Journal of Orthopaedic Trauma最新文献

{"title":"Implementation of the HIP ATTACK Protocol Significantly Decreased Time to Surgery and Physical Therapy Evaluation for Hip Fracture Patients.","authors":"Jack Bragg, Gabriella S Schreiner, Matthew Feldman, Catherine M Call, Dikran R Balian, Scott P Ryan","doi":"10.1097/BOT.0000000000003141","DOIUrl":"10.1097/BOT.0000000000003141","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if implementation of the HIP ATTACK protocol for hip fracture patients decreased delays in surgical fixation or postoperative mobilization. The primary hypothesis was that implementation of the HIP ATTACK protocols would improve time to surgery and time to mobilization.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>This was a retrospective review of patients who underwent hip fracture surgery between January 2011 and January 2021.</p><p><strong>Setting: </strong>A single academic institution where HIP ATTACK protocols were implemented in September 2016.</p><p><strong>Patient selection criteria: </strong>Patients >50 years undergoing surgery for treatment of hip fractures (AO 31A1.2-3, 31A2-3, 31B1-3, 32A-C).</p><p><strong>Outcome measures and comparisons: </strong>Time of diagnosis defined as the time of the initial presenting radiograph and time of mobilization defined as the time the patient stood at edge of bed with physical therapy (PT) were determined. Average values before and after implementation of the HIP ATTACK protocol were compared using a Student t test with a P = 0.05 set as the level of significance for each.</p><p><strong>Results: </strong>A total of 781 patients were included in the analysis. There were 395 patients who had surgery before September 2016 (average age, 79 years; range 50-102 years; 267 women and 187 men), and 386 patients who were operated on after HIP ATTACK implementation (average age, 77 years; range 50-102 years; 232 women and 95 men). Compared with prior years, implementation of HIP ATTACK was associated with decreased time from diagnosis to surgery by an average of 8 hours (30 vs. 22 hours, P < 0.0001) and decreased time from surgery to PT evaluation by an average of 3 hours (30 vs. 27 hours, P = 0.049). Time from surgery to mobilization was not significantly different before and after HIP ATTACK implementation (59 vs. 58 hours, P = 0.63).</p><p><strong>Conclusions: </strong>Implementation of the standardized HIP ATTACK protocol by a multidisciplinary team was associated with improvement in time to surgery and PT evaluation. A standardized, multidisciplinary protocol can minimize delay in caring for patients with hip fractures and is critical in limiting morbidity and mortality.</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":"231-236"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147307044","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":"\"Rescue\" Screws for Stripped 3.5-mm Screw Holes: A Biomechanical Analysis of Pullout Strength and Maximum Insertional Torque of 4.0-mm and 4.5-mm Cortical Screws.","authors":"Justin Harrington, Nathan P Reyes, Noah Paisner, Joshua P Steimel, Brendan J Liakos, JuEun Lee, William Holmes","doi":"10.1097/BOT.0000000000003123","DOIUrl":"10.1097/BOT.0000000000003123","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine the degree of maximum insertional torque (MIT) and pullout strength (POS) restored when 4.0 or 4.5-mm cortical screws were used as rescue screws through a stripped 3.5-mm screw hole in both normal and osteoporotic bone models.</p><p><strong>Methods: </strong>Self-tapping stainless steel screws were tested in 2 synthetic bone models simulating normal and osteoporotic bone. Screw specifications were as follows: 3.5-mm (major/minor diameter 3.5/2.4-mm, 1.25-mm pitch), 4.0-mm (4.0/2.9-mm, 1.25-mm pitch), and 4.5-mm (4.5/3.0-mm, 1.75-mm pitch). Baseline MIT and POS were measured using 3.5-mm screws inserted into native 2.5-mm pilot holes. Stripped holes were created by over-tightening 3.5-mm screws beyond MIT, defined as free screw rotation under constant torque. Rescue screws (4.0 and 4.5 mm) were then inserted into stripped holes. MIT and POS were measured using a torque screwdriver and an Instron 3369 system at 5 mm/min. Restoration of MIT and POS was expressed as a percentage of the baseline 3.5-mm values. Statistical significance was assessed using t tests.</p><p><strong>Results: </strong>In the synthetic normal density bone model, 4.0-mm screws restored 37% of MIT and 62% of POS, while 4.5-mm screws restored 107% of MIT and 98% of POS (P = 0.33, P = 0.34), indicating similarity to native fixation. In the synthetic osteoporotic bone model, 4.0-mm screws restored 79% of MIT and 75% of POS, while 4.5-mm screws restored 229% of MIT and 120% of POS (P < 0.001), showing significant enhancement.</p><p><strong>Conclusions: </strong>The 4.5-mm rescue screws fully restored MIT and POS in synthetic normal and osteoporotic bone models, while 4.0-mm rescue screws provided partial restoration, with better performance in synthetic osteoporotic bone.</p><p><strong>Level of evidence: </strong>Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"40 4","pages":"e101-e105"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444146","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":"Factors Affecting Outcomes of Hindfoot Fusion Nails for Acute Injury: A Multicenter Study.","authors":"Eugene Kim, Paul Tornetta, Jon B Carlson, Alex Schultz, Garrett Wireman, Benjamin Ollivere, Amy Zheng, Clay Spitler, David Patch, Tim White, Nicholas Heinz, Daniel Stinner, Caroline Elizabeth Lahurd, Robert Ostrum, Charles Baumann, Stephen Kottmeier, Michael Doany, Peter Krause, Nathan Redlich, Kenneth Egol, Sanjit Konda, Hassan Mir, Meghan McCaskey, Emil Azer, Jace Kusler, Michael Beltran, Samir Mehta, Kendall Masada, Krystin A Hidden, Nicolas Kuttner","doi":"10.1097/BOT.0000000000003104","DOIUrl":"10.1097/BOT.0000000000003104","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of joint preparation and patient factors on outcomes and complications in patients treated acutely with hindfoot fusion nails for ankle and pilon fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Thirteen US trauma centers and 2 UK trauma centers.</p><p><strong>Patient selection criteria: </strong>Ankle and pilon fractures (AO-OTA types A-C) from 2010 to 2020 acutely treated definitively with hindfoot fusion nail were reviewed. Patients at least 18 years old and with minimum 6 months follow-up or earlier diagnosis of complication were included. Exclusion criteria included nonambulatory at baseline, prior internal fixation that failed and underwent revision, and prior tibiotalar or subtalar arthrodesis.</p><p><strong>Outcome measurements and comparisons: </strong>The primary outcome was final postoperative ambulatory status. Secondary outcomes were infectious and fracture-related complications.</p><p><strong>Results: </strong>One hundred forty-nine patients (75 men; 74 women; age 20-99; median 63 years) were treated for ankle (104) or pilon (45; 8A, 13B, 24C) fractures. Eighty-five patients (44%) had open fractures and 55 (37%) had diabetes. Thirty-six patients (24%) had joint preparation at the time of surgery. Forty-five (30%) were made weight bearing as tolerated postoperatively; the median time to mobilize was 1.5 days (0-210) and to full weight bearing was 35 days (0-1462). Fifty-seven patients (85%) returned to their preinjury ambulatory status, which was not affected by joint preparation (50% vs. 59%, P = 0.327). Joint preparation led to higher articular fusion rates (94% vs. 24%; P = 0.001) and fewer hardware removals (19% vs. 42%, P = 0.013), but trended toward a higher fracture nonunion rate (19% vs. 8%, P = 0.053). Forty-five patients (30%) had infectious complications, 60 (40%) had a fracture-related complication, and 67 (45%) had additional procedures. Open fractures did not lead to any differences in superficial or deep infection. Insulin-dependent diabetes was associated with higher rates of infectious complications (31% vs. 15%, P = 0.028) and amputation (17% vs. 4%, P = 0.029).</p><p><strong>Conclusions: </strong>Hindfoot fusion nails for acute ankle and pilon injuries had high complication rates. More complications occurred in patients with insulin-dependent diabetes. While 95% regained ambulation, only 57% returned to preoperative status. Joint preparation led to higher rates of articular fusion (94% vs. 24%, P < 0.001) but not fracture union (81% vs. 66%, P = 0.106).</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":"40 3","pages":"148-154"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180804","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":"Response Letter to the Editor Regarding Article: Utility of Sonication for Fracture-Related Infections.","authors":"Christina Liu, Austin T Gregg, Stephen C Moye, Alina Fischer, Michael Akodu, Paul Appleton, Edward K Rodriguez, John Wixted","doi":"10.1097/BOT.0000000000003128","DOIUrl":"10.1097/BOT.0000000000003128","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"160"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564170","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":"Intra-Articular Air Predicts Hip Joint Instability Following Posterior Wall Fracture, Irrespective of Fracture Size or History of Dislocation.","authors":"Jonathan D Ellis, Jacob R Meyer, Clay A Spitler, Joey P Johnson, Michael T Archdeacon, Michael J Beltran, Jonathan H Quade, H Claude Sagi","doi":"10.1097/BOT.0000000000003097","DOIUrl":"10.1097/BOT.0000000000003097","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether the presence of intra-articular air on computed tomography (CT) correlates with hip joint instability following posterior wall acetabular fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective chart and radiographic review.</p><p><strong>Setting: </strong>Two, academic, Level 1 trauma centers.</p><p><strong>Patient selection criteria: </strong>Skeletally mature patients with posterior wall acetabulum fractures (AO/OTA 62A1) who underwent stress examination under anesthesia (EUA) from 2014 to 2024.</p><p><strong>Outcome measures and comparisons: </strong>Patients with positive and negative EUAs were compared with regard to history of dislocation, presence of intra-articular air on CT scan, amount of fracture displacement, sagittal angle measurement, and fracture size.</p><p><strong>Results: </strong>There were 38 positive (unstable) and 33 negative (stable) EUAs for posterior wall acetabulum fractures. Demographics were similar between positive [mean age, 28 years; range (18-58 years), 34% female] and negative [mean age, 36 years; range (18-61 years), 30% female] groups. Patients with a positive EUA had a significantly higher incidence of intra-articular air (82% vs. 9%, P < 0.001), fracture displacement greater than 5 mm (76% vs. 33%, P < 0.001), sagittal angle measurement greater than 70 degrees (74 vs. 21%, P < 0.001), and hip dislocation on injury radiograph (61 vs. 18%, P < 0.001). In 43 patients who presented without a history of hip dislocation, intra-articular air was present significantly more often in the positive EUA group (n = 16) compared with the negative EUA group (n = 27) (75% vs. 7%, P < 0.001).</p><p><strong>Conclusions: </strong>Hip joint instability following posterior wall acetabulum fracture was significantly higher in patients with intra-articular air on CT scan-regardless of a history for hip dislocation. Fracture displacement greater than 5 millimeters and sagittal angle measurement greater than 70 degrees were also found to be predictors of positive EUA. When these characteristics are found on injury imaging, an EUA should be considered to rule out hip joint instability.</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":"130-135"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274961","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 response.","authors":"Divya Jeyasingh, Niloofar Dehghan","doi":"10.1097/BOT.0000000000003058","DOIUrl":"10.1097/BOT.0000000000003058","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"e71-e72"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957815","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":"Predicting Contralateral Second Hip Fracture Risk Within 5 Years of First Hip Fracture: A New Risk Tool to Guide Patient/Family Counseling and Bone Health Treatment.","authors":"Christopher J Pettit, Carolyn F Herbosa, Jacob A Linker, Abhishek Ganta, Kenneth A Egol, Sanjit R Konda","doi":"10.1097/BOT.0000000000003060","DOIUrl":"10.1097/BOT.0000000000003060","url":null,"abstract":"<p><strong>Objective: </strong>To develop a stratification tool to identify patients with hip fracture at risk for second contralateral hip fracture and mortality within 5 years of an index fracture, and to assess the cost-effectiveness of prophylactic fixation in high fracture risk/low mortality risk patients.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective prognostic cohort study.</p><p><strong>Setting: </strong>Single academic system with 2 Level 1 Trauma Centers, 1 orthopedic specialty hospital, and 1 tertiary care hospital.</p><p><strong>Patient selection criteria: </strong>Patients who were 60 years or older with OTA 31A/B hip fractures from low-energy mechanisms between 11/1/2014 and 11/31/2023 with ≥5-year follow-up or until death were included.</p><p><strong>Outcome measures and comparisons: </strong>The study included 4 phases: (1) identifying factors associated with second hip fracture within 5 years; (2) using multivariate logistic regression to generate models predicting 5-year second hip fracture (vs. FRAX) and mortality risk; (3) creating a \"risk matrix\" to identify candidates for prophylactic fixation using Youden Index, which determined cutoff points encompassing the maximum sensitivity and specificity for each risk equation and were used to define a value-based target group; and (4) cost analysis comparing standard versus prophylactic care in high fracture risk/low mortality risk patients.</p><p><strong>Results: </strong>Of 426 patients (mean age 80.25 years, 73.4% female), 78 sustained second hip fractures (mean interval: 594 days). Predictors included higher FRAX score ( P = 0.004), dementia ( P < 0.001), ICU stay ( P = 0.014), discharge to subacute care ( P < 0.001), and 90-day readmission ( P = 0.011). Logistic regression predicted 5-year second fracture risk (AUC 0.742 vs. FRAX 0.617, P = 0.012) and 5-year mortality (AUC 0.723). The risk matrix used cutoff points of 18.2% (mortality) and 38.2% (second fracture) to define a value-based target group (n = 26; 13 experienced second fracture). Cost analysis showed that prophylactic fixation of all 26 patients ($781,508) would save $353,067 compared with treating the 13 who fractured again ($1,134,575).</p><p><strong>Conclusions: </strong>A novel matrix was developed that accurately predicted 5-year second hip fracture and mortality risk. Prophylactic fixation in low mortality, high fracture risk patients may reduce costs and prevent future fractures [Tool available: https://sttgmacom.wpcomstaging.com/predicting-risk-of-second-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":"e91-e98"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957703","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":"Management of Tibia Pilon Fractures With Ring External Fixation.","authors":"Stephen J Wallace, Doug Beaman","doi":"10.1097/BOT.0000000000003067","DOIUrl":"10.1097/BOT.0000000000003067","url":null,"abstract":"<p><strong>Summary: </strong>Tibia pilon fractures are complex injuries associated with ankle articular cartilage damage and soft tissue compromise. Modern circular external fixation methods are useful in their surgical management, especially for open fractures, severe soft tissue injury, fracture patterns with bone loss or compromise, severe cartilage loss, and certain patient factors. Surgical techniques involve ring block concepts, strategic distal tibia wire placements, hexapod fixators with software-guided bone alignment, and other uses of circular external fixation including ankle joint distraction, augmentation of internal fixation to create integrated constructs, intentional limb deformation for soft tissue defects, bone transport, and primary arthrodesis. Circular external fixation has comparable and sometimes favorable outcomes versus all internal fixation techniques and can be the treatment of choice for certain complex pilon cases.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 12S","pages":"S19-S24"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513092","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":"Outcomes After Distal Femur Replacement for Fracture: A Multi-Institutional Retrospective Review.","authors":"David C Landy, Jeffrey A Foster, Wyatt G S Southall, Austin T Gregg, Stephen T Duncan, Michael T Archdeacon, William T Obremskey, Joshua M Lawrenz, Christopher Lee, Michael S Sridhar, Arun Aneja","doi":"10.1097/BOT.0000000000003059","DOIUrl":"10.1097/BOT.0000000000003059","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate representative outcomes of patients who underwent distal femur replacement (DFR) for distal femur fractures (DFFs).</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective Cohort Study.</p><p><strong>Setting: </strong>Twelve academic trauma centers in the United States.</p><p><strong>Patient selection criteria: </strong>Adult patients who underwent DFR for native or periprosthetic DFF (OTA/AO 33A1.1-33C3.3) from 2010 to 2022 were included. Patients who underwent DFR for infectious, oncologic, and/or other indications besides fracture fixation were excluded.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was periprosthetic joint infection (PJI). Secondary outcomes included reoperation, 1-year mortality, and function. Outcomes were estimated using proportions and Kaplan-Meier curves with 95% confidence intervals (CI) and stratified by periprosthetic fracture with Fisher exact testing.</p><p><strong>Results: </strong>One hundred seventy-three patients were included, with 130 (75%) having a periprosthetic DFF. The median age was 77 [interquartile range, 70-84] and the median final follow-up was 6 months [interquartile range, 2-14], with 146 women (84%) and several medical comorbidities (63% American Society of Anesthesiologists class III and 24% American Society of Anesthesiologists class IV). The rate of PJI was 5.8% (95% CI, 3.1%-10.5%). PJI was 2.3% for native compared with 6.9% for periprosthetic DFF ( P = 0.45). The reoperation rate was 16.6% (95% CI, 11.7%-23.0%), and the 1-year mortality was 27% (95% CI, 20%-35%). Fifty-five percent of patients returned to their baseline function (95% CI, 46.9%-62.1%).</p><p><strong>Conclusions: </strong>DFR for native and periprosthetic DFF was associated with a PJI rate of 5.8%. The 1-year mortality rate was 27.0%, and the reoperation rate was 16.6%. Fifty-five percent of patients returned to their baseline function. DFR can be considered as an option in cases of complex native and periprosthetic DFF, although surgeons should continue to counsel patients on the considerable risks associated with DFR when assessing treatment options.</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":"644-652"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957699","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":"Results of an Early Showering Protocol After Orthopaedic Trauma Surgery.","authors":"Robert E Bilodeau, Alona Katzir, Heather S Haeberle, Kathryn A Barth, Craig E Klinger, John E Zierenberg, Brian J Page, William M Ricci","doi":"10.1097/BOT.0000000000003056","DOIUrl":"10.1097/BOT.0000000000003056","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the clinical outcomes of a standardized postoperative protocol permitting removal of postoperative dressings, showering, and cleansing of incisional wounds 3 days after fracture surgery.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective review.</p><p><strong>Setting: </strong>Tertiary orthopaedic center.</p><p><strong>Patient selection criteria: </strong>All adult patients, aged 18 years or older, operatively treated for fracture or other musculoskeletal trauma from September 2017 to September 2023 were screened for study eligibility. Patients with open fractures, revision surgery through surgical incisions created <6 weeks before the index procedure, immobilization (eg, splints) precluding surgical wound access, known prior infection, acute traumatic local skin abrasions or lacerations, were excluded because these patients were not treated with the early showering protocol. Also excluded were patients with <3-month follow-up.</p><p><strong>Outcome measures and comparisons: </strong>Outcome measures were reoperation within 3 months for wound or infectious complications and superficial surgical site infection treated with oral antibiotics.</p><p><strong>Results: </strong>A total of 1067 surgical cases were performed during the included time frame. Six hundred and two cases were excluded based on eligibility criteria, leaving 465 surgeries in 444 patients with a mean age of 59 years (range 18-95; 65% female). Mean follow-up was 11.7 months (SD 12.3; range 3.0-73.0). Reoperation for a wound or infectious complication occurred in 1.1% (5/465) of patients and superficial surgical site infection requiring antibiotic treatment occurred in an additional 1.1% of patients (5/465).</p><p><strong>Conclusions: </strong>A protocol of dressing removal and showering at 3 days postoperatively for acute uncomplicated surgical wounds was associated with reoperation for deep infection in 1.1% of patients and superficial infection in 1.1% of patients supporting the safety of an early showering protocol.</p><p><strong>Level of evidence: </strong>Therapeutic 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":"639-643"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873686","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}