Journal of Orthopaedic Trauma最新文献

{"title":"Patient and Hospital Factors Affecting the Timing of Hip Fracture Surgery: A Risk-Stratified Analysis in the United States.","authors":"Daniel You, Nathan N O'Hara, Sara Kheiri, Arissa M Torrie, Gerard P Slobogean","doi":"10.1097/BOT.0000000000002998","DOIUrl":"10.1097/BOT.0000000000002998","url":null,"abstract":"<p><strong>Objective: </strong>To determine the proportion of high-risk for surgical delay hip fracture patients who experienced delayed surgery and if associations exist among hospitals achieving timely surgical care in high-risk patients.</p><p><strong>Methods: </strong>Design: Retrospective cohort.</p><p><strong>Setting: </strong>National Inpatient Sample (NIS) database.</p><p><strong>Patient selection criteria: </strong>Hip fracture patients aged 65 years and older identified using ICD-10 codes in the NIS from 2016 through 2020 were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was surgery on post-admission day 3 or greater (delayed surgery), compared across patient groups stratified by risk for surgical delay using an established model incorporating Elixhauser Comorbidity score, age, gender, and race. Factors associated with hospital-level surgical delay were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>1,142,625 patients met the eligibility criteria. Most patients were female (70%) and Medicare beneficiaries (91%). The median patient age was 83 (IQR 76 to 89). The proportion of patients categorized as high-, moderate-, and low-risk for surgical delay were 7%, 81%, and 12%, respectively. Three percent of low-risk patients received surgery on post-admission day 3 or later compared to 7% and 12% of patients in the moderate- and high-risk groups respectively (P<0.01). At 2176 hospitals (62%), all high-risk patients were reported to have their surgery performed within 2 days. At 620 hospitals (18%), 27% of high-risk patients experienced delays of 3 days or more. Compared to hospitals with no surgical delays in their high-risk patients, the highest twentieth percentile of hospitals with surgical delay in high-risk patients were more likely to be teaching hospitals (OR, 1.4; 95% CI, 1.1 to 1.8; P=0.02), located in the Northeast (OR, 1.8; 95% CI, 1.3 to 2.4; P<0.01) or South (OR, 1.6; 95% CI, 1.3 to 2.1; P<0.01), and have a higher proportion of high-risk patients (OR, 3.4; 95% CI, 1.4 to 5.9; P=0.01).</p><p><strong>Conclusions: </strong>While the majority of patients with a hip fracture in the United States received timely surgery within 2 days, a substantial proportion of high-risk hip fracture patients experienced surgical delays. The causes of these surgical delays remain unclear, whether from resource limitations, time for medical optimization, competing surgical priorities, or systemic factors driving regional variations in care delivery.</p><p><strong>Level of evidence: </strong>Prognostic, Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Treatment of Periprosthetic Distal Femur Fractures Result in Iatrogenic Flexion Instability in Previously Stable Total Knee Arthroplasty? A Single-Center Retrospective Review of 73 patients.","authors":"Neal Krentz, Kallie J Chen, Mark Kodsy, Akash Raju, John K Sontich","doi":"10.1097/BOT.0000000000003000","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003000","url":null,"abstract":"<p><strong>Objectives: </strong>To describe outcomes in patients with periprosthetic distal femur fractures (PPDFF) who underwent retrograde intramedullary nailing (rIMN), including subsequent revision total knee arthroplasty (TKA) and subjective and/or objective evidence of flexion instability (FI). The hypothesis of this study is flexion instability can occur following rIMN in cruciate-retaining total knee arthroplasty (CR-TKA), possibly due to iatrogenic PCL damage.</p><p><strong>Methods: </strong>Design: Retrospective review.</p><p><strong>Setting: </strong>Single academic Level-I trauma center.</p><p><strong>Patient selection criteria: </strong>All patients who sustained a PPDFF, OTA/AO 33A, between 2008-2022 who were treated with a rIMN by a trauma fellowship trained orthopedic surgeon with >3 months follow-up were included. Patients with < 3 months follow-up, treated with locked plating, nail-plate combinations or whose surgery was not performed by a trauma fellowship trained orthopedic surgeon were excluded.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was rate of revision TKA for instability. Secondary outcomes included radiographic measurements (posterior tibial translation, femoral component ratio, and final coronal and sagittal alignment) and complications.</p><p><strong>Results: </strong>73 patients (61, 83.6% female) were included. Average age was 73.8 ± 12.3 years and median length of follow-up was 294 days (IQR: 156, 411 days). There were 4 (6.2%) revision TKA, performed; 3 CR-TKAs and 1 PS-TKA. All three CR-TKA knees revised were for instability. There were 16 (20.5%) complications requiring return to the OR. Median time to return to OR was 204.5 days (IQR of 135-390.25 days). The most common indication was irritable hardware (n=4, 5.5%) and nonunion (n=4, 5.5%) followed by primary instability (n=3, 4.1%). All 3 nonunions underwent revision ORIF. Five (6.8%) patients reported symptoms and 7 (9.6%) had positive physical exam findings suggestive of FI. There were 22 (30.1%) patients with radiographic posterior tibial translation.</p><p><strong>Conclusions: </strong>This retrospective review suggests that flexion instability secondary to damage of the posterior cruciate ligament is a potential complication following retrograde intramedullary of periprosthetic distal femur fractures.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031272","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":"Dual Implants for Geriatric Distal Femur Fractures Results in Greater Healthy Days at Home.","authors":"Makoa Mau, Tyler Thorne, Cole Payne, Kaleb Roach, Reese Svetgoff, Patrick J Kellam, Graham J DeKeyser, Stephen J Warner, Lucas S Marchand, Justin Haller","doi":"10.1097/BOT.0000000000002999","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002999","url":null,"abstract":"<p><strong>Objectives: </strong>To compare Healthy Days At Home (HDAH90) within 90 days of hospital discharge after single implant (SI) or dual implant (DI) fixation in geriatric distal femur fractures.</p><p><strong>Methods: </strong>Design: Retrospective Review.</p><p><strong>Setting: </strong>Three Level I Trauma Centers.</p><p><strong>Patient selection criteria: </strong>Geriatric (age ≥ 60 years) distal femur fracture patients (OTA/AO 33 A, C) operatively treated with SI (lateral plate or retrograde intramedullary nail (IMN)) or DI (two plates or plate and IMN) between January 2018-January 2024 were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was HDAH90, which was calculated from date of surgery to 90 days follow-up and accounted for days after mortality, skilled nursing facilities (SNF), readmissions, and secondary surgeries. HDAH90, days at SNF, 90-day readmission, 90-day mortality, return to baseline ambulatory status at 180-days, and length of hospitalization were compared between patients with SI or DI. A binary logistic multivariate regression was used to compare outcomes while controlling for age, gender, dependence on assistive device, periprosthetic fracture, and post-operative weight bearing status.</p><p><strong>Results: </strong>The 229 SI patients were 2 years younger than the 70 DI patients (73 vs. 75 years, p=0.03). The DI cohort had more female patients (82.9% vs 70.7%, p=0.044), and more periprosthetic fractures (55.7% vs. 35.4%, p=0.002). There was no other demographic, fracture characteristic, or preoperative ambulatory differences between groups (p>0.05). Following regression analysis, DI patients had greater HDAH90 (55 vs 45, p=0.024) and fewer days at SNF (22 vs 32, p=0.026) than SI patients. There were no differences in 90-day readmission (DI odds 1.36, p=0.353), 90-day mortality (DI odds 0.94 p=0.935), return to baseline ambulatory status at 180 days (DI 1.64, p=0.433), and length of hospitalization (DI 10 days vs SI 9 days, p=0.579).</p><p><strong>Conclusions: </strong>Geriatric patients treated with dual implants for distal femur fractures experienced an additional 10 Healthy Days at Home90 as compared to those treated with single implants. Given that a 10-day difference is clinically significant in geriatric fractures for Healthy Days at Home90, using dual implant constructs may represent an improvement in care for distal femur patients.</p><p><strong>Level of evidence: </strong>III, prognostic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970325","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":"The Impact of Time to Surgical Debridement on Infection Rates in Open Tibial Shaft Fractures Treated with Immediate Medullary Nailing.","authors":"Mohamed Kareem Shaath, Rogerio Ferreira, Brendan Page, Griffin Rechter, Bader A Nasir, George J Haidukewych","doi":"10.1097/BOT.0000000000002997","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002997","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate whether time to surgical debridement and medullary nailing of open tibial shaft fractures was predictive of infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective chart review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single, academic, level-1 trauma center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;All skeletally mature patients with open tibial shaft fractures (AO/OTA type 42) who presented to a level-1 trauma center between 2012 and 2024 with a minimum follow-up of 3-months were included. All patients underwent definitive treatment consisting of irrigation and debridement, followed by immediate intramedullary nailing during the same anesthetic. Patients with type IIIB fractures who did not receive soft tissue coverage within 7 days of presentation, as well as those with type IIIC fractures were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The primary outcome measure was the incidence of deep infection necessitating a return to the operating room. Time to surgery was evaluated as a secondary outcome. Time intervals to surgical debridement were categorized as follows: less than 6 hours, 6 to 12 hours, 12 to 18 hours, 18 to 24 hours, and greater than 24 hours. Multivariate binary logistic regression analyses were performed to determine whether key factors, including age, diabetes, fracture type, smoking, ASA classification, and time to debridement at the previously categorized time points were predictive of infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 393 patients (306 males) with a mean age of 38 years (range 15-87 years) were included. Of these, 24 patients (6%) had diabetes and 126 patients (32%) were smokers. There were 78 (20%) type I fractures, 170 (43%) type II fractures, and 144 (37%) type III fractures. Of the type III fractures, 99 (68%) were type IIIA while 45 (32%) were type IIIB. A total of 32 patients (8%) were treated within 6 hours, 111 patients (28%) between 6 and 12 hours, 131 patients (33%) between 12 and 18 hours, 69 patients (18%) between 18 and 24 hours, and 50 patients (13%) after 24 hours. A total of 46 infections (12.5%) were observed: 6 infections (13%) in type I fractures, 14 infections (20%) in type II fractures, 10 infections (22%) in type IIIA fractures, and 16 infections (35%) in type IIIB fractures. Time to surgery was not predictive of infection (p=0.31). Logistic regression analysis showed that patients with a type IIIB fracture were 6.1 times more likely to develop an infection compared to other fracture types (OR = 6.147, 95% CI: 1.975- 19.129, p = 0.002). Smokers were 2.8 times more likely to develop an infection (OR = 2.779, 95% CI: 1.357-5.691, P = 0.005). Age, time to debridement at the specified time points, diabetes, and ASA classification did not significantly predict infection (p = 0.32, 0.31, 0.27, and 0.50, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Smoking and type IIIB fractures were identified as significan","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014884","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":"Association Between Timing of Antibiotics and Deep Surgical Site Infection in Gustilo-Anderson Type III Open Tibia Fractures.","authors":"David Okhuereigbe, Michael Raffetto, Vivian Li, Alice Bell, Joshua E Lawrence, Joanna Kim, Christina A Stennett, Gerard P Slobogean, Nathan N O'Hara, Robert V O'Toole","doi":"10.1097/BOT.0000000000002996","DOIUrl":"10.1097/BOT.0000000000002996","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the association between the timing of antibiotic delivery in the emergency department (ED) and deep surgical site infection in Gustilo-Anderson (GA) type III open tibia fractures.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Single Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients aged ≥18 years with a Gustilo-Anderson (GA) type III open tibia fracture (OTA/AO 41, 42, or 43) from 2016 to 2021 were included.</p><p><strong>Outcome measures and comparisons: </strong>The outcome was deep surgical site infection requiring irrigation and debridement. The effect of time of delivery of antibiotics was compared in 3 analyses: as a continuous variable, before vs after 60 minutes, and before vs after 180 minutes. The study analysis accounted for known confounders for infection, including Injury Severity Score (ISS), GA classification, and wound contamination.</p><p><strong>Results: </strong>The study population included 191 patients with a mean age of 44 years (SD: 17) and 153 males. The median time from arrival to the first antibiotic was 44 minutes (IQR: 21-147). The majority of patients (99.0%) received cephazolin as their initial antibiotic. The overall 90-day risk of deep surgical site infection requiring irrigation and debridement was 10.5%. The timing of antibiotic administration as a continuous variable was not associated with infection (aOR: 1.00, 95% CI: 0.99-1.00, P = 0.39). Similarly, time to antibiotic administration was not associated with infection at thresholds of 1 hour (aOR: 1.02, 95% CI: 0.39-2.68, P = 0.96) or 3 hours (aOR: 1.08, 95% CI: 0.35-3.37, P = 0.89) in separate models.</p><p><strong>Conclusions: </strong>Early antibiotic administration was not associated with a reduced risk of deep surgical site infection in GA type III tibia fractures. These results suggest that the acute timing of antibiotics may not be as impactful to patients' risk of infection as once considered.</p><p><strong>Level of evidence: </strong>Therapeutic, Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of illegal drug use on fracture healing in rats.","authors":"Evren Ozseker, Pınar Efeoglu Ozseker, Tumay Ozgur, Aydıner Kalaci","doi":"10.1097/BOT.0000000000002992","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002992","url":null,"abstract":"<p><strong>Objective: </strong>To investigate how substance use impacts fracture healing.</p><p><strong>Methods: </strong>Male Wistar Albino rats (n=64) weighing 250-300 g were used in this experimental study. Four groups (one control and three experimental) consisted of 16 rats each. No substance was administered to the control group, while morphine (0.3 mg/kg), cannabis (1 mg/kg), and cocaine (2 mg/kg) were intraperitoneally administered to each experimental group, rerspectively, daily to induce addiction over two weeks, and this was continued for six weeks following the experimentally induced fracture.Fractures were induced in the mid-diaphyseal region of the right femur using bone shears through osteotomy after sedoanalgesia, including a control group at the end of the second week. The impact of substance abuse on fracture union was evaluated in terms of biomechanics, histopathology, and radiology.</p><p><strong>Results: </strong>The mean radiological score was 2.3±0.4 in the control group, 2.6±0.6 in the morphine group, 1.7±0.5 in the cocaine group, and 1.9±0.4 in the cannabis group (p=0.024). The mean histopathological scores in the cocaine and cannabis groups (4.0±1.6 and 4.0±2.0, respectively) were higher than those in the control and morphine groups (7.8±0.7 and 7.0±1.1, respectively) (p<0.001). While the mean biomechanical score of the control and cannabis groups was similar (74.0±6.2 and 66.2±3.7), it was lower than that of the morphine and cocaine groups (50.1±9.8 and 55.8±11.9, respectively) (p=0.001).</p><p><strong>Conclusion: </strong>This study specifically demonstrated that the use of cocaine and cannabis delayed fracture union. Therefore, substance use must be considered in cases of delayed fracture healing.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968319","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":"Midfoot Arthrodesis after Failed Lisfranc Open Reduction and Internal Fixation.","authors":"Megan L Campbell, Oliver C Sroka, Tyler Thorne, Anne Hakim, Matthew J Siebert, Justin M Haller, Lucas S Marchand","doi":"10.1097/BOT.0000000000002994","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002994","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the incidence and risk factors for secondary arthrodesis (SA) and compare patients who underwent primary arthrodesis (PA) versus SA following ORIF for Lisfranc injuries.</p><p><strong>Methods: </strong>Design : Retrospective cohort.</p><p><strong>Setting: </strong>Single tertiary level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Adult patients treated surgically for Lisfranc injuries AO/OTA 85.1A-C +/- 85.2.A-C, 85.3A-C; 87.1.1A-C-87.5.1A-C; 89B) between 2003-2023 were included.</p><p><strong>Outcome measures and comparisons: </strong>Patients who underwent index PA were compared to those who underwent index ORIF and subsequent SA. A composite primary outcome was used for comparison which included the development of adjacent midfoot arthrosis, midfoot collapse, or mal/nonunion rated satisfactory, suboptimal, poor, or severe; secondary outcomes were PROMIS measures of physical function (PF) and pain interference (PI). Descriptive and comparative statistics, multivariable analysis, and logistic regression were utilized to compare groups.</p><p><strong>Results: </strong>Of 489 Lisfranc injuries (482 patients), index treatment for 98 (20%) was PA. Average age was 37.7y (SD 15.6); mean follow up was 2.3y (SD 8.8). Fifty six percent of patients were men. There were thirty-four SAs (8.7% of index ORIF group). Patients who underwent SA were more likely to develop a poor (21.9% vs. 6.5% p=0.021) or severe outcome (12.5% vs. 1.1%, p=0.015) compared to those who underwent PA (OR 5.1, CI 1.4-18.5; OR 12.7, CI 1.1-12.8). Patients requiring SA also had significantly higher PI and significantly lower PF at final follow-up (p=0.018, p<0.001). Divergent injuries had higher odds of needing a SA compared to homolateral injuries (OR 6.9, p=0.006), as did index treatment with a tightrope (OR 4.6, p=0.003).</p><p><strong>Conclusions: </strong>Nine percent of patients underwent SA after index ORIF of their Lisfranc injury, and outcomes fared substantially worse than those treated with PA. This emphasizes the importance of identifying risk factors for patients that may fail ORIF. Further work is needed to clearly delineate which patients may best be served with PA.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029875","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":"Elevated Risk of Infection and Reoperation in Low-Energy Gunshot Tibial Fractures: A Comparative Analysis.","authors":"Divya Jeyasingh, David Campbell, Christopher Wedwick, Niloofar Dehghan","doi":"10.1097/BOT.0000000000002995","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002995","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the deep infection and reoperation rates associated with low-energy gunshot wound (LE-GSW) tibial shaft fractures and compare outcomes to fractures caused by blunt-force mechanisms and to analyze the microbial profile of infections in these cases.</p><p><strong>Methods: </strong>Design : Retrospective cohort study.</p><p><strong>Setting: </strong>Three Level 1 trauma centers in a large urban health system from 2014 to 2024.</p><p><strong>Patient selection criteria: </strong>Included were patients aged 16-65 years with tibial shaft fractures (OTA/AO 41A2-3, 42A-C, and 43A) treated with intramedullary nails (IMN) following LE-GSW or blunt-force mechanisms. Exclusions were pre-existing infections, high-velocity gunshot wounds, less than 6 weeks of follow-up, or delayed presentation (greater than 24 hours).</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes included deep infection and unplanned reoperations. Patients were categorized into closed fractures, LE-GSWs, Type I/II, and Type III open fractures. Data between these categories were compared using chi-square, Fisher's exact, and ANOVA with multivariable logistic regression.</p><p><strong>Results: </strong>Included were 195 patients (mean age 37.6 years, range 17-65; M:F ratio 136:59). Fractures were closed (n=68), Type I/II (n=55), Type III (n=37), and LE-GSWs (n=35). LE-GSWs had significantly higher deep infection (34.3%) and reoperation rates (57.1%) compared to closed fractures (1.5% and 13.2%, respectively, p<0.001). Type III infection rates were 16.2%. Multivariable analysis confirmed LE-GSWs as a significant risk factor for both infection (OR 4.26, p=0.003) and reoperations (OR 3.51, p=0.002). Infections in LE-GSW fractures were predominantly polymicrobial and Gram-positive.</p><p><strong>Conclusions: </strong>LE-GSW tibial fractures were associated with high rates of deep infection and reoperation with infection rates comparable to those of Type III open fractures. Treatment options such as broader prophylaxis or local antibiotic treatments should be considered in their initial management.</p><p><strong>Level of evidence: </strong>Level III - Retrospective Cohort Study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022417","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":"Humeral Intramedullary Nailing Utilizing the Minimally Invasive Rotator-Interval Technique (MIR-IT) Improves Shoulder PROMs.","authors":"Lazaro Mesa, Christian M Schmidt, Reed Andrews, Mitchel John, Khaled Abdelghany, Maykel Dolorit, Mir Ibrahim Sajid, David Watson, Hassan R Mir","doi":"10.1097/BOT.0000000000002993","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002993","url":null,"abstract":"<p><strong>Objectives: </strong>To assess whether patients treated with a Minimally Invasive Rotator-Interval Technique (MIR-IT) versus the traditional technique of splitting the rotator cuff (RTCS) for intramedullary nailing of humeral shaft fractures resulted in comparable post-operative clinical and patient-reported outcomes (PROM).</p><p><strong>Methods: </strong>Design: Retrospective Cohort Study.</p><p><strong>Setting: </strong>Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients >18yo with humeral shaft fractures (AO/OTA 12A-C) treated with IMN between 2015 and 2022.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was differences in PROMs (ASES, Quick DASH, and Oxford Shoulder Score) between the MIR-IT and RTCS techniques. Secondary outcome measures included differences in rates of nonunion, superficial and deep surgical infections, wound dehiscence and iatrogenic nerve palsy between the two techniques.</p><p><strong>Results: </strong>Seventy-one patients underwent humeral IMN (MIR-IT - 39; RTCS - 32). Fifty-five patients (MIR-IT- 30; RTCS-25) had radiographic and clinical follow up to union. Mean follow up was 7.5 months (range: 3.1-16.8 months). Patients did not vary significantly with regards to age (MIR-IT: 54.4 ± 22.4; RTCS: 55.1 ± 18.5 years, p=0.896), and gender (Males- MIR-IT: 46.7%, RTCS: 44%, p=0.843). There were no significant differences in nonunion (7.4% vs 4.0% p=1.0), superficial infection (3.6% vs 4% p=1.0) or iatrogenic nerve palsy (3.6% vs 4.0% p=1.0) between the MIR-IT and RTCS groups. There were no deep infections or wound dehiscences in either group. Forty-two patients had PROMs (MIR-IT -21; RTCS -21). Average time to PROMs collection was 35.7 months (MIR-IT: 34.2 months, RTCS: 37.1 months, p=0.682). There were significantly better ASES scores (82.7 vs 71.6 p=.015), Quick DASH scores (9.7 vs 21.0 p=.011) and Oxford Shoulder Scores (39.3 vs 33.9 p=.042) amongst patients treated with the MIR-IT.</p><p><strong>Conclusions: </strong>Humeral IMN utilizing the MIR-IT resulted in better shoulder PROMs compared to the RTCS technique, with similarly low surgical complication rates.</p><p><strong>Level of evidence: </strong>Therapeutic Level II.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014802","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":"Clinical trial of a new continuous compartment pressure monitoring to aid in the diagnosis of Acute Compartment Syndrome.","authors":"Mohammed Ali Balhareth, Kate Vaile, Prism Schneider, Allan Liew, Jeremy Hall, Pierre Guy, Abdel-Rahman Lawendy, Job Doornberg, Ruurd Jaarsma, Ross Leighton","doi":"10.1097/BOT.0000000000002980","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002980","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate a new compartment pressure monitor reporting continuous pressures and its contribution to Acute Compartment Syndrome (ACS) diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Multicenter, non-randomized, prospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Six Level-I Trauma Centers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Enrolled were patients with acute long bone fractures (OTA 11-13, 2R, 2U, 31-33, and 41-43) where the Micro Electric Mechanical Sensor (MEMS) device was inserted either pre- or post-operatively into the compartment most likely to develop ACS, as deemed by the surgeon. Intracompartmental pressures (ICP) were continuously measured for up to 18 hours (as indicated by the FDA and Health Canada); clinical signs were simultaneously assessed for canonical compartment syndrome signs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The primary measurement outcomes were ease of use, accuracy, and safety of the device across all participating sites. Ease of use was assessed through surveys completed by surgeons, which evaluated their confidence in the device's functionality and usability. Accuracy was determined by analyzing patient outcomes, using surgical findings and clinical resolution as the gold standards, to assess whether the device's results corresponded to true positive and true negative cases of compartment syndrome. Feasibility was defined as the device's ability to integrate into the clinical workflow, operate reliably under typical conditions, and provide actionable data for ACS diagnosis. The secondary outcomes included continuous intracompartmental pressure (ICP) measurements and their diagnostic value. Sensitivity and specificity were evaluated by comparing continuous ICP data with clinical assessments based on the \"6 P's\" (pain, pallor, paresthesia, pulselessness, poikilothermia, and paralysis) to determine their combined utility in diagnosing ACS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 100 patients, 68 males and 32 females with an average age of 42 years old (17-80 years old), were enrolled. All of the patients had suffered a fracture, 25 proximal tibias (OTA/AO-41), 40 midshaft tibias (OTA/AO42), 13 distal tibias (OTA/AO43), 11 forearms (OTA/AO 2R.2U), 6 femurs (OTA/AO31-33), 5 humerus (OTA/AO 11-13). Eighty-nine patients received the MEMS device post-operatively and 11 patients pre-operatively. 93% of participating surgeons reported confidence in the device's function and ease of use. Pressures were measured on average for 16h36 (3h-18h). No complications were reported. Post-operative ICPs (25.4 mmHg) were higher (p =0.0462) on average than pre-operative ICPs (18.9 mmHg). Patients that did not develop Compartment Syndrome had their post-operative pressures trend down after 4 hours (23.8mmHg). Sensitivity and specificity analyses of ICP alone, delta P alone, pressure trends alone, or a combination of the three metrics were conducted using patient outcomes","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803205","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}