Journal of Orthopaedic Trauma最新文献

{"title":"Midfoot Arthrodesis after Failed Lisfranc Open Reduction and Internal Fixation.","authors":"Megan L Campbell, Oliver C Sroka, Tyler Thorne, Anne Hakim, Matthew J Siebert, Justin M Haller, Lucas S Marchand","doi":"10.1097/BOT.0000000000002994","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002994","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the incidence and risk factors for secondary arthrodesis (SA) and compare patients who underwent primary arthrodesis (PA) versus SA following ORIF for Lisfranc injuries.</p><p><strong>Methods: </strong>Design : Retrospective cohort.</p><p><strong>Setting: </strong>Single tertiary level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Adult patients treated surgically for Lisfranc injuries AO/OTA 85.1A-C +/- 85.2.A-C, 85.3A-C; 87.1.1A-C-87.5.1A-C; 89B) between 2003-2023 were included.</p><p><strong>Outcome measures and comparisons: </strong>Patients who underwent index PA were compared to those who underwent index ORIF and subsequent SA. A composite primary outcome was used for comparison which included the development of adjacent midfoot arthrosis, midfoot collapse, or mal/nonunion rated satisfactory, suboptimal, poor, or severe; secondary outcomes were PROMIS measures of physical function (PF) and pain interference (PI). Descriptive and comparative statistics, multivariable analysis, and logistic regression were utilized to compare groups.</p><p><strong>Results: </strong>Of 489 Lisfranc injuries (482 patients), index treatment for 98 (20%) was PA. Average age was 37.7y (SD 15.6); mean follow up was 2.3y (SD 8.8). Fifty six percent of patients were men. There were thirty-four SAs (8.7% of index ORIF group). Patients who underwent SA were more likely to develop a poor (21.9% vs. 6.5% p=0.021) or severe outcome (12.5% vs. 1.1%, p=0.015) compared to those who underwent PA (OR 5.1, CI 1.4-18.5; OR 12.7, CI 1.1-12.8). Patients requiring SA also had significantly higher PI and significantly lower PF at final follow-up (p=0.018, p<0.001). Divergent injuries had higher odds of needing a SA compared to homolateral injuries (OR 6.9, p=0.006), as did index treatment with a tightrope (OR 4.6, p=0.003).</p><p><strong>Conclusions: </strong>Nine percent of patients underwent SA after index ORIF of their Lisfranc injury, and outcomes fared substantially worse than those treated with PA. This emphasizes the importance of identifying risk factors for patients that may fail ORIF. Further work is needed to clearly delineate which patients may best be served with PA.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029875","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":"Clinical trial of a new continuous compartment pressure monitoring to aid in the diagnosis of Acute Compartment Syndrome.","authors":"Mohammed Ali Balhareth, Kate Vaile, Prism Schneider, Allan Liew, Jeremy Hall, Pierre Guy, Abdel-Rahman Lawendy, Job Doornberg, Ruurd Jaarsma, Ross Leighton","doi":"10.1097/BOT.0000000000002980","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002980","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate a new compartment pressure monitor reporting continuous pressures and its contribution to Acute Compartment Syndrome (ACS) diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Design: Multicenter, non-randomized, prospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Six Level-I Trauma Centers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Enrolled were patients with acute long bone fractures (OTA 11-13, 2R, 2U, 31-33, and 41-43) where the Micro Electric Mechanical Sensor (MEMS) device was inserted either pre- or post-operatively into the compartment most likely to develop ACS, as deemed by the surgeon. Intracompartmental pressures (ICP) were continuously measured for up to 18 hours (as indicated by the FDA and Health Canada); clinical signs were simultaneously assessed for canonical compartment syndrome signs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;The primary measurement outcomes were ease of use, accuracy, and safety of the device across all participating sites. Ease of use was assessed through surveys completed by surgeons, which evaluated their confidence in the device's functionality and usability. Accuracy was determined by analyzing patient outcomes, using surgical findings and clinical resolution as the gold standards, to assess whether the device's results corresponded to true positive and true negative cases of compartment syndrome. Feasibility was defined as the device's ability to integrate into the clinical workflow, operate reliably under typical conditions, and provide actionable data for ACS diagnosis. The secondary outcomes included continuous intracompartmental pressure (ICP) measurements and their diagnostic value. Sensitivity and specificity were evaluated by comparing continuous ICP data with clinical assessments based on the \"6 P's\" (pain, pallor, paresthesia, pulselessness, poikilothermia, and paralysis) to determine their combined utility in diagnosing ACS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 100 patients, 68 males and 32 females with an average age of 42 years old (17-80 years old), were enrolled. All of the patients had suffered a fracture, 25 proximal tibias (OTA/AO-41), 40 midshaft tibias (OTA/AO42), 13 distal tibias (OTA/AO43), 11 forearms (OTA/AO 2R.2U), 6 femurs (OTA/AO31-33), 5 humerus (OTA/AO 11-13). Eighty-nine patients received the MEMS device post-operatively and 11 patients pre-operatively. 93% of participating surgeons reported confidence in the device's function and ease of use. Pressures were measured on average for 16h36 (3h-18h). No complications were reported. Post-operative ICPs (25.4 mmHg) were higher (p =0.0462) on average than pre-operative ICPs (18.9 mmHg). Patients that did not develop Compartment Syndrome had their post-operative pressures trend down after 4 hours (23.8mmHg). Sensitivity and specificity analyses of ICP alone, delta P alone, pressure trends alone, or a combination of the three metrics were conducted using patient outcomes","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803205","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":"Risk Factors and Infection Presentation of Gram-Negative Fracture Related Infections.","authors":"Elizabeth M Benson, Robert W Rutz, Austin C Atkins, Karen J Carter, Evan G Gross, Matthew Yeager, Joseph P Johnson, Clay A Spitler","doi":"10.1097/BOT.0000000000002981","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002981","url":null,"abstract":"<p><strong>Objective: </strong>To assess factors associated with gram-negative (GN) fracture related infections (FRIs) and the impact of GN infections in treatment and outcomes in FRIs.</p><p><strong>Methods: </strong>Design: Retrospective cohort.</p><p><strong>Setting: </strong>Single Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>All patients with extremity FRIs between 2013-2020.</p><p><strong>Outcome measures and comparisons: </strong>A univariate analysis of FRI bacteriology was conducted in two manners. Two group analysis compared Any GN (AGN) to Gram-positive (GP) only (GPO) FRIs . Three group analysis compared Gram-negative only (GNO) vs. GPO vs. Polymicrobial GN including GP (PGN) FRIs.</p><p><strong>Results: </strong>299 patients met inclusion criteria. The mean age was 45.59 (18-92), and 187 (62.5%) were male. 76 (25%) patients had a GN microbe on intraoperative culture. In the AGN vs. GPO comparison, there were more male GN FRI patients (AGN=74% vs. GPO=59%, p=0.02). Cardiovascular disease was less common in AGN FRI patients (AGN=17% vs. GPO=30%, p=0.028). Multisystem trauma (AGN=67% vs. GPO=50%, p=0.014), external fixation (AGN=50%, vs. GPO=33%, p=0.014), skin grafting (AGN=27% vs. GPO=15%, p=0.045) and flap coverage (AGN=32% vs. GPO=16%, p=0.011) were more common in the AGN FRI. AGN FRI patients had more sinus tracts on presentation (AGN=42% vs. GPO=27%, p=0.013) and higher rates of amputation (AGN=15% vs. GPO=6%, p=0.021. Nonunion rates did not differ between the groups (AGN=20% vs. GPO=22%, p=0.731). Total number of reoperations needed for infection clearance was similar between AGN (3.5 +/-2.7) and GPO (2.9 +/-2.5) FRIs (p=0.068). The 3-group comparison was performed between the following groups (GNO, GPO, PGN). Post-hoc analysis of the 3-group analysis demonstrated PGN infections had no significant differences from GNO FRI in regard to injury characteristics (lower extremity, polytrauma), surgical characteristics (external fixation, flap coverage) and sinus tract formation.</p><p><strong>Conclusion: </strong>Male sex, multi-system trauma, external fixation, and need for flap coverage or skin graft were associated with gram negative FRIs. Nonunion rates were similar between Gram-negative vs. Gram-positive only or Gram-negative vs. polymicrobial including Gram-negative FRIs. In comparison to patients with Gram-positive only FRI, any Gram-negative FRI led to a higher rate of amputation.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803250","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":"Distal Interlock Backout in the RFN-Advanced Retrograde Femoral Nailing System (RFNA) in Femur Fractures: Short Term Outcome Analysis.","authors":"Doriann M Alcaide, Nigel Blackwood, Rodney Arthur, David A Patch, Robert W Rutz, Clay A Spitler","doi":"10.1097/BOT.0000000000002979","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002979","url":null,"abstract":"<p><strong>Objective: </strong>To examine rate of distal screw backout in patients treated with the DePuy Synthes Retrograde Femoral Nail Advanced (RFNA) system.</p><p><strong>Methods: </strong>Design: Retrospective.</p><p><strong>Setting: </strong>Single Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Adults with type 32 and 33 AO/OTA femur fractures that underwent fixation between 2021 and 2024 with the RFNA. Patients were included only if they had healed fractures or demonstrated distal screw backout regardless of follow up.</p><p><strong>Outcome measures and comparisons: </strong>Demographics, injury characteristics, fixation construct, complications such as rates of reoperation, interlock fracture, implant removal, distal screw backout ≥ 5mm and reoperation to promote bone healing were analyzed. Characteristics of patients with and without distal screw backout ≥ 5mm were compared.</p><p><strong>Results: </strong>A total of 101 patients underwent fixation with RFNA for femur fractures. The mean patient age was of 40.4 (18-83), 62.4% were males, and mean BMI was 29.2. The average follow up was 281 days (27-1041 days). Motor vehicle accident was the most common mechanism of injury(48.5%). Fractures consisted of 77.2% AO/OTA type 32 and 22.8% type 33. Nine cases (8.9%) had screw backout (mean 15.5mm (5-31mm)). Among these 55.6% were OTA/AO 32 and 44.4% were OTA/AO 33.No cases had multiple screws backout. The mean time for diagnosis of screw backout was 73.3 days (25-180 days). Five of nine cases with backout underwent a reoperation for screw removal due to symptomatic prominence. There was a 5.0% reoperation rate to promote bone healing, a 5.0% surgical site infection rate, and a 3.0% interlock fracture rate. Excluding patients with supplemental fixation, 4 patients (5.7%) had distal screw backout with 2 undergoing removal of screw and all achieving union. No significant differences in age (37.5 vs 35.6; p=0.821), BMI (31.5 vs 29.4; p=0.607), weight bearing status (WBAT 75% vs 66.7%;p=0.134) or distance from fracture to screw (121 mm vs 132 mm; p=0.804) were observed between patients with and without backout.</p><p><strong>Conclusion: </strong>When used for treating distal femoral and femoral shaft fractures, the Depuy Synthes RFNA showed a 8.9% rate for distal interlock screw backout ≥ 5mm and a 5% reoperation rate for removal of distal screw backout.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780337","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":"Returning to Work Is Associated With Higher Quality of Life: A LIMB-Q Analysis in Patients With Limb-Threatening Injuries.","authors":"Sabrina M Wang, Natasha McKibben, Chao Long Azad, Moreen W Njoroge, Franca Kraenzlin, Nathan N O'Hara, Tim De Jong, Scott T Hollenbeck, Mark J Gage, Lily R Mundy","doi":"10.1097/BOT.0000000000002951","DOIUrl":"10.1097/BOT.0000000000002951","url":null,"abstract":"<p><strong>Objectives: </strong>To identify clinical, demographic, and patient-reported outcomes associated with return to work after lower extremity traumatic injury requiring amputation or limb salvage.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Multicenter across 25 countries.</p><p><strong>Patient selection criteria: </strong>Working patients who sustained lower extremity trauma requiring soft-tissue reconstruction or amputation.</p><p><strong>Outcome measures and comparisons: </strong>The main outcome measurements were LIMB-Q scores. Regression analyses were performed to evaluate associations between functional and quality-of-life outcomes by return-to-work status.</p><p><strong>Results: </strong>Responses were received from 258 participants with 66% being male participants (n = 173) and a mean age of 40 years old (IQR: 19-78). Of respondents that worked before injury, 67% (n = 173) returned to work after a mean 16 months (SD 39). Divorced or widowed status [ P = 0.006; OR 0.107 (95% CI 0.022-0.531)], bilateral injuries [ P = 0.004; OR 0.093 (95% CI 0.019-0.471)], and having a manual labor job [ P = 0.002; OR 0.191 (95% CI 0.027-0.395)] were negatively associated with return to work. Increased time since injury [ P = 0.036, OR 1.08 (95% CI 1.02-1.16)] and higher educational status [ P = 0.024; OR 5.12 (95% CI 1.24-21.0)] were positively associated with return-to-work status. Reconstruction or amputation was not associated with return to work [ P = 0.087, OR (95% CI 0.190-1.11)]. LIMB-Q Function ( P = 0.033; 95% CI [-11.3 to -0.49]) and LIMB-Q Life Impact ( P = 0.008; 95% CI [-13.5 to -2.01]) scores were significantly increased in patients that returned to work after injury.</p><p><strong>Conclusions: </strong>Patients who returned to work after lower extremity injury reported higher levels of function and overall return to normalcy in their lives. Returning to work may improve quality of life in patients following lower extremity trauma.</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":"155-160"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882257","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":"Early Mobilization and Predictors of Delayed Disposition for Geriatric Hip Fractures.","authors":"Ryne Jenkins, Daniel Acampa, Glyn Hinnenkamp, Christopher L Hoehmann, Maksim Vaysman, Nwe Oo Mon, Charles Ruotolo, Dennis Murphy","doi":"10.1097/BOT.0000000000002956","DOIUrl":"10.1097/BOT.0000000000002956","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effect of perioperative variables, including physical therapy (PT) and walking distance on length of stay (LOS) in hip fracture patients.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>A retrospective review.</p><p><strong>Setting: </strong>Single level I trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged 65 years and above with hip fractures Orthopaedic Trauma Association/AO Foundation 31-A and 31-B) between 2017 and 2020 were included. Patients were excluded if they were treated nonoperatively, suffered periprosthetic fracture, or were not admitted under the hip fracture protocol.</p><p><strong>Outcome measures and comparisons: </strong>Admission and perioperative variables including time to surgery and number of postoperative days (PODs) without a documented PT session during the first 3 PODs were assessed for correlation with increased total hospital LOS and postoperative LOS.</p><p><strong>Results: </strong>There were 301 patients included [234 (77.7%) female] with an average age of 84.4 years (±8.1 years). The median total LOS was 5 (interquartile range, 3-7) days and 4 (interquartile range 3-6) days after surgical fixation. Thirty-seven percentage of hip fractures had a delay in discharge. Ninety-five percentage of patients were discharged to a rehabilitation facility. The highest percentage of days with no PT session occurred on Saturdays and Sundays with 43% and 34% on POD 1, respectively; 40% and 33% on POD 2; and 26% and 30% on POD 3; P = 0.0004. In multivariate analysis, longer total LOS was associated with time to surgery more than 24 hours [AOR 5.6; 95% confidence interval (CI), 1.8-17.4; P < 0.0030], major complication (AOR 8.26; 95% CI, 2.8-20.0; P < 0.0014), discharge to subacute rehab (AOR 5.6; 95% CI, 3.0-10.5; P < 0.0001), and walking < 5 feet or not receiving PT (among patients with no assistance required as prehospital ambulatory status) (AOR 6.0; 95% CI, 2.3-15.3; P < 0.02). Longer LOS after surgery was associated with major complication (AOR 11.2; 95% CI, 3.1-39.8; P < 0.0002), discharge to subacute rehab (AOR 5.0; 95% CI, 2.7-9.1; P < 0.0001), and walking < 5 feet or no PT (AOR 4.8; 95% CI, 2.0-11.5; P < 0.01).</p><p><strong>Conclusions: </strong>Emphasis should be placed on minimizing complications while maximizing postoperative PT and early ambulation in the acute postoperative period, given the demonstrated association between inadequate mobilization and delayed disposition, especially if surgical fixation occurs surrounding the weekend or holiday.</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":"180-185"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950495","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":"Importance of Postreduction CT Scans in Posterior and Transverse Posterior Wall Acetabular Fracture-Dislocations.","authors":"Samantha R Gardner, Douglas R Haase, Nikhil Gattu, Stephen J Warner, Milton L Chip Routt, Patrick Kellam, Jonathan G Eastman","doi":"10.1097/BOT.0000000000002954","DOIUrl":"10.1097/BOT.0000000000002954","url":null,"abstract":"<p><strong>Objectives: </strong>To report the frequency of patients with pre-reduction and postreduction computed tomography (CT) scans associated with acetabular fracture-dislocations and the change in position of associated intra-articular fragments occurring with joint reduction.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Regional Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Patients who sustained Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association 62A1 and 62B1 posterior wall or transverse posterior wall acetabular fracture-dislocations with pre-reduction and postreduction CT imaging from February 2020 to July 2023.</p><p><strong>Outcome measures and comparisons: </strong>Intra-articular fragments were identified, and change in position (fossa to cranial, intra-articular to extra-articular, etc.) was noted from pre-reduction to postreduction scans. Operative reports and postoperative CT scans were reviewed to determine the frequency of fragment retrieval.</p><p><strong>Results: </strong>One hundred nineteen (30.2%) of 394 patients meeting fracture pattern inclusion criteria received a CT scan before hip reduction. Of the 394 patients, 100 (25.9%) had pre-reduction and postreduction CT scans and were studied [average age of 35.5 years (range 16-87 years), 59 male patients]. Forty-five (45%) of 100 patients had pre-reduction CT imaging demonstrating the presence of intra-articular fragment(s). Thirty (66.7%) of 45 patients with a pre-reduction intra-articular fragment had an intra-articular fragment location change during the reduction. Of the 55 patients who did not have an intra-articular fragment on pre-reduction imaging, 28 (50.9%) had at least 1 intra-articular fragment on the postreduction CT. Complete fragment retrieval was performed in 71.4% of patients.</p><p><strong>Conclusions: </strong>The study demonstrated that 30.2% of patients with posterior wall and transverse posterior wall acetabular fracture-dislocations received a CT scan before hip reduction. It was common to find intra-articular fragments on the postreduction CT in patients who did not have them on the pre-reduction CT. Obtaining and scrutinizing the postreduction CT scan provided accurate knowledge of the location of all osseous fragments associated with the fracture-dislocations, which facilitated thorough preoperative planning, intraoperative implementation, and hopeful long-term patient outcomes.</p><p><strong>Level of evidence: </strong>Prognostic 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":"167-173"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950497","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":"Exploring Outcomes of Tibial Rigid Intramedullary Nailing in Adolescent Patients.","authors":"Jessica L Koshinski, Joshua T Bram, Preston W Gross, Sarah H Hine, Daniel S Hayes, Peter D Fabricant, Mark A Seeley","doi":"10.1097/BOT.0000000000002957","DOIUrl":"10.1097/BOT.0000000000002957","url":null,"abstract":"<p><strong>Objectives: </strong>To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on postoperative complications and iatrogenic changes in tibial slope due to anterior physeal arrest.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>A large, tertiary care health system in the rural Mid-Atlantic United States, including two Level 1 trauma centers and one Level 2 trauma center.</p><p><strong>Patient selection criteria: </strong>Included were skeletally immature patients within 2 years of skeletal maturity undergoing tibial RIMN for Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen 42 A to C fractures between March 2009 and January 2024 with postoperative follow-up more than 1-year.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was change in tibial slope after RIMN. Secondary outcomes included postoperative weight-bearing status and complications.</p><p><strong>Results: </strong>Thirty-seven skeletally immature patients were included (mean age 15.2 ± 1.3 years, 76% male). For 22 patients with minimum 6-month postoperative radiographs (mean 18.4 ± 12.7 months), there was no significant change from preoperative to postoperative tibial slope (80.0 ± 1.9 vs. 80.1 ± 1.6 degrees, P = 0.86). Time to achievement of full weight-bearing across the series averaged 45.4 ± 35.6 days. Five patients (14%) underwent hardware removal, and 89% of patients reported that they had returned to \"normal\" activity at the latest follow-up (mean 56.2 ± 42.5 months).</p><p><strong>Conclusions: </strong>This study demonstrated that RIMN for tibial shaft fractures in skeletally immature pediatric patients within 2 years of maturity was not associated with iatrogenic physeal injury and resultant changes in tibial slope. Additional favorable clinical outcomes, the potential for early weight-bearing, and few associated postoperative complications indicate that RIMN is a safe option for skeletally immature patients with tibial shaft fractures. Caution should be exercised when extrapolating these results to younger pediatric patients with >2 years of skeletal growth remaining.</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":"186-191"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950496","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":"Comminuted Suprasyndesmotic Ankle Fractures Are Associated With a High Rate of Anterolateral Plafond Involvement.","authors":"Brian D Wahlig, Ankur Khanna, Bailey R MacInnis, Jonathan Copp, William W Cross, Stephen A Sems, Brandon J Yuan, Krystin A Hidden","doi":"10.1097/BOT.0000000000002952","DOIUrl":"10.1097/BOT.0000000000002952","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to identify the rate at which the anterolateral (AL) tibial plafond is affected in comminuted suprasyndesmotic ankle fractures (OTA/AO 44C2) and to assess how its involvement affects clinical outcomes.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective review.</p><p><strong>Setting: </strong>Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients with a preoperative computed tomography treated surgically for OTA/AO 44C2 fractures from January 2005 to December 2021.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome measure was the prevalence of AL plafond impaction or a displaced Tillaux-Chaput fracture. Secondary outcome measures included reoperation rate (excluding hardware removal), rate of new-onset ankle osteoarthritis, rate of ankle osteoarthritis progression, Single Assessment Numeric Evaluation score, and the Olerud Molander Ankle Score.</p><p><strong>Results: </strong>Fifty-three patients met inclusion criteria. The average age was 50 years (range 18-100), and 53% were female. The AL plafond was involved in 26 patients (49%), with AL plafond impaction in 11 patients (21%) and a displaced Tillaux-Chaput fragment in 15 patients (28%). Five patients (19%) received independent fixation of the AL plafond, and 3 of these patients had AL plafond impaction addressed. Thirty-eight patients (72%) had clinical follow-up of at least 6 months. Patients with AL plafond impaction had a higher rate of reoperation (excluding hardware removal) compared with those without any AL plafond involvement (hazard of reoperation = 8.3, 95% confidence interval, 1.4-15.3, P = 0.022) and a higher rate of new-onset ankle osteoarthritis (83% vs. 23%, P = 0.013). There was no difference in the rate of reoperation (11% vs. 9%, P = 0.748) or new-onset osteoarthritis (63% vs. 23%, P = 0.078) when comparing those with a displaced Tillaux-Chaput fracture to those without AL plafond involvement. There were no differences in Single Assessment Numeric Evaluation (75% vs. 78% vs. 85%, P = 0.661) or Olerud Molander Ankle Score (70 points vs. 69 points vs. 81 points, P = 0.517) scores when comparing those with AL plafond impaction, those with Tillaux-Chaput fragments, and those with no AL plafond involvement.</p><p><strong>Conclusions: </strong>Computed tomography evaluation is recommended in patients with comminuted suprasyndesmotic fibula fractures (OTA/AO 44C2) given their high association with AL plafond impaction and Tillaux-Chaput fracture. Patients with AL plafond impaction have a higher reoperation rate and new-onset ankle osteoarthritis compared with those without AL plafond involvement.</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":"174-179"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882255","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":"Technical Trick: Dual Plating with Medial Twist Plate of Distal Femur Fractures.","authors":"Hunter B Yancey, Madeline C Smith, Nicholas A Andring, Mattie E Raiford, Sharon Babcock, Jason J Halvorson, Holly T Pilson, Eben A Carroll","doi":"10.1097/BOT.0000000000002978","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002978","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657413","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}