Journal of Orthopaedic Trauma最新文献

{"title":"A Targeting Arm for Interlocking Screws Reduces Radiation Exposure: Results of a Prospective Randomized Controlled Trial.","authors":"Mackinzie Stanley, Kevin Huang, John Garlich, Milton Little, Geoffrey Marecek, Charles Moon, Mark Vrahas, Carol Lin","doi":"10.1097/BOT.0000000000003066","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003066","url":null,"abstract":"<p><strong>Objectives: </strong>To compare time, fluoroscopic utilization, and number of misses for placement of far interlocking screws in tibial and femoral nails using a targeting arm (Targeter) versus perfect circle technique (Control).</p><p><strong>Methods design: </strong>Prospective randomized controlled trial.</p><p><strong>Setting: </strong>Single-center, large, urban, level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Patients ≥ 18 years old with a tibia or femur fracture (AO/OTA 31A, 32, or 42) treated with an intramedullary nail from November 2022 to December 2023 were included.Outcome Measures and Comparisons: The main outcome measures were number of fluoroscopy images taken and average time elapsed to place each far interlocking screw. The far interlocking screws were defined as the screws farthest from the insertion handle. Comparisons were made between the Targeter and Control cohorts in terms of number of fluoroscopy images taken and average time elapsed to place each far interlocking screw, and the number of misses.</p><p><strong>Results: </strong>31 patients were randomized to Targeter and 31 to Control. There were no significant differences between the Targeter and Control cohorts in patient sex (58.6% vs 54.5% female, p=0.75), age (range (20-90 vs 18-91, mean 52.7 vs 54.2, p=0.81), BMI (mean 25.9 vs 26.2, p=0.66), AO classification (13.8% vs 36.4% 31A, 37.9% vs 21.2% 32, 48.2% vs 42.4% 42, p= 0.20), or number of open fractures (13.8% vs 7.1%, p= 0.67) between the two cohorts. For the Targeter group, fewer images were used compared to Controls for the first (15.0 vs 22.5, p= 0.002), second (11.5 vs 18.0, p= 0.006), and combined first and second (25.0 vs 39.0, p = 0.001) screws. There was no difference between the Targeter and Control cohorts in the time it took to place the first (6.3 vs 7.3 min, p= 0.31), second (5.8 vs 6.2 min, p= 0.63), or combined first and second (11.9 vs 13.7 min, p= 0.63) screws. In the Control cohort, there was one missed screw (1.4%, n=69). In the Targeter cohort, there were three missed screws (5.4%, n=56), a 4-fold increase that did not reach statistical significance (p=0.31).</p><p><strong>Conclusions: </strong>In this prospective randomized controlled trial, a targeting arm decreased the number of fluoroscopic images used for all far interlocking screws as compared to the perfect circle technique without a reduction in time. There was a trend towards increased misses in the Targeter cohort (p=0.31). While the reduction in radiation exposure may have a cumulative beneficial effect over the course of a surgeon's career, the trend of increased misses with the Targeter should be taken into account.</p><p><strong>Level of evidence: </strong>level I.</p>","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":"144958095","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":"Healing the humeral shaft nonunion: Prior surgery confers increased risk of recalcitrant nonunion.","authors":"Erika Roddy, Reza Firoozabadi, Daphne Beingessner, David Barei","doi":"10.1097/BOT.0000000000003065","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003065","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the rate of successful humeral shaft nonunion repair in patients with no prior surgery on the humerus (failed nonoperative management), compared to patients with a history of prior surgery on the humerus (initial operative treatment complicated by nonunion, or prior attempted nonunion repair after failed nonoperative management).</p><p><strong>Methods design: </strong>Retrospective.</p><p><strong>Setting: </strong>Two academic trauma centers (one level 1 and one level 2).</p><p><strong>Patient selection criteria: </strong>All skeletally mature patients undergoing nonunion repair of a presumed aseptic humeral shaft nonunion (AO/OTA 11A, 11B, 11C, 12A, 12B, 12C) were eligible for inclusion.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was osseous union. Univariate analysis was used to examine patient, injury, and treatment factors associated with recalcitrant nonunion between those with and without prior surgery.</p><p><strong>Results: </strong>One hundred fifty-nine patients were included. Eighty-two patients had a history of prior operative treatment. The group with prior operative treatment was significantly younger (47 vs 52, p=0.047) and had fewer comorbidities (average Charlson comorbidity score 1.3 vs 1.9, p=0.015). There were 34 men in the group with prior operative treatment, compared to 37 in the group without (p=0.493). For patients with prior operative treatment, 17/82 (21%) developed a recalcitrant nonunion, versus 2/79 (3%) in patients with no prior operative treatment (p<0.001). The number of prior operations on the arm was significantly associated with increased risk of recalcitrant nonunion (3% risk if no prior surgeries, 19% risk with one prior surgery, 25% risk with 2 prior surgeries, 33% risk with 3 prior surgeries, p=0.004). No demographic factors were associated with development of a recalcitrant nonunion (p>0.05 for all). Nine patients had unexpected positive cultures but this was not associated with increased risk of recalcitrant nonunion (22% in patients with infection vs 26% in those without, p=0.907).</p><p><strong>Conclusions: </strong>Patients undergoing nonunion repair after prior operative treatment of a humeral shaft fracture had a 1 in 5 rate of recalcitrant nonunion, while patients undergoing initial nonunion repair after failed nonoperative management had a 3 in 100 rate of recalcitrant nonunion. Increased risk of persistent nonunion stemmed not from initial treatment strategy for the acute fracture, but rather from the presence of any prior surgery.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes Vary by Surgical Approach for Hemiarthroplasty after Low-energy Displaced Femoral Neck Fracture: A Study of the Arthroplasty for Hip Fracture Consortium.","authors":"Madeline A Sauer, Michael Ewing, Charles A Gusho, Kyle H Cichos, Brett Crist, James Keeney, Arthroplasty For Hip Fracture Consortium, Elie S Ghanem","doi":"10.1097/BOT.0000000000003062","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003062","url":null,"abstract":"<p><strong>Objectives: </strong>To compare hemiarthroplasty (HA) outcomes for low-energy femoral neck fracture (FNF) among a direct anterior approach (DAA), direct lateral approach (DLA), and posterior approach (PA).</p><p><strong>Methods: </strong>Design: Retrospective review.</p><p><strong>Setting: </strong>Nine Level-1 Tertiary Academic Centers.</p><p><strong>Patient selection criteria: </strong>All patients from January 2010 through December 2019 undergoing HA for a low-energy FNF (AO/OTA 31B1-3). Exclusion criteria were pathological fractures, concomitant acetabular fractures, and high-energy mechanisms.</p><p><strong>Outcome measure and comparisons: </strong>Multivariable regression models were constructed for outcomes among DAA and DLA compared to PA including mortality, revision, and infection. It was hypothesized anterior approaches would be independently associated with fewer postoperative complications including infection, dislocation, and mortality.</p><p><strong>Results: </strong>A total of 956 consecutive patients with FNF treated with HA using DAA (n=71; 7.4%; mean (SD) age 82.6 (8.5) years), DLA (n=252; 26.4%; mean (SD) age 81.3 (10.8) years), or PA (n=633; 66.2%; mean (SD) age 79.2 (10.9) years) were included. There were no differences in sex among groups (p=0.83). The DAA was independently associated with higher periprosthetic joint infection (PJI) rates at 90 days (OR, 7.295; 95% CI, 2.35 to 22.61; p<0.001) and one-year (OR, 5.769; 95% CI, 1.93 to 17.22; p=0.002), as was the DLA at 90 days (OR, 2.952; 95% CI, 1.29 to 6.74; p=0.010) and one-year (OR, 3.047; 95% CI, 1.43 to 6.50; p=0.004). The DLA was associated with lower 90-day dislocation (OR, 0.129; 95% CI, 0.03 to 0.60; p=0.009), one-year dislocation (OR, 0.175; 95% CI, 0.05 to 0.63; p=0.008), and greater independent ambulation at discharge (OR, 3.273; 95% CI, 2.00 to 5.37; p<0.001).</p><p><strong>Conclusions: </strong>Among hemiarthroplasty for low-energy femoral neck fracture, the lateral approach was associated with decreased dislocation postoperatively and greater independent ambulation at discharge, but with decreased ambulatory distance compared to a posterior approach. Furthermore, the anterior and lateral approaches were associated with increased infection versus a posterior approach.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957756","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 obturator foramen \"safe zone\" for anterior pelvis internal fixation by trans-obturator cerclage.","authors":"Raymond Bui, Soroush Shabani, Andrew Duong, Avinash Iyer, Phillip Grisdela, Joseph T Patterson","doi":"10.1097/BOT.0000000000003061","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003061","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify the morphology of an avascular \"safe zone\" within the obturator foramen to assess the risk of neurovascular injury with trans-obturator foramen cerclage.</p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Level 1 trauma center and tertiary academic center.</p><p><strong>Patient selection criteria: </strong>Adults ≥18 years without prior pelvic pathology and with pelvic computed tomography angiography (CTA) demonstrating complete visualization of the obturator arteries.</p><p><strong>Outcome measures and comparisons: </strong>The minimal distance from the medial cranial border of the obturator foramen to the obturator artery (DOA) and the obturator foramen area (OFA) bounded by the obturator artery and pubis were measured on CTA in the plane of the obturator foramen. Associations of OFA and DOA with demographic and anthropometric variables were analyzed by multivariable linear regression. The \"safe zone\" for passage of trans-obturator cerclage instrumentation was determined by the 5.0mm outer diameter of a commercially available cable passer.</p><p><strong>Results: </strong>The sample included sixty adults, 35 men (58.3%), with a mean age of 56.2±16.4 years. The mean DOA (left 6.8±1.9mm, right 6.9±1.6mm, p=0.724) and OFA (left 195.1±63.3mm2, right 190.3±55.4mm2, p=0.657) did not vary by laterality. DOA was >3.2mm for all patients but <5.0mm in 23.3% of patients. Multivariable analysis indicated that DOA was associated with patient height (β=0.04, p=0.019) but not sex (β=0.01, p=0.987) or weight (β=0.01, p=0.253).</p><p><strong>Conclusions: </strong>A \"safe zone\" defined by the obturator artery and cranial and medial obturator foramina exists for internal fixation of the anterior pelvic ring by trans-obturator foramen cerclage. While a cerclage device ≤3.2mm in diameter appears safe, passage of a cerclage wire through the cranial and medial obturator foramina for internal fixation anterior pelvic ring disruption with typical instrumentation may injure the obturator neurovascular bundle without additional surgical dissection.</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":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Contralateral Second Hip Fracture Risk Within 5 Years of First Hip Fracture: A New Risk Tool to Guide Patient/Family Counseling and Bone Health Treatment.","authors":"Christopher J Pettit, Carolyn F Herbosa, Jacob A Linker, Abhishek Ganta, Kenneth A Egol, Sanjit R Konda","doi":"10.1097/BOT.0000000000003060","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003060","url":null,"abstract":"<p><strong>Objective: </strong>To develop a stratification tool to identify hip fracture patients at risk for second contralateral hip fracture and mortality within 5 years of an index fracture, and to assess the cost-effectiveness of prophylactic fixation in high-risk/low-mortality patients.</p><p><strong>Methods: </strong>Design: Retrospective prognostic cohort study.</p><p><strong>Setting: </strong>Single academic system with 2 Level 1 Trauma Centers, 1 orthopedic specialty hospital, and 1 tertiary care hospital.</p><p><strong>Patient selection criteria: </strong>Patients who were 60 years or older with OTA 31A/B hip fractures from low-energy mechanisms between 11/1/2014 and 11/31/2023 with ≥5 years follow-up or until death were included.</p><p><strong>Outcome measures and comparisons: </strong>The study included four phases: (1) identifying factors associated with second hip fracture within 5 years; (2) using multivariate logistic regression to generate models predicting 5-year second hip fracture (vs. FRAX) and mortality risk; (3) creating a \"risk matrix\" to identify candidates for prophylactic fixation using Youden's Index which determined cutoff points encompassing the maximum sensitivity and specificity for each risk equation and were used to define a value-based target group; (4) cost analysis comparing standard vs. prophylactic care in high-risk/low-mortality patients.</p><p><strong>Results: </strong>Of 426 patients (mean age 80.25 years, 73.4% female), 78 sustained second hip fractures (mean interval: 594 days). Predictors included higher FRAX score (p=0.004), dementia (p<.001), ICU stay (p=0.014), discharge to subacute care (p<.001), and 90-day readmission (p=0.011). Logistic regression predicted 5-year second fracture risk (AUC 0.742 vs. FRAX 0.617, p=0.012) and 5-year mortality (AUC 0.723). The risk matrix used cutoff points of 18.2% (mortality) and 38.2% (second fracture) to define a value-based target group (n=26; 13 experienced second fracture). Cost analysis showed prophylactic fixation of all 26 patients ($781,508) would save $353,067 compared to treating the 13 who fractured again ($1,134,575).</p><p><strong>Conclusions: </strong>A novel matrix was developed that accurately predicted 5-year second hip fracture and mortality risk. Prophylactic fixation in low-mortality, high-risk patients may reduce costs and prevent future fractures. [Tool available: https://sttgmacom.wpcomstaging.com/predicting-risk-of-second-hip-fractures/].</p><p><strong>Level of evidence: </strong>Level III Diagnostic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes Following Distal Femur Replacement for Fracture: A Multi-Institutional Retrospective Review.","authors":"David C Landy, Jeffrey A Foster, Wyatt G S Southall, Austin T Gregg, Stephen T Duncan, Michael T Archdeacon, William T Obremskey, Joshua M Lawrenz, Christopher Lee, Michael S Sridhar, Arun Aneja","doi":"10.1097/BOT.0000000000003059","DOIUrl":"10.1097/BOT.0000000000003059","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate representative outcomes of patients who underwent distal femur replacement (DFR) for distal femur fractures (DFFs).</p><p><strong>Methods: </strong>Design: Retrospective Cohort Study.</p><p><strong>Setting: </strong>Twelve academic trauma centers in the United States.</p><p><strong>Patient selection criteria: </strong>Adult patients who underwent DFR for native or periprosthetic DFF (OTA/AO 33A1.1 - 33C3.3) from 2010 to 2022 were included. Patients who underwent DFR for infectious, oncologic, and/or other indications besides fracture fixation were excluded.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was periprosthetic joint infection (PJI). Secondary outcomes included reoperation, one-year mortality, and function. Outcomes were estimated using proportions and Kaplan-Meier curves with 95% confidence intervals (C.I.) and stratified by periprosthetic fracture with Fisher's exact testing.</p><p><strong>Results: </strong>173 patients were included, with 130 (75%) having a periprosthetic DFF. The median age was 77 [interquartile range, 70-84] and median final follow-up was 6 months [interquartile range, 2-14], with 146 (84%) females and several medical co-morbidities (63% ASA class III and 24% ASA class IV). The rate of PJI was 5.8% (95% C.I., 3.1-10.5%). PJI was 2.3% for native compared to 6.9% for periprosthetic DFF (P = 0.45). The reoperation rate was 16.6% (95% C.I., 11.7-23.0%), and one-year mortality was 27% (95% C.I., 20-35%). Fifty-five percent of patients returned to their baseline function (95% C.I., 46.9-62.1%).</p><p><strong>Conclusions: </strong>DFR for native and periprosthetic DFF was associated with a PJI rate of 5.8%. The one-year mortality rate was 27.0%, and reoperation rate was 16.6%. Fifty-five percent of patients returned to their baseline function. DFR can be considered as an option in cases of complex native and periprosthetic DFF, though surgeons should continue to counsel patients on the considerable risks associated with DFR when assessing treatment options.</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":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic Neuropathy is an Independent Risk Factor for Poor Orthopedic Outcomes Following Operatively Treated Ankle Fractures.","authors":"Travis Kotzur, Blaire Peterson, Lindsey Peng, Cameron Atkinson, Aaron Singh, Travis Bullock, Ravi Karia, Case Martin","doi":"10.1097/BOT.0000000000003055","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003055","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the impact of diabetic neuropathy on operative bimalleolar or trimalleolar ankle fracture outcomes when compared with both non-diabetic and diabetic patients without neuropathy.</p><p><strong>Methods: </strong>Design: Retrospective comparative study.</p><p><strong>Setting: </strong>TriNetX research network, a global health-collaborative clinical research platform comprising de-identified electronic health records from healthcare organizations across the United States.</p><p><strong>Patient selection criteria: </strong>The TriNetX research network was queried for all patients with an operative bimalleolar or trimalleolar ankle fracture (OTA/AO 44) from 2005 to 2022. From this population, subgroups were formed based on diabetes status and the presence of diabetic neuropathy.</p><p><strong>Outcome measures and comparisons: </strong>Patients with diabetic neuropathy were compared to both non-diabetics and patients with diabetes. Propensity score matching (1:1) was performed to match patients based on demographics and comorbidities across groups, including severity of diabetes by A1C. Following matching, logistic regression was performed to calculate risk ratios and assess differences in postoperative medical and surgical complications between neuropathic and non-diabetic patients, as well as between neuropathic and diabetic patients.</p><p><strong>Results: </strong>Included were 115,162 ankle fracture patients; 94,111 (81.7%) patients without diabetes, 13,741 (12%) patients with diabetes but without diabetic neuropathy, and 7,310 (6.3%) patients with diabetic neuropathy. When compared to patients without diabetes, patients with diabetic neuropathy had increased risk of two-year malunion/nonunion (Risk ratio (RR) 1.79; p<0.001), implant infection (RR 2.12; p<0.001) and amputation (RR 8.01; p<0.001). When compared to patients with diabetes, but without neuropathy, patients with diabetic neuropathy again had significantly higher odds of implant failure (RR 2.00; p<0.001), malunion/nonunion (RR 2.35; p<0.001), and infection (RR 2.25; p<0.001).</p><p><strong>Conclusion: </strong>This study found that patients with diabetic neuropathy had higher odds of postoperative complications, such as malunion/nonunion, infection, and amputation, following surgical fixation of ankle fractures than non-diabetic patients and diabetic patients without neuropathy.</p><p><strong>Level of evidence: </strong>Level III; Retrospective Cohort Study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958171","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 on \"Elevated Risk of Infection and Reoperation in Low-Energy Gunshot Tibial Fractures: A Comparative Analysis\".","authors":"Alan Afsari, Benjamin Best, Usher Khan","doi":"10.1097/BOT.0000000000003057","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003057","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter Regarding \"Elevated Risk of Infection and Reoperation in Low-Energy Gunshot Tibial Fractures: A Comparative Analysis\".","authors":"Divya Jeyasingh, Niloofar Dehghan","doi":"10.1097/BOT.0000000000003058","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003058","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of an Early Showering Protocol Following Orthopaedic Trauma Surgery.","authors":"Robert E Bilodeau, Alona Katzir, Heather S Haeberle, Kathryn A Barth, Craig E Klinger, John E Zierenberg, Brian J Page, William M Ricci","doi":"10.1097/BOT.0000000000003056","DOIUrl":"10.1097/BOT.0000000000003056","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the clinical outcomes of a standardized postoperative protocol permitting removal of post-operative dressings, showering, and cleansing of incisional wounds three days following fracture surgery.</p><p><strong>Methods: </strong>Design: Retrospective Review.</p><p><strong>Setting: </strong>Tertiary orthopaedic center.</p><p><strong>Patient selection criteria: </strong>All adult patients, aged 18 years or older, operatively treated for fracture or other musculoskeletal trauma from September 2017 to September 2023 were screened for study eligibility. Patients with open fractures, revision surgery through surgical incisions created less than six weeks prior to the index procedure, immobilization (e.g., splints) precluding surgical wound access, known prior infection, acute traumatic local skin abrasions or lacerations, were excluded as these patients were not treated with the early showering protocol. Also excluded were patients with less than three-month follow up.</p><p><strong>Outcome measures and comparisons: </strong>Outcome measures were re-operation within three months for wound or infectious complications and superficial surgical site infection treated with oral antibiotics.</p><p><strong>Results: </strong>A total of 1,067 surgical cases were performed during the included time frame. 602 cases were excluded based on eligibility criteria, leaving 465 surgeries in 444 patients with a mean age of 59 years (range 18-95; 65% female). Mean follow-up was 11.7 months (SD 12.3; range 3.0-73.0). Re-operation for a wound or infectious complication occurred in 1.1% (5/465) of patients and superficial surgical site infection requiring antibiotic treatment occurred in an additional 1.1% of patients (5/465).</p><p><strong>Conclusions: </strong>A protocol of dressing removal and showering at three days post-operatively over acute uncomplicated surgical wounds was associated with re-operation for deep infection in 1.1% of patients and superficial infection in 1.1% of patients supporting the safety of an early showering protocol.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}