Journal of Orthopaedic Trauma最新文献

{"title":"Improving Emergency Department Efficiency With Large Language Model-Guided Orthopaedic Triage for Proximal Humerus Fractures.","authors":"Lucy Zhao, Ethan Bott, Arya S Rao, Jacob S Borgida, Samantha Brown, Robert K Wagner, Mitchel B Harris, Thuan V Ly, Marc D Succi","doi":"10.1097/BOT.0000000000003175","DOIUrl":"10.1097/BOT.0000000000003175","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether large language models can reduce consults for proximal humerus fractures that do not meet institutional consult criteria.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective review.</p><p><strong>Setting: </strong>Single-center Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Adults presenting to the emergency department (ED) with isolated proximal humerus fractures over a 2-year period were included. Exclusion criteria were polytrauma, concomitant orthopaedic injuries, pathologic fractures, lack of in-house ED imaging, and fractures missed in the ED.</p><p><strong>Outcome measures and comparisons: </strong>Generative Pretrained Transformer-4o (GPT-4o) and o4-mini were provided history of present illnesses, physical examinations, and X-ray reports and asked whether orthopaedics consultation was indicated based on institutional criteria (open fracture, tenting skin, neurovascular compromise, or humeral head dislocation). A gold standard was determined by 2 independent authors who retrospectively reviewed each case and reached consensus on consult necessity based on these criteria. Large language models alignment with this standard was compared with performance of real-world providers using generalized linear models. Consult wait time and work relative value unit (wRVU) savings were estimated using the cohort's average wait time and Current Procedural Terminology-based wRVUs for a 30-minute low-to-moderate complexity outpatient consult.</p><p><strong>Results: </strong>Three-hundred fifteen patients (99 males and 216 females) were included (average age: 65.1 years, range: 20-100 years). Alignment with consult criteria was 92.4% [95% confidence interval (CI) (88.9%, 94.8%)] for GPT-4o, 94.9% [95% CI (91.9%, 96.9%)] for o4-mini and 32.7% [95% CI (27.7%, 38.1%)] for ED providers. From a baseline of 240 consults, 327.3 wait hours, and 432 wRVUs, GPT-4o could have saved 179 consults, 295.3 wait hours, and 322.2 wRVUs over 2 years. o4-mini could have saved 183 consults, 302.0 wait hours, and 329.4 wRVUs.</p><p><strong>Conclusions: </strong>Large language models accurately identified uncomplicated proximal humerus fractures, potentially conserving unnecessary ED orthopaedic consults.</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":"e174-e180"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627976","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":"Sinus Tarsi Approach With Distractor-Aided Reduction of Displaced Intra-articular Calcaneus Fracture.","authors":"William R Judson, Gianni Ricci","doi":"10.1097/BOT.0000000000003198","DOIUrl":"10.1097/BOT.0000000000003198","url":null,"abstract":"<p><strong>Summary: </strong>This review describes the sinus tarsi approach for operative fixation of intra-articular calcaneus fractures, using a fixed distractor for assistance. The sinus tarsi approach has been shown to decrease wound complication rates and allow for earlier surgical intervention compared with the extensile lateral approach, while still achieving satisfactory anatomical restoration in the operative management of calcaneus fractures. The case presented involves a 46-year-old man who sustained a displaced intra-articular calcaneus fracture after a fall from height. The discussion includes operative indications, relevant imaging studies, patient positioning, and a detailed description of the sinus tarsi technique, as well as intraoperative observations and fracture fixation procedures.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"40 8S","pages":"S25-S26"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471239","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":"Optimizing the Disinfection of Devitalized Bone for Retained Use in Open Fractures: An In Vitro Study.","authors":"Aleksey Dvorzhinskiy, Kathleen Meyers, William Ricci, David Helfet, Alberto Carli, Xu Yang, Mathias Bostrom, David Wellman","doi":"10.1097/BOT.0000000000003190","DOIUrl":"10.1097/BOT.0000000000003190","url":null,"abstract":"<p><strong>Objectives: </strong>To compare several methods of disinfection of a grossly contaminated cortical fragment with regard to residual bacterial load and mechanical properties.</p><p><strong>Methods: </strong></p><p><strong>Microbiologic testing: </strong>Sixty (0.5 × 0.5 × 0.5 cm) cortical pieces of cadaveric femora were immersed in live Staphylococcus aureus ( 1 × 10 8 CFU/mL) for 60 minutes. Samples were randomized to no treatment, saline irrigation, povidone-iodine, chlorohexidine, pasteurization, or autoclave treatment and underwent bacterial enumeration using serial dilution and plating as well as broth turbidity testing.</p><p><strong>Mechanical testing: </strong>Separately, 60 diaphyseal cortical beams were created (2 × 2 × 3 cm) and underwent the aforementioned treatments, and subsequently were mechanically tested using 4-point bending.</p><p><strong>Results: </strong></p><p><strong>Microbiologic testing: </strong>Mean bacterial load was not significantly different with saline irrigation (4 × 10 7 CFU/mL) versus no treatment (5 × 10 7 CFU/mL), ( P = 1). Povidone-iodine (90 CFU/mL), pasteurization (250 CFU/mL), autoclave (0.6 CFU/mL), and chlorohexidine (0 CFU/mL) treatments significantly decreased bacterial load compared with the no treatment and saline groups ( P = 0.002). Samples treated with autoclave (0.6 CFU/mL) and chlorohexidine (0, 0 CFU/mL) achieved near-complete or complete disinfection.</p><p><strong>Mechanical testing: </strong>Autoclave treatment decreased maximum force to failure compared with no treatment (84 vs. 100 N, respectively, P = 0.012). No significant difference was noted in this parameter for the remaining groups ( P = 1). No difference was noted among groups for bending stiffness ( P = 0.318), work to failure ( P = 0.720), or flexural rigidity ( P = 0.235).</p><p><strong>Conclusions: </strong>Chlorohexidine treatment achieved complete disinfection of a grossly contaminated cortical segment without affecting mechanical properties. Povidone-iodine, chlorohexidine, pasteurization, and autoclave disinfection achieved profound reductions in bacterial load. Autoclave treatment modestly decreased the mechanical properties of cortical bone.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"452-458"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774381","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":"Extraction of Broken Intramedullary Nails Using Olive-Tipped Guidewire and Minifragment Screws.","authors":"Alejandro Ordas-Bayon, Matija Krkovic","doi":"10.1097/BOT.0000000000003179","DOIUrl":"10.1097/BOT.0000000000003179","url":null,"abstract":"<p><strong>Summary: </strong>In nonunion surgery, removing a broken intramedullary nail can be technically challenging and time-consuming, often requiring either creating a bone window or an open approach to retrieve the broken nail. A simple, effective, and minimally traumatic technique is presented for removing the difficult-to-access part of broken canulated intramedullary nails. First, the olive-tipped guidewire is inserted and advanced down the nail until the olive end protrudes out of the broken nail. A minifragment screw is inserted through a locking screw hole in the broken part under fluoroscopy. The guidewire is then gradually retracted until it becomes jammed with the minifragment screw in the locking hole of the nail. The construct is sturdy enough to retrieve the broken nail using the necessary force. Ten cases were retrospectively reviewed, including 4 short cephalomedullary femur nails, 1 long cephalomedullary femur nail, 2 antegrade femur nails, and 3 tibia nails, where this technique was used. All broken nails were successfully extracted in no more than 2 attempts. The average extraction time was 21 minutes (17 minutes for femur nails and 26 minutes for tibia nails). This technique relies solely on existing incisions and bone approaches required for standard nail removal, thus avoiding extra trauma to soft tissues and bone.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"e192-e197"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638954","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":"Articular Reduction of a Bicondylar Tibial Plateau Fracture Using a Lateral Tibial Osteotomy.","authors":"Jonathan C Arnold, Elliott Druten, Chirag Soni, Joash Suryavanshi, Malynda Wynn, Yohan Jang, Luke A Lopas","doi":"10.1097/BOT.0000000000003187","DOIUrl":"10.1097/BOT.0000000000003187","url":null,"abstract":"<p><strong>Summary: </strong>Tibial plateau fractures with significant articular depression can present challenges in achieving anatomic reduction, especially without an associated cortical \"split\" to access the depression. This case involved a 23-year-old woman with a valgus-unstable bicondylar tibial plateau fracture and substantial lateral joint depression. This review describes the use of a lateral tibial osteotomy to directly visualize and elevate a depressed articular surface during open reduction and internal fixation, allowing for restoration of alignment and stable fixation.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"40 8S","pages":"S15-S16"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471229","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":"Intraarticular Distal Humerus With Anconeus Pedicle and Olecranon Osteotomy.","authors":"Michele N Cerasani, Gloria Zhang, Sanjit Konda, Abhishek Ganta","doi":"10.1097/BOT.0000000000003208","DOIUrl":"10.1097/BOT.0000000000003208","url":null,"abstract":"<p><strong>Summary: </strong>This review details an open reduction internal fixation technique of a comminuted, intraarticular Y-type bicolumnar distal humerus fracture using supplemental minifragment plating in addition to dual locking plates. Owing to significant articular comminution, an olecranon osteotomy with an anconeus pedicle flap was used to facilitate exposure to achieve an accurate articular reduction to restore elbow function.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"40 8S","pages":"S5-S6"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471284","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":"Deltoid Ligament Repair Does Not Improve Radiographic or Clinical Outcomes in Weber Type C Pronation-External Rotation Ankle Fractures: A Randomized Controlled Trial.","authors":"Jun Young Choi, Oh Jun Yu, Young Ho Jung, Jin Soo Suh","doi":"10.1097/BOT.0000000000003189","DOIUrl":"10.1097/BOT.0000000000003189","url":null,"abstract":"<p><strong>Objective: </strong>To determine the clinical utility of deltoid ligament (DL) repair in Weber type C pronation-external rotation ankle fractures.</p><p><strong>Methods: </strong>.</p><p><strong>Design: </strong>Randomized controlled trial.</p><p><strong>Setting: </strong>A tertiary referral university hospital.</p><p><strong>Patient selection criteria: </strong>Between January 2022 and August 2024, patients with Weber type C ankle fractures (OTA/AO type 44C) and DL injury were enrolled and randomly assigned to either DL repair or no-repair groups after the fracture fixation strategy was established based on preoperative imaging.</p><p><strong>Outcome measure and comparisons: </strong>Radiographic parameters, including the medial clear space (MCS) and talar tilt (TT) were assessed on standing, gravity stress, and valgus stress views at 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Foot and Ankle Ability Measure (FAAM) scores.</p><p><strong>Results: </strong>Seventy-one patients (no repair: n = 36; DL repair: n = 35) completed the 12-month follow-up. Demographics and preoperative parameters were comparable between the repair and no-repair groups (all P > 0.05), including mean age (33.0 vs. 33.4 years), female distribution (27.8% vs. 28.6%), preoperative MCS on gravity stress view (8.6 vs. 9.7 mm), and preoperative TT on gravity stress view (3.8 degrees vs. 4.1 degree). All patients underwent lateral malleolus ORIF using anatomical plates; posterior malleoli were fixed based on computed tomography-defined criteria (fixation rates: 72.2% vs. 77.1%; P = 0.634). MCS remained comparable across all views and time points (all P > 0.05); 12-month valgus stress MCS was 3.8 ± 0.8 mm (no repair) versus 4.2 ± 1.1 mm (DL repair). At 3 months, the no-repair group exhibited significantly greater valgus TT on gravity stress (3.4 ± 1.0° vs. 0.6 ± 1.0°; P = 0.001) and valgus stress views (4.9 ± 1.0° vs. 0.2 ± 0.7; P = 0.001). These differences resolved by 12 months (1.2 ± 0.8 degrees vs. 0.4 ± 1.2 degrees on gravity stress view, and 1.1 ± 1.0° vs. 0.3 ± 1.2 on valgus stress view; all P > 0.05). FAAM scores improved significantly over time in both groups ( P < 0.05); specifically, the FAAM activities of daily living score increased from approximately 61%-63% at 3 months to 89%-90% at 12 months in both groups.</p><p><strong>Conclusions: </strong>In Weber type C fractures, DL repair provided superior early talar stability compared with no repair. Although the no-repair group exhibited transient valgus instability at 3 months, clinicoradiographic parameters became comparable by 12 months.</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":"399-407"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717156","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":"Trends in Posterior Malleolus Fixation and Subsequent Syndesmotic Repair in Trimalleolar Ankle Fractures.","authors":"Aditya Joshi, Jordan Helbing, Mark Haft, Ethan Harris, Nigel Hsu, Amiethab Aiyer, John M Thompson","doi":"10.1097/BOT.0000000000003181","DOIUrl":"10.1097/BOT.0000000000003181","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate treatment trends for trimalleolar fractures, specifically assessing whether increased posterior malleolus fixation was associated with reduced syndesmotic repair.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort analysis.</p><p><strong>Setting: </strong>PearlDiver (Mariner data set) database (2010-2021).</p><p><strong>Patient selection criteria: </strong>Patients were stratified according to ICD-9/10 and Current Procedural Technology codes into 4 cohorts based on index procedure: trimalleolar open reduction and internal fixation (ORIF) with posterior lip fixation and syndesmotic repair, trimalleolar ORIF with posterior lip fixation and without syndesmotic repair, trimalleolar ORIF without posterior lip fixation and with syndesmotic repair, and trimalleolar ORIF without posterior lip fixation and without syndesmotic repair. Exclusion criteria included: younger than18 years, pregnancy, prior ankle osteoarthritis, connective tissue disease, or syndesmotic repair unrelated to trimalleolar ankle fractures.</p><p><strong>Outcome measures and comparisons: </strong>Annual percentage incidence of syndesmotic repair within these cohorts was tabulated and compound annual growth rate (CAGR) and Mann-Kendall analysis was performed to assess trends. χ2 analysis evaluated characteristics associated with posterior fixation.</p><p><strong>Results: </strong>From 2010 to 2021, the incidence of concomitant posterior malleolus fixation in trimalleolar ORIF increased from 17.6% to 21.4% (CAGR: +6.2%, Mann-Kendall P -value: 0.011). The incidence of trimalleolar ORIF without posterior fixation decreased from 82.4% to 78.6% (CAGR: -3.0%, Mann-Kendall P -value: 0.04). The incidence of syndesmotic repair after trimalleolar fixation increased from 10.1% to 29.3% (CAGR for posterior fixation: +17.0%, Mann-Kendall P -value: <0.001; CAGR for no posterior fixation: +13.1%, Mann-Kendall P -value: <0.001). Trimalleolar ORIF with posterior fixation demonstrated similar rates of malunion, nonunion, and reoperation at 2 years postoperative, with no significant differences on χ2 analysis, compared with those without posterior malleolus fixation.</p><p><strong>Conclusions: </strong>The incidence of trimalleolar ORIF with posterior lip fixation increased over the past decade, and contrary to the hypothesis, the rate of subsequent syndesmotic repair after trimalleolar ORIF also increased.</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":"416-423"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645593","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 after Retrograde Intramedullary Nailing of 33C Femur Fractures.","authors":"Mitchel R Obey, Cole Payne, Christian G Falgons, Nathanial B Hunter, Aidan P Wright, Jonathan G Eastman, Joshua L Gary, Andrew M Choo, Timothy S Achor, John W Munz, Stephen J Warner","doi":"10.1097/BOT.0000000000003247","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003247","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the outcomes of patients with complete articular distal femur fractures treated with open reduction and retrograde intramedullary nailing.</p><p><strong>Methods: </strong>Design: Retrospective cohort analysis.</p><p><strong>Setting: </strong>Single-center, Level 1 academic trauma center.</p><p><strong>Patient selection criteria: </strong>Patients treated between January 1, 2016, and January 1, 2023, with complete articular distal femur fractures (AO/OTA 33 C1-3) who underwent independent articular reduction and retrograde intramedullary nailing were included. Patients were included who had a minimum of 3 months of follow-up or until fracture union.</p><p><strong>Outcome measures and comparisons: </strong>Patient data pertaining to demographics, surgical details, and radiographic outcomes were systematically collected and analyzed. Coronal and sagittal alignments were evaluated using the anatomic lateral distal femur angle (aLDFA) and anatomic posterior distal femoral angle (aPDFA), respectively. Reoperations were stratified into planned and unplanned categories and further classified as major or minor.</p><p><strong>Results: </strong>The study cohort comprised 127 patients (52% males) with 130 complete articular distal femur fractures (3 patients with bilateral fractures) with a mean age of 49.9 years (range, 12-95 years). Mean clinical follow-up was 254.1 days (range 90-1882 days). Postoperative mean aLDFA was 83.4 degrees, and aPDFA was 1.2 degrees apex posterior. Articular reductions were anatomic (0mm residual displacement, 93.8%) or near anatomic (between 0mm and 2mm residual displacement, 6.2%) in all cases. All reductions were maintained at final follow up. The reoperation rate was 15.4%, with 3.8% of cases classified as major unplanned operations. The majority of minor unplanned reoperations (8% of cases) were for implant irritation or knee arthrofibrosis. The rate of osseous union was high, with only one case of nonunion observed, yielding an aseptic nonunion rate of 0% and an infected nonunion rate of 0.8%.</p><p><strong>Conclusions: </strong>Independent articular reduction and retrograde intramedullary nailing of AO/OTA 33C femur fractures resulted in an overall reoperation rate of 15.4%, major unplanned reoperation rate of 3.8%, an osseous union rate of 99%, and maintained articular and metaphyseal reductions at final follow up. The study's findings support this technique as an effective treatment option for managing these injuries.</p><p><strong>Level of evidence: </strong>Level 3, Retrospective cohort study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620489","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":"Is the use of retrospectively collected radiographic scores an accurate method to determine time to union? A retrospective clinical cohort.","authors":"Adam M Schlauch, Anna Zakusylo, Nathaniel Schaffer, Cyril Mauffrey, Justin E Hellwinkel, William M Ricci","doi":"10.1097/BOT.0000000000003255","DOIUrl":"10.1097/BOT.0000000000003255","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the accuracy of time to union (TTU) in a cohort of patients after intramedullary nailing (IMN) of tibial shaft fractures where radiographic union was measured retrospectively with uncontrolled intervals between radiographs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Retrospective cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;A single Level I academic Trauma Center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Included were adult patients (18 years and older) treated with IMN for an acute tibial shaft fracture (OTA/AO 42A, 42B, 42C) between January 2020 to January 2025 with at least 6 week and 12-week post-operative radiographic evaluations. Patients who required a reoperation to promote union were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The modified radiographic union scores for tibial fractures (mRUST) were determined at each post-operative radiographic follow-up. The observed TTU was defined as the days from IMN to radiographic union (defined as mRUST ≥ 12). Cohort median time intervals were determined for: the time from IMN to the radiograph immediately prior to union; the time between the radiograph prior to union and union, and the TTU. The inter-quartile range to median ratio (IQR:median) was calculated for these intervals to normalize the time interval ranges and was used to define accuracy. Accuracy was defined as follows: low accuracy = IQR:median ≥0.5; moderate accuracy = IQR:median 0.2-0.5; and high accuracy = IQR:median ≤0.2. A predicted TTU for the cohort was calculated by considering all mRUST scores from the entire cohort over time to estimate the time at which 50% of the population would be expected to achieve radiographic union. This was a way to account for the changing nature of mRUST scores with time in between clinical visits. To determine if the observed TTU over- or underestimated the predicted TTU, the predicted TTU was compared to the observed TTU by taking the difference between the two.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;89 patients with a mean age of 43.1 years (SD = 13.7 years) and 65.9% male were included. The median observed TTU was 96 days (mean 208.6, SD 363.8 days) with an IQR:median of 0.9, indicating low accuracy. The median time from surgery to the radiograph immediately prior to union was 47 days (mean 58.7, SD 37.3 days) with an IQR:median of 0.4 (moderate accuracy). The median time between the radiograph immediately prior to union and union was 49 days (mean 150, SD 358 days) with an IQR:median of 1.1 (low accuracy). The predicted TTU was 61.8 days. The observed TTU over-estimated TTU by 34.2 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In patients treated with tibial IMN, retrospectively determining radiographic time to union (TTU) with uncontrolled interval radiographic evaluations was an inaccurate method to determine TTU. The observed TTU over-estimated a predicted TTU by 34.2 days. These findings highlight the inaccuracy of retrospectively d","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471178","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}