Journal of Orthopaedic Trauma最新文献

{"title":"Primary Suture Closure of External Fixation Pin Sites After Removal Has a Lower Risk of Infection Compared to Pin Sites Left Open.","authors":"Molly Sekar, Jackson Woodrow, Lindsey Lamb, Tram Tran, John Thomas, Divya Jeyasingh, Burak Altintas, Michael McKee, Niloofar Dehghan","doi":"10.1097/BOT.0000000000003054","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003054","url":null,"abstract":"<p><strong>Objectives: </strong>To compare infection rates after external fixation removal, comparing pin sites that were primary closed compared to those left open to heal by secondary intention.</p><p><strong>Methods: </strong>Design: Retrospective review.</p><p><strong>Setting: </strong>Multi-center study.</p><p><strong>Patient selection criteria: </strong>All adult patients (18 years and older) who underwent removal of external fixator that was utilized for extremity fractures from 2007 to 2023 with at least 30 days follow up. Patients were stratified into two cohorts: 1) external fixator pin sites primarily closed after external fixator removal and 2) pin sites left open to heal with secondary intention after external fixator removal.</p><p><strong>Outcome measures and comparisons: </strong>Patient characteristics, fracture characteristics, and details of the external fixator removal surgery were recorded. Comparison of the rate of surgical site infection (SSI) of pin site after external fixation removal were performed between the two groups (pin sites that were closed primarily and those left open after external fixator removal).</p><p><strong>Results: </strong>A total of 412 patients were included, with a mean follow-up of 259 days. There were 254 patients in the closed pin site after pin removal group (mean age 53 years, range 18-95, 39% female) and 158 in the pin sites left open after pin removal group (mean age 54, range 18-93, 49.4% female). Median duration of external fixator in the closed group was 11 days, and 19 days in the open group (p<0.05). Multivariate analysis demonstrated increased odds of SSI of pin site after pin removal if the pin site was left open (OR=3.2; 95% CI: 1.44-7.19, p<0.01) and with tibial plateau fractures (OR=4.45; 95% CI: 1.92-10.32, p<0.001).</p><p><strong>Conclusion: </strong>After external fixation removal, closure of pin sites was associated with lower risk of pin site SSI after pin removal compared to leaving them open when external fixation duration was less than 2 weeks. External fixation is a common procedure, and this study can help change practice and decrease the risk of SSI of pin site after pin removal.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835408","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":"Modified Subvastus Approach to the Medial Distal Femur: Cadaveric Dissection.","authors":"Michael Trumbo, Bradley Carlson, Derran Bedward, Brian Schneiderman, Joseph Elsissy","doi":"10.1097/BOT.0000000000002990","DOIUrl":"10.1097/BOT.0000000000002990","url":null,"abstract":"<p><strong>Summary: </strong>This review describes a modified technique for the surgical management of a displaced medial femoral condyle fracture in a 22-year-old man after a motorcycle accident. This case involved an open reduction and the use of a medial buttress plate to restore joint congruity and reduce the risk of varus failure. The modified transfascial approach through the VMO muscle belly was used to facilitate ample exposure while safely protecting the neurovascular structures behind the robust adductor fascia. This technique highlights the utility and benefits of the modified transfascial approach compared with the traditional medial subvastus approach when used in medial distal femur fracture fixation.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S11-S12"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033585","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":"Percutaneous Plating of the Medial Distal Femur: Cadaveric Dissection.","authors":"Bradley Carlson, Michael Trumbo, Derran Bedward, Joseph Elsissy, Brian Schneiderman","doi":"10.1097/BOT.0000000000002989","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002989","url":null,"abstract":"<p><strong>Summary: </strong>Percutaneous medial plating of distal femur fractures, particularly comminuted fractures, offers improved biomechanical stability without the soft tissue insult of an open approach. The addition of a medial plate neutralizes the cantilever bending force that arises from the offset between the single lateral locking plate and the femur's anatomical axis. This cantilever bending force has been theorized to be a contributor to the high nonunion rate of distal femur fractures. Although concerns about the proximity of the superficial femoral artery have previously limited widespread adoption of medial plating, there is a considerable medial distal femur safe zone where the superficial femoral artery is not at risk. In cases where supplemental medial fixation would be beneficial and soft tissue or host limitations prevent open instrumentation, percutaneous medial plating is a safe and effective alternative.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S13-S14"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033415","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":"Open Reduction of a Posteriorly Locked Shoulder Dislocation: A Case Example.","authors":"Lea McDaniel, Midhat Patel, Paulo Castaneda, Michael D McKee","doi":"10.1097/BOT.0000000000002988","DOIUrl":"10.1097/BOT.0000000000002988","url":null,"abstract":"<p><strong>Summary: </strong>Posterior shoulder dislocations are uncommon but pose diagnostic and treatment challenges, particularly when locked due to humeral head impaction or soft tissue interference. These cases often necessitate surgical intervention, especially when locked or associated with recurrent instability or bony injuries. Preoperative assessment is vital to confirm the diagnosis and guide surgical planning. The surgical procedure begins with patient positioning and anesthesia, followed by a chosen approach, such as the deltopectoral route. In this case, exposure involved identifying and tenodesing the biceps tendon and performing a lesser tuberosity osteotomy. Reduction of the humeral head is achieved under direct visualization and confirmed with fluoroscopy. Stabilization is performed, and any associated lesions are addressed. Postoperative care involved immobilization and gradual rehabilitation. Consideration of patient age, chronicity, and associated bone loss helped dictate the appropriate intervention.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S3-S4"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033383","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":"Box-and-1 Suture Augmented Transosseous Patellar Tendon Repair.","authors":"Chirag Soni, Joash R Suryavanshi, Anthony Sorkin, Luke A Lopas","doi":"10.1097/BOT.0000000000002984","DOIUrl":"10.1097/BOT.0000000000002984","url":null,"abstract":"<p><strong>Summary: </strong>Patellar tendon ruptures resulting in extensor mechanism disruption are typically treated with surgical repair. This case involved a 53-year-old man with an acute right patellar tendon rupture sustained during a basketball game. This review describes the standard transosseous primary repair using Krackow sutures with a novel box-and-1 suture augmentation technique.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S17-S18"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033533","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":"Technical Trick: Coronoid Fracture \"Lasso\" Repair Using Arthroscopic Instrumentation in Terrible Triad Injuries With Fixable Radial Head Fractures.","authors":"Andrew S Bi, Carolyn Herbosa, Matthew V Abola, Sanjit R Konda, Jadie De Tolla, Abhishek Ganta","doi":"10.1097/BOT.0000000000002982","DOIUrl":"10.1097/BOT.0000000000002982","url":null,"abstract":"<p><strong>Summary: </strong>A single-stage operative repair of terrible triad injuries through a laterally-based approach using arthroscopic instrument-assisted reduction of the coronoid fracture in cases in which the radial head is deemed appropriate for repair rather than arthroplasty is described in this technical trick. Using an arthroscopic suture lasso, adjustable drill guides, cannulated guide-pins with nitinol shuttling wires, and a suspensory cortical button allow for a more precise and facile technique of \"lasso\" fixation of coronoid fractures and anterior capsular injuries with intact radial heads in terrible triad injuries.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S7-S8"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033469","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":"Minimally Invasive Plate Osteosynthesis for Scapular Fractures.","authors":"Korbinian Perl, Bryan J M van de Wall, Reto Babst, Frank J P Beeres","doi":"10.1097/BOT.0000000000002985","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002985","url":null,"abstract":"<p><strong>Summary: </strong>This procedure demonstrates a 65-year-old man who sustained an injury approximately 2 weeks ago with a displaced multifragmented intra- and extra-articular scapular fracture. It describes the technique of a minimally invasive approach and fixation with the use of mini fragment plating. Indications are a displaced extra-articular scapula body, glenoid neck, and intra-articular fracture of the glenoid. Intraoperative imaging confirms anatomic reduction and stable fixation. Follow-up shows a good functional outcome and return to normal daily life.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S5-S6"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033528","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":"Medial-Based Myofasciocutaneous Flap Above Knee Amputation.","authors":"Wei Wei Wu, Christopher Finkemeier","doi":"10.1097/BOT.0000000000002987","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002987","url":null,"abstract":"<p><strong>Summary: </strong>This is a case of a 62-year-old man with significant peripheral vascular disease who presented with chronic nonhealing full-thickness ulcerations along his right lower leg, now progressed to deep infection with systemic involvement. This review describes an above knee amputation with a medial-based myofasciocutaneous flap, which was chosen due to its dependency on the less-diseased vascular supply from the obturator artery. The anatomic dissection and myodesis technique are methodical and reproducible for all surgeons.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S15-S16"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033568","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 THA versus ORIF for Acetabular Fractures in Older Adults.","authors":"Priya Singh, Carolina Stocchi, Brocha Z Stern, Arthur Drouaud, Hulaimatu Jalloh, Jashvant Poeran, David Forsh","doi":"10.1097/BOT.0000000000003052","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003052","url":null,"abstract":"<p><strong>Objectives: </strong>To compare outcomes of total hip arthroplasty (THA) versus open reduction internal fixation (ORIF) for acetabular fractures in older adults using a large national database.</p><p><strong>Methods: </strong>Design: Retrospective cohort study using the Medicare Limited Data set.</p><p><strong>Setting: </strong>798 acute short-stay hospitals.</p><p><strong>Patient selection criteria: </strong>Fee-for-service Medicare beneficiaries aged 65+ who underwent inpatient ORIF or THA for acetabular fractures (OTA/AO 62) (without associated femoral fractures) from January 2013 to December 2020 were included.</p><p><strong>Outcome measures and comparisons: </strong>To minimize confounding, 1 THA patient was matched with up to 2 ORIF patients based on sociodemographic factors, comorbidities, and surgery year using a propensity score approach. Multivariable generalized linear models identified adjusted associations between surgery type and outcomes; adjusted odds ratios (ORs) or mean differences with 95% confidence intervals (CI) were reported.</p><p><strong>Results: </strong>Among 5,656 eligible procedures, the matched cohort included 2,879 patients (1,027 THA, mean age 78.6, 42.3% male; 1,852 ORIF, mean age 78.6, 42.4% male). THA (versus ORIF) patients had an increased odds of 30-day and 90-day hospital returns (30-day: OR=1.54, P<0.001; 90-day: OR=1.25, P=0.01) as well as 90-day and 1-year infection (90-day: OR=1.92, P<0.001; 1-year: OR=1.74, P<0.001). THA was also associated with higher odds of 90-day reoperation (OR=2.47, P<0.001) but not 1-year reoperation (OR=0.84, P=0.16). No significant associations were observed for hospital length of stay (P=0.42), discharge disposition (P=0.93), use of 90-day home health services (P=0.13), 90-day venous thromboembolism (P=0.75), or 1-year mortality (P=0.65).</p><p><strong>Conclusions: </strong>Patients who underwent THA for acetabular fractures were more likely to return to the hospital within 30 and 90 days post-surgery, have an infection in the year after surgery, and undergo a reoperation in the 90-day postoperative period compared to those who underwent ORIF. Further investigation of the mechanisms of the observed associations is necessary to understand which surgical approach provides optimal outcomes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784528","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":"Posterior Sternoclavicular Joint Dislocation and Reconstruction.","authors":"Charles C Lin, Allison Morgan, Michael Doran, Neha Jejurikar, Sehar Resad-Ferati, Danielle H Markus, Abhishek Ganta, Sanjit R Konda","doi":"10.1097/BOT.0000000000002986","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002986","url":null,"abstract":"<p><strong>Summary: </strong>This case presentation describes a technique for reconstruction of an acute posterior sternoclavicular joint dislocation. The patient was a 37 year-old female who sustained a left posterior sternoclavicular dislocation after a fall. A curvilinear incision was made directly over the sternoclavicular joint. After reduction, a semitendinosus allograft was used to reconstruct the sternoclavicular joint in a figure-of-8 fashion through drill holes in the manubrium and the proximal clavicle and secured with suture tape. Sternoclavicular reconstruction with semitendinosis allograft provides a reliable option with good clinical outcomes and low rates of recurrent instability.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 8S","pages":"S1-S2"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033515","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}