Journal of Orthopaedic Trauma最新文献

{"title":"Bacteriophage Therapy for Acute Fracture-Related Infections: An Effective Treatment When Compared With Antibiotics in a Canine Model.","authors":"Kyle Schweser, Chantelle C Bozynski, Aaron M Stoker, Tamara Gull, Dana Duren, James L Cook","doi":"10.1097/BOT.0000000000002950","DOIUrl":"10.1097/BOT.0000000000002950","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the effectiveness of bacteriophage therapy for the treatment of fracture related infections compared to antibiotic therapy in a preclinical canine model.Design:Preclinical controlled large-animal model study.Outcome and Measures Comparison:Clearance of bacteria based on CFU/g, callus formation based on radiographs and histomorphometry, callus maturity based on histomorphometry, and biofilm clearance based on semi-quantitative histomorphometry.</p><p><strong>Methods: </strong>A canine model was used for this preclinical study examining bacteriophages specifically cultivated against Staphylococcus aureus (OJ1). Based on sample size calculations and ethical care and use of animals, bilateral 1-cm ulnar defects (n = 32; 16 dogs) were created and stabilized using plate and screw fixation. Implants were incubated in a suspension of biofilm-producing S. aureus (OJ1). After 3 weeks, bone samples from fracture sites were cultured and surgical sites underwent irrigation and debridement (I&D) with retention of hardware, followed by 1 of 4 treatments (n = 8 per group): no additional treatment, 6 weeks of parenteral antibiotics, 7 days of bacteriophage therapy, or combination antibiotic/bacteriophage therapy. At 11 weeks, dogs were humanely euthanatized and bacterial load, callus formation, and histomorphometry for callus maturity and biofilm formation were assessed using quantitative microbial bone cultures, radiography, and semi-quantitative histomorphometry.</p><p><strong>Results: </strong>At 3 weeks, all dogs had confirmed infections. At 11 weeks, fractures that received bacteriophage therapy had statistically significant reductions in CFU/g when compared to those that did not receive bacteriophage. Fractures treated with bacteriophages had statistically significantly more robust callus formation on radiographs at 11 weeks, as well as, decreased biofilm formation and statistically significant increase in bone formation on histology/histomorphometry when compared to fractures that did not receive bacteriophages.</p><p><strong>Conclusions: </strong>Seven days of bacteriophage therapy was at least as good as 6 weeks of antibiotic therapy in terms of clearance of acute FRIs. It was superior in terms of reduction in CFU/g, better callus formation, and biofilm clearance.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"144-152"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828771","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":"Nonunion of Adult Forearm Fractures: Evaluation of Intramedullary Nailing With Grafting as a Treatment Option.","authors":"Tolga Onay, Mesut Akkaya, Mehmet Dilek, Mehmed Nuri Tütüncü, Fuat Akpınar","doi":"10.1097/BOT.0000000000002944","DOIUrl":"10.1097/BOT.0000000000002944","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effectiveness of intramedullary nailing combining with iliac or fibular autograft for the treatment of adult forearm nonunions.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Two academic trauma referral centers.</p><p><strong>Patient selection criteria: </strong>Adult patients who sustained surgical treatment for forearm fracture (OTA/AO 2R2-2U2) nonunion with intramedullary nailing and grafting from May 2005 to January 2023 were included.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was to determine the bone union rates after nonunion surgery with intramedullary nail and grafting. Secondary outcomes were to assess functional scores including The Visual Analog Score; the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; Grace-Eversmann evaluation criteria.</p><p><strong>Results: </strong>The study included 24 patients comprising 19 men and 5 women (7 radius, 14 ulna, 3 both bones) with an average age at the time of surgery of 40.5 ± 11.2 years (range, 23-61 years) and union was achieved for 24 out of 27 bones (88.8%) in 22 out of 24 patients. The mean (average) preoperative and postoperative QuickDASH scores were found as 64.5 ± 18.2 and 15.3 ± 18.9, respectively. The functional improvement was found statistically significant ( P < 0.001). The mean (average) preoperative and postoperative Visual Analog Score was found to be 7.2 ± 2.1 and 1.52 ± 1.5, respectively. The difference was found statistically significant ( P < 0.001). Two cases of radius nonunion healed with 10 degrees and 15 degrees of angulation and shortening, while nonunion persisted in 2 patients. All remaining cases healed without deformity. Excellent to acceptable results were obtained for 83.3% of patients according to Grace-Eversmann criteria.</p><p><strong>Conclusons: </strong>Intramedullary nailing with autologous grafting is a viable option for the treatment of adult forearm nonunions.</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":"120-126"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800255","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":"Frustrations in Providing Orthopaedic Trauma Care: An OTA Member Survey Study.","authors":"Rebekah M Kleinsmith, Stephen A Doxey, Haley D Puckett, Elizabeth A Duckworth, Michael Milshteyn, Austin D Hill, Brian P Cunningham","doi":"10.1097/BOT.0000000000002941","DOIUrl":"10.1097/BOT.0000000000002941","url":null,"abstract":"<p><strong>Objectives: </strong>To determine sources of frustration for surgeons and how they might affect job satisfaction within the orthopaedic trauma community.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Cross-Sectional Survey Study.</p><p><strong>Setting: </strong>International Online Survey.</p><p><strong>Participant selection criteria: </strong>After approval by the OTA research committee, the survey was available to all active and associate OTA Members.</p><p><strong>Outcome measures and comparisons: </strong>A 25-question survey regarding potential common causes of frustration, operating room (OR) utilization, and career satisfaction was electronically distributed to the Orthopaedic Trauma Association (OTA) membership.</p><p><strong>Results: </strong>Four hundred seventy-one surgeons participated in the survey (response rate 27.5%). The highest ranked source of frustration was OR turnover time, followed by staff turnover, and OR scheduling. Most reported they were very satisfied with their career (n = 240, 51.0%). The top 3 strategies to increase career satisfaction from most to least effective were increased compensation, case delay reduction, and decreased work hours. Most surgeons reported that if their number 1 frustration was solved, they would feel a higher level of career satisfaction (very satisfied: n = 344, 73.1%). Most felt their cases did not start on time (n = 273, 58.0%), with most respondents reporting that their cases were delayed on average between 15 and 60 minutes (n = 222, 81.9%). The number 1 ranked reason for case start delays was OR turnover and case setup, followed by the anesthesia team.</p><p><strong>Conclusions: </strong>Many surgeons within the orthopaedic trauma community reported concern with OR turnover time and staff turnover. Addressing these sources of frustration is crucial to maintaining surgeon well-being and can aid in optimizing delivery of patient care. Future studies should seek out institutions that have successfully addressed these common frustrations and identify potential strategies to improve the delivery of orthopaedic trauma care across North America.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"109-113"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769945","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":"Bicortical Compression and Construct Stability With Variable Pitch Locking Screws in Cadaveric Specimens: Erratum.","authors":"Zachary A Koroneos, Shelby Alwine, Peter Tortora, Michaela Pitcher, Christian Benedict, Hwabok Wee, Allen Kunselman, Michael Aynardi, Gregory S Lewis","doi":"10.1097/BOT.0000000000002948","DOIUrl":"10.1097/BOT.0000000000002948","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 3","pages":"153"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414586","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":"Marijuana Use and Complication Risk After Tibia Shaft Fracture Fixation.","authors":"Ridge Maxson, Sarah Rapaport, Oscar Covarrubias, Diane Ghanem, Andres F Moreno-Diaz, Ryan Ross, Victoria E Bergstein, Lucy O'Sullivan, Davis Rogers, Phillip M Mitchell, Babar Shafiq","doi":"10.1097/BOT.0000000000002945","DOIUrl":"10.1097/BOT.0000000000002945","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to investigate the relationship between preoperative marijuana use and complications after tibia shaft fracture fixation.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Two academic Level I trauma centers.</p><p><strong>Patient selection criteria: </strong>Adults age ≥18 years who underwent tibia shaft fracture (OTA/AO 42) fixation from 2014 to 2022 and had a minimum 3 months postoperative follow-up were included. Patients were considered marijuana users if they had current self-reported marijuana use or a urine toxicology screen positive for cannabinoids documented at initial presentation.</p><p><strong>Outcome measures and comparisons: </strong>Bivariate statistics and multivariate regression were used to evaluate the effect of marijuana use on 90-day postoperative thromboembolic and surgical complications, unplanned readmissions, and emergency department visits. Complications related to fracture union were evaluated in patients with ≥6 months follow-up. Multivariate analysis controlled for tobacco use, open fracture, and American Society of Anesthesiologist class ≥3.</p><p><strong>Results: </strong>Among 388 patients included in the study, the mean age was 37.6 years (range, 18-90), and most patients were men (66.5%). Ninety-six patients (25%) were identified as marijuana users. Marijuana users were significantly younger (30.5 years vs. 40 years, P < 0.001) and more likely to be men (79% vs. 62%, P = 0.002) and use tobacco currently (73% vs. 31%, P < 0.001) than nonusers. Marijuana users experienced higher rates of 90-day surgical complications (11.5% vs. 4.8%, P = 0.030) and deep infection (8.3% vs. 2.1%, P = 0.008) than nonusers. No significant difference was observed between groups in the rates of thromboembolic complications, nonunion, or delayed union ( P > 0.05). On multivariate analysis, marijuana use was not associated with odds of developing any 90-day surgical complication (odds ratios 2.01; 95% confidence intervals 0.83-4.84) or deep infection (odds ratios 2.97; 95% confidence interval 0.95-9.25).</p><p><strong>Conclusions: </strong>Preoperative marijuana use was not found to be associated with risk of thromboembolic, surgical, or fracture union-related complications in patients undergoing tibia shaft fracture fixation.</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":"137-143"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801180","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":"Development of a Surgical Difficulty Score for Open Reduction Internal Fixation of Pilon Fractures: Erratum.","authors":"David Burns, Aazad Abbas, Suhas Dasari, Pooja Prabhakar, Jonah Hebert-Davies","doi":"10.1097/BOT.0000000000002949","DOIUrl":"10.1097/BOT.0000000000002949","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"39 3","pages":"153"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414588","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":"Comparison Between in Situ Fixation and Fixation After Closed Reduction in Valgus-Impacted Femoral Neck Fractures: A Multicenter Study.","authors":"Byung-Woong Jang, Jung-Wee Park, Jae-Hwi Nho, Jinjae Kim, Tae-Young Kim, Young-Kyun Lee, Jin-Woo Kim","doi":"10.1097/BOT.0000000000002942","DOIUrl":"10.1097/BOT.0000000000002942","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to compare clinical outcomes between in situ fixation and fixation after closed reduction (CR) in patients aged 50 years and older with valgus-impacted femoral neck fractures using data from multiple centers.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective multicenter cohort study.</p><p><strong>Setting: </strong>Five tertiary-care university hospitals.</p><p><strong>Patient selection criteria: </strong>Patients aged 50 years and older, treated with operative fixation of valgus-impacted femoral neck fractures using multiple cannulated screws from 2003 to 2019.</p><p><strong>Outcome measures and comparisons: </strong>Complications such as fixation failure, osteonecrosis of femoral head (ONFH), and reoperation were compared between the groups (in situ fixation group and fixation after CR group). Postoperative EuroQol-5 Dimension (EQ-5D), Harris Hip Score, and Koval grade were compared.</p><p><strong>Results: </strong>The mean age of the 206 patients (161 in situ fixation group, 45 in fixation after CR group) who met the inclusion criteria was 68.9 ± 10.9 years (range, 50-95 years). There were 39 men and 167 women. Fixation failure occurred in 11.2% (6.8% of in situ fixation group vs. 26.7% of fixation after CR group, P = 0.002). Reoperation was required for 10.2% (7.5% of the in situ fixation group vs. 20% of the fixation after CR group, P = 0.023). Fixation failure and reoperation rates were significantly higher in the fixation after the CR group than in the in-situ fixation group (odds ratio = 4.757, P = 0.002 and odds ratio = 3.104, P = 0.023, respectively). At the 2-year follow-up, ONFH occurred in 5.8% (9 out of 161, in situ fixation group vs. 3 out of 45, fixation after CR group). There was no significant difference in the occurrence of ONFH between the 2 groups ( P = 0.727). The Koval's grade at 6 and 12 months demonstrated better results in the in-situ group ( P = 0.027, 0.044, respectively). Postoperative EQ-5D and Harris Hip Score scores showed no statistically significant differences between the 2 groups.</p><p><strong>Conclusions: </strong>In patients aged 50 years or older with valgus-impacted femoral neck fractures, when fixation was done after reduction, the reoperation rate was higher due to fixation failure compared with in-situ fixation. There was no significant difference in the incidence of ONFH in valgus-impacted femoral neck fractures regardless of whether reduction was performed.</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":"127-131"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801179","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":"Hardware Removal After Lisfranc Open Reduction and Internal Fixation Results in Improved Physical Function.","authors":"Oliver Sroka, Megan Campbell, Tyler Thorne, Justin Haller, David Rothberg, Thomas Higgins, Lucas Marchand","doi":"10.1097/BOT.0000000000002927","DOIUrl":"10.1097/BOT.0000000000002927","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to investigate whether hardware removal (HWR) after Lisfranc open reduction and internal fixation (ORIF) resulted in significant impact through PROMIS physical function (PF) and pain intensity (PI) scores.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Level-1 trauma center.</p><p><strong>Patient selection criteria: </strong>Adult patients with isolated Lisfranc injuries who were treated through ORIF between 2002 and 2023 who had PROMIS PF and PI scores through 6 months follow-up were included. Patients were excluded if they received index treatment other than ORIF or underwent secondary surgical intervention before HWR. A subanalysis was performed at 1-year follow-up.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes were PROMIS PF and PI scores. The Wilcoxon signed-rank test compared differences between PROMIS scores within the HWR group. The Wilcoxon ranked-sum test compared differences between HWR versus no HWR. Distributive MCID was calculated using the 0.5 SD method.</p><p><strong>Results: </strong>There were 482 patients (489 feet) identified with isolated Lisfranc injuries. Seventy-seven feet underwent ORIF followed by HWR. Thirty feet underwent ORIF without HWR. The average age of the no HWR group was 45.8 (18.0-81.3) years versus the HWR group that was 38.7 (18.3-74.1) years ( P = 0.053). Nineteen (63.3%) were women in the no HWR group compared with 33 (42.9%) in the HWR group ( P = 0.084). HWR occurred an average of 4.43 months after ORIF. Patients who underwent HWR had a statistically significant increase in average PF scores (39.7-45.9, P < 0.001) at their standard 6 weeks (1.5 months) postoperative visit. HWR patients had a nonsignificant decrease in average PI scores (56.5-53.9, P = 0.24). Compared with those with retained hardware, the HWR group demonstrated a statistically significant net improvement in PF and PI scores from surgery, with an average improvement of 5.6 and 1.7, respectively ( P = 0.002, 0.008).</p><p><strong>Conclusions: </strong>Patients experienced significant improvement in PROMIS PF scores for Lisfranc ORIF at 6 weeks after HWR. Compared with patients with retained hardware, they also experienced significant improvement in PROMIS PF and PI scores.</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":"90-95"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468162","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":"Benefit of Expedited Time to Hip Fracture Surgery Differs Based on Patient Risk Profile.","authors":"Abhishek Ganta, Lauren A Merrell, Carolyn Herbosa, Kenneth A Egol, Sanjit R Konda","doi":"10.1097/BOT.0000000000002934","DOIUrl":"10.1097/BOT.0000000000002934","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To identify which hip fracture patients benefit the most from operative repair within 24 hours of Emergency Department presentation based on patient risk stratification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective Cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Academic Medical Center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Patients operatively treated for an AO/OTA 31 A, 31 B, or 32 A hip fracture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;Each patient was placed into an \"individualized risk quartile\" (Individual Risk Quartile) using a validated risk stratification tool (The Score for Trauma Triage in the Geriatric and Middle-Aged [Score for Trauma Triage and Geriatric Middle Aged], a tool proven to predict inpatient mortality in trauma patients). Patients were risk stratified into minimal-, low-, moderate-, and high-risk IRQs. In each cohort, patients were separated into 3 groups based on their time from Emergency Department arrival to surgery (&lt;24 hours, &gt;24 hours and &lt;48 hours, and &gt;48 hours). Each of these 12 groups was analyzed for complications (minor inpatient complications included acute kidney injury, urinary tract infection, decubitus ulcer, and acute blood loss anemia, while major inpatient complications included sepsis or septic shock, pneumonia, acute respiratory failure, stroke, myocardial infarction, cardiac arrest, and deep vein thrombosis or pulmonary embolism), mortality rates, and hospital quality measures (length of stay and readmission rates). The results were compared across cohorts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 2472 patients were identified: the mean age of the cohort was 80.6 ± 10.3 and was predominantly female (69%) and white (71%). The data demonstrated improved outcomes (complications, mortality rates, hospital quality measures) across all patients (nonrisk stratified) for surgery within 24 hours compared with surgery between 24 hours and 48 hours and surgery greater than 48 hours (all outcomes P &lt; 0.050). However, these effects were not evenly distributed among the IRQs. In the IRQ4 cohort, major complication rates progressed from 20% to 25% to 34% as a function of time to surgery ( P = 0.007). IRQ1 did not demonstrate similar results ( P = 0.756), with the rates essentially static across surgery time points (3%-2% to 4%). A similar trend was seen when analyzing mortality at 1 year for highest risk patients, with similar 1-year mortality rates across operating room windows of IRQs 1-3 (IRQ1: P = 0.061, IRQ2: P = 0.259, IRQ3: P = 0.524) but increased in IRQ4 with increasing time to surgery (21% vs. 33% vs. 33%, P = 0.006).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrates a differential impact of expedited time to surgery on patients when stratified by the risk profile. The lowest risk hip fracture patients do not fare worse if operated on within 48 hours as compared to 24 hours.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence:","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"68-74"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729710","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":"The Use of External Beam Radiation Therapy for Heterotopic Ossification Prophylaxis After Surgical Fixation of Acetabular Fractures: A Randomized Controlled Trial.","authors":"Adam Boissonneault, Nathan N O'Hara, Gerard P Slobogean, Anna Meyer, Michael Maceroli, Marcus F Sciadini, Jason W Nascone, Mark J Gage, Jolinta Lin, Sheela Hanasoge, Jay Shelton, Zaker Rana, Mark Mishra, Robert V O'Toole","doi":"10.1097/BOT.0000000000002931","DOIUrl":"10.1097/BOT.0000000000002931","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the effect of external beam radiation (XRT) on preventing severe heterotopic ossification (HO) after acetabular surgery.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Randomized controlled trial.</p><p><strong>Setting: </strong>Two level I academic trauma centers.</p><p><strong>Patient selection criteria: </strong>Patients with an acetabular fracture (OTA/AO type 62) surgically treated through a posterior or combined anterior and posterior approach.</p><p><strong>Outcome measures and comparisons: </strong>Radiographic HO was determined using Brooker Classification at the last follow-up. The primary outcome was severe HO (Brooker classes III-IV). The secondary outcome was any HO (Brooker classes I-IV). The incidence of radiographic HO was compared between patients who did and did not undergo postoperative XRT. The results were analyzed in both an intention-to-treat (randomized to XRT) and as-treated (received XRT) basis.</p><p><strong>Results: </strong>Severe HO occurred in 3 of 54 (6%) patients randomized to XRT and 9 of 50 (18%) patients randomized to no XRT (odds ratio 0.24, 95% confidence interval, 0.05 to 0.94; P = 0.05). Any HO occurred in 10 (19%) patients assigned to XRT and 17 (34%) patients in the no XRT control group (odds ratio 0.39; 95% confidence interval, 0.13 to 1.05; P = 0.07).</p><p><strong>Conclusions: </strong>The findings of this dual-center randomized controlled trial suggest that XRT after acetabular surgery significantly reduced the odds of severe HO compared with patients who did not receive XRT. These results can help guide shared decision making between surgeons and patients regarding the use of XRT for HO prophylaxis.</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":"e9-e13"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}