Journal of Orthopaedic Trauma最新文献

{"title":"Methodological Concern Regarding the Multivariable Analysis of Rare Implant Breakage Events.","authors":"Yanhui Yang, Jinlin Liu","doi":"10.1097/BOT.0000000000003222","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003222","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839269","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":"Evaluation of an AI-Driven Risk Stratification System for Clinical Deterioration in Geriatric Hip Fracture Patients.","authors":"Christopher Q Lin, Max Ruiz, Maddison McLellan, Michael J Gardner","doi":"10.1097/BOT.0000000000003212","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003212","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether an artificial-intelligence-driven Clinical Deterioration Index (CDI) could identify geriatric hip-fracture patients at risk of early postoperative complications and to establish an orthopaedic-specific cutoff that identified patients at risk of deterioration.</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 ≥ 65 years who underwent fixation of OTA/AO 31-A/B/C hip fractures between June 2022 and December 2023 were included using ICD-10 codes S72.0-, S72.1-, and S72.2-. Exclusion criteria were pathologic fracture, revision surgery, or absence of 30-day follow-up. The CDI uses 31 clinical measures to generate a score from 0-100 reflecting risk of rapid deterioration. Patients were separated into two groups based on peak CDI in the immediate 48-hour postoperative period: CDI ≥ 65 and CDI < 65. This cutoff of 65 was established by prior institutional validation.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes were in-hospital complications (cognitive changes, cardiac complications, DVT/PE, etc.). Secondary outcomes included length of stay, ambulation distance, and 1-year mortality. Outcomes were compared between CDI groups.</p><p><strong>Results: </strong>Of 197 patients (age range 65-98, 66% female), 15 (7.6%) exceeded the baseline CDI threshold of 65. This group had higher complication rates (93.3% vs 26.4%, P < 0.001), prolonged hospital stays (10.1 vs 5.2 days, P = 0.047), reduced ambulation at discharge (8.8 vs 42.3 feet, P < 0.001), and increased one-year mortality (20.0% vs 3.8%, P = 0.02). CDI ≥ 65 was associated with post-operative complications (OR 37.9). The institutional cutoff of 65 offered high specificity (99.3%) but low sensitivity (22.6%). An optimized threshold (47.7) improved sensitivity (77.4%) with comparable accuracy (75.0%).</p><p><strong>Conclusions: </strong>An elevated Clinical Deterioration Index (CDI) ≥ 65 correlated with poor outcomes in geriatric hip fracture patients. Specialty-specific cutoffs showed potential to improve postoperative risk stratification and identification of higher-risk patients.</p><p><strong>Level of evidence: </strong>III (retrospective cohort study).</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774488","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":"Shifts in Medicare Reimbursement for Common Lower Extremity Orthopaedic Trauma Procedures, 2006-2024.","authors":"Amir Human Hoveidaei, Seyedarad Mosalamiaghili, James E Feng, Afshin A Anoushiravani","doi":"10.1097/BOT.0000000000003205","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003205","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze Medicare reimbursement trends from 2006 to 2024 for open treatment of proximal femoral fractures (CPT 27236), femoral shaft fractures (CPT 27506), tibial shaft fractures (CPT 27759), and bimalleolar ankle fractures (CPT 27814), using data from the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule.</p><p><strong>Methods: </strong>This study analyzed Medicare reimbursement trends for the four most common lower extremity trauma procedures from 2006 to 2024 using data from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS) and the M165Ortho dataset from PearlDiver Technologies. Procedures were selected based on frequency: CPT 27236, 27506, 27759, and 27814. Reimbursement data were obtained from the CMS PFS using the corresponding HCPCS codes. Work reimbursement was calculated by multiplying work RVUs by the CMS conversion factor, and total facility reimbursement by multiplying total facility RVUs by the conversion factor. Values were adjusted to 2024 U.S. dollars using the Consumer Price Index. Percentage changes from 2006 were calculated. A 5-year projection (2020-2024) was generated using the mean and standard deviation of reimbursement changes to model negative (-1 SD), neutral (mean), and positive (+1 SD) scenarios to estimate trends through 2029.</p><p><strong>Results: </strong>Between 2006 and 2024, the unadjusted total reimbursement for the four included procedures increased by 2.7%, but when adjusted for inflation, it decreased by 33.7%. The largest inflation-adjusted decline in total reimbursements was observed in open treatment of bimalleolar ankle fracture, which saw a 37.6% reduction. Work reimbursements also decreased by 5.4% unadjusted, and by 38.9% after accounting for inflation, with the greatest reduction seen in bimalleolar ankle fractures with 43.5%. Projections for 2029, relative to 2024 values, indicate that total reimbursements could decline by an average of 48.1%, 33.1%, or 18.1% under negative, neutral, or positive scenarios, respectively. Work reimbursements are expected to decrease by 57.0%, 40.2%, or 23.3% under the same outlooks.</p><p><strong>Conclusions: </strong>Inflation-adjusted Medicare reimbursements for lower-extremity trauma procedures declined up to 37% from 2006 to 2024, with work reimbursements decreasing up to 44%. If current trends continue, reimbursements are projected to decline further by 2029. These declines may pose financial challenges for orthopaedic trauma surgeons and affect the delivery of trauma care.</p><p><strong>Level of evidence: </strong>Prognostic, Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774371","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":"Adverse Mental Health Outcomes after Modern External Ring Fixation Versus Internal Fixation for Severe Open Tibia Fractures: A Secondary Analysis of the FIXIT Study.","authors":"Natasha M Simske, Justin K Solarczyk, Austin R Thompson, Lisa Reider, Robert V O'Toole, Eben A Carroll, Madhav A Karunakar, William Obremskey, Stephen M Quinnan, J Spence Reid, Heather A Vallier, Saam Morshed","doi":"10.1097/BOT.0000000000003203","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003203","url":null,"abstract":"<p><strong>Objectives: </strong>To report the prevalence of adverse mental health outcomes one year after severe open tibial shaft fractures and their association with treatment and complication risk factors.</p><p><strong>Methods: </strong>Design: Randomized controlled trial.</p><p><strong>Setting: </strong>Multicenter.</p><p><strong>Patient selection criteria: </strong>Eligible patients were 18 to 64 years of age with severe open tibial shaft fractures (AO/OTA 41-43) treated with modern external ring fixation or internal fixation. All Gustilo-Anderson type IIIB fractures were included and some type IIIA meeting specific severity criteria.</p><p><strong>Outcome measures and comparisons: </strong>Outcome measures included Patient Health Questionnaire (PHQ) scores for depression symptoms, posttraumatic stress disorder (PTSD) Checklist for DSM-IV (PCL-S) and the Brief Pain Inventory (BPI). Primary comparisons assessed depression, PTSD and pain between treatment groups (modern external ring fixation versus internal fixation).</p><p><strong>Results: </strong>254 patients were treated with external ring fixation (n=121) or internal fixation (n=133). The mean age was 39 years (SD=13) and 16% were female. At 12-months after injury, 34% of patients had PHQ-9 scores consistent with moderate to severe depression. Risk factors for depression were female sex (RR: 1.70 [1.01, 2.86]), high school educational attainment or less (RR: 1.93 [1.27, 3.04]), and any baseline mental health condition (RR: 1.91 [1.22, 2.99]), all p<0.05. At 12-months, 45% of patients met criteria for PTSD. Any baseline mental health condition was a risk factor for developing PTSD (RR: 2.07 [1.50, 2.88]), p<0.001. Protective factors against the development of depression and PTSD included higher self-efficacy at 6 weeks after injury and any major limb complication (e.g. infection) within 12-months, both p<0.01. Moderate to severe daily pain interference was reported by 49% of participants at 12 months and was associated with high school level education attainment or less (RR: 1.41 [1.03, 1.94]) and was mitigated by self-efficacy at 6-weeks post injury (RR: 0.53 [0.38, 0.74]), both p<0.05. Fixation modality (external ring fixation versus internal fixation) was not associated with depression (RR: 0.82 [0.83, 1.27], p=0.37), PTSD (RR: 1.06 [0.77, 1.48], p=0.71), pain intensity (RR: 0.98 [0.63, 1.51], p=0.92) or pain interference (0.96 [0.70, 1.33], p=0.83).</p><p><strong>Conclusions: </strong>Mental health sequalae and moderate to severe pain were common one year after sustaining a severe open tibial shaft fracture. Adverse mental health outcomes and pain were not influenced by fixation modality (external ring fixation versus internal fixation).</p><p><strong>Level of evidence: </strong>Therapeutic Level 1.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774522","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":"Intramedullary Reaming Biopsy in Diagnosing Metastatic Long Bone Disease.","authors":"Kali N Stevens, Xuankang Pan, Kira L Smith, Collin W Blackburn, Brandon W Jonard, Joshua K Napora","doi":"10.1097/BOT.0000000000003206","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003206","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the diagnostic accuracy of intramedullary reaming biopsy in cancer patients with long bone lesions or suspected pathologic fractures in determining the presence of metastatic disease.</p><p><strong>Methods: </strong>Design: A retrospective review of electronic medical records.</p><p><strong>Setting: </strong>Single academic Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients with a known cancer diagnosis who underwent intramedullary nail fixation for a long bone lesion or pathologic fracture of the femur, humerus, and tibia for whom intramedullary reamings were sent to pathology between January 2013 and October 2021 were included. Patients for whom open biopsy was performed were excluded.</p><p><strong>Outcome measures and comparisons: </strong>The primary study measure was intramedullary reaming biopsy sensitivity.</p><p><strong>Results: </strong>Forty-six reamings from 44 patients were included, with a mean patient age of 69 years (range, 41-85 years) and 35 being female (76%). Approximately half of cases were therapeutic fixation of a pathologic fracture (52%) versus prophylactic (48%) in nature. Most reaming biopsies were from the femur (42/46, 91%), followed by humerus (3/46, 7%) and tibia (1/46, 2%). The most common diagnoses were breast (34%) and lung (20%) carcinoma and multiple myeloma (20%). Thirty-two reamings (70%) were able to establish a diagnosis of metastatic disease. Five samples (11%) were crushed or necrotic based on histopathology reports, and 4/5 (80%) of these were able to provide a diagnosis.</p><p><strong>Conclusions: </strong>Intramedullary reaming biopsy had a 70% sensitivity for diagnosing metastatic disease in cancer patients with long bone lesions or suspected pathologic fractures. Intramedullary reaming biopsy is not a useful diagnostic tool in 30% of these patients, and a formal open biopsy with frozen section should be considered for all patients with osseous lesions or suspected pathologic fractures.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774533","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":"BMP-2 enhanced bone regeneration using clinically available grafting strategies in a chronic caprine tibial defect model.","authors":"Nicolás S Piuzzi, Viviane Luangphakdy, Michael S Ramos, Chao Zhang, G Elizabeth Pluhar, Cathy S Carlson, Joan E Bechtold, George F Muschler","doi":"10.1097/BOT.0000000000003204","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003204","url":null,"abstract":"<p><strong>Objective: </strong>To assess bone grafting strategies in the chronic caprine tibial defect (CCTD) model.</p><p><strong>Methods: </strong>Forty-nine female Spanish Boar goats, aged 5±1 years, underwent the CCTD model. Segmental defects were created by excising 5 cm of tibial diaphysis, 9 cm of periosteum, and 10 g of muscle, followed by stabilization with an intramedullary locking nail and an antibiotic polymethylmethacrylate spacer. After four weeks, the spacer was removed. Defects were then grafted with one of five randomly assigned bone grafting strategies: 1) autogenous cancellous bone (ACB) (N=10); 2) mineralized cancellous allograft (MCA) (N=10); 3) MCA+ autologous bone marrow aspirate (BMA) (N=9); 4) MCA+bone morphogenetic protein-2 (BMP-2) (N=10); and 5) MCA+BMP-2+BMA (N=10). The primary outcome was total bone volume (tBV) measured by MicroCT at twelve weeks. Secondary outcomes included MicroCT measurements of radial percent bone volume and moment angle of inertia, and cortical bone bridging assessed by radiographs, ranked from the most to least bony healing by three trained independent reviewers.</p><p><strong>Results: </strong>Animals with MCA+BMP-2 (4542.1 mm3, P=0.026) and MCA+BMP-2+BMA (3633.1 mm3, P=0.006) grafts showed higher median tBV within the central 2.5 cm of the defect compared to animals with MCA+BMA grafts (12.3 mm3). Median tBV within the central 2.5 cm did not differ significantly between animals grafted with ACB (486.8 mm3) and those with MCA+BMP-2 (4542.1 mm3) or MCA+BMA+BMP-2 (3633.1 mm3) grafts. Adding unprocessed BMA to either MCA (MCA: 2.7 mm3 versus MCA+BMA: 12.3 mm3) or MCA+BMP-2 (MCA+BMP-2: 4542.1 mm3 versus MCA+BMA+BMP-2: 3633.1 mm3) did not significantly increase median tBV within the central 2.5 cm.</p><p><strong>Conclusion: </strong>In the CCTD model, BMP-2 had a positive effect on tBV, comparable to and trending greater than ACB. This study supports using a composite of MCA+BMP-2 for large segmental bone defects, while the effect of unprocessed BMA requires further evaluation.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774466","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":"Blade versus Screw Complication Risk for Intertrochanteric Fracture Fixation.","authors":"Arielle Richey Levine, James L Cross, Trevan Klug, Motasem Salameh, Matthew Riedel, Michael Leslie","doi":"10.1097/BOT.0000000000003201","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003201","url":null,"abstract":"<p><strong>Objective: </strong>To determine if the use of a screw or blade for fixation in intertrochanteric fracture intramedullary nailing is associated with bony complications, specifically cut-through, cut-out, malunion, nonunion, proximal hardware backout, and reoperation.</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 with intertrochanteric hip fractures (OTA/AO 31A) between 2014 - 2023 that underwent fixation with the same type of cephalomedullary nails (CMN) with either a blade or screw for proximal femur stabilization were identified based on Current Procedural Terminology Codes (CPT) 27245.</p><p><strong>Outcomes measures and comparisons: </strong>Bony complications, specifically cut-through, cut-out, malunion, nonunion, proximal hardware backout, and/or reoperation was compared across blade and screw implants for patients. This comparison was completed for the entire cohort, with patients stratified by fracture stability, and with the application of propensity matching across fracture and demographic characteristics.</p><p><strong>Results: </strong>1,078 patients were included. The 615 patients treated with CMN blade, had mean age of 83.1 (range 65-106) years and 451 females. The 463 patients treated with CMN screw had a mean age of 83.3 (range 65-103) years and 354 females. No statistical significance was found between CMN blade versus screw cohorts for complications (Blade: 5.7% vs. Screw: 5.4%, p=0.836) or reoperations (Blade: 5.2% vs. Screw: 3.7%, p=0.232). This held true when patients were stratified based on fracture instability for both complications (Blade: 6.8% vs. Screw: 8.0%, p=0.574) and reoperations (Blade: 5.5% vs. Screw: 5.1%, p=0.835). Logistic regression conducted to find risk factors associated with complications or reoperation identified reduction parameters (adequate reduction in all planes, neck shaft angle and tip-apex distance) and patient characteristics (body mass index, American Society of Anesthesiologists Status, smoking status and fracture stability) as significant (p<0.05). Use of blade or screw did not emerge as predictive in any model.</p><p><strong>Conclusions: </strong>Blade versus screw choice for intertrochanteric femur fragility fractures fixed with cephalomedullary nails was not significantly associated with differences in complications or reoperation when stratified by fracture pattern and adjusted by patient propensity matching, whereas malreduction correlated with all and specific complications, as well as the need for reoperation.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774519","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":"Metabolic Derangements are Independent Additive Risk Factors for Tibial Diaphyseal Nonunion.","authors":"Travis Kotzur, Blaire Peterson, Lane McCoy, Daniel E Pereria, Pooya Hosseinzadeh, Case Martin","doi":"10.1097/BOT.0000000000003202","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003202","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate whether altered metabolic factors (metabolic comorbidities) increase the risk of postoperative tibial diaphyseal nonunion following fracture fixation, and to determine whether additional metabolic risk factors contribute cumulatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective cohort analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The TriNetX Research Network.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Patients with operatively treated tibial diaphyseal fractures (AO/OTA 42) between January 1, 2013 and December 31, 2023 were identified. A minimum of 1 year of follow-up was required. Patients with a prior diagnosis of tibial nonunion or underlying metabolic bone disease were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes measures and comparisons: &lt;/strong&gt;The primary outcome was tibial diaphyseal nonunion following the index fracture. Outcomes were compared between patients with and without each metabolic comorbidity of interest (obesity, hypertension, diabetes, and dyslipidemia), as well as across groups stratified by cumulative metabolic burden to evaluate additive risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 36,474 patients (mean age 41.5 years, range 18-90; 62.7% male) were included in the analysis. Metabolic comorbidities were independently associated with a higher risk of nonunion, including diabetes (Hazard Ratio(HR) 2.82, p&lt;0.001), hypertension (HR 1.87, p&lt;0.001), obesity (HR 1.45, p&lt;0.001), and dyslipidemia (HR 1.25, p&lt;0.001).When stratified by obesity class, the risk of nonunion remained consistently elevated across all BMI categories, including BMI 30-35 (HR 1.44, 95% CI 1.46-1.82; p&lt;0.001), BMI 35-40 (HR 1.50, 95% CI 1.30-1.73; p&lt;0.001), and BMI ≥40 (HR 1.46, 95% CI 1.22-1.74; p&lt;0.001), without a clear dose-response gradient across increasing obesity severity. Importantly, absolute event rates increased in a graded fashion with cumulative metabolic burden. Patients without metabolic derangements had a nonunion incidence of 5.0% (506/10,082). This increased to 8.5% (493/5,767) with one condition, 10.4% (316/3,036) with two conditions, and 11.8% (142/1,208) with three or more conditions. Correspondingly, the hazard of nonunion increased stepwise: one condition (HR 1.59, 95% CI 1.38-1.83; p&lt;0.001), two conditions (HR 2.62, 95% CI 2.21-3.11; p&lt;0.001), three conditions (HR 3.16, 95% CI 2.50-3.99; p&lt;0.001), and four conditions (HR 3.37, 95% CI 2.35-4.84; p&lt;0.001). A similar graded increase was observed for odds of nonunion, with one (OR 1.63), two (OR 2.78), three (OR 3.80), and four conditions (OR 4.21) (all p&lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Metabolic comorbidities, including diabetes, hypertension, obesity, and dyslipidemia, were independently associated with an increased risk of tibial diaphyseal nonunion following fracture fixation. The risk of nonunion increases in a graded fashion as additional metabolic conditions are present, indicating that cumulative metabolic burden confer","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774550","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":"Interpretation Accuracy between Orthopaedic Surgeons and Qualified Remote Spanish Interpreters in a Trauma Setting.","authors":"Todd Jaeblon, Rubén Monarrez, Carlos Molestina, Luis DaConceicao, Marie-Genevieve Babecki, Brent J Bauer, Sneh Talwar, Haley K Demyanovich","doi":"10.1097/BOT.0000000000003207","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003207","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the interpretation accuracy of remote qualified Spanish medical interpreters (QMI) in an orthopaedic trauma setting and determine whether interpretation method (telephonic or video), delivery speed, and subject complexity were associated with interpretation accuracy.</p><p><strong>Methods: </strong>Three clinical vignettes-simple, moderate, and complex-describing fictitious orthopaedic trauma injuries, treatments, complications, and outcomes were written by the investigators. An investigator read each vignette type to a simulated patient through twenty randomly selected QMIs (ten via telephone and ten via video), all of whom were trained, proficiency-tested, and blinded to the study design, yielding 60 total interpretations. Data collected included interpretation method, English delivery speed (words per minute) and vignette complexity. One orthopaedic traumatologist and one bilingual physician assistant evaluated transcriptions of recorded QMI Spanish interpretations using a nonvalidated, criterion-referenced, expert-derived categorical assessment reflecting the degree to which an interpreter preserved the fidelity of the original vignette for patient ascertainment of diagnosis, treatment, risks, and prognosis, termed overall interpretation designation (OID). OID was classified, \"acceptable,\" \"borderline,\" or \"unacceptable.\" A second orthopaedist, blinded to the first two investigators' preliminary translation designations, independently evaluated disputed translations and adjudicated them to consensus OID.</p><p><strong>Results: </strong>Of the 60 interpretations, 46.7% were designated acceptable, 18.3% as borderline, and 35.0% unacceptable. Interpretation accuracy was not associated with vignette complexity (moderate odds ratio [OR] :reference; simple OR: 0.81, 95% CI 0.21-2.95, p = 0.75; complex OR: 1.49, 95% CI 0.36-6.74, p = 0.59) or delivery speed (Avg: 148 words per minute, range: 129.1-169.0, OR 0.98, 95% CI 0.92-1.04, p = 0.53). Odds of an acceptable interpretation were higher with video compared with telephonic interpretation (OR 6.21, 95% CI 2.17-19.48, p < 0.01).</p><p><strong>Conclusions: </strong>Less than half of Spanish interpretations delivered to simulated orthopaedic trauma patients by qualified medical interpreters were designated as acceptable by provider investigators, and 35% were unacceptable. The odds of an acceptable interpretation were over six times greater with remote video interpretation compared with telephonic interpretation.</p><p><strong>Level of evidence: </strong>Level III, Prognostic case control.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774458","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":"Comparative Efficacy of Anterior MIPO with PHILOS versus Posterior ORIF with EA-LCP in Distal Third Humerus Fractures: A Randomized Controlled Trial.","authors":"Siva Srivastava Garika, Pashupati Yadav, Nitish Jagdish Jyoti, Hemant Bansal, Samarth Mittal, Vivek Trikha, Vijay Sharma","doi":"10.1097/BOT.0000000000003200","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003200","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare anterior minimally invasive plate osteosynthesis (MIPO) using the proximal humerus internal locking system (PHILOS) in an upside-down reverse configuration with conventional posterior open reduction and internal fixation (ORIF) using extra-articular locking compression plate (EA-LCP) for the treatment of extra-articular distal-third humeral shaft fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Prospective randomized controlled trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single Level 1 trauma center (New Delhi, India).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Adult patients aged 18-55 years with extra-articular distal third humeral shaft fractures (AO/OTA types 12A-C) presenting within 2 weeks of injury were randomized to undergo anterior MIPO or posterior ORIF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;Radiological union, functional outcomes [Mayo Elbow Performance Score (MEPS), University of California-Los Angeles (UCLA) shoulder rating scale] and elbow range-of-motion (ROM) were assessed and compared at 2 weeks, 6 weeks, 3 months and 6 months post-operatively. Operative time, intraoperative blood loss, radiation exposure, post-operative pain (VAS scores) and complications were also compared.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty patients were included (anterior MIPO, n=14; posterior ORIF, n=16). Mean age was 27.9 years (range 18-55) in the MIPO group and 29.8 years (range 19-48) in the ORIF group, p=0.598. There were 11 males and 3 females in the MIPO group and 11 males and 5 females in the ORIF group, p=0.68. Mean time to radiological union was shorter in the MIPO group (16.3 ± 1.3 weeks) compared to the ORIF group (18.1 ± 1.2 weeks, p=0.001). Operative time was shorter in the MIPO group (78.9 ± 24.4 min vs 112.6 ± 42.0 min, p=0.013), intraoperative blood loss was lower (182.1 ± 137.4 mL vs 328.1 ± 96.8 mL, p=0.002) and immediate post-operative pain on day 2 was lower (VAS, 7 ± 0.5 vs 8 ± 0.6, p&lt;0.001). Functional outcomes showed no statistically significant differences between groups at 6 months (MEPS: 100 vs 100 p=1.000; UCLA: 33.8 ± 0.3 vs 33.7 ± 0.4, p=0.636) with no statistically significant difference in elbow ROM (137.8 ± 2.5° vs 135.4 ± 3.0°, p=0.192). Radiation exposure was higher in the MIPO group (1.5 ± 1.0 mGy vs 0.3 ± 0.5 mGy, p=0.003). Post-operative radial nerve palsy occurred in one patient in the MIPO group and three in the ORIF group, with complete recovery in all cases. Nonunion occurred in one patient in each group, both of whom required revision surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Anterior MIPO using a reverse PHILOS was associated with shorter time to radiological union, lower intraoperative morbidity and no statistically significant differences in functional outcomes compared to posterior ORIF for patients with extra-articular distal humerus fractures. It was a viable and effective alternative for managing distal third humeral shaft fractures.&lt;/p","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774506","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}