ligamentous knee injury, open fracture, vascular injury, polytraumatic injuries, Schatzker classification, and Orthopaedic Trauma Association classification were not associated with meniscal repair ( P > 0.05). Rates of reoperation (42% vs. 31%, P = 0.11), infection (8% vs. 10%, P = 0.60), return to work (78% vs. 75%, P = 0.73), and subsequent total knee arthroplasty (8% vs. 5%, P = 0.39) were also similar between those who had a meniscal repair and those without a meniscal injury, respectively. There was no difference in Patient-Reported Outcomes Measurement Information System Physical Function (46.3 vs. 45.8, P = 0.707), PROMIS-Preference (0.51 vs. 0.50, P = 0.729), and all Knee Injury and Osteoarthritis Outcome Score domain scores at the final follow-up between those who had a meniscal repair and those without a meniscal injury, respectively.</p><p><strong>Conclusions: </strong>In patients with an operatively treated tibial plateau fracture, the presence of a concomitant intraoperatively identified and repaired lateral meniscal tear results in similar midterm PROMs and complication rates when compared with patients without meniscal injury.</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":"109-114"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460535","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":"Implementation of a Fascia Iliaca Compartment Block Program in Geriatric Hip Fractures: The Experience at a Level I Academic Trauma Center.","authors":"Gary Ulrich, Kameron Kraus, Seth Polk, David Zuelzer, Paul E Matuszewski","doi":"10.1097/BOT.0000000000002722","DOIUrl":"10.1097/BOT.0000000000002722","url":null,"abstract":"<p><strong>Objectives: </strong>Determine adherence to a newly implemented protocol of fascia iliaca compartment block (FICB) in geriatric hip fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective review.</p><p><strong>Setting: </strong>Level I trauma center.</p><p><strong>Patient selection criteria: </strong>Patients with a hip fracture treated with cephalomedullary nailing or hemiarthroplasty (CPT codes 27245 or 27236).</p><p><strong>Outcome measures and comparisons: </strong>Adherence to a protocol for FICB, time intervals between emergency department arrival, FICB, and surgery stratified by time of admission.</p><p><strong>Results: </strong>Three hundred eighty patients were studied (average age 78 years, 70% female). Approximately 53.2% of patients received an FICB, which was less than a predefined acceptable adherence rate of 75% ( P < 0.001). Approximately 5.0% received an FICB within 4 hours and 17.3% within 6 hours from admission. Admission during daylight hours (7 am -7p m ) when compared with evening hours (7 pm -7 am ) was associated with improved timeliness ([8.3% vs. 0% within 4 hours, P < 0.001] [27.5% vs. 2.4% within 6 hours, P < 0.001]). Improved adherence to the protocol was observed over time (odds ratio: 1.0013, 95% confidence interval, 1.0001-1.0025, P = 0.0388).</p><p><strong>Conclusions: </strong>FICB implementation was poor but gradually improved over time. Few patients received an FICB promptly, especially during night hours. Overall, this study demonstrates that implementation of an FICB program at a Level I academic trauma center can be difficult; however, many hurdles can be overcome with institutional support and dedication of resources such as staff, space, and additional training.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"96-101"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71521805","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":"Postoperative Computed Tomography Scans of Acetabular Fractures Routinely Identify Indications for Revision Surgery.","authors":"Ye J Kim, Alex M Lencioni, Nicholas J Tucker, Katya E Strage, Joshua A Parry, Cyril Mauffrey","doi":"10.1097/BOT.0000000000002727","DOIUrl":"10.1097/BOT.0000000000002727","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the utility of postoperative computed tomography (CT) scans in identifying indications for revision surgery after surgical fixation of acetabular fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Urban level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Patients with surgically treated acetabular fractures with surgical fixation (open reduction and internal fixation or percutaneous fixation) with routine postoperative CT scans.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcome-revision surgery based on postoperative imaging, including intra-articular osteochondral fragments, implant complications, and malreductions. Secondary outcome-quality of reduction on radiographs versus CT scans.</p><p><strong>Results: </strong>One hundred forty-eight patients were included. The revision surgery rate was 15.5% (23/148); indications included malpositioned implants (6.7%, n = 10), malreductions (5.4%, n = 8), and intra-articular loose bodies (3.4%, n = 5). Only 8.7% (2/23) of the indications for revision surgery were identified on postoperative radiographs, with the remainder being identified on CT scans. Revision surgeries were found to be associated with male gender (proportional difference: 19.6%, 95% confidence interval [CI]: 3.4%-29.4%; P = 0.04) and T-type fractures (PD 28.7%; CI, 9.0%-48.9%; P = 0.001). Revision surgery was not found to be associated with age, body mass index, posterior wall fractures, concurrent pelvic ring fractures, or surgical approach. On radiographs, 51.3% (n = 76/148) had anatomic reductions (<2 mm) compared with only 10.2% (n = 15/148) on CT scans.</p><p><strong>Conclusions: </strong>Indications for revision of acetabular fixation surgeries and poor reductions were frequently missed on plain radiography and identified on postoperative CT scans. This suggests that the use of advanced imaging such as intraoperative 3D imaging or postoperative CT scans may be beneficial.</p><p><strong>Level of evidence: </strong>Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"78-82"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460545","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":"In Memoriam: Sigvard T. Hansen, Jr, MD.","authors":"","doi":"10.1097/BOT.0000000000002739","DOIUrl":"10.1097/BOT.0000000000002739","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 2","pages":"e78"},"PeriodicalIF":2.3,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741286","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":"No Difference in Acute Outcomes for Patients Undergoing Fix and Replace Versus Fixation Alone in the Treatment of Geriatric Acetabular Fractures.","authors":"Pasquale Gencarelli, Luke G Menken, Ian S Hong, Conner J Robbins, Jaclyn M Jankowski, Richard S Yoon, Frank A Liporace","doi":"10.1097/BOT.0000000000002733","DOIUrl":"10.1097/BOT.0000000000002733","url":null,"abstract":"<p><strong>Objectives: </strong>To compare acute outcomes between patients undergoing fix and replace (FaR) versus open-reduction and internal fixation (ORIF) alone in the treatment of geriatric acetabular fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective Cohort Study.</p><p><strong>Setting: </strong>Single Level 2 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Consecutive acetabular fracture patients ≥ 55 years of age treated by two orthopaedic trauma surgeons at one tertiary care center from January 2017 to April 2022 with FaR versus ORIF were identified. Included were those with complete datasets within the 180-day global period. Excluded were patients with previous ORIF of the acetabulum or femur, or revision total hip arthroplasty.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcomes were length of hospital stay (LOS), postoperative weight-bearing status, postoperative disposition, time to postoperative mobilization, and 90-day readmission rates. Secondary outcomes compared included demographic information, injury mechanism, surgical time, complications, revisions, and preoperative and postoperative Hip Disability and Osteoarthritis Outcomes Score for Joint Replacement (HOOS Jr.) scores. These were compared between FaR and ORIF groups.</p><p><strong>Results: </strong>Seventeen FaR patients (average age 74.5 ± 9.0 years) and 11 ORIF patients (average age 69.4 ± 9.6 years) met inclusion criteria. Mean follow-up was 26.4 months (range: 6-75.6 months). More FaR group patients were ordered immediate weight-bearing as tolerated or partial weight-bearing compared with ORIF alone (70% vs. 9.0%, P = 0.03). More patients in the FaR group had pre-existing hip osteoarthritis compared with ORIF alone (71% vs. 27%, P = 0.05). Fracture classification ( P = 0.03) and Charlson Comorbidity Index ( P = 0.02) differed between the 2 groups. There were no other differences in demographics, LOS ( P = 0.99), postoperative disposition ( P = 0.54), time to postoperative mobilization ( P = 0.38), 90-day readmission rates ( P = 0.51), operative time ( P = 0.06), radiographic union ( P = 0.35), time to union ( P = 0.63), pre- ( P = 0.32) or postoperative HOOS Jr. scores ( P = 0.80), delta HOOS Jr. scores ( P = 0.28), or reoperation rates between groups ( P = 0.15).</p><p><strong>Conclusions: </strong>FaR and ORIF seem to be sound treatment options in the management of geriatric acetabular fractures. Patients in the FaR group achieved immediate or partial weight-bearing earlier than the ORIF group; however, time to postoperative mobilization did not differ between the two groups. The remainder of acute postoperative outcomes (LOS, postoperative disposition, and 90-day readmission rates) did not differ between the two groups.</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":"88-95"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460536","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 Outcomes at Midterm Follow-up of Operatively and Nonoperatively Treated Isolated Weber B Ankle Fractures.","authors":"Ge Laurence, Aaron M Perdue, Mark E Hake, Paul G Talusan, James R Holmes, David M Walton","doi":"10.1097/BOT.0000000000002735","DOIUrl":"10.1097/BOT.0000000000002735","url":null,"abstract":"<p><strong>Objectives: </strong>A novel protocol was previously presented for nonoperative management of Weber B (OTA/AO 44B) ankle fractures with criteria of medial clear space <7 mm on gravity stress (GS) radiographs and ipsilateral superior clear space and contralateral GS medial clear space within 2 mm. This study recruited an operative cohort for comparison of outcomes.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Level 1 academic center.</p><p><strong>Patient selection criteria: </strong>The recruited operative cohort consisted of patients who may have been considered for the nonoperative protocol, but underwent surgery instead.</p><p><strong>Outcome measures and comparisons: </strong>Kellgren-Lawrence scale for evaluation of arthritis, American Orthopedic Foot and Ankle Society Hindfoot, Olerud Molander Ankle, Lower Extremity Functional Scale (LEFS), and PROMIS (physical function, depression, pain interference) scores for the current operative cohort were compared with that of the original nonoperative cohort.</p><p><strong>Results: </strong>There were 20 patients in the operative cohort and 29 in the original nonoperative cohort. Mean follow-up was 6.9 and 6.7 years, respectively. The following outcome scores were better for the nonoperative cohort compared with the operative, respectively: LEFS, 75.2 and 68.1 ( P = 0.009); Olerud Molander Ankle, 94.1 and 89.0 ( P = 0.05); American Orthopedic Foot and Ankle Society, 98.5 and 91.7 ( P = 0.0003); PROMIS Physical Function, 58.2 and 50.4 ( P = 0.01); PROMIS Pain Interference, 42.2 and 49.7 ( P = 0.004). The PROMIS Depression, 42.8 and 45.4 ( P = 0.29), was not different between groups. All patients achieved union of their fracture. Surgical complications included implant removal (15%), SPN neurapraxia (5%), and delayed wound healing (5%).</p><p><strong>Conclusions: </strong>In carefully selected patients with isolated Weber B fractures, nonoperative management may be considered because it can lead to equivalent or superior outcomes with none of the risks typically associated with surgical intervention.</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":"115-120"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460532","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":"Civilian Ballistic Arthrotomies: Infection Rates and Operative Versus Nonoperative Management.","authors":"Charles Liu, Mahesh Kumar, Andy Liu, Mary Kate Erdman, Anthony Christiano, Adam Lee, Kelly Hynes, Jason Strelzow","doi":"10.1097/BOT.0000000000002728","DOIUrl":"10.1097/BOT.0000000000002728","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to determine whether a significant difference existed in the rate of infection after ballistic traumatic arthrotomy managed operatively compared with those managed without surgery.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients with ballistic traumatic arthrotomies of the shoulder, elbow, wrist, hip, knee, or ankle who received operative or nonoperative management.</p><p><strong>Outcome measures and comparisons: </strong>The rates of infection and septic arthritis in those who received operative or nonoperative management.</p><p><strong>Results: </strong>One hundred ninety-five patients were studied. Eighty patients were treated nonoperatively (Non-Op group), 16 patients were treated with formal irrigation and debridement in the operating room (I&D group), and 99 patients were treated with formal I&D and open reduction and internal fixation (ORIF) (I&D + ORIF group). Patients in all 3 groups received local wound care and systemic antibiotics. No patients in the Non-Op or I&D group developed an infection. Six patients in the I&D + ORIF group developed extra-articular postoperative infections requiring additional interventions.</p><p><strong>Conclusions: </strong>The infection rate in the I&D + ORIF group was consistent with the infection rates reported in orthopaedic literature after fixation alone. In addition, none of the infections were cases of septic arthritis. This suggests that traumatic arthrotomy does not increase the risk for infection beyond what is expected after fixation alone. Importantly, the Non-Op group represented a series of 80 patients who were treated nonoperatively without developing an infection, indicating that I&D may not be necessary to prevent infection after ballistic arthrotomy. The results suggest that septic arthritis after civilian ballistic arthrotomy is a rare complication regardless of the choice of treatment.</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":"102-108"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460530","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 Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated With Lateral Locked Plating: A Risk-Stratified Analysis.","authors":"David J Stockton, Nathan N O'Hara, Dane J Brodke, Natasha McKibben, Kathleen Healey, Abraham Goch, Haley Demyanovich, Sai Devana, Adolfo Hernandez, Cynthia E Burke, Jayesh Gupta, Lucas S Marchand, Graham J Dekeyser, Lillia Steffenson, Stephen J Shymon, Marshall J Fairres, Paul W Perdue, Colby Barber, Omar H Atassi, Thomas W Mitchell, Zachary M Working, Loren O Black, Ashraf N El Naga, Erika Roddy, Matthew Hogue, Trevor Gulbrandsen, John Morellato, W Hunter Gillon, Murphy M Walters, Eric Hempen, Gerard P Slobogean, Christopher Lee, Robert V O'Toole","doi":"10.1097/BOT.0000000000002680","DOIUrl":"10.1097/BOT.0000000000002680","url":null,"abstract":"<p><strong>Objective: </strong>To identify technical factors associated with nonunion after operative treatment with lateral locked plating.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Ten Level I trauma centers.</p><p><strong>Patient selection criteria: </strong>Adult patients with supracondylar distal femur fractures (OTA/AO type 33A or C) treated with lateral locked plating from 2010 through 2019.</p><p><strong>Outcome measures and comparisons: </strong>Surgery for nonunion stratified by risk for nonunion.</p><p><strong>Results: </strong>The cohort included 615 patients with supracondylar distal femur fractures. The median patient age was 61 years old (interquartile range: 46 -72years) and 375 (61%) were female. Observed were nonunion rates of 2% in a low risk of nonunion group (n = 129), 4% in a medium-risk group (n = 333), and 14% in a high-risk group (n = 153). Varus malreduction with an anatomic lateral distal femoral angle greater than 84 degrees, was associated with double the odds of nonunion compared to those without such varus [odds ratio, 2.1; 95% confidence interval (CI), 1.1-4.2; P = 0.03]. Malreduction by medial translation of the articular block increased the odds of nonunion, with 30% increased odds per 4 mm of medial translation (95% CI, 1.0-1.6; P = 0.03). Working length increased the odds of nonunion in the medium risk group, with an 18% increase in nonunion per 10-mm increase in working length (95% CI, 1.0-1.4; P = 0.01). Increased proximal screw density was protective against nonunion (odds ratio, 0.71; 95% CI, 0.53-0.92; P = 0.02) but yielded lower mRUST scores with each 0.1 increase in screw density associated with a 0.4-point lower mRUST (95% CI, -0.55 to -0.15; P < 0.001). Lateral plate length and type of plate material were not associated with nonunion. ( P > 0.05).</p><p><strong>Conclusions: </strong>Malreduction is a surgeon-controlled variable associated with nonunion after lateral locked plating of supracondylar distal femur fractures. Longer working lengths were associated with nonunion, suggesting that bridge plating may be less likely to succeed for longer fractures.</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":"49-55"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10320540","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":"Do Long-Segment Blocking Screws Increase the Stability of Intramedullary Nail Fixation in Proximal Tibia Fractures, Eliminating the \"Bell-Clapper Effect?\"","authors":"Derek S Stenquist, Meghan McCaskey, Miguel Diaz, Steven D Munassi, Giovanni Ayala, David Donohue, Hassan R Mir","doi":"10.1097/BOT.0000000000002683","DOIUrl":"10.1097/BOT.0000000000002683","url":null,"abstract":"<p><strong>Objectives: </strong>To determine change in stiffness and horizontal translation of a geriatric extra-articular proximal tibia fracture model after intramedullary nailing with distal (long)-segment blocking screws versus proximal (short)-segment blocking screws.</p><p><strong>Methods: </strong>Unstable extra-articular proximal tibia fractures (OTA/AO 41-A3) were created in 12 geriatric cadaveric tibias. Intramedullary nails were locked with a standard construct (4 proximal screws and 2 distal screws). Specimens were then divided into 2 groups (6 matched pairs per group). Group 1 had a blocking screw placed lateral to the nail in the proximal segment (short segment). Group 2 had a blocking screw placed 1 cm distal to the fracture and medial to the nail (long segment). Specimens were then axially loaded and cycled to failure or cycle completion (50,000 cycles).</p><p><strong>Results: </strong>Long-segment blocking screws significantly decreased the amount of horizontal translation at the fracture site compared with short-segment screws (0.77 vs. 2.0 mm, P = 0.039). They also resulted in a greater trend towards greater baseline stiffness, (807.32 ± 216.95 N/mm vs. 583.12 ± 130.1 N/mm, P = 0.072). There was no difference in stiffness after cyclic loading or survival through 50,000 cycles between the long-segment and short-segment groups.</p><p><strong>Conclusion: </strong>Long-segment blocking screws added to an intramedullary nail construct resulted in decreased horizontal translation at the fracture site compared with short-segment screws in this model of a geriatric proximal tibia fracture.</p><p><strong>Clinical relevance: </strong>Blocking screws are commonly used to aid in fracture alignment during intramedullary nailing of proximal tibia fractures. Even when not required to attain or maintain alignment, the addition of a blocking screw in either the proximal or the distal (long) segment may help mitigate the \"Bell-Clapper Effect\" in geriatric patients.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"e4-e8"},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10320542","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}