Journal of Orthopaedic Trauma最新文献

{"title":"What is the Surgical Burden of Treatment for High-Energy Lower Extremity Trauma? A Secondary Analysis of the OUTLET Study.","authors":"Christopher C Stewart, Lisa Reider, Rachel Soifer, Nikan K Namiri, Robert V O'Toole, Madhav A Karunakar, Benjamin K Potter, Michael Bosse, Saam Morshed","doi":"10.1097/BOT.0000000000002959","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002959","url":null,"abstract":"<p><strong>Objectives: </strong>To describe and enumerate surgeries for patients who underwent reconstruction or amputation after severe distal tibia, ankle, and mid to hindfoot injuries.</p><p><strong>Methods: </strong>Design: Secondary analysis of a multicenter prospective observational study.</p><p><strong>Setting: </strong>31 U.S. level-I trauma centers and 3 military treatment facilities.</p><p><strong>Patient selection criteria: </strong>Participants aged 18 to 60 with Gustilo type-III pilon (OTA 43B or 43C), IIIB or C ankle fracture (OTA 44A, 44B, or 44C), type-III talar or calcaneal fracture (OTA 81B, 82B, or 82C), or open or closed crush or blast injuries to the hindfoot or midfoot who underwent limb reconstruction or amputation from 2012 to 2017.</p><p><strong>Outcome measurements and comparisons: </strong>Number of temporizing, definitive, and complication surgeries were compared by treatment and injury.</p><p><strong>Results: </strong>574 participants with 221 ankle and pilon, 140 talus and calcaneal, and 213 other foot injuries were followed for 18 months. The mean age was 38 (range 8-64) and 33% were female. Participants underwent reconstruction (n=472), primary amputation (n=76), and failed reconstruction followed by amputation (n=26). 841 temporizing, 958 definitive, and 501 complication surgeries were performed. The number of surgeries was highest for those who underwent failed reconstruction (mean 5.8, 95% CI: 4.9-6.8, range 3-13) compared to reconstruction (mean 3.8, 95% CI: 3.5-4.0, range 1-21), and primary amputation (mean 4.9, 95% CI: 4.3-5.5, range 2-14) (p<0.01). Those with ankle and pilon injuries required more surgeries (4.7, 95% CI: 4.3-5.1, range 1-21) than hindfoot (3.4, 95% CI: 3.0-3.7, range 1-10), and other foot injuries (3.7, 95% CI: 3.4-4.0, range 1-14) (p<0.01). The average participant would complete definitive treatment 23 days after their injury, and those who required surgery for a complication spent 41 days in the complication phase of treatment.</p><p><strong>Conclusions: </strong>Patients with high-energy lower extremity trauma underwent nearly 4 surgeries over 3 weeks until completion of definitive treatment, regardless of whether they underwent limb reconstruction or amputation. Those with ankle or pilon injuries and failed reconstruction attempts experienced the most operations, and those with complications required over an additional month of surgical care. These data may inform a shared decision-making process around limb optimization.</p><p><strong>Level of evidence: </strong>Therapeutic Level II.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950516","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":"Increased Lag-Screw Slide and All-Cause Revision in a New-Generation Cephalomedullary Nail after Treatment of Geriatric Intertrochanteric Femoral Fractures.","authors":"M Kareem Shaath, Brendan Page, Bader A Nassir, Griffin Rechter, George J Haidukewych","doi":"10.1097/BOT.0000000000002961","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002961","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare lag-screw slide and revision surgery rate between two generations of the Stryker Gamma cephalomedullary nail (Stryker, Kalamazoo, MI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective chart review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single academic, Level-1 Trauma Center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;All geriatric patients (65-years and older) who underwent fixation of an intertrochanteric femoral fracture (AO/OTA type 31A1/2/3) by a single surgeon with the Stryker Gamma System from 2020-2024 with at least 3-month follow-up. The Gamma3 system was utilized until the Gamma4 became available in September 2022. Patients were grouped based on the implant utilized for fixation: Gamma3 (G3) or Gamma4 (G4) and sub-grouped based on the centrum-collum-diaphyseal (CCD) angle of the implant (125° versus 130°).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The main outcome was sliding of the lag screw. Slide distance was calculated from the difference between the screw position immediately post-operatively and at 6 and 12 weeks post-operatively. The secondary outcome variables were revision surgery for any reason, tip-apex distance (TAD), and reduction quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifty-one patients (40 female) with a mean age of 83 years (range 65-99) were in the G3 group compared to 46 patients (31 female) with a mean age of 79 years (range 65-96) in the G4 group. The average BMI of the G3 group was 24 kg/m2 (15-35 kg/m2) compared to 27 kg/m2 in the G4 group (17-41 kg/m2) (p = 0.004). There were no significant differences when comparing diabetes, smoking status, or mechanism of injury between groups (p&gt;0.05). There was no significant difference when comparing the average TAD between the G3 (10 mm) and G4 (9.5 mm) (p = 0.39). There was no significant difference in reduction quality between the G3 (46 good reductions) and the G4 (42 good reductions) groups (p = 0,85).At 6 weeks, the G4 (5 mm) had significantly greater lag screw slide compared to the G3 (3 mm) (p = 0.016). At 12 weeks, the G4 (7 mm) also had significantly greater lag screw slide when compared to the G3 (4 mm) (p = 0.004). There was no significant difference in lag screw slide for the 125° implant between the G3 and G4 groups at 6-weeks (3 mm versus 5 mm, p = 0.44) or 12 weeks (4mm versus 6 mm, p = 0.14). Regarding the 130° implant, the G4 had significantly greater slide compared to the G3 at both at 6-weeks (5 mm versus 3mm, p =0.03; 95% CI -6.07 to -0.41) and 12-weeks (8 mm versus 4 mm, p = 0.03; 95% CI -5.65 to -0.26). The G4 group had 7 revision procedures performed (3 lag screw exchanges for iliotibial band irritation and 4 revision arthroplasties for lag screw slide, fracture shortening, iliotibial band irritation, abductor malfunction, and leg length discrepancy) compared to 1 revision procedure (lag screw exchange for iliotibial band irritation) in the G3 group (p = 0.04).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950498","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":"Interdisciplinary Opportunities for Orthopaedic and Thoracic.","authors":"Thomas W White","doi":"10.1097/BOT.0000000000002924","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002924","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"Sii-Siii"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983937","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":"Best Available Outcomes Evidence Informing Standard of Care.","authors":"Shea Comadoll, Mai P Nguyen","doi":"10.1097/BOT.0000000000002917","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002917","url":null,"abstract":"<p><strong>Summary: </strong>Although nonoperative management is the mainstay for rib fracture treatment, surgical stabilization of rib fractures is becoming more common. Recently, the number of high-quality studies on management of rib fractures has also increased. The primary purpose of this review is to analyze the currently available prospective randomized studies on the management of rib fractures. In addition, we will summarize both short-term and long-term outcomes of patients with rib fractures.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S11-S14"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983914","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":"An Argument for Plate Utilization in Distal Femur Fractures.","authors":"Varun Gudapati, Christopher Lee","doi":"10.1097/BOT.0000000000002906","DOIUrl":"10.1097/BOT.0000000000002906","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12","pages":"670-672"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915166","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":"Rib and Sternum Nonunions: Diagnosis and Treatment and Awareness of Other Potential Posttraumatic Pathology.","authors":"Peter A Cole","doi":"10.1097/BOT.0000000000002922","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002922","url":null,"abstract":"<p><strong>Summary: </strong>As the operative management of acute, chest wall, skeletal injury escalates throughout the world, it has become commonplace for patients with posttraumatic conditions to present with clinical reconstructive challenges as well. In addition, it is becoming clear that rib nonunions are not rare, likely more than 5% of rib fractures. No subspecialty is better equipped to address such painful conditions than orthopaedic surgery. Likewise, there are a plethora of other posttraumatic problems that patients face, from intercostal neuralgia, pleural herniation, rib synostosis, and costal margin and sternal injuries that do not heal properly, which require treatment solutions. This emerging new field of surgery is optimized by an interdisciplinary approach, between general and orthopaedic trauma surgeons, and between thoracic, anesthesia, and rehabilitation specialists. This article emphasizes the workup and operative treatment of painful rib and sternal nonunions, in particular, and familiarizes the orthopaedist with other cold skeletal trauma in general. From the distinctive history and physical examination of the patient with a rib psuedoarthrosis to proper diagnostic studies, the surgeon is led through a principled approach to nonunion surgery, inclusive of autogenous graft harvest to provide both biologic and mechanical variables to bear in the successful treatment of this condition.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S33-S40"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983958","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":"Temporary Reduction Assisting Corridor Constraint Wires for Intramedullary Nailing of Periarticular Fractures: A Technical Trick and Case Series.","authors":"Ryan P Serbin, Calvin Chandler, Benjamin Averkamp, Madeline Rieker, Ziqing Yu, Laurence B Kempton, Joseph R Hsu, Kevin D Phelps","doi":"10.1097/BOT.0000000000002905","DOIUrl":"10.1097/BOT.0000000000002905","url":null,"abstract":"<p><strong>Summary: </strong>Achieving satisfactory alignment during intramedullary nailing of periarticular fractures can be technically challenging due to a combination of deforming forces and the lack of cortical contact by the nail in the articular segment metaphysis allowing malreduction to persist during nail passage. Although blocking screws are described to facilitate reduction, they risk impeding subsequent implant fixation. This article introduces an innovative Temporary Reduction Assisting Corridor Constraint Wires (TRACC-wires) technique to safely correct multiplanar deformities without limiting fixation options. A retrospective case series of 22 patients showed that TRACC-wires effectively facilitated anatomic alignment intraoperatively that was maintained after wire removal. Compared with other methods, advantages include (1) the ability to easily redirect, reposition, or remove (given instant access to the blocking device), (2) malleability of the wires during nail insertion, (3) small bony footprint, and (4) versatility for patient-specific correction. Outcomes support TRACC-wires as a valuable tool for trauma surgeons managing complex periarticular fractures.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"675-679"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348669","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":"Surgical Fixation of Flail Chest Injuries: Reduction and Fixation Options, Tips and Tricks.","authors":"Niloofar Dehghan, Benjamin C Taylor","doi":"10.1097/BOT.0000000000002921","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002921","url":null,"abstract":"<p><strong>Summary: </strong>Modern techniques of rib fracture fixation surgery follow the AO principles of fracture reduction, fixation, and appropriate soft tissue handling. Fixation techniques can be performed using anatomic reduction and rigid fixation, or bridge plate fixation for comminuted fractures. Anatomic and nonanatomic plates can be used, although titanium precontoured locking plates are the most commonly used. Other contemporary intra- and extramedullary fixation strategies have also been developed. Intrathoracic fixation is a novel technique, however, limited literature on clinical outcomes currently exists. This article discusses techniques of reduction, fixation, and tips and tricks for surgical fixation of rib fractures.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S21-S26"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983963","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":"Anatomy of the Ribs, Sternum, and Costal Margin.","authors":"Douglas R Haase, Humza S Shaikh","doi":"10.1097/BOT.0000000000002919","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002919","url":null,"abstract":"<p><strong>Summary: </strong>The ribs, sternum, and costal margin provide a rigid, but flexible chest wall that functions to provide protection to the vital cardiothoracic organs, while also allowing for varying levels of respiration based on physiologic need. The latter function is accomplished through various muscular attachments and rib articulations with both the axial spine posteriorly and the sternum anteriorly. The accessory muscles of inspiration rely on the downward slope and outward curve of each rib, which when contracted move the ribs upward and outward, in turn forcing the sternum anterior and increasing the thoracic volume. Ribs are also classified as true, false, or floating based on their attachment anteriorly to the costal cartilage and sternum. Ribs 1-7 are considered true ribs as their costal cartilage directly articulates with the manubrium and sternum. Ribs 8-10 are considered false ribs because their costal cartilage connects to the cartilage of the immediately superior rib instead of the sternum itself. This complex cartilaginous structure is referred to as the costal margin, which provides attachments for the diaphragm and various abdominal muscles. Although historically thought to be a consistent structure, its variable nature has recently been defined in cadaveric studies. Ribs 11 and 12 are considered floating ribs because they have rudimentary cartilage caps and are not attached to the sternum at all. The sternum comprises the manubrium, body, and xiphoid process. Each component has differing mobility, muscle attachment, and function.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S1-S6"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983911","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":"Out With the Old and in With the New: \"Flexible\" Syndesmotic Fixation.","authors":"Jan P Szatkowski","doi":"10.1097/BOT.0000000000002896","DOIUrl":"10.1097/BOT.0000000000002896","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12","pages":"672-674"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915128","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}