Journal of Orthopaedic Trauma最新文献

{"title":"Short-to Medium-term Results of Displaced Femoral Neck Fractures in Patients Less than 50 Years of Age Undergoing Repair: Comparison of Open vs. Closed Reduction.","authors":"Cory Collinge, Henry Wong, Joseph Patterson, Andrea Finlay, Michael Gardner, George F Lebus, Saam Morshed, Andres Rodriguez-Buitrago, Michael J Beltran, Phillip Mitchell, Jack Will, John Ketz, Paul Tornetta","doi":"10.1097/BOT.0000000000003265","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003265","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the clinical outcomes of open vs. closed reduction methods for femoral neck fractures (FNFs) in young patients treated with fracture repair.</p><p><strong>Methods: </strong>Design: Multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Twenty-six North American Level 1 trauma centers.</p><p><strong>Patient selection criteria: </strong>Skeletally mature patients aged <50 years with displaced FNFs (OTA/AO type 31B) undergoing surgical repair and having minimum follow-up >6 months, except in cases where major complications occurred earlier.</p><p><strong>Intervention: </strong>Open vs. closed fracture reduction.</p><p><strong>Main outcome measurements: </strong>The primary outcome of \"major complication\" was defined as nonunion/failed fixation, osteonecrosis, malunion (vertical or femoral neck shortening of ≥15 mm) and/or subsequent major reconstructive surgery was compared by reduction method using chi-squared tests and risk-adjusted binary mixed effects regression models.</p><p><strong>Results: </strong>A total of 290 patients with FNFs were included in the study, 107 treated with closed reduction (average follow-up 27.1 months [range, 4.1 to 159.5 months]) and 183 treated with open reduction and (average follow-up 22.4 months [range, 3.7 to 141.3 months], P=0.105). Sex distribution showed no difference between the groups, with 25.5% of the closed group, and 29.0% of the open cohort being female (P=0.615). Patients who received open reduction were younger than patients who received closed reductions (mean age 35.6±8.8 vs. 39.5±8.0 years, P<0.001) and had fewer cases of cases of diabetes mellitus (2.2% vs. 8.6%, P=0.027). Overall, adverse events were observed following 57.0% of closed reduction reductions vs. 54.1% of open reductions (P=0.890). No differences were seen in the frequency of defined failure modes, including failed fixation/nonunion (33.6% closed vs. 35.0% open, P=0.919), osteonecrosis (21.5% closed vs. 14.2% open, P=0.151), malunion (17.8% closed vs. 14.8% open, P=0.611), or major reconstructive surgery (33.6% closed vs. 36.6% open, P=0.702).</p><p><strong>Conclusions: </strong>Open and closed reductions of FNFs in patients <50 years old were associated with similar rates of repair failure.</p><p><strong>Level of evidence: </strong>Level III (Therapeutic).</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794443","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 One-Stage Infected Humerus Nonunion Repair in Patients with Prior Operative Fracture Fixation.","authors":"Alona Katzir, Robert E Bilodeau, Rishabh S Bhadouriya, Adam H Kantor, Adam Schlauch, Craig E Klinger, Brian J Page, William M Ricci","doi":"10.1097/BOT.0000000000003264","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003264","url":null,"abstract":"<p><strong>Objective: </strong>To examine the clinical outcomes of one-stage repair for infected humeral nonunion following failed prior ORIF.</p><p><strong>Methods: </strong>Design: Retrospective study.</p><p><strong>Settings: </strong>Tertiary referral hospital.</p><p><strong>Patients selection criteria: </strong>Included were patients with infected humeral nonunion after an initial fixation of fracture, who underwent surgical repair at the study site between 2016-2024.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes were union, infection eradication, number of surgeries, and duration of antibiotic therapy.</p><p><strong>Results: </strong>Fifteen patients (80% male) who underwent humeral nonunion repair surgery, with positive intraoperative cultures were included. The mean age was 48.1 years (range 26-70) and 80% were male. Two patients (13.3%) were active smokers, and two (13.3%) had diabetes mellitus. Nine (60%) patients sustained OTA/AO type 12 fractures, four (26.7%) type 11 fractures, and two (13.3%) type 13 fractures. Twelve (80%) had closed fractures and 3 (20%) had open fractures. The most common initial fixation was plate and screw fixation (n=11, 73.3%), followed by intramedullary nail (n=4, 26.7%). Inflammatory markers were normal in seven patients (46.7%), elevated in three (20%), and unavailable in five (33.3%).A one-stage infected nonunion repair was planned for all cases (100%), with plate and screws (n=13, 86.7%), or intramedullary nailing (n=2, 13.3%). Bone graft was used in 13 (86.7%) cases and local antibiotics in two (13.3%). Cutibacterium acnes grew in 80% of cultures, followed by Staphylococcus aureus (13.3%) and Staphylococcus epidermidis (6.7%).Thirteen patients (86.7%) achieved union. In 10 cases (66.7%), the index single-stage repair was sufficient to achieve union, while 3 cases required additional interventions to achieve union. Mean antibiotic treatment duration was 8.1 months (SD 7.1 months, range 1.2-26.4). Two patients (13.3%) developed recurrent infection, and five patients (33.3%) required unplanned reoperations to promote union or treat infection.</p><p><strong>Conclusions: </strong>This study found a high ultimate union rate (86.7%) for one-stage infected humeral nonunion repair after prior failed osteosynthesis although 1 in 3 patients required unplanned reoperation for recurrent infections or recalcitrant nonunion.Level of Evidence Therapeutic level IV study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794484","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":"Vertically Unstable Pelvic Ring Injuries: Impact of Multilevel and Transsacral Fixation Strategy on Failure Rate.","authors":"Lauren Luther, Ridge Maxson, Andres F Moreno-Diaz, Stephen W Chenard, Lauren M Tatman, Phillip M Mitchell","doi":"10.1097/BOT.0000000000003260","DOIUrl":"10.1097/BOT.0000000000003260","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate outcomes of percutaneous pelvic fixation in the treatment of displaced vertically unstable pelvic ring injuries and identify fixation constructs that predict success.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Level I trauma center.</p><p><strong>Patient selection criteria: </strong>Patients ≥18 years old who underwent operative management of a vertically unstable pelvic ring injury (OTA/AO 61C.1-3) displaced ≥ 10 millimeters (mm) with sacroiliac (SI) or transsacral (TS) screws over a 24-year period. Exclusion criteria were spinopelvic dissociation, pathologic fracture, treatment with spinopelvic fixation or plate fixation of the posterior pelvic ring, and less than six months follow-up.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was treatment failure, defined as ≥10 mm of radiographic displacement compared to initial post-operative imaging. Secondary outcomes included failure rates stratified by posterior pelvic ring injury type and rates of revision surgery. Outcomes were compared between constructs that included both Multilevel sacral fixation and Transsacral fixation (MAT) versus constructs that lacked one or both of these features; that is, constructs with either Single-level fixation or only SI screws (SS).</p><p><strong>Results: </strong>The cohort meeting inclusion criteria comprised sixty-seven patients: MAT fixation N=38 (71% male; median age 37 years, IQR 33-53) and SS fixation N=29 (62% male; median age 39 years, IQR 34-47). The posterior ring injury patterns included sacral fractures ( n=36, 53.7%), sacroiliac fracture dislocations (n=17, 25.3%), and sacroiliac dislocations (n=14, 20.9%). MAT fixation had a significantly lower rate of treatment failure compared to SS fixation (2.6% vs 48.3%, P<0.001). Rates of revision surgery were also significantly lower when MAT fixation was utilized (2.6% vs 31.0%, P= 0.002).</p><p><strong>Conclusions: </strong>In this cohort of vertically unstable pelvic ring injuries, fixation at multiple sacral levels with at least one TS screw was associated with a significantly lower treatment failure rate (2.6%) compared to single-level fixation or SI screw-only fixation (48.3%). When multilevel transsacral fixation cannot be achieved due to patient anatomy or injury, adjunctive fixation strategies should be considered.</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":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726520","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":"Postoperative subclinical nerve injury after closed reduction and percutaneous pinning of paediatric supracondylar humerus fractures: a prospective Electromyographic study.","authors":"İbrahim Kandemir, Servet İğrek, Rahsan Adviye İnan, Mazlum Bayhan, Hüseyin Zihni, Engin Eceviz","doi":"10.1097/BOT.0000000000003258","DOIUrl":"10.1097/BOT.0000000000003258","url":null,"abstract":"<p><strong>Objectves: </strong>To detect early postoperative subclinical nerve injury in pediatric supracondylar humerus fractures and to identify associated risk factors.</p><p><strong>Methods: </strong>Design: Prospective cohort study.</p><p><strong>Setting: </strong>Single Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged 1-12 yr with Gartland type III and IV supracondylar humerus fractures, normal preoperative and postoperative neurovascular examinations, and treated with closed reduction and percutaneous pinning (CRPP) between April 2024 and 2025 were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was electromyography (EMG)-detected axonal injury of the median, ulnar, or radial nerves, assessed within the first week after pin removal at 1 month postoperatively. Secondary outcomes included identification of surgical and radiographic risk factors for ulnar nerve injury. Multivariable logistic regression analysis was performed to determine independent predictors.</p><p><strong>Results: </strong>A total of 73 pediatric patients (31 females and 42 males; mean age, 5.68 ± 2.35yr) were analyzed. EMG findings were normal in 74% (54/73) of patients. Axonal injury was detected in the ulnar nerve in 19.2% (14/73) of patients and in the median nerve in 6.8%(5/73), whereas no radial nerve injury was observed. Among the 14 patients with ulnar nerve injury treated with cross-pinning, the medial pin was positioned posteriorly in the sagittal plane in 85.7% (12/14) and in a inferior position in the coronal plane in 100% (14/14). Posteriorly and inferiorly positioned medial pin insertion sites were associated with significantly higher rates of ulnar nerve injury detected on EMG. (p = 0.024 and p = 0.037, respectively). Logistic regression analysis identified a posterior pin entry site in the sagittal plane as an independent risk factor (p=0.033; OR, 6.745; 95% CI, 1.16-39.00). Among patients with ulnar nerve injury, 71.4% (10/14) had an operative time exceeding one hour. In addition operative time was significantly longer in patients with ulnar nerve injury (p = 0.007). Interobserver agreement for radiographic measurements was excellent (intraclass correlation coefficient (ICC) = 0.864-0.897; 95% CI,0.807-0.907; p < 0.01).</p><p><strong>Conclusions: </strong>Subclinical ulnar nerve injury may occur in pediatric patients with clinically normal postoperative findings following CRPP. EMG detection suggests that injury is associated with a posterior-inferior medial pin entry site. Careful medial pin placement and minimizing operative time may reduce preventable technical risks during CRPP.</p><p><strong>Level of evidence: </strong>Level II, therapeutic study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722767","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":"Quantifying the effects of eccentrically drilled distal interlock screws in cadaveric tibias.","authors":"Casey McDonald, Cameron Atkinson, Andrew Ni, Katerina Papanikolaou, Raja Ullah, Thomas L Hand","doi":"10.1097/BOT.0000000000003256","DOIUrl":"10.1097/BOT.0000000000003256","url":null,"abstract":"<p><strong>Objectives: </strong>Intramedullary nailing (IMN) is the standard treatment for tibial shaft fractures; however, postoperative malalignment remains a relevant complication. Deviations in distal nail position can influence tibial alignment, and eccentric drilling during distal interlocking screw placement may alter fracture reduction and length. The purpose of this study was to quantify the effect of intentionally eccentric distal interlocking screw placement on tibial alignment in a controlled cadaveric model.</p><p><strong>Methods: </strong>Ten paired, formalin-fixed, human-cadaveric tibias underwent standardized IMN via suprapatellar approach following reaming of 1.5mm over nail diameter. A simulated comminuted distal tibia-fibula fracture was created using a 2-cm defect 4-cm proximal to the plafond. A 10mm IMN was then seated and secured with a 60mm interlocking screw, placed in the medial-to-lateral proximal oblique hole. Crossing K-wires were placed in the coronal and sagittal planes to serve as markers for angular and axial displacement. Using fluoroscopic \"perfect-circles\" technique, three surgeons performed standardized, intentional, eccentric-drilling with proximal-to-distal trajectory. Distal screw placement was performed in the medial-lateral plane, then removed and repeated in the anterior-posterior plane. Coronal and sagittal angulation and axial length were measured by digital goniometer and calipers following screw insertion, respectively.</p><p><strong>Results: </strong>For medial-lateral screws, proximal-to-distal eccentric drilling yielded a mean coronal angulation of 6.0° induced valgus (SD= 3.8°, R:1.5°min-12.2°max). While for anterior-posterior screw placement, proximal-to-distal eccentric drilling yielded a mean of 5.8° procurvatum (SD = 2.0°, R: 2.8°min-8.5°max). Translational distraction in the coronal plane was 3.0mm (SD = 2.2mm, R: 0.05mmmin-7.8mmmax), and distraction in the sagittal plane was 3.9mm (SD = 3.0mm, R: 1.1mmmin,-9.8mmmax).</p><p><strong>Conclusion: </strong>Eccentric distal interlocking screw placement produced radiographically appreciable angular and axial changes in distal tibial IMN constructs. Deviations during the \"perfect-circles\" technique can generate malalignment, or alternatively, be used to fine tune reduction in theory. Precise distal screw trajectory and strategies to minimize drilling eccentricity may reduce postoperative malalignment, particularly in distal tibial fractures.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726752","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":"Plate Fixation with and without Suture Endobutton Augmentation of the CoracoClavicular Ligament in displaced Lateral Clavicle Fractures: A Comparative Outcome Study.","authors":"Alona Katzir, Craig E Klinger, Robert Bilodeau, Rishabh S Bhadouriya, Adam Schlauch, Adam H Kantor, Aleksey Dvorzhinskiy, William M Ricci","doi":"10.1097/BOT.0000000000003257","DOIUrl":"10.1097/BOT.0000000000003257","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the clinical outcomes of plate fixation with and without coracoclavicular (CC) suture Endobutton augmentation in the management of displaced lateral clavicle fractures.</p><p><strong>Methods: </strong>Design : Retrospective study.</p><p><strong>Setting: </strong>Tertiary referral hospital.</p><p><strong>Patient selection criteria: </strong>Included were adult patients with displaced lateral clavicle fractures (OTA/AO 15.3) who underwent plate fixation between June 2021 and April 2024. The Augmentation group received adjunctive suture Endobutton fixation, while the Control group did not.</p><p><strong>Outcome measures and comparisons: </strong>Clinical outcomes including union, coracoclavicular (CC) distance, infection, re-operation, and self-reported functional outcomes consisting of the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and numerical rating scale for pain (NRSP) were evaluated and compared between the two groups. To normalize for magnification, the ratio of CC distance to midclavicular width (CCD/MCW) was used to compare the CC distance over time.</p><p><strong>Results: </strong>Forty-nine patients were included, 21 in the Augmentation group (76.2% male, mean age 47.5 years) and 28 in the Control group (75% male, mean age 46.6 years). In the Augmentation group, 15 patients (71.4%) underwent dual plating and 6 (28.6%) underwent single plate fixation. In the Control group, 15 patients (53.6%) underwent dual plating, 10 (35.7%) underwent single plate fixation, and 3 (10.7%) underwent hook plate fixation. The mean study follow-up was 33.7 months (range 4.2-118.6). Union was achieved in all patients (100%) in the Augmentation group, compared to 92.8% in the Control group (p = 0.19). Preoperative CCD/MCW ratios were 2.6 for the Augmentation group and 2.3 for the Control group (p = 0.12). Intraoperative ratios were reduced to 1.4 in both groups (p = 0.6), and maintained at 1.4 during follow-up (p = 0.3). There were no infections. Two patients (9.5%) in the Augmentation group and 7 patients (25%) in the control underwent hardware removal. The median QuickDASH score was 2.3 in both groups (p=0.7), and the median NRSP score was 0.0 in the Augmentation group and 0.5 in the control (p=0.3).</p><p><strong>Conclusions: </strong>In displaced lateral clavicle fractures, plate fixation with CC ligament suture Endobutton Augmentation achieved a 100% union rate, long-term CC stability, and excellent functional results. With the numbers available in the study, the lower (92.8%) healing rate in the control group without Endobutton Augmentation did not reach statistical significance.</p><p><strong>Level of evidence: </strong>A level IV therapeutic retrospective cohort study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726775","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 Aseptic, Septic, and Occult Infected Index Nonunion Repair: A Retrospective Comparative Study.","authors":"Kai Rossbach, Makoa Mau, Lucas Marchand, Thomas Higgins, David Rothberg, Justin Haller","doi":"10.1097/BOT.0000000000003259","DOIUrl":"10.1097/BOT.0000000000003259","url":null,"abstract":"<p><strong>Objectives: </strong>To compare nonunion surgery effectiveness for occult infected, aseptic, and septic nonunions in patients identified using the FRI criteria.</p><p><strong>Methods: </strong>Design: Retrospective Review.</p><p><strong>Setting: </strong>Single Level I Tertiary Academic Center.</p><p><strong>Patients selection criteria: </strong>All skeletally mature patients over a 10-year period with nonunions and inflammatory labs at the time of index surgery were evaluated. Patients were classified using fracture-related infection (FRI) criteria as septic (SP) or aseptic. Aseptic patients were further stratified by intraoperative cultures into aseptic (AP, culture-negative) and occult infected (OP, culture-positive) groups. Exclusion criteria were pathologic fractures.</p><p><strong>Outcome measure and comparisons: </strong>Primary outcome measured was successful union after index nonunion surgery without need for additional surgical interventions.</p><p><strong>Results: </strong>A total of 208 patients with nonunion fractures were included (OP: 29; AP: 125; SP: 54). Mean age was similar between groups (OP: 47.6 ± 21.2 years, range 19.9-79.9 years; AP: 54.5 ± 25.6 years, range 15.4-93.4; SP: 54.9 ± 23.5 years, range 16.5-81.3, p=0.854). Male sex distribution in occult infected patients, aseptic patients, and septic patients was 65.5%, 66.4%, and 46.3%, respectively (p=0.035). Occult infected patients had the highest rate of successful union after index surgery without need for additional operative intervention (79.3%), followed by aseptic patients (72.8%) and septic patients (50.0%) (p=0.004). Postoperative infections following index nonunion surgery were significantly lower in aseptic patients (16.0%) and occult infected patients (10.3%) compared to septic patients (35.2%) (p=0.005).</p><p><strong>Conclusions: </strong>Index nonunion surgery in septic patients, as defined by FRI criteria, was associated with worse outcomes compared to aseptic and occult infected patients. The success of surgery in occult infected nonunion is comparable to aseptic cases, suggesting that subclinical fracture related infection does not significantly compromise outcomes.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723401","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":"Humerus Shaft-Antegrade Intramedullary Nailing.","authors":"Owen Karsmarski, D Alex Stroh","doi":"10.1097/BOT.0000000000003209","DOIUrl":"10.1097/BOT.0000000000003209","url":null,"abstract":"<p><strong>Summary: </strong>This review describes intramedullary nailing of humeral shaft fractures through antegrade technique. The case involved a high-energy injury to the humerus in a patient with relevant comorbidities, and discusses the rationale for both surgery in general and nailing in specific. Indications for surgery, setup considerations unique to the lateral decubitus position, and intraoperative methods for avoiding complications are all discussed. A brief review of current relevant literature is included.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"40 8S","pages":"S3-S4"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471255","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":"Higher Baseline Resiliency Scores Correlate With Better Patient-Reported Outcomes After Acetabular Fixation.","authors":"Ryan N McIlwain, Robin M Litten, Mary J McConnell, Humza S Bhatti, Jonathan D Ellis, Joey P Johnson, Clay A Spitler","doi":"10.1097/BOT.0000000000003180","DOIUrl":"10.1097/BOT.0000000000003180","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether patient resiliency is associated with patient-reported outcomes at 6 and 12 months after surgical fixation of acetabular fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single Level I trauma center (2022-2024).</p><p><strong>Patient selection criteria: </strong>Adults who sustained an acetabulum fracture (AO/OTA 62) treated operatively and completed Brief Resilience Scale (BRS) surveys 2 weeks postoperatively and Patient-Reported Outcomes Measurement Information System (PROMIS) surveys at 6 and/or 12 months postoperatively were included.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes were scores for PROMIS physical function, global physical health, global mental health, pain interference, depression, anxiety, and BRS. PROMIS scores were compared between low- and high-resiliency individuals at 6 and 12 months, as defined by the cohort median BRS score. Multivariable linear regression was used to adjust for relevant clinical covariates.</p><p><strong>Results: </strong>A total of 111 patients were included; 81 patients (64.2% male, 60.5% White; mean age 51.1 years) completed 6-month surveys and 56 patients (75.0% male, 66.1% White; mean age 51.8 years) completed 12-month surveys. At 6 months, high resiliency BRS (≥3.7) was independently associated with higher PROMIS physical function (β = 6.73 [2.93-10.54], P < 0.001), global physical health (β = 8.88 [5.47-12.28], P < 0.001), and global mental health (β = 12.40 [8.48-16.32], P < 0.001) with lower pain interference (β = -7.83 [-11.25 to -4.40], P < 0.001), depression (β = -15.33 [-19.69 to -10.97], P < 0.001), and anxiety (β = -11.54 [-16.35 to -6.72], P < 0.001) scores on regression analysis. Similarly, highly resilient (BRS ≥ 3.6) individuals completing 12-month surveys had significantly positive associations across all domains.</p><p><strong>Conclusions: </strong>Compared with patients with low resilience, high baseline resilience was associated with significantly better PROMIS outcomes at 6 and 12 months after acetabular 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":"446-451"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645678","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":"Comparison of Early Bracing Versus Splinting for the Initial Treatment of Acute Humeral Shaft Fractures (The COBRAS Trial).","authors":"Matthew T Kingery, Abhishek Ganta, Kenneth A Egol","doi":"10.1097/BOT.0000000000003196","DOIUrl":"10.1097/BOT.0000000000003196","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare 2 methods of initial immobilization of closed humeral shaft fractures-coaptation splinting followed by delayed functional bracing and immediate functional bracing-with respect to pain, satisfaction, and skin-related complications during the initial 10-day post-injury period.&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;Multicenter, randomized, two-arm, parallel clinical trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;One academic medical center with 2 Level 1 academic trauma centers and 1 tertiary care orthopaedic center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Patients with acute, closed humeral shaft fractures (AO/OTA 12A, 12B, 12C) were randomized to either initial coaptation splinting followed by delayed transition to Sarmiento bracing or immediate Sarmiento bracing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;Pain intensity over time measured by a patient-reported Likert scale (numerical rating scale, 0-10) once daily at the same time during the first 10 days post-injury, skin-related complications (skin damage ranging from abrasion or blistering to full-thickness skin loss secondary to pressure from the splint or brace), analgesic consumption in morphine milligram equivalent (MME), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function scores, and patient satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifty-eight patients were included in the analysis with a mean age of 48.8 ± 23.9 years (mean 50.5 years [range 18.4-92.2 years] in the coaptation splint group vs. mean 47.3 years [range 19.7-85.9 years] in the immediate Sarmiento brace group). Patients in the immediate Sarmiento bracing group reported significantly higher pain scores compared with coaptation splinting during the first 10 days postinjury (mean treatment effect = 0.97 points, 95% CI [0.26-1.69], P = 0.010; Figure 3). Cumulative opioid consumption over the 10-day period was similar between groups (median 20.0 MME for the coaptation splint group vs. 32.5 MME for the Sarmiento brace group, P = 0.308). PROMIS Physical Function scores were not significantly different between groups on postinjury day 7 (median 53.0 [IQR 44.5-68.5] for the splint group vs. 51.1 [IQR 45.0-60.5] for the brace group, P = 0.756). The rate of skin-related complications was higher in the Sarmiento brace group (33.3% vs. 7.1%, P = 0.022). Patient satisfaction scores at day 7 were not significantly different between groups (6.3 ± 2.7 for the coaptation splint group vs. 5.8 ± 3.1 for the Sarmiento brace group, P = 0.520).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Immediate Sarmiento bracing was associated with increased patient-reported pain (roughly 1 point on the 0-10 numeric rating scale) and higher skin complication rates during the initial 10-day period after injury compared with initial coaptation splinting for acute humeral shaft fractures, without demonstrable benefits in function, analgesic requirements,","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"40 8","pages":"408-415"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471195","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}