Journal of Orthopaedic Trauma最新文献

{"title":"Is the Orthopaedic Trauma Association-Open Fracture Classification Better Than the Gustilo-Anderson Classification at Predicting Fracture-Related Infections in the Tibia?","authors":"Philip Khoury, Nina Hazra, Anthony DeMartino, Kevina Birungi-Huff, Gerard P Slobogean, Robert V O'Toole, Nathan N O'Hara","doi":"10.1097/BOT.0000000000002907","DOIUrl":"10.1097/BOT.0000000000002907","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate and compare the predictive ability of the Orthopaedic Trauma Association-Open Fracture Classification (OTA-OFC) and the Gustilo-Anderson classification systems for fracture-related infections (FRI) in patients with open tibia fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged 16 years or older with an operatively treated open tibia fracture (OTA-AO 41, 42, and 43) between 2010 and 2021.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was FRI. The OTA-OFC and the Gustilo-Anderson classifications were compared in their ability to predict FRI.</p><p><strong>Results: </strong>Eight hundred ninety patients (mean age, 43 years [range, 17 to 96]; 75% men) with 912 open tibia fractures were included. In total, 142 (16%) had an infection. The OTA-OFC was not significantly better at predicting FRI than the Gustilo-Anderson classification (area under the curve, 0.66 vs. 0.66; P = 0.89). The Gustilo-Anderson classification was a stronger predictor of FRI than any single OTA-OFC domain, explaining 72% of FRI variance. Only the addition of the OTA-OFC wound contamination domain to Gustilo-Anderson significantly increased the variance explained (72% vs. 84%, P = 0.04). Embedded contamination increased the risk of FRI by approximately 10% as the risk of FRI with embedded contamination was 16% for type I or type IIs, 26% for type IIIAs, 45% for type IIIBs, and 46% for type IIICs.</p><p><strong>Conclusions: </strong>The more complex OTA-OFC system was not better than the Gustilo-Anderson classification system in predicting FRIs in patients with open tibia fractures. Adding embedded wound contamination to the Gustilo-Anderson classification system significantly improved its prognostic ability.</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":"655-660"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108449","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":"Pleural Space Management in Thoracic Trauma.","authors":"Erin E Devine, Joseph D Forrester","doi":"10.1097/BOT.0000000000002923","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002923","url":null,"abstract":"<p><strong>Summary: </strong>Thoracic injuries are common, occurring in up to 60% of polytrauma patients and represent 25% of trauma deaths. Thoracic trauma frequently involves injury to the pleural space resulting in hemothorax and pneumothorax-effective management of the pleural space is essential. Reviewed in this article is management of the pleural space in chest wall trauma (including pneumothorax and hemothorax), and chest tube placement, indications for video-assisted thoracoscopic surgery, management, and complications.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S27-S32"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983939","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":"Using an Intraoperative Stress Examination to Direct Treatment in Posterior Femoral Head Fracture-Dislocations.","authors":"David A Zuelzer, Lunden Ryan, Ryan Mayer, Tyler Pease, Stephen Warner, Jon Eastman, Raymond D Wright, Milton L C Routt","doi":"10.1097/BOT.0000000000002912","DOIUrl":"10.1097/BOT.0000000000002912","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the results of a treatment algorithm incorporating an examination under anesthesia (EUA) performed intraoperatively after fixation of the femoral head through a Smith-Petersen approach to determine the need for posterior wall or capsule repair.&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;Retrospective review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Two Level 1 trauma centers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;All acute, traumatic femoral head fractures from posterior hip dislocations treated at participating centers over a 5-year period from 2017 to 2022. Injuries were classified according to the Pipkin system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The primary outcome was the result of intraoperative EUA performed after femoral head fixation to determine the need for Kocher-Langenbeck exposure for posterior wall and/or capsule fixation. The secondary outcomes included rates of avascular necrosis, heterotopic bone formation, late instability, and conversion to total hip arthroplasty (THA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 63 men and 22 women with a mean age of 32.5 (range 18-71) years were studied. Seventy-nine of 85 (92.9%) patients had a stable EUA after fixation of the femoral head through a Smith-Petersen approach. Six (6/85, 7.1%) underwent an additional Kocher-Langenbeck approach for posterior wall or capsule fixation. This included 1 Pipkin I, 1 Pipkin II, and 4 Pipkin IV injuries. Of the Pipkin IV injuries, 51/55 (92.7%) had stable EUA and did not require fixation of their posterior wall. This included seven patients with wall involvement &gt;20%. Five patients were excluded because of planned fixation of their posterior wall based on preoperative imaging. Of patients with at least 6 months follow-up, 16 of 65 (26.4%) developed radiographic evidence of avascular necrosis and 21 of 65 (32.3%) evidence of heterotopic bone formation. Seven out of 65 (10.8%) were converted to THA over the study period. When comparing patients with a single exposure and those with additional KL exposure, it was found that they did not vary in their rate of avascular necrosis (27.1% vs. 0.0%, P = 0.3228), heterotopic ossification formation (30.5% vs. 50.0%, P = 0.3788), or conversion to THA (10.2% vs. 16.7%, P = 0.510).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study found residual posterior hip instability after femoral head fixation in patients with and without posterior wall fractures after posterior dislocations. The results of this study support the use of an EUA after femoral head fixation to identify residual posterior hip instability in all femoral head fractures from posterior hip dislocations, regardless of Pipkin type. Use of the Smith-Petersen exposure remains a viable surgical option and may be improved with the incorporation of an EUA after femoral head fixation. For Pipkin IV injuries with posterior wall fractures with indeterminate stability, an EUA acc","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"641-647"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108451","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":"Embracing a New Horizon in Orthopaedic Surgery: Chest Wall Injury and the Surgical Stabilization of Rib and Sternum Fractures.","authors":"Peter A Cole","doi":"10.1097/BOT.0000000000002916","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002916","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"Si"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983927","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":"Injury Patterns and Surgical Approaches.","authors":"Humza S Shaikh, Douglas R Haase","doi":"10.1097/BOT.0000000000002920","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002920","url":null,"abstract":"<p><strong>Summary: </strong>Effective management of bony and cartilaginous thoracic injury is a vital part of the care of the polytraumatized patient. Commonly because of high-energy accidents including motor vehicle collisions and falls, these patients routinely require multidisciplinary care and surgical intervention. As our understanding of unstable chest wall injuries and pulmonary sequelae of the injury grows, it is imperative that injury patterns and surgical approaches become familiar to the orthopaedic trauma-trained surgeon. Common rib fracture patterns and muscle-sparing surgical approaches are detailed, with the goal of restoring chest wall stability to improve the mechanics of respiration and pain control in these challenging patients.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S15-S20"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983933","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":"Discussion of Surgical Indications: The Black, White, and Gray.","authors":"David J Weatherby","doi":"10.1097/BOT.0000000000002918","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002918","url":null,"abstract":"<p><strong>Summary: </strong>Chest wall trauma is rapidly evolving and now represents a multidisciplinary field with incredible growth in research and surgical intervention; however, even with more than 800 publications on chest wall trauma to date, surgical indications are not black and white. Injury patterns need to be better defined and outcome measurements need to evolve for accurate longer term functional assessment of patients if this field of surgery is to move beyond historical indications for operative intervention. This essay will communicate what is known about operative indications in a way that stratifies the need for surgery.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12S","pages":"S7-S10"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983917","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":"Displaced Femoral Neck Fracture in a Young Patient: Should I Perform an Open Reduction?","authors":"Augustine M Saiz","doi":"10.1097/BOT.0000000000002894","DOIUrl":"10.1097/BOT.0000000000002894","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12","pages":"668-670"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915171","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":"Management of Femoral and Tibial Shaft Fractures in Patients With Chronic Spinal Cord Injury.","authors":"Andres Fidel Moreno-Diaz, Cade A Morris, Sarah Obudzinski, Patrick R Taylor, Marissa Pazik, Jaquelyn Kakalecik, Michael Talerico, Laura Lins, Gabrielle Kuhn, Paul Whiting, Andrew Chen, Andrew Farley Tyler, Phillip M Mitchell, William T Obremskey","doi":"10.1097/BOT.0000000000002902","DOIUrl":"10.1097/BOT.0000000000002902","url":null,"abstract":"<p><strong>Objectives: </strong>To compare outcomes and complications between nonoperative and operative management of femur and tibia fractures in patients with paraplegia or quadriplegia from chronic spinal cord injury (SCI).</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Three Level-1 Trauma centers.</p><p><strong>Patient selection criteria: </strong>All adult patients with paraplegia or quadriplegia due to a chronic SCI with operative or nonoperative treatment of a femoral or tibial shaft fracture from January 1, 2009 through December 31, 2019 were included.</p><p><strong>Outcome measures and comparisons: </strong>Outcomes collected included range of motion, pain, return to baseline activity, extent of malunion, and treatment complications (infection, pressure ulcers, nonunion, deep vein thrombosis/pulmonary emobolus, stroke, amputation, death). Comparison between operative and nonoperative treatment were made for each outcome.</p><p><strong>Results: </strong>Fifty-nine patients with acute lower extremity fracture in the setting of chronic SCI fulfilled inclusion criteria with a median age of 46 years in the operative group and 47 years in the nonoperative group. Twelve patients (70.6%) in the nonoperative group were male with 32 (76.2%) male patients in the operative group. Forty-six patients (78%) presented as low energy trauma. Differences were seen between operative and nonoperative management for pressure ulcers (19% vs. 52.9%, P = 0.009) and mean Visual Analog Scale pain score at first follow-up (1.19 vs. 3.3, P = 0.03). No difference was seen for rates of infection, nonunion, deep vein thrombosis/pulmonary emobolus, stroke, amputation, death, return to baseline activity, and range of motion.</p><p><strong>Conclusions: </strong>Tibial and femoral shaft fractures commonly resulted from low energy mechanisms in patients with chronic SCI. Operative treatment seemed to decrease morbidity in these patients via lowered rates of pressure ulcers and decreased pain compared with nonoperative management.</p><p><strong>Level of evidence: </strong>Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"592-595"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916994","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":"Pelvic Binder Radiography Is Safe and Feasible for Quantifying Fracture Instability in LC1 Pelvis Fractures: A Clinical Trial.","authors":"Joseph T Patterson, Andrew M Duong, Camille Flynn, Annabel Kim, Kenji Inaba, Sravanthi Reddy, Sarah R Blumenthal, Joshua L Gary","doi":"10.1097/BOT.0000000000002883","DOIUrl":"10.1097/BOT.0000000000002883","url":null,"abstract":"<p><strong>Objectives: </strong>To demonstrate fracture displacement, patient tolerance, and in-hospital safety quantifying lateral compression type 1 (LC1) pelvis fracture stability with awake stress radiography using a pelvic binder (PBR).</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Prospective clinical trial of PBR diagnostic intervention.</p><p><strong>Setting: </strong>Two centers, Level I trauma center and academic hospital.</p><p><strong>Patient selection criteria: </strong>Alert adults with LC1 (OTA/AO B1.1/2.1) pelvic fractures from blunt mechanism presenting within 3 weeks of injury between February and December 2023 without hypotension or injury precluding pelvic binder application.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was fracture displacement on PBR. Secondary outcomes included feasibility (≥85% patient tolerance) and safety (no major adverse events). Exploratory outcomes included pain during examination, opioid medication consumption within 96 hours, length of hospital stay, discharge destination, and correlation between fracture displacement on PBR and examination under anesthetic.</p><p><strong>Results: </strong>One hundred sixty-nine patients with pelvis fractures were screened, 58 were eligible, and 31 were enrolled. The mean age of enrolled patients was 58.7 ± 23 years, 54.8% were female, 22.6% were White, and 67.7% Hispanic. Fracture displacement was 4.3 ± 4.7 mm on PBR at 5 kg and 8.4 ± 9.0 mm at 10 kg. All patients tolerated PBR. Sixteen patients (52%) reported pain during PBR but completed the test. No patient experienced an adverse event. Patients received 40.4 ± 56.4 mg oral morphine equivalents within 96 hours of PBR. Ten patients (32.2%) received internal fixation. The median hospital stay was 6 days (interquartile range 5.5 days) with no inpatient mortality. Fourteen patients (45.2%) discharged home.</p><p><strong>Conclusions: </strong>PBR is feasible and safe as a point-of-care test for LC1 pelvis fracture instability.</p><p><strong>Level of evidence: </strong>Level II Diagnostic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 11S","pages":"S15-S22"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468182","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":"Ipsilateral Femoral Neck and Shaft Fractures: Complex Injuries With High Rates of Femoral Shaft Nonunion.","authors":"Douglas R Haase, Augustine M Saiz, Jonathan G Eastman, Timothy S Achor, Andrew M Choo, John W Munz, Stephen J Warner","doi":"10.1097/BOT.0000000000002886","DOIUrl":"10.1097/BOT.0000000000002886","url":null,"abstract":"<p><strong>Objective: </strong>To investigate nonunion rates and risk factors in patients with ipsilateral femoral neck and shaft fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective review.</p><p><strong>Setting: </strong>Two Level I trauma centers.</p><p><strong>Patient selection criteria: </strong>Two hundred seven patients treated for ipsilateral femoral neck (AO/OTA 31-B) and shaft (AO/OTA 32A-C) fractures from 2013 to 2022. Patients with less than 6 months of follow-up were excluded.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome of this study was femoral shaft nonunion. Risk factors for nonunion were evaluated, including smoking, open fracture, delay to full weight-bearing, blood transfusions, and AO/OTA classification.</p><p><strong>Results: </strong>Two hundred twenty-seven patients were initially identified, but only 154 patients had sufficient follow-up and were included in final analysis. The mean age was 38.9 years (SD = 15.3), and injury severity score was 19.5 (9.7). One hundred ten patients (71%) were male and 69 (45%) required intensive care unit care. Thirty-eight patients (25%) experienced an open fracture, and 44 fractures (29%) were AO/OTA Type C. Thirty patients (20%) underwent initial external fixation, and 88 patients (57%) received a perioperative transfusion. Thirty-four patients (22%) developed a femoral shaft nonunion, and 5 (3%) experienced a surgical site infection. Nonunion was associated with perioperative blood transfusion, AO/OTA Type C fracture, postoperative non-weight-bearing, and delay to full weight-bearing ≥12 weeks. Multivariable regression identified perioperative blood transfusion ≥3 (risk ratio [RR] = 1.91; CI, 1.12-2.72; P = 0.02) and AO/OTA Type C fracture (RR = 2.45; CI, 1.50-3.34; P = 0.001) as independent risk factors.</p><p><strong>Conclusions: </strong>Ipsilateral femoral neck and shaft fractures remain difficult injuries to treat. Much attention is given to diagnosis and treatment of the femoral neck component. These results suggest that successful treatment of the femoral shaft component presents its own challenges with high nonunion rates.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 11S","pages":"S48-S53"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468168","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}