Journal of Orthopaedic Trauma最新文献

{"title":"Diagnostic Value of the Neutrophil-Lymphocyte Ratio in Fracture-Related Infections: A Retrospective Analysis.","authors":"Hans Lapica, Akshay Daji, Josué G Layuno-Matos, Paul E Gerges, Devin John, Miguel A Cartagena-Reyes, Scott M Sandilands","doi":"10.1097/BOT.0000000000003082","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003082","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether the previously established neutrophil-to-lymphocyte ratio (NLR) threshold of 2.45 accurately diagnoses fracture-related infection (FRI).</p><p><strong>Methods: </strong>Design: Retrospective diagnostic study.</p><p><strong>Setting: </strong>Single Level I trauma center.</p><p><strong>Patient selection criteria: </strong>Included were consecutive adults (≥18 y) who underwent deep-tissue or bone biopsy for suspected FRI between January 1, 2018, and December 31, 2024; excluded were patients with immunosuppressive and oncological disorders or missing laboratory data.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcome was diagnostic accuracy of NLR-reported as sensitivity, specificity, and area under the receiver-operating-characteristic (ROC) curve-for fracture-related-infection. Neutrophil-lymphocyte-ratios of patients with confirmed fracture-related-infection confirmed via bone or deep tissue biopsy were compared with those of patient's with negative (aseptic) biopsies. Per AO/ASIF consensus criteria, biopsy results were considered positive for infection if: (1) phenotypically indistinguishable pathogens were identified by culture from at least two separate deep tissue/implant specimens, or (2) the presence of microorganisms in deep tissue specimens confirmed by histopathological examination.</p><p><strong>Results: </strong>Forty biopsies from 29 patients met inclusion criteria. Of the 40 biopsies, 27 were septic and 13 aseptic. The septic cohort had a mean age of 44 years with a range of 18-64 and consisted of 20 males and 2 females. The aseptic cohort had a mean age of 49 with a range of 27-70 and consisted of 6 males and 1 female. Using the pre-specified NLR threshold of 2.45, sensitivity and specificity for diagnosing fracture-related infection were 92.6% (95% CI 75.7-99.1) and 92.3% (95% CI 64.0-99.8), respectively. Exploratory Receiver operating characteristic analysis suggested an optimal NLR cut-off point of 2.52 for detecting FRI, with an area-under-the-curve of 0.89 (95 % CI 0.74-1.00). Median NLR was significantly higher in septic biopsies, 4.79 (IQR 3.95-8.54), than in aseptic biopsies, 1.78 (IQR 1.50-2.15) (p = 0.003). An NLR > 2.45 occurred in 92.6 % of septic versus 7.7 % of aseptic biopsies (p < 0.001; OR 150, 95 % CI 12.4-1822.3).</p><p><strong>Conclusions: </strong>An NLR threshold of 2.45 provided high sensitivity and specificity for detecting fracture-related infection. These findings support its potential utility as a non-invasive screening tool to detect fracture-related infections.</p><p><strong>Level of evidence: </strong>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":"145086462","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":"Impact of Time to Re-vascularization on Patients with Avascular Lower Extremity Open Fractures.","authors":"Umar Khan, Colin Harrington, Kristin Turner, Joshua Lawrence, Gerard P Slobogean, Robert V O'Toole, Nathan N O'Hara, Rishi Kundi, Mark J Gage","doi":"10.1097/BOT.0000000000003078","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003078","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the impact of time to revascularization on nonunion, deep surgical site infection (SSI), and amputation in Gustilo-Anderson (GA) Type 3C open lower extremity fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective cohort 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;Patients aged 18-79 years with GA type 3C open lower extremity fractures and documented avascularity at presentation, treated at a level-1 trauma center between 2016 and 2022 with either immediate amputation or revascularization (direct primary repair, graft reconstruction, or temporizing shunt) and osseous fixation were included. Exclusion criteria were initial admission to another facility, death prior to initial surgery, and unavailable injury time (based on 911 call time in EMS reports).Outcome Measures and Comparisons: The primary outcome was amputation. The secondary outcome was limb salvage with complication, defined as nonunion or deep surgical site infection (SSI). The primary exposure was time from injury to restoration of distal arterial flow. For patients with temporary shunts, this was used as the time to restoration of flow. Multinomial logistic regression was used to evaluate associations between revascularization times and outcomes, adjusting for American Society of Anesthesiologists (ASA) score, sex, and smoking status. Mean times to revascularization were compared among outcome groups (delayed amputation, limb salvage without complication, and limb salvage with complication).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-five patients (46 limbs) were included: 10 (21.7%) underwent limb salvage without complication (median age 25 years, 100% male), 9 (19.6%) underwent limb salvage with complication (median age 36 years, 89% male), 12 (26.1%) underwent delayed amputation (median age 52 years, 67% male), and 15 (32.6%) underwent acute amputation without revascularization (median age 49 years, 60% male), most commonly due to irreparable popliteal or trifurcation-level vascular injuries with severe soft tissue loss. Of the 31 revascularized limbs, 12 (39%) required delayed amputation a mean 18 days post-injury. Nineteen limbs (19/46, 41%) were ultimately salvaged; nine (47% of salvaged; 20% overall) developed nonunion or deep SSI (limb salvage with complication). Mean time to revascularization was 277 minutes for limb salvage without complication, 430 minutes for delayed amputation (mean difference 153 minutes; 95% CI, 48 - 259, p&lt;0.01) and 390 minutes for limb salvage with complication (mean difference 113 minutes; 95% CI, 15 - 211, p=0.03). Each additional hour of ischemia increased the odds of delayed amputation by 3.4-fold (95% CI, 1.1-10.6; p=0.04). When time to revascularization exceeded 6 hours, the probability of limb salvage without complication decreased to 12% (95% CI, 0-25%). ASA classification, DM, HTN, depression/anxiety, smoking","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":"145086435","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":"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":"Structures at risk with intrapelvic guide wire migration during cephalomedullary fixation of hip fractures: CT based analysis.","authors":"Arman Vahabi, Yusuf Kerem Limon, Çağatay Öncel, Mehmet Kemal Gürsoy, Kemal Aktuğlu","doi":"10.1097/BOT.0000000000003080","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003080","url":null,"abstract":"<p><strong>Objectives: </strong>To identify which intrapelvic structures may be injured in cases of intrapelvic migration of the guide wire used for head screw/blade placement during cephalomedullary nail fixation.</p><p><strong>Methods: </strong>Design: Retrospective review.</p><p><strong>Setting: </strong>Single academic, level 1 orthopaedic trauma subspeciality unit in university hospital.</p><p><strong>Patient selection criteria: </strong>Patients with contrast-enhanced computed tomography treated with cephalomedullary nail fixation for AO/OTA type 31A1,31A2,31A3 fractures from December 2022 to July 2024.Outcome Measures and Comparisons: The primary outcome measure of this study was the quantification of pelvic structures that are at risk of iatrogenic injury related to mispositioned/over advanced guide wire. Six simulation scenarios were created with variations applied in the sagittal axis: neutral anteversion, 7.5° anteversion, and 7.5° retroversion. Each three scenario applied for penetration depths of 2 cm and 5 cm. Additionally, the safe distance was recorded. All simulations and measurements were analyzed both pooled and comparatively based on sex and laterality.</p><p><strong>Results: </strong>88 patients were included in the analysis, 47 (53.4%) were female and 41 (46.6%) were male. The median age was 77.5 years (IQR 65-85). In 48 (54.5%) patients, measurements were performed on the right hip. In neutral version trajectory, penetration of 2 cm resulted in contact with anatomical structures in 78% of cases, increasing to 98% at 5cm. With anteversion, the rates were 90% at 2 cm and 98% at 5 cm. With retroversion, the corresponding rates were 55% and 93%, respectively. The most frequently affected structures at 2 cm were the external iliac artery (EIA) and vein (EIV), whereas at 5 cm, the small intestine and colon were most involved structures in addition to EIA and EIV. Other at-risk structures included the uterus, bladder, internal iliac artery, and internal iliac vein at both penetration depths and uterine venous plexus at 5cm penetration. Notably, injury to external iliac vessels was significantly more common in males under the neutral sagittal projection(63% vs 34% at 2 cm and 63% vs 36% at 5 cm) (p < 0.05 for both depths). Safe distances were significantly greater in males across all simulations(12.6 cm vs 11.4 cm in neutral version, 12.4cm vs 11.0 cm in anteversion, 12.2 cm vs 10.9 cm in retroversion) (p < 0.05 for all).</p><p><strong>Conclusion: </strong>Intrapelvic mispositioning of the guide wire used for head screw/blade placement during cephalomedullary nail fixation posed a substantial risk of iatrogenic injury to intrapelvic structures and this risk increased further with deeper penetration. However, the clinical implications of such injuries remain unclear.</p><p><strong>Level of evidence: </strong>Diagnostic Level IV.</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":"145092047","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":"Monitored Anesthesia Care-Soft Tissue Infiltration with Local Anesthesia (MAC-STILA) Decreases Incidence of Short-Term Postoperative Altered Mental Status in Hip Fracture Patients.","authors":"Nina D Fisher, Matthew T Kingery, Lauren Merrell, Manasa L Kadiyala, Lisa Reider, Abhishek Ganta, Kenneth A Egol, Sanjit R Konda","doi":"10.1097/BOT.0000000000003074","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003074","url":null,"abstract":"<p><strong>Objective: </strong>To determine if the occurrence of short-term post-operative altered mental status (AMS) was lower in geriatric patients undergoing operative repair of hip fractures with Monitored Anesthesia Care and Soft-Tissue Infiltration with Local Anesthesia (MAC-STILA) when compared with general anesthesia (GA).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Two U.S. hospitals within a single academic medical center.</p><p><strong>Patient selection criteria: </strong>Geriatric patients with hip fractures (AO/OTA 31A and 31B) undergoing operative repair were identified. Propensity matching was performed in a 1:2 ratio to minimize selection bias (age, sex, BMI, ASA class, fracture pattern, fixation construct, pre-injury ambulatory status, and assistive device use).</p><p><strong>Outcome measures: </strong>Patients who underwent surgical fixation with MAC-STILA were compared with GA. Primary outcome was post-operative AMS, defined as missing ≥1 items on the alert and oriented assessment (person, place, and time) at any point from post-operative days 0-3.</p><p><strong>Results: </strong>After matching, 228 patients (76 MAC-STILA: 152 GA) were included in the analysis. The average age of patients in both groups was 83 years. In the MAC-STILA group, 62% were female and 33% had baseline dementia while in the GA group 66% were female and 29% had baseline dementia. Treating patients with MAC-STILA was associated with 72% lower odds of having AMS compared with GA, controlling for baseline comorbidity and dementia (OR: 0.28. 95% CI: 0.09-0.075, p=0.016). Among patients with baseline dementia, the rate of AMS was lower in patients treated with MAC-STILA compared with GA (64.0% vs 95.3%, p = 0.001).</p><p><strong>Conclusion: </strong>Monitored Anesthesia Care and Soft-Tissue Infiltration with Local Anesthesia (MAC-STILA) was associated with lower odds of short-term postoperative altered mental status (AMS) compared to general anesthesia (GA) in hip fracture patients undergoing operative repair. Given the high rate of post-operative AMS and complications associated with geriatric hip fracture patient, MAC-STILA should be considered for use in patients with increased risk of post-operative AMS, particularly in the setting of preoperative dementia.</p><p><strong>Level of evidence: </strong>Therapeutic III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064925","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":"Nail Alone Results in Similar Clinical Outcomes with Less Perioperative Morbidity Compared to Nail Plate Combination In Treatment of Native Distal Femur Fractures.","authors":"Maria Kammire, Aseel Dib, Madeline Rieker, Ryan Serbin, Charles Arendale, Ziqing Yu, Rachel B Seymour, Suman Medda","doi":"10.1097/BOT.0000000000003064","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003064","url":null,"abstract":"<p><strong>Objectives: </strong>To compare outcomes and complications of retrograde intramedullary nailing (rIMN), plating, and combined rIMN+plate constructs for native distal femur fractures.</p><p><strong>Methods design: </strong>Retrospective review of operative distal femur fractures, 2018-2022.</p><p><strong>Setting: </strong>Urban level one trauma center.</p><p><strong>Patient selection criteria: </strong>Included were patients >18 years-old with AO/OTA 33A or 33C distal femur fractures and >=6 months follow-up.</p><p><strong>Outcome measures and comparisons: </strong>Demographics, fracture type, operative time, estimated blood loss (EBL), changes in radiographic alignment, union rates (mRUST ≥10), re-operations, complications, and return to weightbearing. were collected and compared between the three fixation constructs.</p><p><strong>Results: </strong>137 patients were included (71 rIMN, 27 plate, 39 rIMN+plate). Median age was older for rIMN+plate compared to rIMN (61 vs 54 years, P =0.015) and similar between rIMN+plate and plate groups (61 years for both, P = 0.68) . There were no other differences in demographics among groups (P>0.05). The rIMN+plate group had longer operative time (256 min) and higher EBL (250cc) compared to rIMN alone (150 min, P = 0.0006 and 200cc, P = 0.023) and similar operative time and EBL compared to plate alone (168 min, P = 0.071 and 250cc, P = 0.73) There were no differences in final coronal or sagittal alignment (P=0.78, P=0.87 respectively) or reoperation rates (P=0.74) among groups. The rIMN+plate group showed a higher rate of radiographic union (66.7%) compared to the rIMN (42.3%) and plate (44.4%) groups (P=0.042) . When controlling for patient age, time to weight bearing was similar among the groups (P =0.79).</p><p><strong>Conclusions: </strong>While the rIMN+plate combination led to higher rates of union, it did not decrease time to weightbearing or re-operation rates compared to rIMN alone, and was associated with longer operative time and greater blood loss.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992792","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 W-plate: a novel technique for fixation of unstable pelvic ring injuries.","authors":"Cyril Mauffrey, Guillaume David, Abramo Fratus, Brandi Krieg, Keenan Onodera, Nicholas J Tucker","doi":"10.1097/BOT.0000000000003063","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003063","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957883","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}