Journal of Orthopaedic Trauma最新文献

{"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}

{"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":"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":"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":1.8,"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}