Journal of Orthopaedic Trauma最新文献

{"title":"Can We Predict 30-Day Readmission After Hip Fracture?","authors":"Christopher J Pettit, Carolyn F Herbosa, Abhishek Ganta, Steven Rivero, Nirmal Tejwani, Philipp Leucht, Sanjit R Konda, Kenneth A Egol","doi":"10.1097/BOT.0000000000002946","DOIUrl":"10.1097/BOT.0000000000002946","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the most common reason for 30-day readmission after hospitalization for hip fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>A retrospective review.</p><p><strong>Setting: </strong>Single academic medical center that includes a Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Included were all patients operatively treated for hip fractures (OTA 31) between October 2014 and November 2023. Patients who died during their initial admission were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Patient demographics, hospital quality measures, outcomes, and readmission within 30 days after discharge for each patient were reviewed. Thirty-day readmission reason was recorded and correlation analysis was performed.</p><p><strong>Results: </strong>A total of 3032 patients were identified with a mean age of 82.1 years and 70.5% of patients being women. The 30-day readmission cohort was 2.6 years older ( P < 0.001) and 8.8% more male patients ( P = 0.027), had 0.5 higher Charleston comorbidity index ( P < 0.001), 0.3 higher American Society of Anesthesiologists class ( P < 0.001), and were 9.2% less independent at the time of admission ( P = 0.003). Hemiarthroplasty procedure (32.7% vs. 24.1%) was associated with higher 30-day readmission compared with closed percutaneous screw fixation (4.5% vs. 8.8%) and cephalomedullary nail fixation (52.2% vs. 54.4%, P < 0.001). Those readmitted by 30 days developed more major (16.7% vs. 8.0%; P < 0.001) and minor (50.5% vs. 36.4%; P < 0.001) complications during their initial hospitalization and had a 1.5-day longer length of stay during their first admission ( P < 0.001). Those discharged home were less likely to be readmitted within 30 days (20.7% vs. 27.6%, P = 0.008). Multivariate regression revealed increasing American Society of Anesthesiologists class (odds ratio 1.47, P = 0.002) and preinjury ambulatory status (odds ratio 1.42, P = 0.007) was most associated with increased 30-day readmission. The most common reason for readmission was pulmonary complications (17.1% of complications) including acute respiratory failure, chronic obstructive pulmonary disease exacerbation, and pneumonia.</p><p><strong>Conclusions: </strong>Thirty-day readmission after hip fracture was associated with older, sicker patients with decreased preinjury ambulation status. Hemiarthroplasty for femoral neck fracture was also associated with readmission. The most common reason for 30-day readmission after hip fracture was pulmonary complications.</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":"200-206"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801170","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}

{"title":"Treatment of Incompletely Displaced Femoral Neck Fractures Using Trochanteric Fixation Nail-Advanced(TFNA) in Patients over 50 years of Age.","authors":"Jee Young Lee, Gyu Min Kong","doi":"10.1097/BOT.0000000000002976","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002976","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze the outcomes of patients with femoral neck fractures aged 50 years or older treated with Trochanteric Fixation Nail-Advanced (TFNA; DePuy Synthes, Paoli, PA) to determine the stability of fracture fixation and the effectiveness of the treatment.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Single level I trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged 50 years or older who underwent fixation with TFNA helical blade for femoral neck fractures (OTA/AO 31-B) and were followed for more than 1 year were included.</p><p><strong>Outcome measures and comparisons: </strong>Radiological examinations were evaluated to determine bone union, femoral neck shortening, development of avascular necrosis (AVN) of the femoral head, and breakage of metal fixation. A comparison was made between patients with femoral neck shortening (>5 mm) and those without (<5 mm).</p><p><strong>Results: </strong>A total of 45 patients were included in this study. The mean age of the patients was 70.2 (50-89) years, and 68.9% were females. No early postoperative complications, such as postoperative infection, deep vein thrombosis, or pulmonary embolism, were observed. All patients achieved bone union within 23 weeks. The average femoral neck shortening was 2.6 mm (0-16.8), with femoral neck shortening >5 mm observed in 7 patients (15.6%). Significant femoral neck shortening was observed in patients with displaced fractures compared to non-displaced fractures (p=0.006). One patient developed AVN of the femoral head. No metal fixation failure was observed.</p><p><strong>Conclusions: </strong>In patients aged 50 years or older, TFNA fixation for non-displaced femoral neck fractures demonstrated relatively minimal femoral neck shortening and a low complication rate, indicating that it is an effective technique for treating these fractures. However, for displaced fractures, surgeons should be mindful of the potential for excessive neck shortening and carefully select the surgical method.</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":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630572","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":"What is the rate and timing of salvage surgery after operative treatment of talus fractures?","authors":"Erika Roddy, William Hannay, Bilal Khilfeh, Kira Newell, David Dalstrom, Bruce Sangeorzan, Stephen Benirschke, Reza Firoozabadi","doi":"10.1097/BOT.0000000000002975","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002975","url":null,"abstract":"<p><strong>Objectives: </strong>To report on the short-term, mid-term, and long-term rates of salvage treatment after operative treatment of talus fractures.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Level one trauma center.</p><p><strong>Patient selection criteria: </strong>All patients with a talus fracture (AO/OTA 81.1-81.3) treated surgically at a level one trauma center between 2008 and 2018 were eligible for inclusion.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was conversion to salvage treatment, defined as conversion to arthroplasty, arthrodesis, or amputation.</p><p><strong>Results: </strong>A total of 343 patients with operatively treated talus fractures were identified. One hundred and twenty eight patients were reached by telephone for long-term follow-up. Two hundred and twenty two (65%) were men. The mean age was 35 (SD 10, range 14-70). There were 195 (57%) talar neck fractures, 113 talar body fractures, 5 talar head fractures, and 30 lateral process fractures. The mean duration of follow-up was 5 years. Twenty-four patients (7%) underwent 24 salvage procedures. The rate of salvage was 1% (95% CI 0-3%) at 1 year, 3% (95% CI 1-6%) at 2 years, 10% (95% CI 6-15%) at 5 years, 13% (95% 9-20%) at 10 years, and 15% (10-22%) at 16 years. All salvage procedures occurred within 11 years, and 80% occurred within 5 years of injury. In multivariate cox analysis, the presence of higher Hawkins type as well as the presence of AVN with collapse (HR 4.67 (95% CI 1.82, 11.99, p=0.001)) and arthritis (HR 5.70 (95% CI 1.25, 25.78, p=0.024) remained predictive of conversion to salvage treatment.</p><p><strong>Conclusions: </strong>The rate of salvage surgery was 15% at 16 years after operative treatment of talus fractures. The highest risk of conversion to salvage treatment was within the first 5 years. The presence of a neck or body fracture, higher Hawkins classification, development of AVN with collapse, and arthritis were associated with increased risk of conversion to salvage treatment.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630573","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":"Formal Physical Therapy Improves Patient-Reported Outcome Measurement Information System Physical Function for High Anxiety Patients After Ankle ORIF.","authors":"Willie Dong, Makoa Mau, Silvia Soule, Eleanor Sato, Tyler Thorne, Thomas Higgins, David Rothberg, Lucas Marchand, Justin Haller","doi":"10.1097/BOT.0000000000002940","DOIUrl":"10.1097/BOT.0000000000002940","url":null,"abstract":"<p><strong>Objectives: </strong>To compare outcomes after ankle fracture fixation between those receiving formal physical therapy (PT) versus no formal PT and those with high versus low patient-reported outcome measurement information system (PROMIS) anxiety score (AS), and to evaluate the effect of PT in the setting of PROMIS ASs.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Level 1 trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged >18 years undergoing isolated ankle fracture (OTA/AO 44A, 44B, 44C) fixation with documented PROMIS scores postoperatively.</p><p><strong>Outcome measures and comparisons: </strong>The postoperative PROMIS physical function (PF) and pain interference (PI) were compared between patients receiving formal PT versus those receiving no PT and those with baseline high versus low PROMIS ASs. A subanalysis was performed between patients with low anxiety and no PT (LANP) versus low anxiety with PT (LAP) versus high anxiety and no PT (HANP), and high anxiety with PT (HAP).</p><p><strong>Results: </strong>A total of 161 patients, 111 women (68.9%), with an average age of 46 years (range: 18-72 years), were included in this study: 127 PT, 34 no PT, 88 low anxiety, and 73 high anxiety. PT did not yield any significant differences in PROMIS PF (44.9 PT vs. 42.6 no PT, P = 0.180) or PI (53.5 PT vs. 54.4 no PT, P = 0.656) at final follow-up. At final follow-up, patients with high anxiety had similar PROMIS PF (43.0) versus patients with low anxiety (45.5, P = 0.088), but significantly worse PROMIS PI scores (51.5 vs. 56.7, respectively; P = 0.001). Univariate analysis demonstrated a significant difference in age between patients with high and low anxiety and was thus selected as a control variable in the analysis of HANP, HAP, LANP, and LAP. After controlling for age, pairwise comparisons of estimated PROMIS PF scores at final follow-up were significantly lower for HANP (39.0) than for HAP (43.9, P = 0.05), LANP (45.1, P = 0.05), and LAP patients (45.9, P = 0.04). Final PROMIS PI scores were significantly worse for HANP (59.1) and HAP (56.5) when compared with LANP (51.3, P = 0.021 vs. HANP, P = 0.049 vs. HAP) and LAP (51.3, P = 0.005 vs. HANP, P = 0.004 vs. HAP) groups.</p><p><strong>Conclusions: </strong>Patients with high anxiety who undergo isolated ankle fracture fixation perform worse regarding PROMIS PI irrespective of PT status. However, some patients with high anxiety may benefit from formal PT referral to maximize their functional outcomes.</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":"97-104"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769978","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 Midline Lateral Parapatellar Arthrotomy: A Safe Alternative Approach for Lateral Tibial Plateau Fractures.","authors":"Nathan Heineman, Alexander Turner, Mingyuan Cheng, Ishvinder Grewal, Drew Sanders, Ashoke Sathy","doi":"10.1097/BOT.0000000000002938","DOIUrl":"10.1097/BOT.0000000000002938","url":null,"abstract":"<p><strong>Objectives: </strong>The midline lateral parapatellar (LP) approach has been shown in a cadaveric study to provide superior articular exposure compared with the anterolateral approach (AL). The purpose of this study was to report on outcomes and complications with the LP approach.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective comparative cohort study and prospective cohort.</p><p><strong>Setting: </strong>Academic Level-I trauma center.</p><p><strong>Patient selection criteria: </strong>Adult patients with minimum 3 months follow-up who underwent open reduction internal fixation of an acute, isolated lateral tibial plateau fracture (OTA/AO 41-B1, 41-B2, 41-B3) through an LP arthrotomy or AL submeniscal arthrotomy between 2010 and 2019.</p><p><strong>Outcome measures and comparisons: </strong>Retrospective cohort evaluated using postoperative complications including infection, delayed wound healing, and reoperation rate. Prospective cohort evaluated using Short Musculoskeletal Function Assessment, knee range of motion, and complications.</p><p><strong>Results: </strong>A total of 81 patients were studied. The mean age for the LP cohort was 41.5 years (19-79) and 18 of 32 (56.3%) patients were men. The mean age for the AL cohort was 42.8 years (18-71) and 29 of 49 (59.2%) patients were men. The mean age for patients in the prospective study was 31.4 years (19-59) and 9 of 14 (64.3%) patients were men. Mean follow-up was 9.3 months and 20.3 months for the retrospective and prospective cohorts, respectively. There was no significant difference in complication or reoperation rate ( P > 0.39). For the prospective cohort of 14 patients, mean range of motion was 130 degrees. Mean Short Musculoskeletal Function Assessment dysfunction index was 9.0 and mean bother index was 11.1.</p><p><strong>Conclusions: </strong>The LP approach resulted in comparable clinical and functional outcomes with those reported with the anterolateral approach. It is a safe alternative and may be of most benefit when treating comminuted lateral tibial plateau fractures.</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":"114-119"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729715","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 of Surgery for Elbow Fractures (OTA 13 A-C and 21 A-C) and Patient Outcomes.","authors":"Jacob A Linker, Christopher J Pettit, Abhishek Ganta, Sanjit R Konda, Kenneth A Egol","doi":"10.1097/BOT.0000000000002943","DOIUrl":"10.1097/BOT.0000000000002943","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if there is a correlation between time to surgery (TTS) and outcomes after repair of elbow fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective comparative study.</p><p><strong>Setting: </strong>A single, urban hospital system.</p><p><strong>Patient selection criteria: </strong>Patients from March 2011 to September 2022 who sustained an isolated fracture about the elbow joint (AO/OTA 13-A, B, and C and 21-A, B, and C), underwent surgical repair, and had at least 6 months of postoperative follow-up identified from an Institutional Review Board-approved database.</p><p><strong>Outcome measures and comparisons: </strong>TTS, in days, was recorded. Radiographic and clinical follow-up was obtained at all visits, and a Mayo Elbow Performance Index was calculated based on the latest follow-up. Complications recorded include elbow contracture, infection, early hardware failure, reoperation, and fracture nonunion. Multivariable regression and Spearman correlation analysis were used to determine any significant outcome differences based on TTS.</p><p><strong>Results: </strong>Three hundred fifty-one patients included with a mean age of 54.8 (range: 18-86) years with 217 females (61.8%) and 134 males (38.2%). Eighty-two patients (23.4%) developed at least 1 complication, whereas 269 patients (76.6%) did not. As a continuous variable, TTS was not correlated with arc of motion at any follow-up visit nor with the latest recorded Mayo Elbow Performance Index score ( P > 0.05). Mean TTS for patients who did and did not experience a complication was 6 (range: 0-24) and 10 (range: 0-38) days, respectively, and this was not significantly different ( P = 0.217). Complication rate and any of the individual complications were not associated with TTS after a multivariable analysis controlling for age, sex, injury mechanism, open fracture, Charlson Comorbidity Index, and AO/OTA classification ( P > 0.05 for all).</p><p><strong>Conclusions: </strong>Timing of surgery after OTA 13 A-C and 21 A-C elbow fractures was not associated with differences in postoperative complications or range of elbow motion.</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":"132-136"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800747","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":"Mixing Metals During Operative Fixation and Reconstruction in the Appendicular Skeleton: Does Theoretical In Vivo Galvanization Cause Clinically Detrimental Outcomes?","authors":"Andrea Attenasio, Ian S Hong, Christian G Zapf, Aditya Paul Bhalla, Sachin D Shah, Daniel R Dziadosz, Jaclyn M Jankowski, Richard S Yoon, Frank A Liporace","doi":"10.1097/BOT.0000000000002947","DOIUrl":"10.1097/BOT.0000000000002947","url":null,"abstract":"<p><strong>Objectives: </strong>Traditional training and teaching have advised against mixing varying metal types to avoid the potential for in vivo galvanization and corrosion. The objective of this study was to retrospectively analyze patients who have undergone operative reconstruction with mixed metal (MM) constructs to report any related complications.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Single Level II trauma center.</p><p><strong>Patient selection criteria: </strong>Patients who underwent trauma and/or arthroplasty surgery at a single Level II trauma center between 2017 and 2022 with \"mixed\" fixation defined as contact or proximity within the bone (≤ 10 mm) with complete radiographs, medical records, and minimum 1 year follow-up were eligible for study inclusion.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome measure was incidence of corrosion directly related to hardware complications causing unplanned reoperation.</p><p><strong>Results: </strong>The final analysis included 56 patients (67.9% women), with a mean age of 62.0 ± 16.6 years, mean body mass index of 28.9 ± 8.4 kg/m 2 , and mean Charlson comorbidity index of 2.5 ± 1.8. Seventy-three percent of the MM implants had direct metal-on-metal contact, and the average distance between noncontacting metals was 0.32 ± 0.28 cm. The most common combination of metals was titanium + stainless steel (69.6%). At an average postoperative follow-up of 25.9 ± 19.6 months, hardware-related complications were observed in 15 (26.8%) patients, with reoperation due to hardware complications in 12 (21.4%) within 18.5 ± 15.8 months. No evidence of metal-on-metal galvanic corrosion was observed on radiographic evaluation at an average of 25.9 ± 19.6 months.</p><p><strong>Conclusions: </strong>Patients who received MM implants showed no radiographic or clinical signs of corrosion. Although theoretical concerns exist regarding use of MM implants, these findings suggest that the consequence of such combinations in clinical practice may not be as significant.</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":"105-108"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800208","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}