Journal of Orthopaedic Trauma最新文献

{"title":"Letter to the Editor: Periprosthetic Supracondylar Femoral Fractures Above a Total Knee Replacement: An Updated Compatibility and Technique Guide for Fixation With a Retrograde Intramedullary Nail.","authors":"Rachel Honig, Marcus Sciadini","doi":"10.1097/BOT.0000000000003020","DOIUrl":"10.1097/BOT.0000000000003020","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor Regarding: Periprosthetic Supracondylar Femoral Fractures Above a Total Knee Replacement: An Updated Compatibility and Technique Guide for Fixation with a Retrograde Intramedullary Nail.","authors":"Daniel E Gerow, Hunter L Ross, Andrew Bodrogi, Kory J Johnson, Terrence J Endres","doi":"10.1097/BOT.0000000000003019","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003019","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159687","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":"Maximum Compressive Forces of Rescue Screws with Varying Diameters and Thread Patterns in Synthetic Osteoporotic and Normal Bone Models.","authors":"Tyler Thorne, Makoa Mau, Lucas Marchand, Justin M Haller","doi":"10.1097/BOT.0000000000003018","DOIUrl":"10.1097/BOT.0000000000003018","url":null,"abstract":"<p><strong>Objectives: </strong>\"Rescue screws\" are used to address screw stripping during fracture fixation. Bone screw fasteners (BSF; Osteocentric Technologies) have a thread pattern that may enhance purchase. This study compared maximum compressive forces of traditional buttress screws (TBS; Stryker) and BSF in rescue/lag modes using synthetic models of osteoporotic and normal bone.</p><p><strong>Methods: </strong>2.7-mm TBS screws were placed in lag mode and the maximum compression force prior to stripping was measured. Rescue screws, varied by screw type and diameter, were placed in lag mode through previously stripped lag holes, using appropriate glide holes in the proximal cortex and the maximum compression force prior to stripping was measured. Force differences were compared between the stripped 2.7-mm TBS screws, and each rescue screws (3.5-mm TBS, 2.7-mm BSF, and 3.5-mm BSF). Trials were conducted on two synthetic-layered biomechanical models, a synthetic 20-10 pound-per-cubic-foot (PCF) osteoporotic model and a 40-30 PCF normal bone density model.</p><p><strong>Results: </strong>2.7-mm rescue BSF produced similar compression to the original 2.7-mm TBS lag screw (BSF-501.0 N vs TBS-577.0 N, p=0.441) in normal bone, but lower compression in osteoporotic bone (61.0 N vs 104.0 N, p=0.001). 3.5-mm TBS and BSF rescue screws increased the amount of compression in osteoporotic bone (3.5-mm TBS vs 2.7-mm BSF: 136.0 N (16.4) vs 61.0 N (14.5); 3.5mm BSF vs 2.7-mm BSF: 198.4 N (4.2) vs 61.0 N (14.5) p<0.001) and in normal bone (3.5-mm TBS vs 2.7-mm BSF: 968.0 N (30.3) vs 501.0 N (197.7); 3.5-mm BSF vs 2.7-mm BSF: 1136.0 N (51.2) vs 501.0 N (197.7) p<0.001) versus 2.7-mm rescue screws.3.5-mm rescue BSF produced more compression than 3.5-mm TBS (198.4 N (4.2) vs 136.0 N (16.3), p<0.001) in osteoporotic bone, but not in normal bone (1136.0 N (51.2) vs 968.0 N (30.3), p=0.106).</p><p><strong>Conclusions: </strong>After stripping of a 2.7-mm Traditional Buttress Screw (TBS), 3.5-mm rescue TBS and Bone screw fasteners (BSF) generated more compressive force than the original lag screws in both normal and osteoporotic surrogate bone. 2.7-mm rescue BSF provided similar compression as the original lag screw in normal bone, but not osteoporotic bone. Depending on bone quality, surgeons can use different rescue screws to obtain similar or more fracture compression and construct stability.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159683","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":"In Response: Timing, Dosing, and Ethical Concerns in the TXA Trial in Hip Fractures.","authors":"Brandon J Yuan, Krystin A Hidden, William W Cross, Stephen A Sems","doi":"10.1097/BOT.0000000000003017","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003017","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150725","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":"Timing, Dosing, and Ethical Concerns in the TXA Trial in Hip Fractures.","authors":"J Ambrose Martino, Richard J Friedman","doi":"10.1097/BOT.0000000000003016","DOIUrl":"10.1097/BOT.0000000000003016","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150727","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":"Sagittal Malalignment and Unsatisfactory Fracture Gap Reduction are Risk Factors for Conversion to Total Knee Arthroplasty After High-Energy Bicondylar Tibial Plateau Fractures.","authors":"Garrett Gordon, Sarah Kurkowski, Samuel Gerak, Nihar Shah, Michael Archdeacon, T Toan Le","doi":"10.1097/BOT.0000000000003015","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003015","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the incidence of and risk factors for conversion to total knee arthroplasty after bicondylar tibial plateau fractures.</p><p><strong>Methods: </strong>Design: Retrospective, prognostic study.</p><p><strong>Setting: </strong>Tertiary-referral, single-center, Level I trauma center.</p><p><strong>Patient selection criteria: </strong>From 2008-2021, patients were included if they had an operative 41C1-C3 tibial plateau fractures and had ≥2 years of follow-up.</p><p><strong>Outcome measures and comparisons: </strong>Age, sex, BMI, smoking status, injury mechanism, medical history, surgical details (meniscal repair, external fixation, time to fixation), and radiographic data (Kellgren-Lawrence grade, reduction quality (defined as gap <2 mm after reduction), medial proximal tibial angle (MPTA), posterior proximal tibial angle (PPTA)) were collected and compared between patients that went onto require total knee arthroplasty (TKA) and those that did not.</p><p><strong>Results: </strong>243 patients were included with mean age of 49.7 (19-89) years and 58.8% were male. Mean follow-up was 5.2±2.6 years. 13.6% (33) required total knee arthroplasty (TKA) after an average of 23.4 months. TKA patients were older (54.0 vs. 49.0 years, p=0.042) and had larger fracture gaps (2.9 vs. 1.7 mm, p=0.024). They also had less satisfactory reductions in fracture gap (42.4% vs. 62.9% achieving reduction with a gap of <2mm, p=0.026) and PPTA (33.3% vs. 61.9%, p=0.002). Risk factors for TKA included fracture gap >2.45 mm after fixation, age >50.5, and PPTA >15°.</p><p><strong>Conclusions: </strong>Sagittal malalignment, age, and poor fracture gap reduction increased the risk of TKA conversion after OTA41C1-C3 fracture fixation.</p><p><strong>Level of evidence: </strong>III, prognostic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078541","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":"Evaluation of risk factors for treatment failure in pertrochanteric nonunion repair.","authors":"Avrey A Novak, Brian J Vasquez, David P Barei, Michael F Githens","doi":"10.1097/BOT.0000000000003014","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003014","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize the rate of failure and risk factors for treatment failure when operatively treating pertrochanteric and intertrochanteric femur nonunions.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>One Level 1 North American trauma center.</p><p><strong>Patient selection criteria: </strong>Patients from 2008-2022 presenting with intertrochanteric or pertrochanteric (AO/OTA 31A1.2-31A3.3) nonunions that underwent nonunion repair.</p><p><strong>Outcomes measures and comparisons: </strong>The primary outcome measure was treatment failure, which was defined as conversion to arthroplasty for reasons other than progression of pre-existing arthritis or persistent nonunion one year after nonunion repair. Patient demographics, caput-collum-diaphyseal (CCD) angle, the presence of medial bone loss, index implant selection, complications, use of bone graft, and presence of atypical femur fractures were examined for association with treatment failure.</p><p><strong>Results: </strong>Sixty-three patients met inclusion criteria and had adequate follow-up to union or treatment failure (average 23.3 months, range 3-129). Mean age was 59 (range 24-93, SD 15.6), and 47.6% of patients were male. 42 patients (65.1%) were treated with an angled blade plate (ABP); 19 (30.2%) with a cephalomedullary nail (CMN). The rate of failure was 26.5% (n=17). In 23.8% of cases autograft was utilized (n=15), 11.1% a synthetic biologic (n=7), 17.5% allograft (n=11), and 11.1% with allograft and autograft (n=7). [A1] A biologic augment was more frequently utilized in patients treated with an ABP versus CMN (71.4% versus 42.1%, p=0.02). Of the 42 patients managed with ABP there were 14 treatment failures (33.3%), compared with 3 of 19 patients treated with CMN (15.8%, p=0.15). Active tobacco use was associated with treatment failure; 7 of 14 patients went on to treatment failure compared to 10 of 49 without active tobacco use (50% vs 20.4%, p=0.03). In 14 cases, (22.2%) there was medial bone loss noted at the time of revision. 50% of these cases (7/14) failed to unite compared to 20.4% (10/49) of patients without medial bone loss (p=0.02).</p><p><strong>Conclusion: </strong>Despite variations in implant choice, use of biologic augments, and patient age a failure rate of 26.5% was observed in patients undergoing pertrochanteric and intertrochanteric nonunion repair. Medial bone loss and tobacco use were each associated with a 50% rate of treatment failure, highlighting consideration of these factors preoperatively when considering undertaking nonunion repair.</p><p><strong>Level of evidence: </strong>Retrospective Cohort Study - 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":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026739","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":"Cementotomy-Assisted Masquelet Technique: A Novel Method for Efficient Cement Extraction in Distal Femur Bone Defect Management.","authors":"Asif Imran, Agraharam Devendra, Purnaganapathi Sundaram Velmurugesan, Perumal Ramesh, Zackariya Mohamed, Sp Sivakumar, Jayaramaraju Dheenadhayalan, Shanmuganathan Rajasekaran","doi":"10.1097/BOT.0000000000003011","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003011","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preservation versus Sacrifice of the Supraclavicular Nerves during Clavicle ORIF: A Randomized Controlled Trial.","authors":"Indraneel S Brahme, Geneva Tranchida, Jeffrey D Winter, Gaonhia Y Moua, Patrick Horrigan, Brian Cunningham, Peter A Cole","doi":"10.1097/BOT.0000000000003013","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003013","url":null,"abstract":"<p><strong>Objectives: </strong>To discover postoperative symptom differences between nerve-sparing and nerve-sacrificing techniques during ORIF of clavicle fractures.</p><p><strong>Methods: </strong>Design: Prospective, partially blinded randomized controlled trial.</p><p><strong>Setting: </strong>Single academic Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients with closed, isolated, displaced, midshaft clavicle fractures (OTA/AO 15-2A, -2B, -2C) underwent ORIF and were consented and randomized to a \"nerve-sacrificing\" or \"nerve-sparing\" group.</p><p><strong>Outcome measures and comparisons: </strong>Semmes-Weinstein monofilament used to test for sensation changes around the supraclavicular area, single assessment numerical evaluation (SANE) scores and symptom severity level (SSL) providing patient self-reported changes, and patient morbidity questionnaires were issued at follow-up. One trained research fellow measured and mapped area of anesthesia. Outcomes between \"nerve-sacrificing\" and \"nerve-sparing\" groups were compared.</p><p><strong>Results: </strong>21 patients (median age 41.5, 28.6% female) were randomized to \"nerve-sacrificed\" and 16 (median age 45.6, 18.8% female) to the \"nerve-spared\" group. There were no statistical differences in age or gender ratio (p=0.304 and 0.702 respectively). Longitudinal models including an interaction between group and time, showed cohort differences being driven by 12-weeks (49.3 (95% CLM 7.68, 90.92)) and 24-weeks (23.92 (95%CLM 1.70, 46.14)). While point estimates for the spare group were still lower at 2- and 52-weeks, they were not significantly different between groups. SANE scores and SSL data showed improvements in both cohorts over time, however; there were no statistically significant differences between the groups (p=0.176 and 0.155, respectively).</p><p><strong>Conclusions: </strong>Sparing the supraclavicular nerve during open reduction and internal fixation of clavicle fractures significantly decreased chest-wall area of anesthesia at 12- and 24-weeks postoperatively. However, nerve sparing did not provide clinically significant differences in other symptoms compared to sacrificing the nerve.</p><p><strong>Level of evidence: </strong>Level I, Therapeutic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprosthetic Fracture Rate in Elderly Patients Undergoing Hip Hemiarthroplasty: A Comparison of Fit-and-Fill, Tapered-Wedge, and Cemented Stems.","authors":"Michael J DeRogatis, Neil Jain, Robert Gomez, Margaret J Higgins, Jeremy A Dubin, Paul S Issack, Douglas Lundy","doi":"10.1097/BOT.0000000000003012","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003012","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the periprosthetic fracture rates of three stem designs: cemented, press-fit fit-and-fill, and tapered wedge for hemiarthroplasty in geriatric patients with femoral neck fractures.</p><p><strong>Methods: </strong>Design: Retrospective review.</p><p><strong>Setting: </strong>Two institutions, including one level I trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged 70 years or older with a displaced femoral neck fracture (OTA/AO 31B) treated with press-fit or cemented hemiarthroplasty were included. Patients treated with total hip arthroplasty, conversion procedures, concomitant acetabular fracture, and pathologic fractures were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Rates of intraoperative and postoperative periprosthetic femur fracture (PFF), 30-day and 1-year mortality, operative time, length of stay, and rate of reoperation were compared between stem subtypes.</p><p><strong>Results: </strong>A total of 758 consecutive patients (404 tapered wedge, 227 fit-and-fill, and 127 cemented) were included. The mean follow-up was 10.1±14.1, 13.0±16.6, 6.8±10.9 months, for tapered wedge, fit-and-fill, and cemented stems, respectively. Tapered wedge stems had an average age of 83.6 years (range 70-100) with 29.2% male; fit-and-fill stems had an average age of 84.3 years (70-102) with 34.8% male; and cemented stems had an average age of 84.1 years (range 70-100) with 26.0% male. 56 (41 intraoperative and 15 postoperative) PFFs were identified. The rate of PFF between tapered wedge (9.4%), fit-and-fill (4.8%), and cemented stems (5.5%) differed significantly (P = 0.01). Fit-and-fill implants had a lower rate of PFF than tapered wedge implants (P = 0.04) and were equivalent to cemented fixation (P = 0.78). Among intraoperative PFFs, tapered wedge stems had a significantly higher calcar fracture rate than fit-and-fill (P = 0.03) and cemented (P = 0.02) stems. Use of fit-and-fill stems did not result in a higher rate of intraoperative calcar fracture than cemented stems (P = 0.85). Postoperative PFF reoperation rates did not reach statistical significance between fit-and-fill (1.8%), tapered wedge (1.7%), and cemented (0.8%) stems (P = 0.39). Fit-and-fill stems had significantly less operative time than cemented stems (93.6 ± 30.0 vs 108.7 ± 41.0 minutes, respectively; P <0.001). No differences in 30-day (4.5%, 4.9%, 5.5%; P = 0.88) or 1-year mortality (17.1%, 17.0%, 22.4%; P = 0.37) were observed between tapered wedge, fit-and-fill, and cemented stems, respectively.</p><p><strong>Conclusions: </strong>When treating displaced femoral neck fractures, tapered wedge stems may result in a higher rate of PFF. As an alternative, fit-and-fill stems may lower PFF rates without the risk of bone cement implant syndrome and longer operative times.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}