Journal of Orthopaedic Trauma最新文献

{"title":"Regional Only Anesthesia is a Safe Alternative to Perform Arthroplasty for Femoral Neck Fracture.","authors":"Carolyn F Herbosa, Christopher J Pettit, Steven Rivero, David Furgiuele, Abhishek Ganta, Sanjit Konda, Kenneth Egol","doi":"10.1097/BOT.0000000000003010","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003010","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the efficacy of regional only anesthesia for arthroplasty surgery following displaced femoral neck fractures.</p><p><strong>Methods: </strong>Design: Retrospective study.</p><p><strong>Setting: </strong>A single academic medical center and Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients with displaced femoral neck fracture (AO/OTA 31B1.3) treated with either hemi- or total hip arthroplasty were identified. Patients who had general (GA) and Spinal (SA) anesthesia were each matched 2:1 to those who underwent Lateral Femoral Cutaneous and Over the Hip (LOH),based on the Score for Trauma Triage in the Geriatric and Middle Aged (STTGMA) risk score and arthroplasty type.</p><p><strong>Outcome measures and comparisons: </strong>Patient demographics, injury characteristics, and surgical history were compared. Outcomes included postoperative complications, 90-day readmission rates, 1-year mortality and discharge location. Significance was p>0.05.</p><p><strong>Results: </strong>145 patients were analyzed: 58 GA, 58 SA, and 29 Regional. Cohorts were similar in demographics: mean age was 79.9 +9.9 for LOH, 79.8+11.00 for GA and 82.2+8.6 for SA (p=0.3), with 72% female patients in the LOH, 67% female in the GA and 76% female in SA (p=0.585). GA patients had the highest BMI (25.3±5.3 kg/m2, p=0.004). SA patients had the highest ASA score (2.9±0.7, p=0.036). GA patients had the longest anesthesia (2:55 hours, p=0.013) and operating room time (3:35, p=0.009). Regional anesthesia had the shortest anesthesia (2:26, p=0.013) and operating room time (2:54, p=0.009). GA had a higher complication rate (56.9%, p=0.039), including major complications (20.7%, p=0.025) and post-operative anemia (34.5%, p=0.049). GA had a longer length of stay (6.4±2.9 days, p=0.022). Patients operated on under regional only were discharged to home (62%, p=0.003) while more GA (79%) and SA (71%) patients were discharged to SNF (p<0.001). LOH patients ambulated sooner following surgery (1.03±0.2 days, p=0.001). No post-operative complications, blood transfusions (p=0.321), mortality (p=0.089), 30-day readmission (p=0.819), and post-operative delirium (p=0.514) were significantly different.</p><p><strong>Conclusion: </strong>Regional only anesthesia (LOH Block) was safe and effective for hemi and total hip arthroplasty for a displaced femoral neck fracture as compared to spinal and general anesthesia. This anesthetic approach allowed for successful procedures and yielded lower associated rates of post-operative complications and operative time in addition to improved quality measures.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Is the complexity of fibular nailing worth it?\"","authors":"Hassan Mir","doi":"10.1097/BOT.0000000000003009","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003009","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030840","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":"Outcomes of Clavicle Nonunion Repair: A Retrospective Cohort Study of 125 Patients.","authors":"Daniël C de Reus, Robert K Wagner, Eric Tutuhatunewa, Adam N Musick, Austin T Gregg, Stein J Janssen, Arun Aneja, Thuan V Ly","doi":"10.1097/BOT.0000000000003007","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003007","url":null,"abstract":"<p><strong>Objectives: </strong>To describe outcomes following operative repair of clavicle nonunions and identify risk factors for recalcitrant nonunion.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Two academic Level-1 trauma centers.</p><p><strong>Patient selection criteria: </strong>Included were adults who underwent repair of a clavicle fracture (AO/OTA 15) nonunion from January 2004 to 2024.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was recalcitrant nonunion, defined as nonunion requiring additional revision surgery after nonunion repair or absence of healing at final follow-up. Univariate and multivariable logistic regression was performed to determine associations between patient, nonunion, and treatment characteristics (fixation construct and position, use of bonegraft, substitutes or compression) with recalcitrant nonunion. The secondary outcome was reoperation for complications other than recalcitrant nonunion.</p><p><strong>Results: </strong>125 patients were included (mean age 44 years [range 18-82], 55% male). The median follow-up was 16 months and 82% of acute fractures were treated nonoperatively. No patients presented with confirmatory criteria of fracture-related-infection. Twenty-four patients (19%) developed recalcitrant nonunion, with 17 undergoing revision. BMI (5-point increase, OR 3.38, p < 0.001), smoking (OR 4.49, p = 0.020), nonunion duration (3-month increase, OR 1.04, p = 0.013), age (10-year increase, OR 1.62, p = 0.042), and non-diaphyseal nonunion location (OR 4.79, p = 0.013) were identified as independent risk factors for recalcitrant nonunion in multivariable analysis. No treatment characteristics were associated with recalcitrant nonunion in univariate analysis (p > 0.05). Twenty-five patients (20%) underwent reoperations for complications other than recalcitrant nonunion.</p><p><strong>Conclusions: </strong>Operative repair for clavicle nonunion failed in 1 in 5 patients. Higher BMI, smoking, longer nonunion duration, older age, and non-diaphyseal nonunion locations were associated with increased risk of failure. No treatment characteristics were associated with failure. Surgeons may target modifiable risk factors, such as smoking and BMI, to achieve more reliable healing rates.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040884","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":"Letter to the Editor: Is the complexity of fibular nailing worth it?","authors":"Sean T Campbell","doi":"10.1097/BOT.0000000000003008","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003008","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016288","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":"Interprosthetic Femur Fractures: A Multi-Center Retrospective Study.","authors":"Samuel Landoch, Jeffrey A Foster, Lisa K Cannada, William T Obremskey, Ryan Will, Brianna Fram, Simon C Mears, Jeffrey B Stambough, Benjamin M Stronach, Harrison Brown, Jason J Halvorson, Nicholas Andring, Natalie Marenghi, Niloofar Dehghan, Tony Huynh, Scott Ryan, Guy Guenthner, Aaron Shiinoki, Jacob M Fischman, Elsa Rodriguez, Andres F Moreno-Diaz, Aleksander Mika, Farhan Chowdry, Andrew Chen, Zohair Zaidi, Anna N Miller, Joseph Gutbrod, Erin Hofer, Carmen Quatman, Jarrod Dumpe, Marek Denisiuk, Marylou Sutherland, Heidi Israel, Paul E Matuszewski, Arun Aneja","doi":"10.1097/BOT.0000000000003003","DOIUrl":"10.1097/BOT.0000000000003003","url":null,"abstract":"<p><strong>Objectives: </strong>To identify practices for treating interprosthetic femur fracture (IFFs) and determine factors that positively impact patient outcomes.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Fifteen trauma centers in the United States.</p><p><strong>Patient selection criteria: </strong>Patients aged 50 to 90 years who underwent operative fixation of an AO/OTA 32 A-B-C type IFF fracture from 2011 to 2021 were included. Patients who underwent revision arthroplasty at the time of fixation or were non-ambulatory were excluded.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was union rate. Secondary outcomes included post-operative complications, revision surgery, mortality, and change in ambulation status. Univariate analyses using Chi-square tests, Fisher's exact tests, and analysis of variance were performed to detect associations between demographic, injury, and surgical characteristics with post-operative outcomes.</p><p><strong>Results: </strong>One hundred thirty-nine patients were included, with 110 (79%) females and median age 78 [range, 57-90]. Distal one-third fractures were most common 68% (N=95). One hundred eighteen (85%) patients were treated with a lateral plate, 8% (N=11) were treated with nail-plate combination and 7% (N=10) were treated with dual plates. The median time to full-weight bearing (FWB) was 2.5 months. Dual plate combination was associated with the fastest time to FWB (p = 0.048) at two weeks. 61% (n=85) of patients returned to baseline ambulation status (100% [11] IMN/plate, 60% [71] lateral plate and 25% [3] dual plate) with patients treated with nail-plate had higher rates of return to baseline function (p = 0.009). The overall mortality rate was 13% and associated with greater than 1 comorbidity (p = 0.022).</p><p><strong>Conclusions: </strong>A spanning lateral plate was the most common fixation of IFF in our study. Patients with dual fixation were more likely to return to baseline ambulatory status, particularly those with intramedullary nail/plate combination. The mortality rate at one year was 11% and comorbidity burden was associated with higher risk of mortality.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000843","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":"Characteristics, Patterns and Optimal Treatment Strategies of Morel-Lavallee Lesions: A Systematic Review.","authors":"Marc Daniel Bouchard, Cameron Pow, Justin Gilbert, David Slawaska-Eng, Prushoth Vivekanantha, Rotana Fageeh, James Yan","doi":"10.1097/BOT.0000000000003005","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003005","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the diagnostic accuracy of imaging modalities and outcomes of treatment strategies for Morel-Lavallée lesions (MLLs) and provide evidence-based recommendations for optimal management.</p><p><strong>Methods: </strong>Data Sources: MEDLINE, Embase, and Emcare databases were systematically searched for English-language studies published up to September 2024.</p><p><strong>Study selection: </strong>Observational studies and randomized controlled trials (RCTs) reporting diagnostic accuracy or treatment outcomes for MLLs were included. Case reports, small series, animal studies, and non-English articles were excluded.</p><p><strong>Data extraction: </strong>Study quality was assessed using the Methodological Index for Non-randomized Studies (MINORS) tool. Data on demographics, lesion characteristics, imaging modalities, and outcomes were extracted. Lesions were categorized as small (<100 cm3) or large (≥100 cm3) based on volume.</p><p><strong>Data synthesis: </strong>Descriptive statistics summarized outcomes. Recurrence rates were calculated and pooled proportions compared across treatment modalities.</p><p><strong>Results: </strong>Twenty-nine studies (928 patients, 964 lesions) were included. MLLs most frequently occurred in the thigh (26.5%), greater trochanter (24.9%), and lumbar region (20.3%). Among smaller lesions (<100 cm3), nonoperative treatment had a low recurrence rate (5.6%), while for larger lesions (>100 cm3), percutaneous management was associated with the highest recurrence rate (15%) compared to other treatment approaches. Operative treatment of large lesions had a 50% recurrence rate in one study, while sclerodesis achieved the lowest rate (4.8%) for lesions averaging 387 cm3, however, this finding is based on a limited number of cases (21 lesions). MRI was the most common single imaging modality reported (n=162 lesions, 19.5%), favoured for its superior soft-tissue characterization. Ultrasound was used in 121 lesions (14.6%) as an accessible initial assessment tool, while CT, often performed incidentally during trauma evaluation, diagnosed 339 lesions (40.9%).</p><p><strong>Conclusions: </strong>MRI was the most used single modality for diagnosing MLLs. Small, acute lesions were effectively managed nonoperatively. Large lesions (>100 cm3) often required operative management. Sclerodesis appears promising with the lowest recurrence (4.8%), but further studies are needed. Standardized treatment protocols may help improve outcomes and reduce recurrence.</p><p><strong>Level of evidence: </strong>IV, systematic review.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014960","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":"Posttraumatic Hip Osteoarthritis After Pelvic Ring Injuries.","authors":"James D Brodell, Hashim J F Shaikh, Thomas F Rodenhouse, Brian D Giordano, John P Ketz, Sandeep P Soin, Noah M Joseph","doi":"10.1097/BOT.0000000000002958","DOIUrl":"10.1097/BOT.0000000000002958","url":null,"abstract":"<p><strong>Objectives: </strong>While rates of posttraumatic osteoarthritis after acetabulum fracture have been thoroughly studied, there has been less emphasis on hip osteoarthritis after pelvic ring injuries. The objective of this study was to determine the frequency of posttraumatic hip osteoarthritis in pelvic ring injury patients. It was hypothesized that more severe pelvic ring injuries would be associated with greater rates of posttraumatic hip osteoarthritis.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective Cohort.</p><p><strong>Setting: </strong>Urban/Suburban Academic Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Subjects were identified using a retrospective search for OTA/AO type A, B, and C pelvic ring injuries. Patients were included if they were aged 18 years or older, had a pelvic ring injury, and had 1 year or more of radiographic follow-up. Patients were excluded if they had prior total hip arthroplasty or hip hemiarthroplasty, femoral neck fracture, acetabulum fracture, femoral head fracture, or inadequate radiographic follow-up.</p><p><strong>Outcome measures and comparisons: </strong>Both hips were graded using the Tönnis classification at the time of injury and available follow-up pelvis films. Comparison of rate of osteoarthritis progression was made between stable (LC I injuries stable on examination under anesthesia, all APC I injuries) and unstable (APC II, APC III, LC II, LC III, and LC I injuries unstable on examination under anesthesia) pelvic ring injury patients, as well as severity of injury using the Young-Burgess classification.</p><p><strong>Results: </strong>Two hundred eleven patients were included for final analysis. Average age was 58.8 years (SD 28.1 years, range 18-100 years). Eighty-eight patients (41.7%) were male. One hundred twenty-seven patients underwent nonoperative management, and 84 underwent surgical stabilization. 34.5% (29/84) of patients with unstable pelvic ring injuries and 6.2% (8/127) of patients with stable pelvic ring injuries demonstrated progression of osteoarthritis on the ipsilateral side of their injury ( P < 0.001). More severe pelvic ring injury patterns had a greater rate of posttraumatic osteoarthritis (PTOA) based on the Young-Burgess injury classification (44.4% of LC III vs. 11.1% of LC I pelvic ring injury patients, P < 0.001).</p><p><strong>Conclusions: </strong>A significant frequency of posttraumatic osteoarthritis after pelvic ring injuries was identified. A higher rate of progression to PTOA was found with unstable injuries compared with stable pelvic injuries.</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":"229-236"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007082","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 Rapid Escalation of Fractures and Hospital Admissions From Electric Bicycle Injuries in the United States: An Analysis of National Injury Data From 2019 to 2023.","authors":"Nikan K Namiri, Auston R Locke, Niklas H Koehne, Avanish Yendluri, Kyle K Obana, Katrina Nietsch, Jennifer Yu, John J Corvi, Junho Song, Jeremy Podolnick, David A Forsh, Robert L Parisien","doi":"10.1097/BOT.0000000000002965","DOIUrl":"10.1097/BOT.0000000000002965","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to examine the characteristics, trends, and attributes of fractures sustained by electric bicycle riders and assess the recent health care burden in hospital admissions.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective review.</p><p><strong>Setting: </strong>National sample of 100 emergency departments in the United States.</p><p><strong>Patient selection criteria: </strong>The National Electronic Injury Surveillance System (NEISS) was queried for emergency department presentations with fractures related to e-bicycles between January 1, 2019, and December 31, 2023. The clinical narrative associated with each case was reviewed to exclude cases unrelated to fractures sustained by e-bicycle riders.</p><p><strong>Outcome measures and comparisons: </strong>NEISS data are a probability sample of US hospitals; each observed sample has an associated weight enabling a population estimate for each individual sample. Sample weights were determined by NEISS using factors that influence likelihood of selection such as hospital size and geographic locations. US population projections (weighted cases) of fractures and admissions were obtained by summing the weights of raw, unweighted NEISS sampled injuries. Pearson χ 2 tests were applied to determine differences in injury characteristics among subjects who were admitted to the hospital and those who were not admitted.</p><p><strong>Results: </strong>A total of 22,432 e-bicycle fractures occurred in the United States from 2019 to 2023, which was a weighted population estimate from 520 raw, unweighted NEISS samples. The number of fractures and admissions increased by 2371% and 3146% in 2023, respectively, compared with 2019. Collision with a motor vehicle occurred in nearly one-fourth of fractures, and motor vehicle involvement was significantly associated with hospital admission (36.4% vs. 25.1%; P = 0.01). Overall, 27.7% of e-bicycle fractures were admitted to the hospital. Upper leg fractures had the highest association with admission (90.7% admission rate) but only consisted of 2.7% of all fractures. The most common fracture location in riders younger than 18 years was the wrist, while the 35-55 age group and older than 55 years group were most likely to possess upper trunk fractures (cervical spine, thoracic spine, ribs, and sternum). The 18-34 age group and 35-55 age group most commonly sustained fractures involving motor vehicles (29.7% and 28.7%, respectively), but the 35-55 age group possessed a significantly higher rate of overall admission among all age groups ( P = 0.04).</p><p><strong>Conclusions: </strong>There has been a substantial increase in fractures and resource utilization as a result of hospital admissions from e-bicycle riding from 2019 to 2023. Most fractures occurred above the waist, although lower extremity injuries more commonly resulted in admission, and riders aged 35-55 years sustained the la","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"269-274"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189610","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":"Homelessness and the Outcome of Hip Fracture Surgical Management: A Nationwide Study in the United States.","authors":"Amir Human Hoveidaei, Kasra Pirahesh, Fatemeh Kanaani Nejad, Amirhossein Ghaseminejad-Raeini, Basilia Onyinyechukwu Nwankwo, Janet D Conway","doi":"10.1097/BOT.0000000000002967","DOIUrl":"10.1097/BOT.0000000000002967","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether people experiencing homelessness (PEH) have more postoperative complications after hemiarthroplasty, total hip arthroplasty (THA), hip open reduction and internal fixation (ORIF), and percutaneous skeletal fixation surgeries after hip fracture in the United States.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>A nationwide study in the United States using the PearlDiver Patient Records Database.</p><p><strong>Patient selection criteria: </strong>Patients who underwent hemiarthroplasty, THA, ORIF, and percutaneous skeletal fixation surgeries after hip fracture from 2010 to 2022 were included. The CPT codes corresponding to surgical procedures were searched through the database. Then, the housing status was extracted using the corresponding ICD codes for homelessness. Those who did not have ICD codes assigned for homelessness were considered to be housed. PEH were matched with housed patients in a 1:3 ratio based on age, sex, and year of surgery.</p><p><strong>Outcome measures and comparisons: </strong>Baseline patient characteristics and comorbidities were accessed through ICD and CPT codes. After matching, the postoperative 30-day and 90-day rates of acute renal failure, myocardial infarction (MI), respiratory failure, sepsis, venous thromboembolism, pneumonia, urinary tract infection (UTI), surgical site infection (SSI), and readmission were compared between PEH and housed patients using two models: (1) A χ 2 test and (2) a multivariate logistic regression while controlling for the Elixhauser comorbidity index, obesity, diabetes, alcohol abuse, tobacco use, and drug abuse.</p><p><strong>Results: </strong>A total of 692,933 housed patients and 2795 homeless patients (mean age of 59.1 ± 11.6 years, 70.0% male) were evaluated. After matching the PEH to housed patients for age, sex, and year of surgery with a 1:3 ratio, a total of 8382 housed patients (mean age of 59.1 ± 11.6, 70.0% male) were selected for the postoperative complication analysis in comparison with 2795 PEH. In the Chi-squared analysis, it was observed that rates of postoperative 90-day acute renal failure [1.36 (1.18-1.56)], sepsis [1.70 (1.44-1.99)], respiratory failure [1.33 (1.16-1.52)], UTI [1.37 (1.19-1.58)], pneumonia [1.49 (1.28-1.74)], SSI [2.03 (1.62-2.54)], and readmission [1.60 (1.45-1.77)] were significantly higher among PEH ( P < 0.001). In the regression model, it was found that homelessness was an independent factor for 90-day SSI [1.47 (1.13-1.91), P = 0.004] and UTI [1.21 (1.03-1.43), P = 0.022] after surgical management of hip fracture.</p><p><strong>Conclusions: </strong>This study found that homelessness was an independent risk factor for surgical complications, including SSIs and UTIs, within 90 days. In addition, homelessness was associated with higher comorbidity rates, which were linked to increased complications and readmissions.</p><p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"245-251"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458316","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":"Tranexamic Acid and Heterotopic Ossification Formation Following Elbow Surgery: A Prospective Randomized Controlled Trial.","authors":"Erez Avisar, Ahmad Essa, Ryan Paul, Eric Kachko, Oded Rabau, Rom Mattan, Jonathan Persitz","doi":"10.1097/BOT.0000000000002963","DOIUrl":"10.1097/BOT.0000000000002963","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates whether the intraoperative administration of intravenous tranexamic acid (TXA), known for its hemostatic and potential anti-inflammatory properties, affects the incidence of heterotopic ossification (HO) following surgery for elbow fracture dislocations.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Prospective, randomized clinical trial.</p><p><strong>Setting: </strong>Hand and Upper Extremity Surgery Unit.</p><p><strong>Patient selection criteria: </strong>Patients aged 18-75 years with acute traumatic elbow fracture dislocations requiring surgical management from June 1, 2016, to October 31, 2022, were eligible. Inclusion criteria included traumatic nonpathological elbow fracture dislocations. Patients were randomized 1:1 to receive either intraoperative TXA or no additional treatment.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was the occurrence of HO, defined by new bone formation observed in radiographic exams during postoperative follow-ups. Secondary outcomes included the presence of clinically relevant HO, reoperation rate due to symptomatic HO, and time to HO reoperation. Compared were patients who received TXA with controls.</p><p><strong>Results: </strong>Out of 47 patients with elbow fracture dislocations who completed the follow-up, 23 (49%) received TXA prophylaxis while 24 (51%) were controls. The average age was 51.2 years (range, 18-77 years) with a mean follow-up of 12.9 months (range, 6.11-34.2). In the TXA group, 11 (47.8%) were men and 12 (52.2%) were women, while in the control group, 14 (58.3%) were men and 10 (41.7%) were women. HO was observed in 30% of patients, primarily around the radial head (71%). In this study, 43.5% of patients in the TXA group developed HO compared with 16.7% in the control group. The differences in HO formation suggest a potentially higher risk in the TXA group (relative risk = 2.6, 95% 1.0 to 8.5, P = 0.06). Clinically relevant HO led to reoperation in 2 of 10 (20%) patients in the TXA group, while none of the patients in the control group required reoperation, resulting in an overall reoperation rate of 14.3% in the study cohort.</p><p><strong>Conclusions: </strong>This prospective trial identified a possible increased risk of HO formation in patients receiving TXA, however, with the sample size available a statistically significant difference was unable to be detected. These findings highlight the need for further research emphasizing larger prospective comparative studies to assess TXA's impact on HO. A deeper understanding of this relationship will enable clinicians to balance TXA's potential risks and benefits more effectively, optimizing outcomes in orthopedic surgery.</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":"261-268"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023886","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}