Journal of Orthopaedic Trauma最新文献

{"title":"Cementotomy-Assisted Masquelet Technique: A Novel Method for Efficient Cement Extraction in Distal Femur Bone Defect Management.","authors":"Asif Imran, Agraharam Devendra, Purnaganapathi Sundaram Velmurugesan, Perumal Ramesh, Zackariya Mohamed, Sp Sivakumar, Jayaramaraju Dheenadhayalan, Shanmuganathan Rajasekaran","doi":"10.1097/BOT.0000000000003011","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003011","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029817","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":"Preservation versus Sacrifice of the Supraclavicular Nerves during Clavicle ORIF: A Randomized Controlled Trial.","authors":"Indraneel S Brahme, Geneva Tranchida, Jeffrey D Winter, Gaonhia Y Moua, Patrick Horrigan, Brian Cunningham, Peter A Cole","doi":"10.1097/BOT.0000000000003013","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003013","url":null,"abstract":"<p><strong>Objectives: </strong>To discover postoperative symptom differences between nerve-sparing and nerve-sacrificing techniques during ORIF of clavicle fractures.</p><p><strong>Methods: </strong>Design: Prospective, partially blinded randomized controlled trial.</p><p><strong>Setting: </strong>Single academic Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients with closed, isolated, displaced, midshaft clavicle fractures (OTA/AO 15-2A, -2B, -2C) underwent ORIF and were consented and randomized to a \"nerve-sacrificing\" or \"nerve-sparing\" group.</p><p><strong>Outcome measures and comparisons: </strong>Semmes-Weinstein monofilament used to test for sensation changes around the supraclavicular area, single assessment numerical evaluation (SANE) scores and symptom severity level (SSL) providing patient self-reported changes, and patient morbidity questionnaires were issued at follow-up. One trained research fellow measured and mapped area of anesthesia. Outcomes between \"nerve-sacrificing\" and \"nerve-sparing\" groups were compared.</p><p><strong>Results: </strong>21 patients (median age 41.5, 28.6% female) were randomized to \"nerve-sacrificed\" and 16 (median age 45.6, 18.8% female) to the \"nerve-spared\" group. There were no statistical differences in age or gender ratio (p=0.304 and 0.702 respectively). Longitudinal models including an interaction between group and time, showed cohort differences being driven by 12-weeks (49.3 (95% CLM 7.68, 90.92)) and 24-weeks (23.92 (95%CLM 1.70, 46.14)). While point estimates for the spare group were still lower at 2- and 52-weeks, they were not significantly different between groups. SANE scores and SSL data showed improvements in both cohorts over time, however; there were no statistically significant differences between the groups (p=0.176 and 0.155, respectively).</p><p><strong>Conclusions: </strong>Sparing the supraclavicular nerve during open reduction and internal fixation of clavicle fractures significantly decreased chest-wall area of anesthesia at 12- and 24-weeks postoperatively. However, nerve sparing did not provide clinically significant differences in other symptoms compared to sacrificing the nerve.</p><p><strong>Level of evidence: </strong>Level I, Therapeutic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022976","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":"Periprosthetic Fracture Rate in Elderly Patients Undergoing Hip Hemiarthroplasty: A Comparison of Fit-and-Fill, Tapered-Wedge, and Cemented Stems.","authors":"Michael J DeRogatis, Neil Jain, Robert Gomez, Margaret J Higgins, Jeremy A Dubin, Paul S Issack, Douglas Lundy","doi":"10.1097/BOT.0000000000003012","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003012","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the periprosthetic fracture rates of three stem designs: cemented, press-fit fit-and-fill, and tapered wedge for hemiarthroplasty in geriatric patients with femoral neck fractures.</p><p><strong>Methods: </strong>Design: Retrospective review.</p><p><strong>Setting: </strong>Two institutions, including one level I trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged 70 years or older with a displaced femoral neck fracture (OTA/AO 31B) treated with press-fit or cemented hemiarthroplasty were included. Patients treated with total hip arthroplasty, conversion procedures, concomitant acetabular fracture, and pathologic fractures were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Rates of intraoperative and postoperative periprosthetic femur fracture (PFF), 30-day and 1-year mortality, operative time, length of stay, and rate of reoperation were compared between stem subtypes.</p><p><strong>Results: </strong>A total of 758 consecutive patients (404 tapered wedge, 227 fit-and-fill, and 127 cemented) were included. The mean follow-up was 10.1±14.1, 13.0±16.6, 6.8±10.9 months, for tapered wedge, fit-and-fill, and cemented stems, respectively. Tapered wedge stems had an average age of 83.6 years (range 70-100) with 29.2% male; fit-and-fill stems had an average age of 84.3 years (70-102) with 34.8% male; and cemented stems had an average age of 84.1 years (range 70-100) with 26.0% male. 56 (41 intraoperative and 15 postoperative) PFFs were identified. The rate of PFF between tapered wedge (9.4%), fit-and-fill (4.8%), and cemented stems (5.5%) differed significantly (P = 0.01). Fit-and-fill implants had a lower rate of PFF than tapered wedge implants (P = 0.04) and were equivalent to cemented fixation (P = 0.78). Among intraoperative PFFs, tapered wedge stems had a significantly higher calcar fracture rate than fit-and-fill (P = 0.03) and cemented (P = 0.02) stems. Use of fit-and-fill stems did not result in a higher rate of intraoperative calcar fracture than cemented stems (P = 0.85). Postoperative PFF reoperation rates did not reach statistical significance between fit-and-fill (1.8%), tapered wedge (1.7%), and cemented (0.8%) stems (P = 0.39). Fit-and-fill stems had significantly less operative time than cemented stems (93.6 ± 30.0 vs 108.7 ± 41.0 minutes, respectively; P <0.001). No differences in 30-day (4.5%, 4.9%, 5.5%; P = 0.88) or 1-year mortality (17.1%, 17.0%, 22.4%; P = 0.37) were observed between tapered wedge, fit-and-fill, and cemented stems, respectively.</p><p><strong>Conclusions: </strong>When treating displaced femoral neck fractures, tapered wedge stems may result in a higher rate of PFF. As an alternative, fit-and-fill stems may lower PFF rates without the risk of bone cement implant syndrome and longer operative times.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025197","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":"Regional Only Anesthesia is a Safe Alternative to Perform Arthroplasty for Femoral Neck Fracture.","authors":"Carolyn F Herbosa, Christopher J Pettit, Steven Rivero, David Furgiuele, Abhishek Ganta, Sanjit Konda, Kenneth Egol","doi":"10.1097/BOT.0000000000003010","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003010","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the efficacy of regional only anesthesia for arthroplasty surgery following displaced femoral neck fractures.</p><p><strong>Methods: </strong>Design: Retrospective study.</p><p><strong>Setting: </strong>A single academic medical center and Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients with displaced femoral neck fracture (AO/OTA 31B1.3) treated with either hemi- or total hip arthroplasty were identified. Patients who had general (GA) and Spinal (SA) anesthesia were each matched 2:1 to those who underwent Lateral Femoral Cutaneous and Over the Hip (LOH),based on the Score for Trauma Triage in the Geriatric and Middle Aged (STTGMA) risk score and arthroplasty type.</p><p><strong>Outcome measures and comparisons: </strong>Patient demographics, injury characteristics, and surgical history were compared. Outcomes included postoperative complications, 90-day readmission rates, 1-year mortality and discharge location. Significance was p>0.05.</p><p><strong>Results: </strong>145 patients were analyzed: 58 GA, 58 SA, and 29 Regional. Cohorts were similar in demographics: mean age was 79.9 +9.9 for LOH, 79.8+11.00 for GA and 82.2+8.6 for SA (p=0.3), with 72% female patients in the LOH, 67% female in the GA and 76% female in SA (p=0.585). GA patients had the highest BMI (25.3±5.3 kg/m2, p=0.004). SA patients had the highest ASA score (2.9±0.7, p=0.036). GA patients had the longest anesthesia (2:55 hours, p=0.013) and operating room time (3:35, p=0.009). Regional anesthesia had the shortest anesthesia (2:26, p=0.013) and operating room time (2:54, p=0.009). GA had a higher complication rate (56.9%, p=0.039), including major complications (20.7%, p=0.025) and post-operative anemia (34.5%, p=0.049). GA had a longer length of stay (6.4±2.9 days, p=0.022). Patients operated on under regional only were discharged to home (62%, p=0.003) while more GA (79%) and SA (71%) patients were discharged to SNF (p<0.001). LOH patients ambulated sooner following surgery (1.03±0.2 days, p=0.001). No post-operative complications, blood transfusions (p=0.321), mortality (p=0.089), 30-day readmission (p=0.819), and post-operative delirium (p=0.514) were significantly different.</p><p><strong>Conclusion: </strong>Regional only anesthesia (LOH Block) was safe and effective for hemi and total hip arthroplasty for a displaced femoral neck fracture as compared to spinal and general anesthesia. This anesthetic approach allowed for successful procedures and yielded lower associated rates of post-operative complications and operative time in addition to improved quality measures.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Is the complexity of fibular nailing worth it?\"","authors":"Hassan Mir","doi":"10.1097/BOT.0000000000003009","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003009","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Is the complexity of fibular nailing worth it?","authors":"Sean T Campbell","doi":"10.1097/BOT.0000000000003008","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003008","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016288","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 Clavicle Nonunion Repair: A Retrospective Cohort Study of 125 Patients.","authors":"Daniël C de Reus, Robert K Wagner, Eric Tutuhatunewa, Adam N Musick, Austin T Gregg, Stein J Janssen, Arun Aneja, Thuan V Ly","doi":"10.1097/BOT.0000000000003007","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003007","url":null,"abstract":"<p><strong>Objectives: </strong>To describe outcomes following operative repair of clavicle nonunions and identify risk factors for recalcitrant nonunion.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Two academic Level-1 trauma centers.</p><p><strong>Patient selection criteria: </strong>Included were adults who underwent repair of a clavicle fracture (AO/OTA 15) nonunion from January 2004 to 2024.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was recalcitrant nonunion, defined as nonunion requiring additional revision surgery after nonunion repair or absence of healing at final follow-up. Univariate and multivariable logistic regression was performed to determine associations between patient, nonunion, and treatment characteristics (fixation construct and position, use of bonegraft, substitutes or compression) with recalcitrant nonunion. The secondary outcome was reoperation for complications other than recalcitrant nonunion.</p><p><strong>Results: </strong>125 patients were included (mean age 44 years [range 18-82], 55% male). The median follow-up was 16 months and 82% of acute fractures were treated nonoperatively. No patients presented with confirmatory criteria of fracture-related-infection. Twenty-four patients (19%) developed recalcitrant nonunion, with 17 undergoing revision. BMI (5-point increase, OR 3.38, p < 0.001), smoking (OR 4.49, p = 0.020), nonunion duration (3-month increase, OR 1.04, p = 0.013), age (10-year increase, OR 1.62, p = 0.042), and non-diaphyseal nonunion location (OR 4.79, p = 0.013) were identified as independent risk factors for recalcitrant nonunion in multivariable analysis. No treatment characteristics were associated with recalcitrant nonunion in univariate analysis (p > 0.05). Twenty-five patients (20%) underwent reoperations for complications other than recalcitrant nonunion.</p><p><strong>Conclusions: </strong>Operative repair for clavicle nonunion failed in 1 in 5 patients. Higher BMI, smoking, longer nonunion duration, older age, and non-diaphyseal nonunion locations were associated with increased risk of failure. No treatment characteristics were associated with failure. Surgeons may target modifiable risk factors, such as smoking and BMI, to achieve more reliable healing rates.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040884","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":"Characteristics, Patterns and Optimal Treatment Strategies of Morel-Lavallee Lesions: A Systematic Review.","authors":"Marc Daniel Bouchard, Cameron Pow, Justin Gilbert, David Slawaska-Eng, Prushoth Vivekanantha, Rotana Fageeh, James Yan","doi":"10.1097/BOT.0000000000003005","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003005","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the diagnostic accuracy of imaging modalities and outcomes of treatment strategies for Morel-Lavallée lesions (MLLs) and provide evidence-based recommendations for optimal management.</p><p><strong>Methods: </strong>Data Sources: MEDLINE, Embase, and Emcare databases were systematically searched for English-language studies published up to September 2024.</p><p><strong>Study selection: </strong>Observational studies and randomized controlled trials (RCTs) reporting diagnostic accuracy or treatment outcomes for MLLs were included. Case reports, small series, animal studies, and non-English articles were excluded.</p><p><strong>Data extraction: </strong>Study quality was assessed using the Methodological Index for Non-randomized Studies (MINORS) tool. Data on demographics, lesion characteristics, imaging modalities, and outcomes were extracted. Lesions were categorized as small (<100 cm3) or large (≥100 cm3) based on volume.</p><p><strong>Data synthesis: </strong>Descriptive statistics summarized outcomes. Recurrence rates were calculated and pooled proportions compared across treatment modalities.</p><p><strong>Results: </strong>Twenty-nine studies (928 patients, 964 lesions) were included. MLLs most frequently occurred in the thigh (26.5%), greater trochanter (24.9%), and lumbar region (20.3%). Among smaller lesions (<100 cm3), nonoperative treatment had a low recurrence rate (5.6%), while for larger lesions (>100 cm3), percutaneous management was associated with the highest recurrence rate (15%) compared to other treatment approaches. Operative treatment of large lesions had a 50% recurrence rate in one study, while sclerodesis achieved the lowest rate (4.8%) for lesions averaging 387 cm3, however, this finding is based on a limited number of cases (21 lesions). MRI was the most common single imaging modality reported (n=162 lesions, 19.5%), favoured for its superior soft-tissue characterization. Ultrasound was used in 121 lesions (14.6%) as an accessible initial assessment tool, while CT, often performed incidentally during trauma evaluation, diagnosed 339 lesions (40.9%).</p><p><strong>Conclusions: </strong>MRI was the most used single modality for diagnosing MLLs. Small, acute lesions were effectively managed nonoperatively. Large lesions (>100 cm3) often required operative management. Sclerodesis appears promising with the lowest recurrence (4.8%), but further studies are needed. Standardized treatment protocols may help improve outcomes and reduce recurrence.</p><p><strong>Level of evidence: </strong>IV, systematic review.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014960","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":"Interprosthetic Femur Fractures: A Multi-Center Retrospective Study.","authors":"Samuel Landoch, Jeffrey A Foster, Lisa K Cannada, William T Obremskey, Ryan Will, Brianna Fram, Simon C Mears, Jeffrey B Stambough, Benjamin M Stronach, Harrison Brown, Jason J Halvorson, Nicholas Andring, Natalie Marenghi, Niloofar Dehghan, Tony Huynh, Scott Ryan, Guy Guenthner, Aaron Shiinoki, Jacob M Fischman, Elsa Rodriguez, Andres F Moreno-Diaz, Aleksander Mika, Farhan Chowdry, Andrew Chen, Zohair Zaidi, Anna N Miller, Joseph Gutbrod, Erin Hofer, Carmen Quatman, Jarrod Dumpe, Marek Denisiuk, Marylou Sutherland, Heidi Israel, Paul E Matuszewski, Arun Aneja","doi":"10.1097/BOT.0000000000003003","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003003","url":null,"abstract":"<p><strong>Objectives: </strong>To identify practices for treating interprosthetic femur fracture (IFFs) and determine factors that positively impact patient outcomes.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Fifteen trauma centers in the United States.</p><p><strong>Patient selection criteria: </strong>Patients aged 50 to 90 years who underwent operative fixation of an AO/OTA 32 A-B-C type IFF fracture from 2011 to 2021 were included. Patients who underwent revision arthroplasty at the time of fixation or were non-ambulatory were excluded.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was union rate. Secondary outcomes included post-operative complications, revision surgery, mortality, and change in ambulation status. Univariate analyses using Chi-square tests, Fisher's exact tests, and analysis of variance were performed to detect associations between demographic, injury, and surgical characteristics with post-operative outcomes.</p><p><strong>Results: </strong>One hundred thirty-nine patients were included, with 110 (79%) females and median age 78 [range, 57-90]. Distal one-third fractures were most common 68% (N=95). One hundred eighteen (85%) patients were treated with a lateral plate, 8% (N=11) were treated with nail-plate combination and 7% (N=10) were treated with dual plates. The median time to full-weight bearing (FWB) was 2.5 months. Dual plate combination was associated with the fastest time to FWB (p = 0.048) at two weeks. 61% (n=85) of patients returned to baseline ambulation status (100% [11] IMN/plate, 60% [71] lateral plate and 25% [3] dual plate) with patients treated with nail-plate had higher rates of return to baseline function (p = 0.009). The overall mortality rate was 13% and associated with greater than 1 comorbidity (p = 0.022).</p><p><strong>Conclusions: </strong>A spanning lateral plate was the most common fixation of IFF in our study. Patients with dual fixation were more likely to return to baseline ambulatory status, particularly those with intramedullary nail/plate combination. The mortality rate at one year was 11% and comorbidity burden was associated with higher risk of mortality.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000843","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":"Posttraumatic Hip Osteoarthritis After Pelvic Ring Injuries.","authors":"James D Brodell, Hashim J F Shaikh, Thomas F Rodenhouse, Brian D Giordano, John P Ketz, Sandeep P Soin, Noah M Joseph","doi":"10.1097/BOT.0000000000002958","DOIUrl":"10.1097/BOT.0000000000002958","url":null,"abstract":"<p><strong>Objectives: </strong>While rates of posttraumatic osteoarthritis after acetabulum fracture have been thoroughly studied, there has been less emphasis on hip osteoarthritis after pelvic ring injuries. The objective of this study was to determine the frequency of posttraumatic hip osteoarthritis in pelvic ring injury patients. It was hypothesized that more severe pelvic ring injuries would be associated with greater rates of posttraumatic hip osteoarthritis.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective Cohort.</p><p><strong>Setting: </strong>Urban/Suburban Academic Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Subjects were identified using a retrospective search for OTA/AO type A, B, and C pelvic ring injuries. Patients were included if they were aged 18 years or older, had a pelvic ring injury, and had 1 year or more of radiographic follow-up. Patients were excluded if they had prior total hip arthroplasty or hip hemiarthroplasty, femoral neck fracture, acetabulum fracture, femoral head fracture, or inadequate radiographic follow-up.</p><p><strong>Outcome measures and comparisons: </strong>Both hips were graded using the Tönnis classification at the time of injury and available follow-up pelvis films. Comparison of rate of osteoarthritis progression was made between stable (LC I injuries stable on examination under anesthesia, all APC I injuries) and unstable (APC II, APC III, LC II, LC III, and LC I injuries unstable on examination under anesthesia) pelvic ring injury patients, as well as severity of injury using the Young-Burgess classification.</p><p><strong>Results: </strong>Two hundred eleven patients were included for final analysis. Average age was 58.8 years (SD 28.1 years, range 18-100 years). Eighty-eight patients (41.7%) were male. One hundred twenty-seven patients underwent nonoperative management, and 84 underwent surgical stabilization. 34.5% (29/84) of patients with unstable pelvic ring injuries and 6.2% (8/127) of patients with stable pelvic ring injuries demonstrated progression of osteoarthritis on the ipsilateral side of their injury ( P < 0.001). More severe pelvic ring injury patterns had a greater rate of posttraumatic osteoarthritis (PTOA) based on the Young-Burgess injury classification (44.4% of LC III vs. 11.1% of LC I pelvic ring injury patients, P < 0.001).</p><p><strong>Conclusions: </strong>A significant frequency of posttraumatic osteoarthritis after pelvic ring injuries was identified. A higher rate of progression to PTOA was found with unstable injuries compared with stable pelvic injuries.</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":"229-236"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007082","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}