Journal of Orthopaedic Trauma最新文献

{"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}

{"title":"Outcomes of early vs delayed medial malleolar fixation in the treatment of open ankle fractures.","authors":"Isaiah X Hughes, Daniel R Baka, Branden J Wright, John E Dibato, Pietro M Gentile, Rock Hwang, Kenneth W Graf, Rakesh P Mashru, Henry J Dolch","doi":"10.1097/BOT.0000000000003280","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003280","url":null,"abstract":"<p><strong>Objective: </strong>To investigate outcomes after early versus delayed fixation of clean open ankle fractures involving the medial malleolus.</p><p><strong>Methods: </strong>Design: Retrospective review.</p><p><strong>Setting: </strong>Single-center academic Level I trauma center.</p><p><strong>Patient selection criteria: </strong>Patients undergoing open reduction and internal fixation from November 2016 to July 2024 for an open ankle fracture involving the medial malleolus (AO/OTA A2-C3).</p><p><strong>Outcome measures and comparisons: </strong>Infection rate, length of stay, number of operations, and return to the operating room were compared between early and delayed fixation groups.</p><p><strong>Results: </strong>The early fixation group consisted of 55 patients (67% female; mean age 55.8 ± 21.1 years), while the delayed fixation group consisted of 44 patients (68% female; mean age 57.5 ± 15.9 years). Infection rates were 22% in the early group and 9% in the delayed group (p=0.09). Early, compared to delayed, fixation was associated with a shorter length of stay (7.8 vs. 12.8 days; p=0.0004), lower external fixation rate (11% vs 82%) and fewer operations (1.3 vs. 2.4; p<0.0001). Wound care was initiated more frequently in the early fixation group (56% vs 27%; p=0.0037). However, there were no statistically significant differences in union rates, antibiotic use, time to full weight bearing, pain scores, or symptomatic nonunion (P>0.05). A post hoc analysis excluding isolated medial malleolus fractures demonstrated a higher infection rate in the early fixation cohort (22% vs 7%; p=0.0487).</p><p><strong>Conclusion: </strong>Early fixation was associated with a higher observed infection rate, particularly in bimalleolar and trimalleolar fractures, although this difference did not reach statistical significance in the overall cohort. Early fixation may be appropriate in select cases to reduce hospital resource utilization. However, surgeons should use caution when considering early fixation of higher energy injuries such as open bimalleolar and trimalleolar ankle fractures.</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":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990285","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":"Antibiotic-Impregnated Bone Grafts in the Masquelet Technique Reduce the Risk of Persistent Infection at Early Follow-up.","authors":"Loïc Fonkoue, Sylvain Wembou, Kennedy Muluem, Cedric Mayopa, Freddy Bombah, Olivier Ngongang, Elvis Antibe, Gaspary Fodjeu, Jean Bahebeck, Olivier Cornu","doi":"10.1097/BOT.0000000000003281","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003281","url":null,"abstract":"<p><strong>Objectives: </strong>To compare antibiotic-impregnated composite bone grafts (AIBG) with the standard autologous cancellous bone graft for reconstruction of infected segmental bone defects (ISBD) using the induced membrane technique (IMT).</p><p><strong>Design: </strong>Retrospective study of prospectively collected data.</p><p><strong>Setting: </strong>Four tertiary care hospitals in Cameroon.</p><p><strong>Patient selection criteria: </strong>All adult patients with ISBD treated with the IMT between January 1, 2020, and June 30, 2024, were included. At the second stage, bone reconstruction was performed using an autologous cancellous bone graft (standard group, 2020-2022) or a handmade antibiotic-impregnated composite bone graft (AIBG group, 2023-2024), corresponding to two consecutive time periods.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcomes were bone union and infection recurrence. Outcomes were compared between the AIBG group and the standard group. Subgroup analyses compared outcomes according to culture status at stage 2 and treatment group.</p><p><strong>Results: </strong>Forty patients were included, with 13 in the AIBG group (84.6% male; mean age 38.7 ± 19.9 years) and 27 in the standard group (70.4% male; mean age 39.9 ± 16.6 years). Mean follow-up was 20.7 ± 12.1 months. Bone union was achieved in 92.3% (12/13) of the AIBG group and 85.2% (23/27) of the standard group (p = 0.52). Recurrent infection occurred in 7.7% (1/13) of the AIBG group and 29.6% (8/27) of the standard group (p = 0.22). Twelve patients (30.0%) had positive cultures at stage 2. Positive cultures at stage 2 were associated with a higher risk of treatment failure (nonunion or infection recurrence) compared with culture-negative patients (66.7% vs 14.3%, p = 0.002; OR = 12.9, 95% CI [2.4-59.4]). Among culture-positive patients, infection recurrence occurred in 75.0% (6/8) of the standard group and 0.0% (0/4) of the AIBG group (p = 0.01). Bone union without infection recurrence occurred in 75.0% (3/4) of the AIBG group and 12.5% (1/8) of the standard group (p = 0.03).</p><p><strong>Conclusion: </strong>In patients with persistent positive cultures at the second stage (bone grafting) of the induced membrane technique, antibiotic-impregnated composite bone grafts were associated with lower infection recurrence and higher rates of bone union without infection recurrence.</p><p><strong>Level of evidence: </strong>Therapeutic Level II.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990291","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 Influence of Multiple Doses of Intravenous Tranexamic Acid on Transfusions and Complications in the Treatment of Fragility Hip Fractures.","authors":"Stephen Davis, Matthew J Solomito, Caitlin McCracken, Mandeep Kumar","doi":"10.1097/BOT.0000000000003274","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003274","url":null,"abstract":"<p><strong>Objective: </strong>To determine the association between multiple intravenous tranexamic acid (TXA) doses and blood transfusions and complication rates in patient treated for fragility hip fractures.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single Level I trauma center.</p><p><strong>Patients/participants: </strong>Patients that were at least 50 years old and treated for a fragility fracture of the femoral neck (OTA31B), intertrochanteric (OTA31A1/A2), or subtrochanteric (OTA31A3) aspect of the femur between January 2018 and January 2024 were included .</p><p><strong>Intervention: </strong>TXA dosing (i.e. none, single dose, multiple doses) based on institutional protocols. TXA dosing was not based on intra-operative blood loss.</p><p><strong>Main outcomes: </strong>The primary outcomes were post-operative blood transfusions, venous thromboembolism (VTE), surgical site infections (SSI), and death within one year of surgery compared among the study groups (patients that received no TXA, a single dose, or multiple doses).</p><p><strong>Results: </strong>A total of 1,691 patients (632 patients [average age 81.4 (53 to 104), 71.8% female] did not receive TXA, 551 [average age 79.9 (51 to 102), 72.4% female] received a single TXA dose, 508 [average age 79.2 (51 to 100), 70.3% female] received multiple TXA doses). Surgical time did not differ between groups (no TXA: 72.6 ± 30.9 minutes, single dose: 74.9 ±32.9 minutes, and multiple doses: 70.6 ± 32.3 minutes, p=0.073). TXA use significantly reduced the risk of blood transfusion compared to the no TXA group (no TXA: 31.8%, single dose: 15.9%, multidose 14.2%, p<0.001). There were no significant differences in transfusion rates with two, three and four doses of TXA compared to the single dose group (single dose: 15.9%, two doses: 15.3% three doses 13.6% and four doses 13.1%, p=0.791). The frequency of VTE was the lowest in the single dose group compared to the other study groups (no TXA: 2.7%, single dose: 0.9%, multiple dose 2.7%, p=0.040). There was no difference in death rates among study groups (no TXA: 9.3%, single dose: 7.3%, multiple dose 8.5%, p=0.433).</p><p><strong>Conclusion: </strong>Intravenous tranexamic acid (TXA) reduced transfusion needs without an increased complication rate in comparison to not using TXA. Regression analysis demonstrated that three and four doses of TXA did significantly reduce the transfusion rate beyond a single dose of TXA, but did not provide significant reduction beyond two-doses.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Resilience with Clinical and Patient-Reported Outcomes Following Operative Fixation of Pilon Fractures.","authors":"Robin M Litten, Ryan N McIlwain, Alexis N Alders, Shaheryar Asad, Clay A Spitler, Michael D Johnson, Joey P Johnson","doi":"10.1097/BOT.0000000000003275","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003275","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between resilience, as measured by the Brief Resilience Scale (BRS), and both clinical and patient-reported outcomes (PROs) following operative fixation of pilon fractures.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Single Level I trauma center.</p><p><strong>Patient selection criteria: </strong>Adult patients (≥18 years) with AO/OTA 43 pilon fractures treated operatively between 2022 and 2026 were included. Patients without postoperative PROs or a 6-month BRS were excluded. Patients were stratified by median 6-month BRS into low (<3.67) and high (≥3.67) resilience groups.</p><p><strong>Outcome measures and comparisons: </strong>Patient-Reported Outcomes Measurement Information System domains (global physical health [GPH], global mental health [GMH], physical function [PF], pain interference [PI], depression, anxiety) and percent of normal function at multiple postoperative timepoints (6 weeks, 3 months, 6 months, 1 year, 2 years). Clinical outcomes included reoperation, fracture-related infection, nonunion, and amputation. Outcomes were compared between resilience groups.</p><p><strong>Results: </strong>A total of 105 patients were included (low resilience: n = 48; high resilience: n = 57). Low- and high-resilience groups were similar in age (46.7 [range, 20.0-76.9] vs 51.6 years [range: 18.5-88.7], respectively), BMI (29.6 vs 30.7 kg/m2, respectively), sex (52.1% vs 42.1% male respectively), and race (60.4% vs 73.7% White, respectively), although patients in the low-resilience group demonstrated higher ISS (15.8 vs 9.8, p < 0.001). Compared with the low-resilience group, the high-resilience group demonstrated higher GMH at all timepoints (all p ≤ 0.021), while depression and anxiety scores were lower at 6 weeks, 3 months, and 6 months (all p ≤ 0.019). Compared with the low-resilience group, the high-resilience group also demonstrated higher GPH and PF scores and lower PI scores at 3 and 6 months (all p ≤ 0.045), as well as higher percent of normal function at 6 months (51.7% vs 40.5%, p = 0.040).</p><p><strong>Conclusion: </strong>Higher resilience was associated with improved PROs following operative fixation of pilon fractures, with differences observed early and persisting over time. Resilience represents an important patient-specific factor associated with recovery and may provide additional context when interpreting postoperative outcomes.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919860","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":"10.1097/BOT.0000000000003203","url":null,"abstract":"<p><strong>Objectives: </strong>To report the prevalence of adverse mental health outcomes 1 year after severe open tibial shaft fractures and their association with treatment and complication risk factors.</p><p><strong>Methods: </strong>.</p><p><strong>Design: </strong>Randomized controlled trial.</p><p><strong>Setting: </strong>Multicenter.</p><p><strong>Patient selection criteria: </strong>Eligible patients were 18-64 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 scores for depression symptoms, posttraumatic stress disorder (PTSD) Checklist for DSM-IV (PCL-S), and the Brief Pain Inventory. Primary comparisons assessed depression, PTSD, and pain between treatment groups (modern external ring fixation vs. internal fixation).</p><p><strong>Results: </strong>A total of 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 Patient Health Questionnaire-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 (eg, 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 postinjury (RR: 0.53 [0.38-0.74]), both P < 0.05. Fixation modality (external ring fixation vs. 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 sequelae and moderate to severe pain were common 1 year after sustaining a severe open tibial shaft fracture. Adverse mental health outcomes and pain were not influenced by fixation modality (external ring fixation vs. internal fixation).</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":"466-472"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","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":"Comparative Efficacy of Anterior MIPO With PHILOS Versus Posterior ORIF With EA-LCP in Distal-Third Humerus Fractures: A Randomized Controlled Trial.","authors":"Siva S Garika, Pashupati Yadav, Nitish J Jyoti, Hemant Bansal, Samarth Mittal, Vivek Trikha, Vijay Sharma","doi":"10.1097/BOT.0000000000003200","DOIUrl":"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 in an upside-down reverse configuration with conventional posterior open reduction and internal fixation (ORIF) using extra-articular locking compression plate for the treatment of extra-articular distal-third humeral shaft fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;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, University of California-Los Angeles shoulder rating scale), and elbow range-of-motion were assessed and compared at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Operative time, intraoperative blood loss, radiation exposure, postoperative pain (visual analog scale 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). The 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 men and 3 women in the MIPO group and 11 men and 5 women in the ORIF group, P = 0.68. The mean time to radiological union was shorter in the MIPO group (16.3 ± 1.3 weeks) compared with the ORIF group (18.1 ± 1.2 weeks, P = 0.001). Operative time was shorter in the MIPO group (78.9 ± 24.4 minutes vs. 112.6 ± 42.0 minutes, P = 0.013), intraoperative blood loss was lower (182.1 ± 137.4 mL vs. 328.1 ± 96.8 mL, P = 0.002), and immediate postoperative pain on day 2 was lower (visual analog scale, 7 ± 0.5 vs. 8 ± 0.6, P &lt; 0.001). Functional outcomes showed no statistically significant differences between groups at 6 months (Mayo Elbow Performance Score: 100 vs. 100 P = 1.000; University of California-Los Angeles: 33.8 ± 0.3 vs. 33.7 ± 0.4, P = 0.636), with no statistically significant difference in elbow range-of-motion (137.8 ± 2.5 degrees vs. 135.4 ± 3.0 degrees, 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). Postoperative 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 proximal humerus internal locking system was associated with shorter time to radiological union, lower intraoperative morbidity, and no statistically significant differences in functional outcomes compar","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"482-491"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","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}

{"title":"Infection Rate by Gustilo-Anderson Classification in Open Tibial Shaft Fractures Treated With an Intramedullary Nail-A Meta-Analysis.","authors":"Janse T Schermerhorn, Patrick J McGlone, Arissa M Torrie, Anthony R Carlini, Renan C Castillo, Bijan Abar, Stephanie Hendren, Benjamin R Wesorick, Alex V Helbling, Yiqiu Zhang, Tara K Mann, Cambre Kelly, Robert V O'Toole","doi":"10.1097/BOT.0000000000003199","DOIUrl":"10.1097/BOT.0000000000003199","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify deep surgical site infection (SSI) rates after intramedullary nailing of open tibial shaft fractures stratified by Gustilo-Anderson (G-A) classification.</p><p><strong>Methods: </strong></p><p><strong>Data sources: </strong>A systematic review of MEDLINE, Embase, and Scopus screened for English language studies published from January 2000 through May 2025 in accordance with PRISMA guidelines.</p><p><strong>Study selection: </strong>Studies included skeletally mature patients with open tibial shaft fractures (OTA/AO 42) treated with locked intramedullary nailing and reporting deep SSI rates by G-A type.</p><p><strong>Data extraction: </strong>Two independent reviewers screened studies and extracted data, with conflicts resolved through consensus or adjudication by a third independent reviewer.</p><p><strong>Data synthesis: </strong>A single-arm meta-analysis was performed to estimate pooled infection rates using fixed-effects and random-effects models, with between-study heterogeneity assessed using Cochran Q and the I2 statistic.</p><p><strong>Results: </strong>Seventeen studies composed of 2063 total patients met inclusion criteria. The overall pooled deep SSI rate was 13.2% [95% confidence interval (CI), 11.8%-14.8%]. Stratified pooled infection rates were 6.2% (95% CI, 3.7%-10.3%) for G-A type I, 7.6% (95% CI, 5.6%-10.1%) for type II, 11.9% (95% CI, 9.5%-14.6%) for type IIIA, 25.0% (95% CI, 18.6%-32.6%) for type IIIB, and 41.8% (95% CI, 21.3%-65.5%) for type IIIC fractures. Subgroup analysis demonstrated a significant difference in pooled deep SSI rates across G-A fracture classifications (Q = 104.85, df = 4, P < 0.001), indicating substantial heterogeneity attributable to fracture severity. Between-study heterogeneity was low across most analyses, with moderate heterogeneity observed for type IIIB fractures (I 2 = 50.7%), indicating increased variability in this subgroup.</p><p><strong>Conclusions: </strong>Deep SSI rates after intramedullary nailing of open tibial shaft fractures increased with G-A severity. High-grade injuries, particularly G-A types IIIB and IIIC, remain associated with substantial fracture-related infection risk.</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":"459-465"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774471","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":"Effect of Perioperative Tranexamic Acid on Blood Loss in Posterior Acetabular Fracture Fixation.","authors":"Matthew T Yeager, Robert W Rutz, Joseph K Dekle, Doriann M Alcaide, Robin M Litten, Ryan N McIlwain, Margaret M Fisher, Travis A Fortin, Jonathan D Ellis, Joey P Johnson, Clay A Spitler","doi":"10.1097/BOT.0000000000003267","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003267","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of perioperative intravenous (IV) tranexamic acid (TXA) on total blood loss (TBL) and transfusion requirements in patients who underwent acetabular fracture fixation (AO/OTA 62) via a posterior surgical approach. The authors hypothesized that patients who received perioperative IV TXA would demonstrate lower TBL compared with those who did not receive perioperative TXA.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Single Level I trauma center (2010-2023).</p><p><strong>Patient selection criteria: </strong>Adult patients who underwent acetabular fracture (AO/OTA 62) fixation through a posterior surgical approach from 2010 to 2023.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was TBL among patients receiving perioperative TXA versus no TXA. Secondary outcomes were hospital length of stay (LOS), postoperative hemoglobin at 24 and 48 hours, and transfusion requirements.</p><p><strong>Results: </strong>A total of 591 patients met inclusion criteria, of which 186 (31.5%) received perioperative IV TXA and 405 (68.5%) did not. The TXA group had a mean age of 39.7 years (range, 18-80 years) and included 123 male patients (66.1%), while the no-TXA group had a mean age of 38.6 years (range, 18-89 years) and included 273 male patients (67.4%). Age (p = 0.396) and BMI (p = 0.489) did not differ between groups. The TXA group demonstrated a higher rate of protrusio (9.7% vs. 4.4%, p = 0.016) but lower rates of intraarticular fragments (34.9% vs. 47.2%, p = 0.006) and wall comminution (41.4% vs. 51.4%, p = 0.027). On unadjusted analysis, patients receiving TXA demonstrated shorter operative duration (171.4 vs 188.5 minutes, p = 0.036), whereas calculated TBL did not differ between groups (p = 0.600). On multivariable regression, perioperative TXA use was not independently associated with calculated TBL (β = 32.5 mL; 95% CI, -123.2 to 188.2; p = 0.682). There were no differences in perioperative hemoglobin values (all p ≥ 0.063), intraoperative or postoperative transfusion requirements (all p ≥ 0.493), hospital LOS (p = 0.750), or postoperative complications, including thromboembolic events, fracture-related infection, heterotopic ossification, or all-cause mortality (all p ≥ 0.381).</p><p><strong>Conclusion: </strong>Perioperative IV TXA use was not independently associated with calculated TBL following posterior approach acetabular fracture fixation. Instead, longer operative duration and fracture-related characteristics were independently associated with greater TBL. TXA use was also not associated with differences in transfusion requirements or short-term postoperative outcomes.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808564","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":"Fixation of Zone 2 Sacral Fractures Utilizing a Novel Compressive Bolt - A Biomechanical Comparison.","authors":"Devin L Froerer, Sebastion Jenson, Colin S Gregersen, Chukwuebuka Achebe, Justin Haller","doi":"10.1097/BOT.0000000000003266","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003266","url":null,"abstract":"<p><strong>Objectives: </strong>To compare a novel bicortical compression bolt to standard partially threaded transiliac-transsacral cannulated screws for fixation of Denis zone 2 sacral fractures in a biomechanical model. The hypothesis was that the compression bolt would demonstrate greater resistance to deforming forces, with less rotational displacement and reduced fracture gap formation.</p><p><strong>Methods: </strong>Twelve standardized Sawbones pelvic models with zone 2 sacral fractures and ipsilateral superior and inferior pubic ramus fractures were randomized to cannulated screw (n=6) or compression bolt (n=6) fixation at S1 and S2. Both transiliac-transsacral constructs were placed with washers and tightened to a target of 1.13 N-m. Custom 3D-printed cutting jigs ensured identical fracture creation and implant placement across specimens. Models underwent cyclic loading to 250 N in a single-leg stance configuration for 10,000 cycles. Infrared optical tracking quantified rotational displacement in three planes and fracture gap formation. Construct completion rates, sacral fracture gap formation, rotational displacement in the sagittal, transverse, and coronal planes, and variance heterogeneity were compared between groups.</p><p><strong>Results: </strong>Five of six cannulated screw constructs completed testing versus all six compression bolt constructs; the single screw failure resulted from S1 implant backout with synthetic-bone fracture at 6,277 cycles. At 10,000 cycles, the cannulated screw group demonstrated significantly greater sacral gap widening (3.5 mm vs. 0.6 mm, p=0.008) and rotational displacement in the sagittal (15.9° vs. 3.6°, p=0.002) and coronal planes (2.1° vs. 0.3°, p=0.018). The compression bolt group exhibited 51-fold less variance in fracture gap formation (95% CI: 4.3-382.1, p<0.001).</p><p><strong>Conclusion: </strong>In this synthetic biomechanical model of Denis zone 2 sacral fractures, compression bolts demonstrated greater resistance to sagittal and coronal deforming forces compared to cannulated screws, with significantly less fracture gap formation and greater fixation reliability. Bicortical fixation with adjustable compression represents an alternative approach for zone 2 sacral fracture stabilization.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808567","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}