Journal of Orthopaedic Trauma最新文献

{"title":"Response to the Letter to the Editor Regarding \"Maternal and Fetal Perioperative Outcomes After Pelvic Ring or Acetabulum Fracture in Gravid Patients\".","authors":"Meghan Wally, Rachel B Seymour, Madhav A Karunakar","doi":"10.1097/BOT.0000000000003288","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003288","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111130","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 application and effectiveness analysis of the InterTan nail in the treatment of femoral neck fractures.","authors":"Hao Liu, Jiliang He, Mingyu Li, Quansah Augustine, Pingshan Wang, Xiaosong Liu, Xiangquan Chu","doi":"10.1097/BOT.0000000000003295","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003295","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the clinical and radiographic outcomes of the InterTan nail as a stand-alone internal fixation device for predominantly high-energy displaced femoral neck fractures in younger and middle-aged adults.</p><p><strong>Methods: </strong>Design: Retrospective case series.</p><p><strong>Setting: </strong>Single-center study at a tertiary trauma hospital in China.</p><p><strong>Patient selection criteria: </strong>Patients aged ≤65 years with isolated, unilateral femoral neck fractures (OTA/AO 31B) treated with InterTan nail fixation between January 1, 2017, and January 1, 2022, were included. Patients with local infection or inflammation, open or pathological fractures, multiple fractures, severe systemic comorbidities precluding surgery, or psychiatric or neuromuscular disorders that could predispose to fixation failure or postoperative complications were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Outcomes included reduction quality, fracture union, femoral neck shortening, complications, reoperation, Harris Hip Score, pain, and postoperative weight-bearing progression.</p><p><strong>Results: </strong>Twenty-five patients were included; mean age was 50.0 ± 13.2 years (range, 17-65 years), and 8 (32.0%) were female. Mean follow-up was 34.6 ± 17.6 months (range, 24-84 months). Twenty-one fractures (84.0%) were Pauwels type III and 21 (84.0%) were Garden type III or IV. All patients achieved acceptable reduction, defined as a Garden Alignment Index of 155°-180° on anteroposterior radiographs, and all fractures achieved union. Mean femoral neck shortening was 1.7 ± 1.9 mm (range, 0-7.3 mm). At 24 months, mean Harris Hip Score was 90.8 ± 6.2. One patient (4.0%) underwent reoperation for osteonecrosis of the femoral head within 2 years postoperatively.</p><p><strong>Conclusions: </strong>In patients aged ≤65 years with predominantly high-energy displaced femoral neck fractures, InterTan nail fixation following acceptable reduction was associated with fracture union in all patients, and a 4.0% reoperation rate within 2 years. These findings supported InterTan nail fixation as a potential fixation option for this specific patient population.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111127","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":"Mini Fragment T-Plate Fixation for Medial Malleolar Fractures Achieves Comparable Outcomes to Small Fragment Screw Fixation Without Increased Complication Risk.","authors":"Emily Lau, Rachit Saggar, Abdulganeey Olawin, Kevin Li, Gele Moloney","doi":"10.1097/BOT.0000000000003294","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003294","url":null,"abstract":"<p><strong>Objectives: </strong>To compare clinical outcomes between mini fragment T-plate (MFTP) fixation and traditional small fragment screw (SFS) fixation for medial malleolar ankle fractures, with a focus on complication rates and fracture patterns.</p><p><strong>Methods: </strong>Design: Retrospective comparative cohort study.</p><p><strong>Setting: </strong>Single academic level I trauma center.</p><p><strong>Patient selection criteria: </strong>Inclusion criteria: age ≥18 years, OTA/AO type 44 medial malleolar fractures treated with either MFTP (2.0 or 2.4 mm) or SFS (3.5 bicortical or 4.0mm partially threaded) from November 2016 to August 2023, and minimum 6-month radiographic and clinical follow-up. Exclusion criteria: prior ipsilateral ankle surgery, vertical fractures not amendable to screw fixation alone.</p><p><strong>Intervention: </strong>Medial malleolar fracture fixation with one of the aforementioned constructs.Outcome Measures and Comparisons: Primary outcomes compared between MFTP and SFS groups included infection rates, nonunion rates, and reoperation rates. Secondary outcomes included fracture pattern analysis and time to weight bearing. Statistical analysis used chi-square or Fisher's exact test for categorical variables and Student's t-test for continuous variables.</p><p><strong>Results: </strong>From 194 consecutive patients, 141 met inclusion criteria: 68 MFTP (age 47.1±15.9 years, 72% female) and 73 SFS (age 51.0±17.6 years, 64% female). No significant demographic differences were observed between groups with regards to age (p = 0.168), BMI (p = 0.107), sex (p = 0.393), smoking status (p = 0.556), nor presence of diabetes (p = 0.499). Fracture pattern analysis using the Herscovici classification revealed that low transverse fractures (Type B) were treated with MFTP in 94% of cases vs SFS in 6% (p<0.001), while high transverse fractures showed a more balanced treatment distribution (47% versus 53% SFS versus (p=0.865)). Comparing MFTP with SFS fixation, rates of infection (10.3% vs 8.3% respectively, p=0.777), unplanned reoperation rates (7.0% vs 10.0% respectively, p=0.780), and symptomatic hardware requiring reoperation (4.4% vs 2.7% respectively, p=0.672) were comparable. There was no failure of medial malleolar fixation in either group. One nonunion occurred in the MFTP group and one in the SFS group (p=1.000). Presence of an open fracture in the MFTP and SFS groups was significantly different at 4.4% and 19.4% respectively (p=0.009).</p><p><strong>Conclusion: </strong>MFTP demonstrated comparable outcomes and complication rates to SFS fixation for medial malleolar ankle fractures. These findings support MFTP as a viable alternative for medial malleolar fixation where fragment morphology may preclude safe dual-screw placement.</p><p><strong>Level of clinical evidence: </strong>3, Therapeutic Cohort Study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111174","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":"Letter to the Editor Regarding \"Maternal and Fetal Perioperative Outcomes After Pelvic Ring or Acetabulum Fracture in Gravid Patients\".","authors":"Harun Sağlıcak","doi":"10.1097/BOT.0000000000003289","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003289","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111195","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":"NonTobacco Nicotine Dependence Is Associated With Increased Fracture Risk in Adolescents and Young Adults.","authors":"Jeffrey Zhang, Yoli Meydan, Bryan Chen, James Barsi","doi":"10.1097/BOT.0000000000003220","DOIUrl":"10.1097/BOT.0000000000003220","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to evaluate whether nontobacco nicotine dependence (NTND) in adolescents and young adults is associated with an increased risk of new-onset fractures over a medium-term and long-term follow-up.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>retrospective cohort query of TriNetX network.</p><p><strong>Setting: </strong>Multicenter study conducted using deidentified electronic health records from the TriNetX network of participating health care organizations.</p><p><strong>Patient selection criteria: </strong>Adolescents and young adults (≤21 years) were included if they had a diagnosis of NTND between June 1, 2005, and June 1, 2020. Exclusions: any previous tobacco use, environmental tobacco exposure, tobacco use disorder, preexisting bone/joint pathology (eg, osteoporosis, osteoarthritis, osteogenesis imperfecta, and malignant neoplasms of bone/cartilage), or previous fracture. Patients with NTND were propensity score matched 1:1 with controls without any documented nicotine or tobacco use.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was incident fracture after the most recent eligible clinical encounter documented between June 1, 2005, and June 1, 2020. Fracture risk was assessed over a fixed 5-year period after the index date and across the longest available follow-up in TriNetX. Risk ratios (RR) and 95% confidence intervals (CI) were calculated. Kaplan-Meier survival analysis was used to estimate hazard ratios (HR) for time-to-event comparison.</p><p><strong>Results: </strong>The matched cohort was comprised of 10,576 patients per group with an average age at index of 19.4 ± 1.7 years. The NTND group was comprised of 44.9% males and 54.7% females, whereas the control group was comprised of 44.7% males and 55.0% females. At 5 years, fracture incidence was 1.1% in the NTND group and 0.5% in controls (RR, 2.1; 95% CI, 1.5-2.9; P < 0.001). Over the extended follow-up, fracture incidence was observed to be 2.0% in NTND group and 1.0% in the control group (RR, 1.9; 95% CI, 1.5-2.4; P < 0.001). Over the extended follow-up, the elevated fracture risk in NTND group when compared with controls was confirmed time-to-event analysis (HR, 1.9; 95% CI, 1.5-2.4).</p><p><strong>Conclusions: </strong>Nontobacco nicotine dependence was associated with a two-fold increased risk of fracture among adolescents and young adults (RR, 2.1; 95% CI, 1.5-2.9 at 5 years; RR, 1.9; 1.5-2.4 over an extended follow-up period). It is suggested by these findings that skeletal health consequences should be considered when evaluating the long-term effect of nicotine use in youth.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"543-548"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839304","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":"Determining a Timeline for Returning to Driving After a Right Femoral Fracture: A Braking Simulator-Based Study.","authors":"Claire E Hayes, Daniel Hayes, Ahmed Nageeb Mahmoud, Zane D Patterson, Joseph Patrick Carey, Juan Bernate, Erik A Kennedy, Daniel S Horwitz","doi":"10.1097/BOT.0000000000003287","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003287","url":null,"abstract":"<p><strong>Objectives: </strong>To determine when patients with surgically treated right femoral fractures achieve objective criteria for driving readiness after surgery.</p><p><strong>Methods: </strong>Design: Prospective cohort study.</p><p><strong>Setting: </strong>Single Level I trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged ≥18 years who are licensed drivers and sustained a surgically treated right femoral fracture (OTA/AO 31-33) at a single Level I trauma center were prospectively enrolled after surgery between 2020 and 2024 and underwent braking simulator testing during postoperative follow-up visits. Patients were weight-bearing as tolerated at the time of testing, and those with associated fractures or neurologic deficits were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Brake reaction time (BRT) and maximum brake force (BF) were measured using a custom braking simulator during postoperative visits. Driving readiness was defined as BRT <1 second and BF >350 N, consistent with conservative published thresholds. Patients were classified as meeting both thresholds (I), BRT only (II), BF only (III), or neither (IV), and category distributions were reported across four postoperative intervals: 1-25, 26-75, 76-125, and >125 days.</p><p><strong>Results: </strong>Forty-five patients were included in this study. Patients were 23 females and 22 males, with a mean age of 58.9 years (range, 18-90). The number of simulator tests performed was 18 at 1-25 days, 33 at 26-75 days, 25 at 76-125 days, and 24 at >125 days. Within the first 25 postoperative days, one patient met both thresholds, while 50% were category III-IV. Mean brake reaction time was 0.87 ± 0.40 seconds at 26-75 days and 0.77 ± 0.22 seconds at 76-125 days, while mean maximum brake force was 333.1 ± 136.9 N and 352.6 ± 110.0 N, respectively.At >125 days postoperatively, a majority of testing observations met both thresholds, with 62.5%, 12.5%, 20.8%, and 4.2% falling into categories I, II, III, and IV, respectively.</p><p><strong>Conclusions: </strong>Patients with right femoral fractures generally did not meet the predefined simulator braking time thresholds in the first 25 days postoperatively, whereas a majority first met both thresholds after 125 days. Simulator-based assessment may help guide individualized postoperative counseling.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039461","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":"Cerclage for Fracture Reduction is Not Associated with Nonunion in Vancouver B or C Periprosthetic Femur Fractures with Stable Implants: A Multicenter Retrospective Study.","authors":"Christopher R Leland, Alice W Wong, Carla H Lehle, Robert K Wagner, Phillip T Grisdela, Jacob S Borgida, Arun Aneja, Thuan V Ly, Nishant Suneja, John J Wixted, Paul T Appleton, Edward K Rodriguez, Mitchel B Harris, Michael J Weaver, Arvind G von Keudell, Derek S Stenquist","doi":"10.1097/BOT.0000000000003285","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003285","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether circumferential cerclage wiring for fracture reduction during lateral locked plating (LLP) of Vancouver B1 and C periprosthetic femur fractures is associated with nonunion.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Three academic Level I trauma centers.</p><p><strong>Patient selection criteria: </strong>Patients aged >50 years with a Vancouver B1 or C periprosthetic femur fracture (OTA/AO IV.3B1 and IV.3C) who underwent open reduction and internal fixation with a single LLP with or without circumferential cerclage for fracture reduction from 2010-2023 were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was nonunion. The association between cerclage use and nonunion was assessed using multivariable logistic regression controlling for age, sex, ASA classification, and Vancouver classification. Secondary outcomes included deep infection and implant revision.</p><p><strong>Results: </strong>141 patients were included: 102 patients (72%; median age 78 years [IQR, 70-87]; 67% female) were treated with cerclage for fracture reduction and 39 patients (28%; median age 82 years [IQR, 70-89]; 85% female) were not. More patients treated with cerclage sustained a Vancouver B1 than Vancouver C fracture (n=78/102 [76%] vs. n=24/39 [24%]; P<0.001). Plates were longer (16 holes [IQR, 13-18] vs. 14 holes [IQR, 13-16]; P=0.02), stainless steel (n=91/102 [89%] vs. n=27/39 [69%]; P<0.01), and used in neutralization mode (n=96/102 [94%] vs. n=28/39 [72%]; P=0.001) in patients treated with cerclage. Nonunion occurred in 4 patients (4%) treated with cerclage and 4 patients (10%) without (P=0.30). Cerclage use was not associated with developing nonunion in multivariable regression (adjusted odds ratio, 0.3; 95% CI, 0.1-1.8; P=0.19). Infection occurred in 6 patients (6%) treated with cerclage and 0 patients (0%) without (P=0.28). Implant revision occurred in 8 patients (8%) treated with cerclage and 6 patients (15%) without (P=0.31).</p><p><strong>Conclusions: </strong>While baseline between-group differences were noted in Vancouver classification, the judicious use of circumferential cerclage wiring for fracture reduction and stabilization in Vancouver B and C periprosthetic femur fractures with stable implants was not associated with nonunion. No differences were noted in incidence of deep infection or implant revision following cerclage use in this population.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025217","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":"Pre-Reduction Position of Posterior Wall Fragment is Associated with Intra-Articular Displacement.","authors":"Connor C Park, Kathryn A Barth, Christian G Falgons, Jonahs Galloway, Samantha Gardner, Milton Lee Chip Routt, Patrick J Kellam, Johnathan G Eastman, Stephen J Warner","doi":"10.1097/BOT.0000000000003283","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003283","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize the rate and risk factors for a posterior wall fragment becoming intra-articular following closed reduction in posterior acetabular fracture-dislocations when the fragment was positioned between the femoral head and acetabulum prior to reduction.</p><p><strong>Methods: </strong>Design: Retrospective case series.</p><p><strong>Setting: </strong>Regional Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Patients with posterior wall, posterior column-posterior wall, or transverse-posterior wall acetabular fracture-dislocations and posterior hip dislocation between January 2019 and December 2023 were reviewed. Inclusion required pre- and post-reduction CT imaging demonstrating a posterior wall fragment between the femoral head and acetabulum.</p><p><strong>Outcome measures and comparisons: </strong>Pre- and post-reduction CT scans were reviewed to define fragment position relative to the femoral head and determine whether fragments were intra- or extra-articular after reduction.</p><p><strong>Results: </strong>Of 44 patients with a posterior wall fragment positioned between the femoral head and acetabulum prior to reduction, 21 (47.7%) had the fragment become intra-articular following closed reduction. All fragments that displaced into the joint were medial to the femoral head (100%) prior to closed reduction (mean age 37.4 years [18.0-77.0], 57.1% male) and 23 (52.3%) remained extra-articular (mean age 34.3 years [20.0-80.0], 65.2% male). Among intra-articular fragments, 21 of 21 (100.0%) were medial to the femoral head before reduction compared with 6 of 23 (26.1%) extra-articular fragments (p<0.001). Inferior fragment position was present in 20 of 21 (95.2%) intra-articular fragments and 8 of 23 (34.8%) extra-articular fragments (OR 37.5, 95% CI 4.2-333.1; p<0.001). Fragment length was 2.6 ± 1.1 cm versus 3.6 ± 1.0.98 cm (p=0.003). Medial fragment position was associated with non-concentric reduction (74.2% vs. 30.8%; OR 6.5, 95% CI 1.6-26.9; p=0.015), whereas inferior fragment position was not (p=0.172; OR 2.9, 95% CI 0.8-10.9; p=0.172).</p><p><strong>Conclusions: </strong>Medial and inferior posterior wall fragment position before reduction were each associated with post-reduction intra-articular translation, while medial position was also associated with non-concentric reduction. Recognition of this morphology may aid surgical planning and anticipation of fragment retrieval.</p><p><strong>Level of evidence: </strong>Prognostic Level IV.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025234","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":"Ceftriaxone versus cefazolin plus gentamicin for antibiotic prophylaxis in Gustilo-Anderson type III open lower extremity fractures.","authors":"Cameron Foster, Landon Richardson, Brian Pegg, Vedant Garg, Brian Kye, Xinlin Lu, Porter Young","doi":"10.1097/BOT.0000000000003286","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003286","url":null,"abstract":"<p><strong>Objectives: </strong>To compare fracture related infection (FRI) rates and outcomes between ceftriaxone (CTX) and cefazolin plus gentamicin (C+G) for antibiotic prophylaxis in Gustilo-Anderson (GA) type III open lower extremity fractures.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Single, academic level one trauma center.</p><p><strong>Patient selection criteria: </strong>Included were patients age 18-89 years with GA type III open lower extremity fractures (AO/OTA 32,33,41,42,43,4F3, 44) from 2013 to 2024 with at least 6 weeks follow-up.</p><p><strong>Outcome measurements and comparisons: </strong>The primary outcome was FRI. Secondary outcomes included acute kidney injury (AKI), nonunion, and other complications. Cox proportional hazards models and multivariable logistic regression adjusted for confounding variables.</p><p><strong>Results: </strong>Of 3,334 lower extremity fractures reviewed, 307 met inclusion criteria: 229 C+G and 78 CTX. Mean age (40.4 [range 18-88] vs 41.2 [range 18-81] years, p=0.7) and sex (75.1% vs 64.1% male, p=0.084) were similar between the C+G and CTX cohorts. Mean follow-up was 23.8 months (C+G) and 14.0 months (CTX) (P=0.002). The C+G cohort had more tibial shaft fractures (34.1% vs 19.2%, P=0.014) and type IIIB injuries (19.7% vs 7.7%, P=0.014). On unadjusted analysis, there was no significant difference in FRI (18.3% vs 12.8%, P=0.343) or AKI (11.4% vs 12.8%, P=0.728) or organisms cultured. After adjusting for GA type, fracture location, time to debridement and time to antibiotics there remained no significant difference in FRI (HR=1.26, 95% CI: 0.59-2.68, P=0.545), AKI (OR=1.51, 95% CI: 0.62-3.49, P=0.349) or other complications between antibiotic regimens. Tibial shaft fractures trended towards higher risk of FRI compared to femur fractures (HR=2.15, P=0.052). GA type IIIB/C fractures (HR=3.05, p<0.001) and time to antibiotics of >60min (HR=2.56, p=0.003) were associated with higher odds of FRI.</p><p><strong>Conclusions: </strong>Ceftriaxone monotherapy demonstrated similar rate of FRI and complications compared to cefazolin plus gentamicin for Gustilo-Anderson type III open lower extremity fractures. Severity of the open fracture and time to antibiotics were independently associated with higher infection risk regardless of antibiotic regimen.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025274","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":"Revisiting the Use of a Femoral Distractor for Provisional Reduction of Lateral Compression Pelvic Injuries: A Technical Trick.","authors":"Healy S Vise, Christopher R Leland, Carla H Lehle, Raymond D Wright, Arun Aneja","doi":"10.1097/BOT.0000000000003282","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003282","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012513","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}