Journal of Orthopaedic Trauma最新文献

{"title":"Elevated Risk of Infection and Reoperation in Low-Energy Gunshot Tibial Fractures: A Comparative Analysis.","authors":"Divya Jeyasingh, David Campbell, Christopher Wedwick, Niloofar Dehghan","doi":"10.1097/BOT.0000000000002995","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002995","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the deep infection and reoperation rates associated with low-energy gunshot wound (LE-GSW) tibial shaft fractures and compare outcomes to fractures caused by blunt-force mechanisms and to analyze the microbial profile of infections in these cases.</p><p><strong>Methods: </strong>Design : Retrospective cohort study.</p><p><strong>Setting: </strong>Three Level 1 trauma centers in a large urban health system from 2014 to 2024.</p><p><strong>Patient selection criteria: </strong>Included were patients aged 16-65 years with tibial shaft fractures (OTA/AO 41A2-3, 42A-C, and 43A) treated with intramedullary nails (IMN) following LE-GSW or blunt-force mechanisms. Exclusions were pre-existing infections, high-velocity gunshot wounds, less than 6 weeks of follow-up, or delayed presentation (greater than 24 hours).</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes included deep infection and unplanned reoperations. Patients were categorized into closed fractures, LE-GSWs, Type I/II, and Type III open fractures. Data between these categories were compared using chi-square, Fisher's exact, and ANOVA with multivariable logistic regression.</p><p><strong>Results: </strong>Included were 195 patients (mean age 37.6 years, range 17-65; M:F ratio 136:59). Fractures were closed (n=68), Type I/II (n=55), Type III (n=37), and LE-GSWs (n=35). LE-GSWs had significantly higher deep infection (34.3%) and reoperation rates (57.1%) compared to closed fractures (1.5% and 13.2%, respectively, p<0.001). Type III infection rates were 16.2%. Multivariable analysis confirmed LE-GSWs as a significant risk factor for both infection (OR 4.26, p=0.003) and reoperations (OR 3.51, p=0.002). Infections in LE-GSW fractures were predominantly polymicrobial and Gram-positive.</p><p><strong>Conclusions: </strong>LE-GSW tibial fractures were associated with high rates of deep infection and reoperation with infection rates comparable to those of Type III open fractures. Treatment options such as broader prophylaxis or local antibiotic treatments should be considered in their initial management.</p><p><strong>Level of evidence: </strong>Level III - Retrospective Cohort Study.</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":"144022417","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":"Humeral Intramedullary Nailing Utilizing the Minimally Invasive Rotator-Interval Technique (MIR-IT) Improves Shoulder PROMs.","authors":"Lazaro Mesa, Christian M Schmidt, Reed Andrews, Mitchel John, Khaled Abdelghany, Maykel Dolorit, Mir Ibrahim Sajid, David Watson, Hassan R Mir","doi":"10.1097/BOT.0000000000002993","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002993","url":null,"abstract":"<p><strong>Objectives: </strong>To assess whether patients treated with a Minimally Invasive Rotator-Interval Technique (MIR-IT) versus the traditional technique of splitting the rotator cuff (RTCS) for intramedullary nailing of humeral shaft fractures resulted in comparable post-operative clinical and patient-reported outcomes (PROM).</p><p><strong>Methods: </strong>Design: Retrospective Cohort Study.</p><p><strong>Setting: </strong>Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients >18yo with humeral shaft fractures (AO/OTA 12A-C) treated with IMN between 2015 and 2022.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was differences in PROMs (ASES, Quick DASH, and Oxford Shoulder Score) between the MIR-IT and RTCS techniques. Secondary outcome measures included differences in rates of nonunion, superficial and deep surgical infections, wound dehiscence and iatrogenic nerve palsy between the two techniques.</p><p><strong>Results: </strong>Seventy-one patients underwent humeral IMN (MIR-IT - 39; RTCS - 32). Fifty-five patients (MIR-IT- 30; RTCS-25) had radiographic and clinical follow up to union. Mean follow up was 7.5 months (range: 3.1-16.8 months). Patients did not vary significantly with regards to age (MIR-IT: 54.4 ± 22.4; RTCS: 55.1 ± 18.5 years, p=0.896), and gender (Males- MIR-IT: 46.7%, RTCS: 44%, p=0.843). There were no significant differences in nonunion (7.4% vs 4.0% p=1.0), superficial infection (3.6% vs 4% p=1.0) or iatrogenic nerve palsy (3.6% vs 4.0% p=1.0) between the MIR-IT and RTCS groups. There were no deep infections or wound dehiscences in either group. Forty-two patients had PROMs (MIR-IT -21; RTCS -21). Average time to PROMs collection was 35.7 months (MIR-IT: 34.2 months, RTCS: 37.1 months, p=0.682). There were significantly better ASES scores (82.7 vs 71.6 p=.015), Quick DASH scores (9.7 vs 21.0 p=.011) and Oxford Shoulder Scores (39.3 vs 33.9 p=.042) amongst patients treated with the MIR-IT.</p><p><strong>Conclusions: </strong>Humeral IMN utilizing the MIR-IT resulted in better shoulder PROMs compared to the RTCS technique, with similarly low surgical complication rates.</p><p><strong>Level of evidence: </strong>Therapeutic Level II.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014802","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":"Mechanical Failure of the Stryker T2 Alpha Retrograde Femoral Nail.","authors":"Luke A Lopas, Chirag Soni, Roman M Natoli, Yohan Jang, Mason Milburn, Todd O McKinley, Brian Mullis, Jan P Szatkowski","doi":"10.1097/BOT.0000000000002955","DOIUrl":"10.1097/BOT.0000000000002955","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate mechanical failure rates of retrograde femoral nails in the treatment of distal femur fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Urban Academic Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Included were adult patients who sustained a distal femur fracture (Arbeitsgemeinschaft fur Osteosynthesefragen Foundation/Orthopaedic Trauma Association 33) who were treated with a retrograde intramedullary nail from August 2021 through September 2022.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was the rate of mechanical failure of the intramedullary nail defined as deformation and/or breakage of the intramedullary nail. The rate of mechanical failure was compared among retrograde femoral nails used at the same institution during the same time period.</p><p><strong>Results: </strong>One hundred and twenty distal femur fractures were identified (77 native distal femur, 43 periprosthetic) that were treated with a retrograde intramedullary nail. Average patient age was 67 years (SD 15.1, range 18-96 years). Eighty-three (69.2%) patients were women. Four mechanical nail failures (deformation and/or breakage of the intramedullary nail) were observed within 6 months of surgery, 2 in patients with native distal femur fractures and 2 in patients with periprosthetic distal femur fractures. All failures occurred among 49 fractures treated with a newly released retrograde femoral nail, the T2 Alpha Retrograde Femoral Nail (Stryker, Mahwah, NJ). This represents an 8.2% mechanical failure rate of distal femur fractures treated with this new nail compared with no failures observed with any other nail ( P = 0.03).</p><p><strong>Conclusions: </strong>Mechanical nail failures, within 6 months of surgery for distal femur fracture, of a new retrograde femoral nail were observed to be higher than seen with other nails. Further evaluation is needed to determine whether this experience represents factors related to patient, injury, or surgical characteristics, an anomaly, or a safety signal.</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":"192-199"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950510","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":"Ring Fixator Bone Transport Is Associated With Fewer Unplanned Major Reoperations Than Masquelet in the Treatment of Segmental Bone Defects of the Tibia.","authors":"Keith G Whitlock, Dane J Brodke, Philip H Khoury, Vivian Li, Alice Bell, David Okhuereigbe, Marcus F Sciadini, Jason W Nascone, Robert V O'Toole, Nathan N O'Hara, Mark J Gage","doi":"10.1097/BOT.0000000000002953","DOIUrl":"10.1097/BOT.0000000000002953","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether bone transport or Masquelet results in higher rates of major unplanned reoperations for the treatment of segmental tibial bone defects ≥4 cm in length.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Level I trauma center.</p><p><strong>Patient selection criteria: </strong>Adult patients with segmental tibial defects (OTA/AO 41, 42, 43) ≥4 cm who underwent surgical treatment with ring fixator bone transport or Masquelet between 2011 and 2022 with a minimum 1-year follow-up were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was a major unplanned reoperation after corticotomy (bone transport) or autografting (Masquelet), including below knee amputation, surgical debridement for deep infection, or surgical intervention for nonunion. Ring fixator bone transport and Masquelet were compared using multivariable logistic regression, adjusting for defect size as a potential confounder.</p><p><strong>Results: </strong>Twenty-four patients treated with bone transport [mean age 40 years (18-66), 100% men] and 22 patients treated with Masquelet [mean age 42 years (22-71), 91% men] were included. Defect etiology was identified as acute traumatic in 25 patients (54%) and postinfectious in 21 patients (46%) ( P = 0.23). The median defect size was 7.2 cm (interquartile range 6.1-10.1) for transport and 5.8 cm for Masquelet (interquartile range 4.7-8.0) ( P = 0.08). Bone transport was associated with an 85% reduction in the odds of a major unplanned reoperation compared to treatment with the Masquelet technique (odds ratio, 0.15; 95% confidence interval, 0.03-0.58; P = 0.01). Bone transport patients underwent a mean of 0.38 major unplanned reoperations compared to 0.91 in the Masquelet group. Reoperation for deep infection occurred significantly less in the bone transport group (21%) compared to the Masquelet group (46%) (odds ratio, 0.18; 95% confidence interval, 0.03-0.76; P = 0.03).</p><p><strong>Conclusions: </strong>Bone transport was associated with a reduction in major reoperations compared to Masquelet for segmental tibial bone defects. This finding may have been driven by fewer surgeries for infection in the bone transport group.</p><p><strong>Level of evidence: </strong>Therapeutic 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":"161-166"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922029","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}