Journal of Orthopaedic Trauma最新文献

{"title":"Response to the Letter to the Editor Regarding \"Proton Pump Inhibitors Are Associated With Increased Risk of Site-specific Nonunion After Open Reduction Internal Fixation\".","authors":"Melissa Romoff, Michael S Kim, John A Scolaro","doi":"10.1097/BOT.0000000000003168","DOIUrl":"10.1097/BOT.0000000000003168","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"e172-e173"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433628","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":"Fragmented Sleep And Opioid Medication Utilization During Hospitalization Following Orthopaedic Trauma.","authors":"David Marvin, Jack Hudson, Jaimo Ahn, Mara Schenker, Jesse Seilern Und Aspang, JLynn Lewis, Nicholas Cantu, Jonathan P Yawman, Nicholas A Giordano","doi":"10.1097/BOT.0000000000003237","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003237","url":null,"abstract":"<p><strong>Objectives: </strong>To objectively characterize inpatient sleep patterns following orthopaedic trauma and evaluate their association with opioid medication utilization while hospitalized.</p><p><strong>Design: </strong>This was a retrospective analysis of a prospective randomized clinical trial (NCT04154384).</p><p><strong>Setting: </strong>An Urban, Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Adult patients with isolated orthopaedic injuries treated surgically were eligible to participate in the original trial if they could consent, comprehend English, were not pregnant or incarcerated, and had a cell phone. Participants were enrolled within 12 hours of surgery and provided with wrist worn actigraphy devices, which are non-invasive devices that measure activity and rest, for the duration of hospitalization thereafter. Participants who wore the actigraphy device for ≥70% of their hospitalization were included in the analysis; those who did not meet this threshold were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Total sleep time while participants were admitted to the hospital recorded by actigraphy devices. Linear mixed-effects models examined associations between inpatient sleep and inpatient opioid use, measured in morphine milligram equivalents daily.</p><p><strong>Results: </strong>The final sample of N=99 participants was predominantly Black (71.7%) and female (55.6%) with a mean age of 48 (range 18-89). Patients had an average total sleep time of 6 hr 36 min (±4 hr 17 min) per 24 hours. Sleep was fragmented, averaging 9.1 awakenings totaling 26.6 minutes. Median opioid use was 45.1 morphine milligram equivalents daily (MED). Each additional MED during the hospitalization period was associated with shorter inpatient sleep duration, specifically an average of 2.7 minutes less of sleep (p=0.004).</p><p><strong>Conclusion: </strong>This study demonstrated that participants needing surgery for isolated orthopaedic injuries experienced short, fragmented sleep while hospitalized. This study's findings also indicate that higher inpatient opioid utilization is associated with worse sleep quality.</p><p><strong>Level of evidence: </strong>Level 2.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283882","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":"Reliability of modified Radiographic Union Scale for Tibial Fractures (mRUST) Scores in Ballistic Lower Extremity Trauma.","authors":"Patrick Sun, Jennifer Eurich, Douglas Zhang, Gregory Schimizzi, Anthony Christiano, Mary Kate Erdman","doi":"10.1097/BOT.0000000000003236","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003236","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the reliability of the modified Radiographic Union Scale for Tibial Fractures (mRUST) scores in ballistic lower extremity trauma and to assess the ability of 3-month post-op mRUST in predicting union status at 9-months.</p><p><strong>Methods: </strong>Design: Retrospective review.</p><p><strong>Setting: </strong>Single Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients that sustained a ballistic femoral (AO/OTA 32) or tibial shaft fracture (AO/OTA 42) aged 18 or over and were treated with intramedullary nailing between 2019 and 2023.</p><p><strong>Outcome measures and comparisons: </strong>Inter- and intra-rater reliability of mRUST score measurements between three fellowship trained orthopaedic trauma surgeons was assessed. The sensitivity and specificity of predicting nonunion at 9-months postoperatively from mRUST 3-months postoperatively was assessed. Inclusion criteria for nonunion analysis required patients to have a 3-month mRUST score as well as a determinable union status.</p><p><strong>Results: </strong>107 ballistic femoral shaft fractures (203 radiograph sets; 100 male; mean age 31 [18-56]) and 62 ballistic tibial shaft fractures (153 radiograph sets; 51 male; mean age 33 [18-61]) were used to calculate reliability metrics. Inter-rater reliability (Intraclass Correlation Coefficient, ICC) of mRUST in ballistic femoral shaft fractures was 0.64 (95% CI[0.34,0.80]). Intra-rater reliability of mRUST in ballistic femoral shaft fractures was 0.87 (95% CI[0.85,0.89]). Inter-rater reliability of mRUST in ballistic tibial shaft fractures was 0.61 (95% CI[0.43,0.73]) and intra-rater reliability of mRUST in ballistic tibial shaft fractures was 0.81 (95% CI[0.77, 0.84]). In 28 ballistic femoral shaft fractures (24 male; mean age 31 [18-46]), an mRUST-3MO < 8 predicted nonunion in ballistic femoral shaft fractures with a sensitivity of 1.00 and specificity of 0.83. In 25 ballistic tibial shaft fractures (17 males; mean age 34 [18-61]), an mRUST-3MO < 8 predicted nonunion with a sensitivity of 0.71 and specificity of 0.94.</p><p><strong>Conclusions: </strong>This study suggests that the modified Radiographic Union Scale for Tibial Fractures (mRUST) scores possess a lower inter and intra rater reliability in ballistic fractures compared to blunt fractures. They may predict union at 9-months well in ballistic femoral fractures, but only moderately in ballistic tibia fractures.</p><p><strong>Level of evidence: </strong>Diagnostic Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283787","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 Definitive Fixation and Risk of Deep Surgical-Site Infection After Tibial Plateau ORIF: A Systematic Review and Meta-analysis.","authors":"Justin Le, Katherine Xie, Benjamin Hershfeld, Adam D Bitterman, Michael S Linn","doi":"10.1097/BOT.0000000000003235","DOIUrl":"https://doi.org/10.1097/BOT.0000000000003235","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether early definitive fixation of tibial plateau fractures (TPF) was associated with a lower risk of deep surgical-site infection (SSI) compared with delayed fixation.</p><p><strong>Methods: </strong>Data Sources: PubMed, Cochrane, Web of Science, Embase, and Google Scholar were searched for English-language studies from January 1, 2010, through December 12, 2025. Study Selection: Comparative studies evaluating early versus delayed definitive fixation of Schatzker I-VI and/or AO/OTA 41B-C TPFs with infection and/or postoperative complications included. Data Extraction: ROBINS-I assessed bias. Data Synthesis: Early fixation was fixation within 72 hours of injury or before fasciotomy closure. The primary outcome was deep SSI, with subgroup analyses by timing threshold (<24 hours, <72 hours, <5 days), fracture pattern, and fasciotomy status. Secondary outcomes included superficial infection, overall infection, wound complications, and reoperation using the <72-hour definition of early fixation. Random-effects risk ratios (RRs) with 95% confidence intervals, event rates, and subgroup differences were reported. Between-study heterogeneity was assessed using I2.</p><p><strong>Results: </strong>Nine studies (n = 1,412) were included. Demographic-reporting studies included 668 early fixation (weighted age 46.1 years; 70.1% male) and 582 delayed fixation patients (weighted age 47.9 years; 67.9% male). Age ranges were not uniformly reported by fixation group. Early fixation within 72 hours had lower deep SSI risk (8.7% vs 16.1%; RR 0.54; P = 0.04). Deep SSI did not differ using <24-hour (10.8% vs 12.9%; RR 0.60; P = 0.13) or <5-day thresholds (7.8% vs 14.5%; RR 0.60; P = 0.26). No subgroup interaction was identified by timing threshold (P = 0.64) or fracture pattern (P = 0.92). Overall infection was lower after early fixation (14.0% vs 19.6%; RR 0.59; P = 0.02). Superficial infection (3.4% vs 4.3%), wound dehiscence (7.5% vs 2.9%), wound necrosis (7.5% vs 7.1%), and reoperation (16.9% vs 20.8%) did not differ significantly (RRs 0.63-2.47; all P ≥ 0.09).</p><p><strong>Conclusions: </strong>Early definitive fixation of tibial plateau fractures was associated with lower pooled risk of deep SSI and overall infection compared with delayed fixation, without increased complications. However, these findings should be interpreted cautiously and do not establish causality.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283851","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 Regarding Article \"Orthopaedic Trauma Association Annual Meetings Consistently Provide Academic Value for Attendees.\"","authors":"Joshua R Blomberg","doi":"10.1097/BOT.0000000000003234","DOIUrl":"10.1097/BOT.0000000000003234","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218193","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 Letter to the Editor Regarding Article \"Orthopaedic Trauma Association Annual Meetings Consistently Provide Academic Value for Attendees\".","authors":"Dustin A Greenhill, Douglas Lundy, Nareena Imam, Neil Jain","doi":"10.1097/BOT.0000000000003233","DOIUrl":"10.1097/BOT.0000000000003233","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218195","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":"Knee Hemarthrosis Aspiration and Its Effect on Compartment Pressures in Tibial Plateau Fractures.","authors":"Austin Wynn, Jordan Murphy, Jennifer Bruggers, Jeffrey Donahue, David Smith, Robert T Fairman, Stephen Becher","doi":"10.1097/BOT.0000000000003157","DOIUrl":"10.1097/BOT.0000000000003157","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the effect knee hemarthrosis aspiration had on compartment pressures of the leg in patients with tibial plateau fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Prospective pre-post interventional study.</p><p><strong>Setting: </strong>Single Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Included were nonobtunded patients with tibial plateau fractures (OTA/AO 41B/41C) who were undergoing spanning external fixation, with or without compartment syndrome from December 2023 to December 2024.</p><p><strong>Outcome measures and comparisons: </strong>Intracompartmental pressures in the anterior, lateral, superficial, and deep posterior compartments of the leg pre- and postknee hemarthrosis aspiration, volume of knee hemarthrosis aspiration, and diastolic blood pressure were obtained. Intracompartmental pressures and diastolic blood pressure were compared pre- and posthemarthrosis aspiration. Also, correlation between volume of aspirate and magnitude of pressure change was measured, and need for 4 compartment fasciotomies for compartment syndrome was evaluated.</p><p><strong>Results: </strong>Twenty patients were enrolled: 13 men and 7 women with an average age of 48 years, ranging from 18 to 68 years. The average aspiration volume was 42 mL (range 5-120 mL). Across all compartments in the leg, the average preaspiration pressure was 36 mm Hg and postaspiration pressure was 29 mm Hg ( P < 0.0025). Individual compartment pressure changes ranged from 0 to 25 mm Hg ( P < 0.005) that represented up to approximately 20% decrease in compartment pressures. There was no correlation between aspiration volume and pressure decrease found with this range of aspirate volumes (Pearson correlation coefficient approaching 0 for each compartment). Five patients underwent 4 compartment fasciotomy for compartment syndrome after aspiration, and no fasciotomies were required in the 15 legs that did not undergo release at the time of index surgery.</p><p><strong>Conclusions: </strong>Aspiration of the knee hemarthrosis associated with tibial plateau fractures produced a drop in compartment pressures in the leg (average magnitude range 4-7 mm Hg). The clinical significance of this change is yet to be fully understood. The study showed at least a portion of the increased pressure in the compartments of the leg after tibial plateau fractures may be attributed to direct increases of pressure in the knee capsule due to hemarthrosis formation from fracture bleeding that may be relieved from aspiration. Time of effect and effect of continuous drains are further avenues of study to be evaluated.</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":"336-339"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284183","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":"Minimally Invasive Treatment of Calcaneal Fractures Based on 3D Fluoroscopic Robot-Assisted Percutaneous Reduction and Screw Fixation Combined With a Novel Circular Distractor.","authors":"Bin Zhao, Qi Liu, Anjie Shen, Jinqi Li, Fan Yang, Maoqi Gong, Xinbao Wu, Xieyuan Jiang, Wei Han, Junqiang Wang","doi":"10.1097/BOT.0000000000003162","DOIUrl":"10.1097/BOT.0000000000003162","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To introduce a surgical technique and evaluate the clinical outcome of minimally invasive treatment of calcaneal fractures based on 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation combined with a novel circular distractor.&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 case series.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single Level-1 trauma center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult patients with calcaneal fractures (OTA/AO 82C, Sanders type II, III) who were treated with 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation combined with a novel circular distractor from January 2022 to June 2024 were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;Demographic characteristics, operative information, radiological and functional outcomes, and complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-seven patients (43 men and 4 women, 52 fractures) with a mean age of 46.5 ± 12.2 years (range: 24-73), a mean weight of 73.4 ± 13.0 kg (range: 55-106), and a mean height of 170.1 ± 6.4 cm (range: 150-180) were followed for an average duration of 20.4 months (range: 9-36 months). According to the Sanders classification, there were 39 type II and 13 type III fractures. Based on the Essex-Lopresti classification, 25 fractures were tongue-type and 27 were joint depression-type. The average time from injury to surgery was 8.7 ± 4.2 days (range: 2-18), and the mean operative duration was 86.8 ± 33.9 minutes (range: 45-180). Postoperative radiographic parameter assessment revealed significant restoration of the calcaneal anatomy, with a marked reduction in width (from 47.8 ± 4.6 to 43.4 ± 4.2 mm, P &lt; 0.001) and significant improvements in height (from 39.3 ± 4.8 to 46.2 ± 4.0 mm, P &lt; 0.001) and length (from 79.2 ± 5.9 to 81.6 ± 5.1 mm, P &lt; 0.001). Furthermore, both Böhler angle (from 7.4 ± 13.5 to 25.4 ± 9.2 degrees, P &lt; 0.001) and Gissane angle (from 119.3 ± 13.4 to 113.4 ± 10.1 degree, P &lt; 0.001) were significantly corrected. The vertical articular step significantly decreased from 4.3 ± 0.8 mm before the operation to 0.9 ± 0.5 mm ( P &lt; 0.001). There were no wound complications. At the final follow-up, the mean Maryland Foot Scale, American Orthopedic Foot and Ankle Society ankle-hindfoot score, and visual analogue scale score were 93.5 ± 6.4, 91.3 ± 7.6, and 1.0 ± 1.0, respectively. No patients required secondary surgery, except for 5 patients for whom the internal fixation was removed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrated favorable clinical outcomes for the minimally invasive treatment of calcaneal fractures using 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation in combination with a novel circular distractor. This surgical protocol is suggested to be both safe and reliable on the basis of this findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;Therapeutic Level IV. See Instructions for Autho","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"e134-e141"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271443","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":"Effect of Insert Material on Interlocking Screw Stability in Retrograde Femoral Nailing: Ultra-High Molecular Weight Polyethylene Versus Polyetheretherketone.","authors":"Brendan E Page, Kareem M Shaath, Timothy J Baker, Griffin R Rechter, Astrid Casin, Jonathan P Yawman, Elizabeth Jacobs, Joshua R Langford, George J Haidukewych","doi":"10.1097/BOT.0000000000003154","DOIUrl":"10.1097/BOT.0000000000003154","url":null,"abstract":"<p><strong>Objectives: </strong>To compare short-term implant complications between 2 iterations of the Retrograde Femoral Nailing System Advanced (DePuy Synthes, Raynham, MA), specifically evaluating interlocking screw backout in constructs using ultra-high molecular weight polyethylene (UHMWPE) versus polyetheretherketone (PEEK) distal inserts.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Single academic, Level-1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Included were adult patients (age ≥18 years) who underwent retrograde femoral nailing for AO/OTA type 32 or 33 fractures between July 2024 and July 2025 with at least 3-month follow-up. The UHMWPE insert was used until December 2024; the PEEK insert was implemented system-wide beginning January 2025.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was rate of distal interlocking screw backout. Secondary outcomes included reoperation, infection, and nonunion.</p><p><strong>Results: </strong>A total of 109 patients (113 fractures) met inclusion criteria: 50 fractures in the UHMWPE group [28 males (61%)] and 63 in the PEEK group [32 males (50%)]. There were no significant differences in sex, body mass index, diabetes, smoking status, or fracture pattern distribution between groups ( P > 0.05). The average age was higher in the PEEK group (63 vs. 48 years; P < 0.001). Screw backout occurred in 3 of 50 fractures (6%) in the UHMWPE group compared with 0 of 63 in the PEEK group ( P = 0.04). Two of the 3 patients with backout in the UHMWPE group required reoperation. There were 2 (4%) nonunions in the UHMWPE group and none in the PEEK group ( P = 0.11). All fractures in the PEEK group went on to union without evidence of screw backout or nonunion. There was one infection in the PEEK group requiring irrigation and debridement.</p><p><strong>Conclusions: </strong>The use of a PEEK insert in the Retrograde Femoral Nailing System Advanced system was associated with favorable early outcomes, including the absence of interlocking screw backout compared with the original UHMWPE insert. These findings support the effectiveness of the design modification and may guide implant selection in femoral fracture fixation.</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":"324-328"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150105","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":"Assessment of Knee Laxity After Retrograde Intramedullary Nailing for Periprosthetic Distal Femur Fractures: A Cadaveric Study.","authors":"Joshua P Rainey, Lucas A Anderson, Ian M Duensing, Jeremy M Gililland, Patrick J Kellam","doi":"10.1097/BOT.0000000000003148","DOIUrl":"10.1097/BOT.0000000000003148","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Periprosthetic distal femur fractures have grown in volume because the rate of primary total knee arthroplasty (TKA) has increased. These injuries are increasingly treated with intramedullary nailing (IMN), but knee instability after retrograde IMN has not been well studied. A cadaveric study was performed to investigate TKA balance after retrograde femoral IMN. The main hypothesis was that retrograde femoral IMN preparation would lead to increased flexion space laxity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A medial parapatellar approach and measured resection TKA technique were performed in 8 cadaveric knees. A tensioner was used to measure the flexion and extension spaces in millimeters and the anterior-to-posterior (AP) translation of the knee at various times. Flexion and extension gaps were measured at a constant 50 Newton-meters both with and without a femoral trial component in place. A tibial trial component was not placed to have a flat surface to reference. Owing to the size of the tensioner, the extension gap could only be measured without a femoral component in place. All knees were then closed, underwent opening reaming for a retrograde femoral nail (rIMN) under fluoroscopy, and then reopened to assess flexion and extension spaces and AP translation. A tibial component was intentionally not implanted to isolate the effect of femoral TKA preparation on rIMN placement and its subsequent impact on the flexion gap and AP stability of the knee. Differences were measured between the pre- and post-rIMN gaps and calculated as the post-rIMN gap minus the pre-rIMN gap. Simple descriptive statistics were performed, including mean and SD. Differences between the pre- and post-IMN measurements were assessed with paired students t tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Without a femoral component and compared with the pre-IMN space, the post-IMN flexion space was greater by 1.5 ± 1.2 mm ( P = 0.01), the post-IMN extension space was not different at 0 ± 0.53 mm ( P = 0.60), and the post-IMN AP translation was greater by 3.13 ± 2.3 mm ( P = 0.01). With a femoral component and compared with the pre-IMN space, the post-IMN flexion space was not different at 0.13 ± 0.64 mm ( P = 0.60).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;After TKA femoral preparation, retrograde IMN did not significantly affect the flexion gap when a femoral component was in place. Without a femoral component in place, the extension gap was unchanged after IMN placement. Although the flexion gap was statistically greater after IMN placement when measured without a femoral component, the clinical relevance is questionable given this difference was, on average, only 1.5 mm greater and a femoral component was not present. Similarly, the differences in AP translation observed without a femoral component were attenuated once the component was in place, which may have been further attenuated if a tibial component was able to be placed. These findings suggest limited","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"e142-e147"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052626","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}