Journal of Orthopaedic Trauma最新文献

{"title":"The Rapid Escalation of Fractures and Hospital Admissions From Electric Bicycle Injuries in the United States: An Analysis of National Injury Data From 2019 to 2023.","authors":"Nikan K Namiri, Auston R Locke, Niklas H Koehne, Avanish Yendluri, Kyle K Obana, Katrina Nietsch, Jennifer Yu, John J Corvi, Junho Song, Jeremy Podolnick, David A Forsh, Robert L Parisien","doi":"10.1097/BOT.0000000000002965","DOIUrl":"10.1097/BOT.0000000000002965","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to examine the characteristics, trends, and attributes of fractures sustained by electric bicycle riders and assess the recent health care burden in hospital admissions.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective review.</p><p><strong>Setting: </strong>National sample of 100 emergency departments in the United States.</p><p><strong>Patient selection criteria: </strong>The National Electronic Injury Surveillance System (NEISS) was queried for emergency department presentations with fractures related to e-bicycles between January 1, 2019, and December 31, 2023. The clinical narrative associated with each case was reviewed to exclude cases unrelated to fractures sustained by e-bicycle riders.</p><p><strong>Outcome measures and comparisons: </strong>NEISS data are a probability sample of US hospitals; each observed sample has an associated weight enabling a population estimate for each individual sample. Sample weights were determined by NEISS using factors that influence likelihood of selection such as hospital size and geographic locations. US population projections (weighted cases) of fractures and admissions were obtained by summing the weights of raw, unweighted NEISS sampled injuries. Pearson χ 2 tests were applied to determine differences in injury characteristics among subjects who were admitted to the hospital and those who were not admitted.</p><p><strong>Results: </strong>A total of 22,432 e-bicycle fractures occurred in the United States from 2019 to 2023, which was a weighted population estimate from 520 raw, unweighted NEISS samples. The number of fractures and admissions increased by 2371% and 3146% in 2023, respectively, compared with 2019. Collision with a motor vehicle occurred in nearly one-fourth of fractures, and motor vehicle involvement was significantly associated with hospital admission (36.4% vs. 25.1%; P = 0.01). Overall, 27.7% of e-bicycle fractures were admitted to the hospital. Upper leg fractures had the highest association with admission (90.7% admission rate) but only consisted of 2.7% of all fractures. The most common fracture location in riders younger than 18 years was the wrist, while the 35-55 age group and older than 55 years group were most likely to possess upper trunk fractures (cervical spine, thoracic spine, ribs, and sternum). The 18-34 age group and 35-55 age group most commonly sustained fractures involving motor vehicles (29.7% and 28.7%, respectively), but the 35-55 age group possessed a significantly higher rate of overall admission among all age groups ( P = 0.04).</p><p><strong>Conclusions: </strong>There has been a substantial increase in fractures and resource utilization as a result of hospital admissions from e-bicycle riding from 2019 to 2023. Most fractures occurred above the waist, although lower extremity injuries more commonly resulted in admission, and riders aged 35-55 years sustained the la","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"269-274"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189610","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":"Homelessness and the Outcome of Hip Fracture Surgical Management: A Nationwide Study in the United States.","authors":"Amir Human Hoveidaei, Kasra Pirahesh, Fatemeh Kanaani Nejad, Amirhossein Ghaseminejad-Raeini, Basilia Onyinyechukwu Nwankwo, Janet D Conway","doi":"10.1097/BOT.0000000000002967","DOIUrl":"10.1097/BOT.0000000000002967","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether people experiencing homelessness (PEH) have more postoperative complications after hemiarthroplasty, total hip arthroplasty (THA), hip open reduction and internal fixation (ORIF), and percutaneous skeletal fixation surgeries after hip fracture in the United States.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>A nationwide study in the United States using the PearlDiver Patient Records Database.</p><p><strong>Patient selection criteria: </strong>Patients who underwent hemiarthroplasty, THA, ORIF, and percutaneous skeletal fixation surgeries after hip fracture from 2010 to 2022 were included. The CPT codes corresponding to surgical procedures were searched through the database. Then, the housing status was extracted using the corresponding ICD codes for homelessness. Those who did not have ICD codes assigned for homelessness were considered to be housed. PEH were matched with housed patients in a 1:3 ratio based on age, sex, and year of surgery.</p><p><strong>Outcome measures and comparisons: </strong>Baseline patient characteristics and comorbidities were accessed through ICD and CPT codes. After matching, the postoperative 30-day and 90-day rates of acute renal failure, myocardial infarction (MI), respiratory failure, sepsis, venous thromboembolism, pneumonia, urinary tract infection (UTI), surgical site infection (SSI), and readmission were compared between PEH and housed patients using two models: (1) A χ 2 test and (2) a multivariate logistic regression while controlling for the Elixhauser comorbidity index, obesity, diabetes, alcohol abuse, tobacco use, and drug abuse.</p><p><strong>Results: </strong>A total of 692,933 housed patients and 2795 homeless patients (mean age of 59.1 ± 11.6 years, 70.0% male) were evaluated. After matching the PEH to housed patients for age, sex, and year of surgery with a 1:3 ratio, a total of 8382 housed patients (mean age of 59.1 ± 11.6, 70.0% male) were selected for the postoperative complication analysis in comparison with 2795 PEH. In the Chi-squared analysis, it was observed that rates of postoperative 90-day acute renal failure [1.36 (1.18-1.56)], sepsis [1.70 (1.44-1.99)], respiratory failure [1.33 (1.16-1.52)], UTI [1.37 (1.19-1.58)], pneumonia [1.49 (1.28-1.74)], SSI [2.03 (1.62-2.54)], and readmission [1.60 (1.45-1.77)] were significantly higher among PEH ( P < 0.001). In the regression model, it was found that homelessness was an independent factor for 90-day SSI [1.47 (1.13-1.91), P = 0.004] and UTI [1.21 (1.03-1.43), P = 0.022] after surgical management of hip fracture.</p><p><strong>Conclusions: </strong>This study found that homelessness was an independent risk factor for surgical complications, including SSIs and UTIs, within 90 days. In addition, homelessness was associated with higher comorbidity rates, which were linked to increased complications and readmissions.</p><p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"245-251"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458316","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":"Tranexamic Acid and Heterotopic Ossification Formation Following Elbow Surgery: A Prospective Randomized Controlled Trial.","authors":"Erez Avisar, Ahmad Essa, Ryan Paul, Eric Kachko, Oded Rabau, Rom Mattan, Jonathan Persitz","doi":"10.1097/BOT.0000000000002963","DOIUrl":"10.1097/BOT.0000000000002963","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates whether the intraoperative administration of intravenous tranexamic acid (TXA), known for its hemostatic and potential anti-inflammatory properties, affects the incidence of heterotopic ossification (HO) following surgery for elbow fracture dislocations.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Prospective, randomized clinical trial.</p><p><strong>Setting: </strong>Hand and Upper Extremity Surgery Unit.</p><p><strong>Patient selection criteria: </strong>Patients aged 18-75 years with acute traumatic elbow fracture dislocations requiring surgical management from June 1, 2016, to October 31, 2022, were eligible. Inclusion criteria included traumatic nonpathological elbow fracture dislocations. Patients were randomized 1:1 to receive either intraoperative TXA or no additional treatment.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was the occurrence of HO, defined by new bone formation observed in radiographic exams during postoperative follow-ups. Secondary outcomes included the presence of clinically relevant HO, reoperation rate due to symptomatic HO, and time to HO reoperation. Compared were patients who received TXA with controls.</p><p><strong>Results: </strong>Out of 47 patients with elbow fracture dislocations who completed the follow-up, 23 (49%) received TXA prophylaxis while 24 (51%) were controls. The average age was 51.2 years (range, 18-77 years) with a mean follow-up of 12.9 months (range, 6.11-34.2). In the TXA group, 11 (47.8%) were men and 12 (52.2%) were women, while in the control group, 14 (58.3%) were men and 10 (41.7%) were women. HO was observed in 30% of patients, primarily around the radial head (71%). In this study, 43.5% of patients in the TXA group developed HO compared with 16.7% in the control group. The differences in HO formation suggest a potentially higher risk in the TXA group (relative risk = 2.6, 95% 1.0 to 8.5, P = 0.06). Clinically relevant HO led to reoperation in 2 of 10 (20%) patients in the TXA group, while none of the patients in the control group required reoperation, resulting in an overall reoperation rate of 14.3% in the study cohort.</p><p><strong>Conclusions: </strong>This prospective trial identified a possible increased risk of HO formation in patients receiving TXA, however, with the sample size available a statistically significant difference was unable to be detected. These findings highlight the need for further research emphasizing larger prospective comparative studies to assess TXA's impact on HO. A deeper understanding of this relationship will enable clinicians to balance TXA's potential risks and benefits more effectively, optimizing outcomes in orthopedic surgery.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"261-268"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023886","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":"Impact of Modifier-22 on Reimbursement Following Acetabular Fracture Fixation.","authors":"Caleb J Bischoff, Kylee Rucinski, Wayne Hoskins, Douglas R Haase, Jaime L Bellamy","doi":"10.1097/BOT.0000000000002960","DOIUrl":"10.1097/BOT.0000000000002960","url":null,"abstract":"<p><strong>Objectives: </strong>The 22-modifier in the Current Procedural Terminology (CPT) system indicates increased surgical procedure complexity, aiming to secure greater reimbursement for surgeons. This study investigated the 22-modifier on reimbursement amounts after acetabular fracture fixation.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Included were patients with third-party reimbursement for acute acetabular fracture (AO/OTA 62A-C) fixation through an open approach from 2005 to 2021 as identified using CPT codes 27226, 27227, and 27228.</p><p><strong>Outcome measures and comparisons: </strong>Chart review identified procedures where the 22-modifier for obesity or fracture complexity was applied. A cohort without the 22-modifier matched by diagnosis, primary CPT code, and insurance carrier was made for comparison. The primary outcome measure was the difference in financial reimbursement when the 22-modifier was used. Secondary outcomes were the difference in billed charges and operative time.</p><p><strong>Results: </strong>A total of 785 cases were initially identified with 747 meeting the inclusion criteria, and 73 having the 22-modifier applied. After removing surgeries that did not receive compensation from their insurance, 52 of these patients were compared with 52 matched cases without a 22-modifier. The 22-modifier group and the nonmodifier group had no significant difference in reimbursed amounts ($4112.71 USD vs. $3851.00, P = 0.644). However, patients in the 22-modifier group had significantly greater billed charges ($8007.35 vs. $7120.94 USD; P = 0.0096), longer operative times (301.7 vs. 240.2 minutes, P < 0.001), and greater body mass index (43.1 vs. 29.3 kg/m 2 ; P < 0.001).</p><p><strong>Conclusions: </strong>Despite increased complexity and greater billed charges, the use of a 22-modifier in acetabular fracture cases did not result in improved collected reimbursements, and reimbursement is equal to when the 22-modifier is not used. Policymakers and insurers should revise reimbursement structures to better align reimbursements for acetabular fixation with surgical complexity.</p><p><strong>Level of evidence: </strong>Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"207-210"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950512","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":"Mortality Rates After Nonoperative Geriatric Hip Fracture Treatment: A Matched Cohort Analysis: Erratum.","authors":"Edward D Shin, Kevin P Sandhu, Benjamin R Wiseley, Scott J Hetzel, Alec E Winzenried, Natasha M Simske, Kristina P Johnson, David C Goodspeed, Christopher J Doro, Paul S Whiting","doi":"10.1097/BOT.0000000000002969","DOIUrl":"10.1097/BOT.0000000000002969","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 5","pages":"275"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997093","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":"What is the Surgical Burden of Treatment for High-Energy Lower Extremity Trauma? A Secondary Analysis of the OUTLET Study.","authors":"Christopher C Stewart, Lisa Reider, Rachel Soifer, Nikan K Namiri, Robert V O'Toole, Madhav A Karunakar, Benjamin K Potter, Michael Bosse, Saam Morshed","doi":"10.1097/BOT.0000000000002959","DOIUrl":"10.1097/BOT.0000000000002959","url":null,"abstract":"<p><strong>Objectives: </strong>To describe and enumerate surgeries for patients who underwent reconstruction or amputation after severe distal tibial, ankle, and mid- to hindfoot injuries.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Secondary analysis of a multicenter prospective observational study.</p><p><strong>Setting: </strong>Thirty-one US level I trauma centers and 3 military treatment facilities.</p><p><strong>Patient selection criteria: </strong>Participants aged 18 to 60 years with Gustilo type-III pilon fracture (Orthopaedic Trauma Association [OTA] 43B or 43C), IIIB or C ankle fracture (OTA 44A, 44B, or 44C), type-III talar or calcaneal fracture (OTA 81B, 82B, or 82C), or open or closed crush or blast injuries to the hindfoot or midfoot who underwent limb reconstruction or amputation from 2012 to 2017.</p><p><strong>Outcome measurements and comparisons: </strong>The number of temporizing, definitive, and complication surgeries was compared by treatment and injury.</p><p><strong>Results: </strong>Five hundred seventy-four participants with 221 ankle and pilon injuries, 140 talus and calcaneal injuries, and 213 other foot injuries were followed for 18 months. The mean age was 38 (range 8-64) years, and 33% were female. Participants underwent reconstruction (n = 472), primary amputation (n = 76), and failed reconstruction followed by amputation (n = 26). Eight hundred forty-one temporizing, 958 definitive, and 501 complication surgeries were performed. The number of surgeries was highest for those who underwent failed reconstruction [mean 5.8, 95% confidence interval (CI), 4.9-6.8, range 3-13] compared with reconstruction (mean 3.8, 95% CI, 3.5-4.0, range 1-21) and primary amputation (mean 4.9, 95% CI, 4.3-5.5, range 2-14) ( P < 0.01). Those with ankle and pilon injuries required more surgeries (4.7, 95% CI, 4.3-5.1, range 1-21) than those with hindfoot (3.4, 95% CI, 3.0-3.7, range 1-10) and other foot (3.7, 95% CI, 3.4-4.0, range 1-14) injuries ( P < 0.01). The average participant would complete definitive treatment 23 days after their injury, and those who required surgery for a complication spent 41 days in the complication phase of treatment.</p><p><strong>Conclusions: </strong>Patients with high-energy lower extremity trauma underwent nearly 4 surgeries over 3 weeks until completion of definitive treatment, regardless of whether they underwent limb reconstruction or amputation. Those with ankle or pilon injuries and failed reconstruction attempts experienced the most operations, and those with complications required over an additional month of surgical care. These data may inform a shared decision-making process around limb optimization.</p><p><strong>Level of evidence: </strong>Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"237-244"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Revision-Free Survival Following Operative Fixation of Femoral Neck Fractures in Young Adults.","authors":"Nicholas M Panarello, Alex Gu, Sarah Dance, Colin J Harrington, Samantha L Ferraro, Christopher H Renninger, Robert S Sterling, James N DeBritz","doi":"10.1097/BOT.0000000000002962","DOIUrl":"10.1097/BOT.0000000000002962","url":null,"abstract":"<p><strong>Objectives: </strong>To identify the rate of fixation failure following femoral neck fracture (FNF) fixation in young adults within a national database.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>National all-payer claims database.</p><p><strong>Patient selection criteria: </strong>Adults aged between 18 and 49 years who underwent operative fixation for FNF (OTA/AO 31-B) between January 2010 and April 2019 were identified.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome measure was 5-year risk of revision surgery for fixation failure following operative management of FNF. Additional data variables included rate of fixation failure following open versus closed reduction techniques and the rate of revision fixation, intertrochanteric osteotomy for nonunion or malunion, and conversion to arthroplasty.</p><p><strong>Results: </strong>A total of 3534 young adults underwent operative fixation of an FNF during the study period. The mean age of the study population was 41.1 ± 3.91 years (18-49), and a majority were male (52.6%). The 5-year revision-free survival of young adults who underwent operative fixation for FNF was 86.1% (95% confidence interval, 85.5%-89.1%). Four hundred ninety-two patients (13.9%) required revision surgical intervention for fixation failure, including 210 (5.9%) revision fixation procedures and 21 (0.6%) intertrochanteric osteotomies; 261 patients (7.4%) underwent conversion to arthroplasty. There was no significant difference in rate of fixation failure when comparing open (n = 392, 14.9%) and closed (n = 100, 13.3%) reduction techniques ( P = 0.351).</p><p><strong>Conclusions: </strong>Following operative management of FNF in young adults, fixation failure due to avascular necrosis, nonunion/malunion, or posttraumatic arthritis occurred at a rate of 13.9%. There was no difference in the rate of treatment failure between open and closed reduction.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"224-228"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Lag-Screw Slide and All-Cause Revision in a New-Generation Cephalomedullary Nail After Treatment of Geriatric Intertrochanteric Femoral Fractures.","authors":"M Kareem Shaath, Brendan Page, Bader A Nasir, Griffin Rechter, George J Haidukewych","doi":"10.1097/BOT.0000000000002961","DOIUrl":"10.1097/BOT.0000000000002961","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare lag-screw slide and revision surgery rate between 2 generations of the Stryker Gamma cephalomedullary nail (Stryker, Kalamazoo, MI).&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 chart review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single academic, Level-1 Trauma Center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;All geriatric patients (65 years and older) who underwent fixation of an intertrochanteric femoral fracture (AO/OTA type 31A1/2/3) by a single surgeon with the Stryker Gamma System from 2020 to 2024 with at least 3-month follow-up. The Gamma3 (G3) system was used until the Gamma4 became available in September 2022. Patients were grouped based on the implant used for fixation: G3 or Gamma4 (G4) and subgrouped based on the centrum-collum-diaphyseal angle of the implant (125 degrees vs. 130 degrees).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The main outcome was sliding of the lag screw. Slide distance was calculated from the difference between the screw position immediately postoperatively and at 6 and 12 weeks postoperatively. The secondary outcome variables were revision surgery for any reason, tip-apex distance, and reduction quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifty-one patients (40 women) with a mean age of 83 years (range 65-99) were in the G3 group compared with 46 patients (31 women) with a mean age of 79 years (range 65-96) in the G4 group. The average BMI of the G3 group was 24 kg/m 2 (15-35 kg/m 2 ) compared with 27 kg/m 2 in the G4 group (17-41 kg/m 2 ) ( P = 0.004). There were no significant differences when comparing diabetes, smoking status, or mechanism of injury between groups ( P &gt; 0.05). There was no significant difference when comparing the average tip-apex distance between the G3 (10 mm) and G4 (9.5 mm) ( P = 0.39). There was no significant difference in reduction quality between the G3 (46 good reductions) and the G4 (42 good reductions) groups ( P = 0.85). At 6 weeks, the G4 (5 mm) had a significantly greater lag screw slide compared with the G3 (3 mm) ( P = 0.016). At 12 weeks, the G4 (7 mm) also had a significantly greater lag screw slide when compared with the G3 (4 mm) ( P = 0.004). There was no significant difference in lag screw slide for the 125 degrees implant between the G3 and G4 groups at 6 weeks (3 mm vs. 5 mm, P = 0.44) or 12 weeks (4 mm vs. 6 mm, P = 0.14). Regarding the 130 degrees implant, the G4 had a significantly greater slide compared with the G3 at both at 6 weeks (5 mm vs. 3 mm, P = 0.03; 95% CI, -6.07 to -0.41) and 12 week (8 mm vs. 4 mm, P = 0.03; 95% CI, -5.65 to -0.26). The G4 group had 7 revision procedures performed (3 lag screw exchanges for iliotibial band irritation and 4 revision arthroplasties for lag screw slide, fracture shortening, iliotibial band irritation, abductor malfunction, and leg length discrepancy) compared with 1 revision procedure (lag screw exchange for iliotibial band irrit","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"252-260"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the Top Articles and Authors of the Journal of Orthopaedic Trauma and Bibliometric Comparison of Impact Factors of Orthopaedic Surgery Journals.","authors":"McKenna W Box, Troy Puga, Laurel Marsh, Wrangler Beal, Vinay Chandrasekaran, John T Riehl","doi":"10.1097/BOT.0000000000002964","DOIUrl":"10.1097/BOT.0000000000002964","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to determine the top 100 cited authors and the top 20 articles in the Journal of Orthopaedic Trauma (JOT) and compare its impact factor (IF) with the orthopaedic and nonorthopaedic surgery literature.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective.</p><p><strong>Setting: </strong>The Web of Science (WoS) and Journal Citation Reports (JCR) databases.</p><p><strong>Patient selection criteria: </strong>Literature published in JOT from 1995 to present indexed in the WoS and JOT orthopaedic subspecialty and nonorthopaedic journals indexed in JCR with reported IF in 2023.</p><p><strong>Outcome measures and comparisons: </strong>WoS: Top 20 cited articles originating in JOT and top 100 cited author in the first, last, and any author position of JOT articles, author location of training and current place of work. JCR: Comparison of yearly IF and yearly IF percent growth of selected orthopaedic trauma, other orthopaedic subspecialty, and nonorthopaedic journals to JOT from 1997 to 2023.</p><p><strong>Results: </strong>The number of citations for the top 20 cited articles in JOT ranged from 302 to 787. Of the top 100 JOT first authors by the citation number, 93 were orthopaedic surgeons. In total, 65% of these completed a residency in the United States, 61% worked in the United States, and of the authors who work in the United States, 70.5% practice in an academic setting. From 1997 to 2023, JOT 's mean yearly IF was 1.6, and the mean yearly IF percent growth was 6.1%. The mean IF for included comparison orthopaedic subspecialty journals was 2.3, with 5.6% mean yearly IF percent growth. JOT's median IF was 1.8 and was second to Injury (IF 1.9) within orthopaedic trauma journals evaluated.</p><p><strong>Conclusions: </strong>This bibliometric analysis shows that JOT's most cited authors are primarily US-trained orthopaedic surgeons in academic environments. JOT has consistently experienced annual growth in its IF throughout its almost 30-year history and has one of the highest impact factors of measured orthopaedic trauma journals.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"211-223"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065758","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":"Utility of Sonication for Fracture-Related Infection.","authors":"Christina Liu, Austin T Gregg, Stephen C Moye, Alina Fischer, Michael Akodu, Paul Appleton, Edward K Rodriguez, John Wixted","doi":"10.1097/BOT.0000000000003006","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003006","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the utility of sonication compared to traditional tissue culture in the setting of fracture-related infections (FRIs).</p><p><strong>Methods: </strong>Design: Retrospective cohort.</p><p><strong>Setting: </strong>One Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients with prior fracture fixation that required a reoperation for suspected infection, nonunion, or hardware failure with available sonication data between 2018 and 2023 were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was positivity of sonication compared to traditional tissue culture. FRI was diagnosed based on clinical FRI diagnosis by the treating team in collaboration with infectious disease specialists. Secondary aims were to identify specificity and sensitivity of sonication and tissue culture and patient-specific factors associated with positive sonication in the setting of negative tissue culture.</p><p><strong>Results: </strong>Of 79 patients identified, 67 met inclusion criteria. Mean age was 57 years (IQR: 43-72), and 50% were female. Most fractures were in the lower extremity (85%), and 73% were treated with plate fixation. Eighteen patients had positive tissue cultures, of which 15 were positive on sonication. Forty-nine patients had negative tissue cultures. Twenty-seven patients (40%) had positive sonication. Thirty cases were classified as FRI. Patients with positive sonication with negative tissue cultures were more likely male (66.6% vs. 32.4%, p=0.048), older (65.5 vs. 55.7 years, p=0.045), and had higher reoperation rates for suspected infection (50% vs. 13.5%, p=0.0093) compared to negative sonication. Sonication demonstrated a higher sensitivity (80% vs. 56%) and lower specificity (92% vs. 97%) than tissue culture for FRI detection. The total sonication cost was $229 per patient compared to $122 for standard tissue cultures.</p><p><strong>Conclusion: </strong>Sonication demonstrated higher sensitivity for FRI detection compared to traditional tissue culture. Given its minimal additional cost and higher sensitivity, sonication is recommended as an adjunct diagnostic tool in reoperations for suspected orthopedic infections, hardware failure, and nonunion of unclear etiology.</p><p><strong>Level of evidence: </strong>Diagnostic Level IV.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970417","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}