Journal of Orthopaedic Trauma最新文献

{"title":"Trends in Utilization of Multimodal Pain Management After Pilon Fracture Open Reduction and Internal Fixation.","authors":"Philip P Ratnasamy, Arjun Aron, John Slevin, Jonathan N Grauer, Brianna R Fram","doi":"10.1097/BOT.0000000000003151","DOIUrl":"10.1097/BOT.0000000000003151","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate trends in pain medication prescriptions after pilon fracture open reduction and internal fixation (ORIF) in the context of recent initiatives to reduce opioid use and promote multimodal pain management.</p><p><strong>Methods: </strong>.</p><p><strong>Design: </strong>Retrospective database study.</p><p><strong>Setting: </strong>US national administrative data set (PearlDiver M170Ortho database).</p><p><strong>Patient selection criteria: </strong>Included were patients undergoing pilon fracture (AO-OTA 43A/B/C) ORIF from 2010 to 2021 without history of preinjury narcotic use, polytrauma, substance abuse, or neoplasm.</p><p><strong>Outcome measures and comparisons: </strong>This study captured prescriptions for pain medications within 90 days postoperatively after definitive pilon fracture fixation, categorized by drug category. Annual prescriptions and morphine milligram equivalents per 1000 surgeries were trended during the study interval. Timing of opioid prescriptions postoperatively was determined. Multivariable analysis was performed to determine factors independently associated with opioid prescriptions.</p><p><strong>Results: </strong>Included were 13,108 patients with pilon fracture ORIF, of whom the average age was 50 years (range 18-84 years (49.9%) female). Discretely billed outpatient opioid prescriptions decreased from 434.1 per 1000 surgeries in 2010 to 165.7 in 2021 (-61.8%). Prescriptions of other pain management drugs on aggregate decreased less drastically from 276.6 in 2010 to 195.3 in 2021 (-29.4%). The proportion of all analgesic medications prescribed postoperatively that were opioids decreased from 60.3% in 2010 to 45.9% in 2021. Among patients who received opioids within 90 days postoperatively, morphine milligram equivalents prescribed per 1000 pilon fracture ORIF surgeries decreased from 589,486 in 2010 to 59,795 in 2021 (-91.3%). The 97% of opioids were prescribed in the first 2 weeks postoperatively. Predictors of postoperative opioid prescriptions by multivariate analysis included younger age (odds ratio [OR] 1.29 per decade decrease), male sex (OR 1.54), and lower Elixhauser Comorbidity Index (OR 1.28) ( P < 0.0001 for all). Patients who had repair of tibia and fibula fractures did not have greater odds of postoperative opioid prescriptions than those who had repair of the tibia alone.</p><p><strong>Conclusions: </strong>Opioid prescriptions after pilon fracture ORIF decreased substantially from 2010 to 2021. Prescriptions for nonopioid analgesic medications also decreased but to a lesser extent. Younger age, male sex, and lower comorbidity burden were associated with higher postoperative opioid prescribing.</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":"329-335"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052658","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":"Ceftriaxone Versus Piperacillin-Tazobactam Monotherapy for Open Fracture Prophylaxis: A Retrospective Cohort Study.","authors":"A Hampton Sisson, Robin M Litten, Ryan N McIlwain, Ashley N Kimbel, Doriann M Alcaide, Addison M Cimino, Joey P Johnson, Clay A Spitler","doi":"10.1097/BOT.0000000000003153","DOIUrl":"10.1097/BOT.0000000000003153","url":null,"abstract":"<p><strong>Objective: </strong>To compare rates of fracture-related infection (FRI) and acute kidney injury (AKI) in patients with open fractures treated with ceftriaxone (CTX) monotherapy or piperacillin-tazobactam (PIP-TAZ) monotherapy.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single Level I Trauma Center (2020-2023).</p><p><strong>Patient selection criteria: </strong>Adults who sustained an open fracture of the femur, tibia, humerus, radius/ulna, and foot fractures (metatarsals, calcaneus, talus) and underwent operative irrigation and debridement. Exclusion criteria were less than 6 months of follow-up, hospital transfers, primary amputation, receipt of vancomycin within the first 48 hours in addition to CTX or PIP-TAZ, and cases requiring vascular bypass, rotational or free flaps, or full-thickness skin grafts.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes were rates FRI and AKI. Outcomes were compared between patients receiving prophylactic CTX versus PIP-TAZ monotherapy.</p><p><strong>Results: </strong>A total of 156 patients with open fractures were identified, of which 136 met inclusion criteria: 67 treated with CTX monotherapy and 69 with PIP-TAZ monotherapy. The mean age was 46.2 years (range: 18-86) in the CTX cohort and 41.6 years (range: 19-83) in the PIP-TAZ cohort, and males comprised 56.7% and 72.3% of each group, respectively. Differences between groups were limited to a longer mean follow-up duration in the PIP-TAZ cohort ( P < 0.001) and a higher prevalence of soil contamination in the CTX cohort (11.9% vs. 1.4%, P = 0.015). There were no statistically significant differences in rates of FRI (25.4% CTX vs. 29.0% PIP-TAZ, P = 0.501) or AKI (11.9% vs. 15.9%, P = 0.636) between groups. On multivariate analysis, diabetes (OR 6.62, P = 0.003) was independently associated with increased FRI risk, whereas soil contamination (OR 3.42, P = 0.180) and external fixation (OR 1.92, P = 0.163) demonstrated nonsignificant trends toward higher risk.</p><p><strong>Conclusions: </strong>In this retrospective cohort of patients with open fractures, ceftriaxone and piperacillin-tazobactam demonstrated comparable outcomes in both fracture-related infection and acute kidney injury. Diabetes was found to be a statistically significant risk factor for FRI.</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":"294-299"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086129","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":"Protein Supplementation for Hip Fracture Recovery in Elderly Patients: A Randomized Controlled Trial.","authors":"Seyed Hadi Kalantar, Mohammad Poursalehian, Mohammadreza Donyazad, Hossein Shafie, Jayran Zebardast, Razieh Khalooeifard, Seyed Mohammad Javad Mortazavi","doi":"10.1097/BOT.0000000000003158","DOIUrl":"10.1097/BOT.0000000000003158","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether protein supplementation improves mobility recovery, nutritional markers, mortality rates, and postoperative complications in elderly patients after proximal femoral fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Prospective, randomized, double-blind, placebo-controlled clinical trial.</p><p><strong>Setting: </strong>Tertiary academic orthopaedic centers.</p><p><strong>Patient selection criteria: </strong>Adults 60 years and older with radiographically confirmed proximal femoral fractures (OTA/AO 31-A1, 31-A2, 31-A3,31-B1, 31-B2, and 31-B3) requiring surgery were eligible. Exclusion criteria included prior supplement use, periprosthetic fractures, renal impairment, severe systemic disease, or contraindications to supplementation. Participants were randomized to receive either a creatine- and HMB-enriched protein supplement or an isocaloric maltodextrin placebo, administered once daily for 1 month.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was mobility recovery measured using the Parker Mobility Score (PMS), compared between groups at 1 and 6 months. Secondary outcomes included serum albumin, hemoglobin, lymphocyte count, total protein, mortality, and postoperative complications. Planned comparisons evaluated biochemical changes from baseline to 1 month, mortality across 6 months, and complications within 1 month.</p><p><strong>Results: </strong>The intervention group (N = 40) had a mean age of 72.3 ± 8.7 years (range: 60-88), with 52.5% men, while the control group (N = 40) had a mean age of 73.2 ± 8.9 years (range: 60-90), with 42.5% men. Baseline demographic characteristics were comparable between the 2 groups. At 1 month, the intervention group showed higher PMS (4.83 ± 0.85 vs. 2.65 ± 0.63; P < 0.001), with no difference at 6 months (6.33 ± 2.4 vs. 6.19 ± 2.9; P = 0.859).At 1 month, albumin normalization was observed in all patients in the intervention group compared with 85% of patients in the control group; however, this difference did not remain statistically significant after Bonferroni adjustment (adjusted P = 0.219). Other nutritional markers showed no significant intergroup differences (all adjusted P > 0.05). Supplementation was associated with a lower 6-month mortality rate (HR 4.5; 95% CI, 1.12-18.26; P = 0.034). Complication rates within 1 month were similar between groups (N = 4 vs. N = 8; P = 0.20).</p><p><strong>Conclusions: </strong>In elderly patients with hip fracture, creatine- and HMB-enriched protein supplement improved early mobility, accelerated albumin normalization, and was associated with lower 6-month mortality, without affecting complication rates.</p><p><strong>Level of evidence: </strong>Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"286-293"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150143","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":"A Comparative Analysis of Distal Femur Fracture Fixation: Nail-Plate Combination Reduces Construct Failure and Improves Postoperative Mobility.","authors":"Luke Verlinsky, Cameron L Atkison, Elizaveta Reznichenko, Samuel S Ornell, Blaire C Peterson, Lindsey N Peng, Jeffrey Hills, Thomas L Hand, Case W Martin, Ravi A Karia","doi":"10.1097/BOT.0000000000003156","DOIUrl":"10.1097/BOT.0000000000003156","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare implant failure rates, reoperations, and postoperative mobilization between lateral locked plate (LLP), retrograde intramedullary nail (rIMN), and nail-plate combination (NPC) constructs in treating distal femur fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective cohort study.&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;Patient selection criteria: &lt;/strong&gt;Adult patients treated operatively for distal femur fractures (OTA/AO 33A and 33C) from 2019 to 2024 were included. Patients were excluded if they sustained partial articular injuries, pathologic fractures, multifocal femoral injuries, or critical bone defects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;Construct failure was the primary outcome, defined as displaced implant breakage, gross loss of fracture reduction, or any reoperation for nonunion. Secondary outcomes included all-cause reoperation, deep infection, death within 90 days, and mobilization status at the time of discharge.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 196 distal femur fractures in 188 patients were included. There were 83 fractures treated with NPC fixation (mean age 70 years, 24% men, BMI 31), 37 fractures treated with rIMN (mean age 55 years, 54% men, BMI 28), and 76 fractures treated with LLP (mean age 65 years, 29% men, BMI 32). Across the 3 treatment groups, patients with rIMN were younger ( P &lt; 0.001) and had a higher proportion of men ( P = 0.004). Immediate weightbearing was allowed in 70% of NPC constructs, 32% of rIMN constructs, and 3% of LLP constructs, respectively ( P &lt; 0.001). After controlling for age, BMI, and open fracture status, NPC was associated with a lower risk of construct failure, occurring in 1 of 83 (1.2%) cases, compared with LLP, which failed in 15 of 76 (19.7%) cases (hazard ratio 17.43 [95% confidence interval [CI], 2.23-136.10], P = 0.006). Although NPC had the lowest rate of failure among the 3 constructs, the difference between NPC and rIMN, which failed in 2 of 37 (5.4%) cases, was not statistically significant (hazard ratio 7.62 [95% CI, 0.66-88.24], P = 0.104). All-cause reoperation occurred in 7 (8.4%) patients in the NPC group, 4 (10.8%) patients in the rIMN group, and 18 (24.7%) patients in the LLP group. Deep infection occurred in 6 (7.2%) patients in the NPC group, 1 (2.7%) patient in the rIMN group, and 1 (1.3%) patient in the LLP group ( P = 0.085). There were no differences in estimated blood loss ( P = 0.137), or death ( P = 0.999) between groups. Geriatric patients (age ≥60 years) with NPC fixation were more likely to discharge within a higher mobilization strata relative to single implant constructs (OR 2.93, P = 0.049).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;NPC and rIMN demonstrated a lower hazard of construct failure and reoperation than LLP in the treatment of acute distal femur fractures. Although NPC had a higher number of deep infection cases,","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"314-323"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150140","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":"Increased Efficiency With Use of a Mini C-Arm in Emergency Department Closed Reductions.","authors":"Mara Bajic, Carolyn Meinerz, Matthew Laprade, Andrew Kleven, Peyton Keeling, Steven Cherney, Elizabeth Nolte","doi":"10.1097/BOT.0000000000003147","DOIUrl":"10.1097/BOT.0000000000003147","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether use of a mini C-arm increased emergency department (ED) efficiency and decreased patient radiation exposure and the frequency of repeat closed reductions, as compared with traditional postreduction radiographs in patients with isolated distal radius and ankle fracture.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Academic Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Adult patients with an isolated distal radius (OTA/AO 2R3A2), bimalleolar or trimalleolar ankle (OTA/AO 44B1) fractures requiring closed reduction by the orthopaedic surgery team in an academic level 1 trauma center ED from 2013 to 2023 were included. Patients with pathologic fractures were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Closed reductions in which mini C-arm imaging was used were compared with those that used traditional postreduction radiographs. Total radiation exposure to the patient during the encounter (mGy), closed reduction radiation exposure (mGy), the number of repeated reductions in the ED requiring an additional analgesic/anesthetic event and splint application, orthopaedic consult time, doctor visit to discharge time, and time under sedation (conscious or unconscious) were compared between the mini C-arm group and the traditional postreduction radiographs group.</p><p><strong>Results: </strong>A total of 199 subjects met inclusion criteria (81 ankle fractures and 118 distal radius fractures). For the mini C-arm group, the mean age was 59 years (range 25-93) and 58% of the patients were female (n = 14). For the traditional postreduction radiographs group, the mean age was 58 years (range 21-90) and 55% of the patients were female (n = 96). Use of a mini C-arm (16 ankle fractures and 8 distal radius fractures) versus traditional postreduction radiographs (65 ankle fractures and 110 distal radius fractures) resulted in significantly lower total radiation exposure, 0.9 mGy versus 0.4 mGy ( P < 0.001), and closed reduction radiation exposure, 0.5 versus 0.1 mGy ( P < 0.001); fewer repeated reductions, 65 versus 0 repeated reductions ( P < 0.001); and shorter time from doctor visit to discharge, 6.2 versus 3.8 hours ( P < 0.001), orthopaedic consult time, 4.0 versus 1.7 hours ( P < 0.001), and time under sedation, 37 versus 26 minutes ( P = 0.046).</p><p><strong>Conclusions: </strong>This study found that the use of a mini C-arm compared with traditional postreduction radiographs for distal radius and ankle fracture closed reductions improved ED efficiency and decreased patient radiation exposure and repeated closed reductions.</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":"e128-e133"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052601","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":"Initial Patella Vertical Fracture Displacement Is a Predictor of Nonunion and Hardware Failure.","authors":"Alexander M Lashgari, Amelia R Goldstein, George W Monroe, Abhishek Ganta, Sanjit Konda, Kenneth A Egol","doi":"10.1097/BOT.0000000000003149","DOIUrl":"10.1097/BOT.0000000000003149","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine if initial vertical fracture displacement affects postoperative outcomes after operative treatment of patella fractures.&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;Prognostic retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single multisite urban academic institution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient selection criteria: &lt;/strong&gt;Included were patients aged ≥18 years who underwent open reduction internal fixation of a patella fracture (AO/OTA 34A-C) with minimum 6-month follow-up and complete trauma knee x-ray series. Vertical fractures and those without significant vertical displacement (&lt;2 mm) were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures and comparisons: &lt;/strong&gt;Initial vertical fracture displacement was recorded. Follow-up data included knee range-of-motion and postoperative complications: nonunion, fracture-related infection, hardware failure, suspected fracture-related infection, knee contracture, inferior sleeve displacement, and venous thromboembolism events. Comparisons were made between the initial amount of displacement and postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Two hundred twenty-nine patients with a median follow-up duration of 12 months (Interquartile range: 6-14) were included. The mean age was 61.2 ± 15.1 years, body mass index was 25.4 ± 4.7 kg/m 2 , and 69.0% (n = 158) were female. Orthopaedic Trauma Association fracture classification was 35.4% C1, 32.3% C3, 17.9% C2, and 14.4% A1. Fixation methods included 63.8% tension band wiring, 17.9% suture repair, 13.5% plate and screws, and 4.8% screws with suture. Thirty-three (14.4%) patients sustained complications. The mean displacement was significantly higher in patients who developed complications (21.6 mm ± 15.0 mm vs. 14.8 mm ± 10.1 mm, P = 0.018), particularly for nonunion (29.8 mm ± 13.5 mm vs. 15.1 mm ± 10.6 mm, P &lt; 0.001) and hardware failure (30.8 mm ± 12.0 mm vs. 15.4 mm ± 10.9 mm, P &lt; 0.001). Suture-only and screw-with-suture fixation had higher nonunion rates ( P = 0.004, P = 0.005) than other fixation methods independent of displacement. Initial displacement predicted nonunion and hardware failure (AUROCs = 0.818 and 0.838). Youden Index thresholds of &gt;26.6 mm and &gt;21.7 mm identified patients at increased risk for nonunion and hardware failure. Each millimeter increase in displacement raised nonunion and hardware failure risk by 14.9% (OR = 1.1, P = 0.003) and 14.6% (OR = 1.1, P = 0.003).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study supports the future use of initial vertical fracture displacement as a prognostic tool for nonunion and hardware failure after patella open reduction internal fixation. Displacement &gt;2 cm placed patients at high risk for these complications. Nonunion rates were higher in both suture-only and screw-with-suture fixation when compared with other fixation constructs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;Prognostic Level III. See Instructions for Authors for ","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"307-313"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052652","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":"Rethinking Avascular Necrosis After Displaced Talus Fractures and Dislocations.","authors":"Abigail Frazer, Silvio Ndoja, Veronica Grad, Gabrielle Fortin, Mark MacLeod, Abdel-Rahman Lawendy, Clayton Inculet, Christopher Del Balso, Emil Schemitsch, David Sanders","doi":"10.1097/BOT.0000000000003150","DOIUrl":"10.1097/BOT.0000000000003150","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship of avascular necrosis (AVN) of the talus with postoperative outcomes and to assess the utility of the Hawkins sign and its ability to predict talar vitality following talar fracture or dislocation.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single center, academic, Level I Trauma center.</p><p><strong>Patient selection criteria: </strong>Patients with talus injuries (AO/OTA 81-A, 81-B, 81-C) treated from 2007 to 2017 were included.</p><p><strong>Outcome measures and comparisons: </strong>Variables analyzed included anatomic location, fracture classification, timing of surgery, reduction quality, and the presence or absence of Hawkins sign. Outcomes measured included development of AVN, degree of collapse, union, posttraumatic arthritis, prognostic reliability of the Hawkins sign, and secondary reconstructive surgery (SRS). Data were analyzed using binary logistic regressions.</p><p><strong>Results: </strong>Seventy-nine patients were reviewed, 65% of which were male, with mean age of 37.7 years (range 18-83 years). Patients were followed for average of 32.5 months postsurgery. Of the 79 patients, 30 developed AVN (38%) and 20 of the 79 required SRS (25%). Of the 20 SRS cases, AVN was an indication for 6 cases (30%). Of the 30 AVN cases, 27 (90%) demonstrated less than 25% collapse of the talar dome, with 3 demonstrating more than 25% collapse. Age at the time of surgery and a higher number of incisions were associated with AVN (B = 0.051, P = 0.01 and B = 2.173, P = 0.001). Timing of surgery (<24 hours) and anatomic reduction were not associated with the development of AVN (B = 0.602, P = 0.286 and B = 0.641, P = 0.491). Nonanatomic reduction was associated with higher rates of SRS (B = -1.777, P = 0.033).</p><p><strong>Conclusions: </strong>Radiographic evidence of AVN was common after fractures and dislocations of the talus, with 38% of patients in this study developing AVN. However, the development of AVN did not influence the rate of SRS at follow-up. This may be explained by the fact that most AVN patients (90%) had less than 25% collapse. Factors associated with AVN development included increased age at surgery and an increase in the number of incisions. The development of AVN had no detrimental clinical impact in this study.</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":"281-285"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052649","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":"Safety, Efficacy, and Screw Accuracy of CT-Navigated INFIX for Unstable Pelvic Ring Fractures: A Retrospective Study.","authors":"Akihiko Hiyama, Taku Ukai, Miyu Tamaki, Masahiko Watanabe","doi":"10.1097/BOT.0000000000003152","DOIUrl":"10.1097/BOT.0000000000003152","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the clinical performance, screw placement accuracy, and complication profile of intraoperative computed tomography (CT)-guided anterior subcutaneous internal fixation (INFIX) for unstable anterior pelvic ring fractures.</p><p><strong>Methods: </strong>.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Single tertiary emergency medical center, equivalent to a Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>A retrospective review was performed of skeletally mature patients with unstable anterior pelvic ring injuries (Orthopaedic Trauma Association/AO type 61) treated with CT-navigated INFIX fixation between December 2020 and December 2024. Patients with incomplete imaging or follow-up were excluded.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes included operative time, intraoperative blood loss, screw placement accuracy (axial angle and skin-to-head distance), and functional outcomes using a modified Majeed score (excluding work and sexual activity domains). Complications were recorded and compared by fixation construct.</p><p><strong>Results: </strong>A total of 41 patients were included, with a mean age of 50.7 ± 24.0 years. Mean operative time was 121.0 ± 61.8 minutes, and mean intraoperative blood loss was 86.8 ± 113.0 mL. Temporary external fixation was used in 48.8% of cases. The normalized modified Majeed score averaged 87.5 ± 12.7, and 65.9% of patients achieved \"excellent\" outcomes. The most frequent complication was lateral femoral cutaneous nerve injury (26.8%). No screw displacement occurred in cases with additional posterior fixation. Postoperative CT demonstrated consistent screw placement (mean axial angle, 27.0 degrees; mean skin-to-head distance, 15.3 mm), and no major neurovascular complications were observed.</p><p><strong>Conclusions: </strong>CT-guided INFIX allowed accurate screw placement with a low rate of major complications. Early functional outcomes were favorable when assessed with a modified score tailored to the study population. Combined anterior-posterior constructs enhanced fixation stability. Prospective comparative studies were warranted to clarify long-term outcomes.</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":"e148-e155"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052629","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":"Static Proximal Fixation of Intramedullary Nails Used to Treat Intertrochanteric Femur Fractures Does Not Increase the Risk of Failure. Radiographic Outcomes From a Randomized Controlled Trial.","authors":"Mark Rickman, Dominic Thewlis, Andreas Ladurner, James Bassett, Thomas Nijman","doi":"10.1097/BOT.0000000000003145","DOIUrl":"10.1097/BOT.0000000000003145","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the outcomes of intramedullary fixation of intertrochanteric femur fractures treated with a single lag screw (Gamma3) and a dual integrated screw design (Intertan), including outcomes depending on the mode of proximal lag screw fixation (static or dynamic).</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>A pragmatic, single-blinded RCT with a three-arm parallel group design.</p><p><strong>Setting: </strong>A multicenter PRCT, with a Level 1 academic trauma center and a second linked smaller level 2 hospital.</p><p><strong>Patient selection criteria: </strong>Patients older than 60 years undergoing intramedullary screw fixation of a standard obliquity intertrochanteric femur fracture (AO/OTA 31A1 or A2) were randomized into 3 groups: single lag screw (dynamically locked), dual integrated lag screw (dynamically locked), and dual integrated lag screw (statically locked).</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome measure was radiographic failure of the device by 6 months, judged by any one of cut-out requiring reoperation, a change in tip-apex distance of more than 10 mm, or breakage of the metal. Pairwise comparisons were performed between the 3 study groups. Secondary outcomes included all cause reoperation rates and degree of secondary collapse.</p><p><strong>Results: </strong>A total of 477 patients were randomized. 27 patients were excluded after randomization and 95 died before 6 months. 226 had full follow-up to the primary outcome point of 6 months: (80 Gamma, mean age 83 (range 60-101), 60% female; 72 Intertan dynamic, mean age 80 (range 60-101), 63% female; 74 Intertan static, mean age 82 (range 61-97), 72% female). A further 129 had clinical follow-up but no radiographs. No difference was seen in radiographic failure by 6 months between the Gamma nail (single lag screw) and the Intertan Dynamic (dual lag screw) groups (11.3% vs. 9.7%, P = 0.74); Initial tip-apex distance remained statistically the most significant independent predictor of failure (mean TAD of 15.7 mm in the nonfailure group, 23 mm in the failure group, P < 0.001). The Intertan group with a statically locked proximal lag screw had a lower (nonstatistically significant) radiological failure rate (1.4%) than either dynamically locked group (Gamma 11.3%, Intertan dynamic 9.7%, P = 0.05). Reoperation rates were similar for all groups (Intertan static 2%, Gamma 3.3%, Intertan dynamic 5.3%, P = 0.42).</p><p><strong>Conclusions: </strong>In patients older than 60 years undergoing intramedullary fixation of standard obliquity intertrochanteric fractures, the failure rate was not higher when using the Intertan nail in the proximally locked mode, when compared with either the Intertan nail or Gamma nail used in the dynamic proximal locking mode.</p><p><strong>Level of evidence: </strong>Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"e110-e118"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030132","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":"Ballistic Pelvic Fractures With Bowel-First Trajectory Are Associated With Increased Rates of Bony Infection: A Multicenter Assessment.","authors":"Andrew P Collins, Loren O Black, Jessica Porras, Joseph T Patterson, Nigel Blackwood, Clay A Spitler, Nolan Farrell, Michael J Beebe, Christian G Falgons, Jonathan G Eastman, Jennifer T Eurich, Mary Kate Erdman, Zachary E Zeller, Paul Tornetta, Mir Ibrahim Sajid, Hassan R Mir, Reza Firoozabadi","doi":"10.1097/BOT.0000000000003146","DOIUrl":"10.1097/BOT.0000000000003146","url":null,"abstract":"<p><strong>Objectives: </strong>To compare deep infection rates from ballistic ilium fractures in which the trajectory traversed the bowel before entering bone versus those that enter the bone before bowel, and to identify factors associated with deep infection of the bony pelvis.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Eight Level I trauma centers.</p><p><strong>Patient selection criteria: </strong>Patients 18 years or older with ballistic ilium fractures (OTA/AO 61) and minimum 6 months of radiographic and clinical follow-up from January 2019 to December 2024.</p><p><strong>Outcome measures and comparisons: </strong>The primary study outcome was the rate of secondary deep pelvic bony infection requiring subsequent surgical irrigation and debridement. Associations between ballistic trajectory (traversing bowel before entering bone [Bowel] vs. bone before entering the abdomen [Bone]) were determined from computed tomography images; concomitant associated injuries, patient characteristics, and other interventions with the primary outcome were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>A total of 201 patients with ballistic ilium fractures were included; 88.6% were men, and the average age was 32.9 ± 12.3 years. Of these, 83 (41%) sustained ballistic injuries that traversed the bowel before entering bone (Bowel), 69 (34%) entered the bone before the bowel (Bone), and 49 (24%) had an indeterminate trajectory. The Bowel cohort had a higher average injury severity score (20.2 vs. 12.5, P < 0.001), lower prevalence of other drug use (39.8% vs. 56.5%, P = 0.025), and greater incidence of exploratory laparotomy (90.4% vs. 36.2%, P < 0.001). Patients with bowel experienced higher rates of deep infection requiring surgical debridement (10.8% vs. 1.4%, P = 0.017). On multivariate analysis, deep infection requiring surgical bony debridement was significantly associated with bullet trajectory traversing the bowel before entering the bone (odds ratio: 14.6; 95% confidence interval: 1.3-160.8, P = 0.021).</p><p><strong>Conclusions: </strong>Ballistic ilium fractures that traverse the bowel before entering bone were associated with higher rates of deep infection requiring bony debridement. The role of acute bony irrigation and debridement in these patients warrants further investigation.</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":"269-274"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030176","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}