Orthopedics最新文献

{"title":"Are Patient-Reported Social Needs and the Social Vulnerability Index Associated With Physical Function in Orthopedic Surgery?","authors":"Bill Young, Sara L Kemper, Derek F Amanatullah, Loretta Chou, Michael J Gardner, Serena S Hu, Marc Safran, Robin N Kamal","doi":"10.3928/01477447-20260814-01","DOIUrl":"https://doi.org/10.3928/01477447-20260814-01","url":null,"abstract":"<p><strong>Background: </strong>A gap exists in understanding the association of health-related social needs (HRSN), social determinants of health, and patients' physical function after orthopedic surgery. In this study, we asked: (1) Are HRSN and the social vulnerability index (SVI) associated with each other, and (2) are HRSN and SVI associated with patients' physical function after surgery?</p><p><strong>Materials and methods: </strong>We conducted a prospective study in a multispecialty academic orthopedic clinic from June 2024 to October 2024. We enrolled new adult patients who consented to participate and presented with an orthopedic condition. Patients completed the Accountable Health Communities HRSN Screening Tool to assess HRSN; and the Patient-Reported Outcome Measure Information System Physical Function 10a (PROMIS PF-10a), which measures a patient's self-reported physical function. We also used patient addresses to determine the SVI for each participant. The primary outcome was the association between HRSN and SVI. The secondary outcome was the association between HRSN or SVI and PROMIS PF-10a.</p><p><strong>Results: </strong>We enrolled 127 new patients. Housing and food were the most frequently reported unmet HRSNs, affecting 14 (11.0%) patients each. There was no significant association between HRSNs and SVI. HRSNs and SVI showed inverse correlations with PROMIS PF-10a scores (r = -0.30 and r = -0.32, respectively; <i>P</i> < .001 for both).</p><p><strong>Conclusion: </strong>The findings suggest that area-level social determinants of health and individual patient HRSNs may independently affect physical function in orthopedic patients, which should be reflected in screening tools.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"1-7"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of GLP-1 Agonists With Postoperative Complications Following Knee Extensor Mechanism Repair:An Analysis of 1,092 Patients.","authors":"Elliot Forst, Lindsey Tully, Thomas E Moran, Alyssa D Althoff","doi":"10.3928/01477447-20260811-01","DOIUrl":"https://doi.org/10.3928/01477447-20260811-01","url":null,"abstract":"<p><strong>Background: </strong>Diabetes and obesity are recognized as risk factors for postoperative complications including increased surgical site infection (SSI) and reoperation in patients undergoing knee extensor mechanism repair. However, limited literature evaluates how preoperative glucagon-like peptide-1 (GLP-1) receptor agonist therapy may influence these outcomes. This study evaluated GLP-1 receptor agonist use as an independent risk factor for postoperative outcomes following knee extensor mechanism repair.</p><p><strong>Materials and methods: </strong>Patients who underwent quadriceps or patellar tendon repair from 2012 to 2025 were identified in the TriNetX database and stratified by GLP-1 agonist use within 1 year of surgery. One-to-one propensity score matching yielded 2 well-balanced cohorts (n = 546). Postoperative complications were assessed at 90 days, 1 year, and 2 years, and Kaplan-Meier survival analysis was performed.</p><p><strong>Results: </strong>No significant 90-day postoperative differences were observed. At 1 year, patients using GLP-1 agonists demonstrated significantly lower rates of SSI (2.38% vs 5.31%; odds ratio [OR] = 0.435; <i>P</i> = .0118) and wound complications (2.02% vs 5.31%; OR = 0.367; <i>P</i> = .0037). Differences persisted at 2 years, with lower rates of SSI (2.75% vs 6.04%; OR = 0.439; <i>P</i> = .0079), wound complications (2.38% vs 6.04%; OR = 0.379; <i>P</i> = .0026), and acute kidney injury (9.71% vs 13.55%; OR = 0.686; <i>P</i> = .0474). No significant differences in revision surgery were found. Kaplan-Meier analysis demonstrated significant separation for SSI and wound complications beginning at 1 year.</p><p><strong>Conclusion: </strong>Preoperative GLP-1 receptor agonist therapy was associated with reduced postoperative SSI and wound complications following knee extensor mechanism repair. These findings suggest potential for perioperative risk modulation as GLP-1 use becomes increasingly prevalent in patients undergoing knee extensor mechanism repair.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"1-20"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distractor-assisted Reduction for Volar Shear Distal Radius Fractures: A Retrospective Case Series.","authors":"Jialiu Fang, Tingjun Li, Jinhao Cheng, Jun Li, Jisen Zhang, Yanfang Yang","doi":"10.3928/01477447-20260817-01","DOIUrl":"10.3928/01477447-20260817-01","url":null,"abstract":"<p><strong>Background: </strong>Volar shear distal radius fractures are technically challenging due to the difficulty in controlling small volar fragments. This study aimed to evaluate the clinical and radiographic outcomes of a distractor-assisted reduction technique in the surgical management of these fractures.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 23 consecutive patients treated with distractor-assisted reduction and volar plating between January 2024 and March 2025. Radiographic outcomes (ie, radial height, inclination, volar tilt) and functional outcomes, including wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Modified Mayo Wrist Score (MMWS), were assessed.</p><p><strong>Results: </strong>A total of 23 patients completed follow-up at a mean of 13.4 months. Radiographic alignment was well restored, with a mean radial height of 11.6 ± 1.8 mm, radial inclination of 22.4° ± 3.1°, and volar tilt of 11.2° ± 3.6°. Wrist motion recovered satisfactorily, with mean wrist extension of 64° ± 11° and flexion of 71° ± 12°. The mean DASH score was 12.8 ± 7.4. According to the MMWS, outcomes were rated as excellent in 15 patients, good in 7, and fair in 1. Grip strength recovered to 83% ± 9% of the contralateral side. No major complications were observed.</p><p><strong>Conclusion: </strong>Distractor-assisted reduction appears to be a useful adjunct in the surgical treatment of volar shear distal radius fractures.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"1-5"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Copper-to-Zinc Ratio and Postoperative Delirium After Hip Fracture Surgery: A Propensity Score-matched Cohort Study.","authors":"Cheol Lee, Young Jean Ahn, Kwangjin Lee, Jina Kim","doi":"10.3928/01477447-20260604-01","DOIUrl":"10.3928/01477447-20260604-01","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is frequent after hip fracture surgery, yet objective biomarkers that improve risk stratification beyond age, dementia, and frailty are limited. The serum copper-to-zinc (Cu/Zn) ratio reflects combined inflammatory and nutritional vulnerability, but its association with POD after hip fracture surgery is uncertain.</p><p><strong>Materials and methods: </strong>We performed a single-center retrospective cohort study of 420 consecutive patients aged ≥65 years undergoing surgery for low-energy hip fracture. The preoperative Cu/Zn ratio, measured within 48 hours before surgery, was the exposure (prespecified high ratio >2.0). The primary outcome was POD within 7 postoperative days or before discharge. Secondary outcomes were numeric rating scale pain scores, 24-hour morphine-equivalent opioid consumption, and hospital length of stay (LOS).</p><p><strong>Results: </strong>In the matched cohort, POD occurred in 23/124 (18.5%) patients with low Cu/Zn ratios and 56/124 (45.2%) with high ratios (odds ratio [OR], 3.62; 95% confidence interval [CI], 2.04-6.42; <i>P</i> < .001). In the full cohort, high Cu/Zn remained associated with POD after adjustment (adjusted OR, 3.35; 95% CI, 2.00-5.59; <i>P</i> < .001). After matching, early postoperative pain and 24-hour opioid consumption were not significantly different, whereas LOS was modestly longer in the high Cu/Zn group (mean difference = 1.0 day).</p><p><strong>Conclusion: </strong>A high preoperative Cu/Zn ratio (>2.0) was independently associated with increased odds of POD and slightly longer hospital LOS after hip fracture surgery in older adults, with minimal impact on early pain-related outcomes.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e301-e309"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supracondylar Distal Femur Fracture Fixation: Early Experiences Comparing the Retrograde Nail With Locking Attachment Washer (LAW) Plate to Traditional Fixation Techniques.","authors":"Peter Bishara, Ereny Bishara, Samira Perez, Sharon Hill, Damayanti Samanta, Nancy M Duvall","doi":"10.3928/01477447-20260605-01","DOIUrl":"10.3928/01477447-20260605-01","url":null,"abstract":"<p><strong>Background: </strong>The locking attachment washer (LAW) plate offers an advancement in fixation techniques for supracondylar distal femur fractures. This study compared fixation outcomes for supracondylar distal femur fractures managed with traditional fixation techniques (ie, retrograde intramedullary nail, locking plate) versus DePuy Synthes RFN-ADVANCED Retrograde Femoral Nailing System incorporating the LAW plate.</p><p><strong>Materials and methods: </strong>A retrospective single-center comparative analysis was conducted of adult patients with supracondylar distal femur fractures treated between December 2022 and December 2024. Patients were divided into two groups: (1) traditional fixation and (2) nail plate construct using retrograde femoral nail with LAW plate. Outcomes focused on surgical parameters, functional recovery, and clinical implications.</p><p><strong>Results: </strong>Forty-five patients met inclusion criteria: 17 treated with traditional fixation, 28 with the LAW construct. Patients in the LAW group were significantly more likely to have an estimated 76.43-minute reduction in operative time compared to patients in the traditional group (<i>P</i> = .009). Hospital length of stay trended shorter with LAW (7.5 vs 15.2 days) but failed to achieve statistical significance in both univariate and multivariate analyses. Postoperative weight bearing was significantly more common with LAW (67.8% vs 23.6%, <i>P</i> = .032), and the rate of radiographic union trended lower with LAW but did not achieve statistical significance.</p><p><strong>Conclusion: </strong>The LAW construct demonstrated shorter operative times and earlier advancement in weight-bearing protocols, despite use in an older cohort. Radiographic union and complication rates were comparable. Potential advantages of the LAW construct lend to clinical and research opportunities for these complex injuries.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e293-e300"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising Incidence of Group A Streptococcal Musculoskeletal Infections in Pediatric Patients.","authors":"Sarah Bradley, Cody Ashy, Henry Baird, Joshua Abrams, Jonathan Pire, Ryan McFadden, Stephen Thacker, Sara Van Nortwick, Matthew Dow, Robert Murphy","doi":"10.3928/01477447-20260619-01","DOIUrl":"10.3928/01477447-20260619-01","url":null,"abstract":"<p><strong>Background: </strong>Group A streptococcal (GAS) musculoskeletal infections (MSKI) are an increasingly recognized cause of pediatric morbidity alongside methicillin-sensitive and methicillin-resistant <i>Staphylococcus aureus</i> (MSSA, MRSA). Seasonal variation in these infections remains poorly defined. This study evaluated epidemiologic trends and seasonal patterns of pediatric MSKI at a single institution over 9 years.</p><p><strong>Materials and methods: </strong>We performed a retrospective review of pediatric patients surgically treated for MSKI from 2015 to 2023. Demographics, clinical presentation, laboratory and imaging findings, operative reports, and culture results were collected. Seasonal variation was analyzed using odds ratios with 95% confidence intervals and Fisher's exact tests (<i>P</i> ≤ .05).</p><p><strong>Results: </strong>Fifty-three patients requiring surgical intervention were identified (median age, 5 years [IQR 1.8 to 9.0]; 49.1% female). Culture-positive infections occurred in 70% of cases, including 13 MSSA, 8 MRSA, and 9 GAS. Eight of 9 GAS infections (89%) occurred from 2019 to 2023, representing a nearly 3-fold increase, while <i>S. aureus</i> infections declined 1.4-fold. Most (78%) GAS cases presented in January to May, 6 with a viral prodrome; 2 developed osteomyelitis. Seasonally, GAS infections were most frequent in fall (37.5%) compared with winter (15.4%), spring (20.0%), and summer (0%). Fall carried higher risk versus winter (odds ratio, 3.30) and spring (odds ratio, 2.40). In contrast, <i>S. aureus</i> infections peaked in summer (64.3%), exceeding winter (30.8%), spring (40.0%), and fall (37.5%).</p><p><strong>Conclusion: </strong>GAS MSKI increased nearly 3-fold over the study period, with a 6.7-fold greater risk after 2019. These findings highlight the rising incidence and distinct seasonal patterns of pediatric GAS MSKI.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e330-e336"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Residency to Specialization: A Critical Analysis of Residency Leadership and Impact on Specialty Selection.","authors":"Apurva S Choubey, Peter Chebi, Brett Drake, Deepa Dhillon, Sean Cooke, Majd Mzeihem, Alfonso Mejia, Mark H Gonzalez","doi":"10.3928/01477447-20260722-01","DOIUrl":"https://doi.org/10.3928/01477447-20260722-01","url":null,"abstract":"<p><strong>Background: </strong>Orthopedic surgery fellowships have evolved from optional to nearly mandatory since accreditation in 1981, yet factors influencing subspecialty selection remain incompletely defined. We evaluated orthopedic residency program director (PD) and department chair demographics and training backgrounds, resident fellowship match patterns, fellowship availability, and concordance between leadership training and resident subspecialty selection.</p><p><strong>Materials and methods: </strong>Using programs accredited by the Accreditation Council for Graduate Medical Education, we analyzed available PD and department chair demographics and fellowship training. Five years of alumni fellowship data and fellowship availability at each institution were collected from program websites. Descriptive statistics, chi-squared tests, and crude odds ratios (ORs) were used, with <i>P</i> < .05 considered significant.</p><p><strong>Results: </strong>Among 109 residency programs and 5,443 recent graduates, residents most often matched into sports medicine (24.44%), arthroplasty (17.86%), and hand surgery (16.57%). PDs were most commonly trained in trauma, sports medicine, and hand surgery; chairs were most commonly trained in sports medicine, trauma, and spine surgery. Leadership was predominantly male and White (PDs: 87.16% male, 78.90% White; chairs: 93.58% male, 88.07% White). Programs offering spine, hand, or orthopedic oncology fellowships had higher match rates into those specialties than programs without them (OR: 1.20, 1.42, and 1.94; all <i>P</i> < .05). Residents were also more likely to enter arthroplasty when their PD was arthroplasty trained and to enter hand surgery or orthopedic oncology when their chair had concordant training.</p><p><strong>Conclusion: </strong>Fellowship availability and leadership training background were each associated with resident subspecialty selection. Applicants with subspecialty interests should consider both factors when evaluating residency programs.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"49 4","pages":"e368-e375"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Convolutional Neural Network Performs Similarly to Orthopedic Surgeons in Radiographic Grading of Knee Osteoarthritis.","authors":"Sarah L Lu, Michael Fei, Joseph G Elsissy, Brian A Schneiderman","doi":"10.3928/01477447-20260720-01","DOIUrl":"https://doi.org/10.3928/01477447-20260720-01","url":null,"abstract":"<p><strong>Background: </strong>Convolutional neural networks (CNNs) have shown promise in automated grading of knee osteoarthritis (OA) using the Kellgren-Lawrence (KL) scale. This study aimed to externally validate a CNN model against KL grading by fellowship-trained orthopedic surgeons.</p><p><strong>Materials and methods: </strong>CNN architectures (VGG16, ResNet34, DenseNet196, EfficientNetV2) were trained on 8,260 knee radiographs. Model performance was evaluated using accuracy, area under the curve (AUC) on a receiver operating curve, and F1 score. External validation was performed by comparing model outputs to KL grades assigned by 20 orthopedic surgeons using a blinded survey of 10 radiographs. Agreement was assessed using intra-class correlation coefficients (ICC) and Bland-Altman analysis.</p><p><strong>Results: </strong>EfficientNetV2 demonstrated the highest performance (AUC: 0.83; accuracy: 71%). The model achieved a mean absolute error of 0.58 KL grades relative to the average physician score and performed best at identifying KL0 and KL4 cases, with reduced performance for intermediate grades, particularly KL1. Average physician and model KL scores did not differ significantly (<i>P</i> = .23). Agreement between physicians and the model was high for both good-performing (ICC 0.93) and poor-performing images (ICC 0.94), exceeding inter-physician agreement (ICC 0.74 and 0.72, respectively). Bland-Altman analysis demonstrated minimal bias (-0.25 KL grades), indicating that physicians graded more conservatively than did the model.</p><p><strong>Conclusion: </strong>CNN-based grading demonstrated performance comparable to orthopedic surgeons, supporting its potential role as a screening or triage tool to improve consistency and efficiency in clinical workflows.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"49 4","pages":"e337-e342"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Declining Overall Use of Cervical Disk Arthroplasty in Medicare Beneficiaries Despite Outpatient Migration, 2016 to 2022.","authors":"Mitchell K Ng, Paul G Mastrokostas, Aaron B Lavi, Luke B Schwartz, Leonidas E Mastrokostas, Jonathan Dalton, Yulia Lee, William Green, Yasmine Eichbaum, Gregorio Baek, Joshua Mathew, Morgan Hitchner, Alexander Kucherina, Alec Giakas, Pemla Jagtiani, Jad Bou Monsef, Afshin E Razi, Thomas D Cha, Mark F Kurd, Zachary Wilt, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.3928/01477447-20260608-02","DOIUrl":"10.3928/01477447-20260608-02","url":null,"abstract":"<p><strong>Background: </strong>Cervical disk arthroplasty (CDA) has gained popularity as a motion-preserving alternative to anterior cervical diskectomy and fusion (ACDF) for treating cervical degenerative disk disease. The aim of this study was to evaluate national trends in Medicare use and reimbursement for CDA across settings, provider types, and geographic regions.</p><p><strong>Materials and methods: </strong>This is a retrospective national database analysis using Centers for Medicare and Medicaid Services Medicare Part A and Part B claims from 2016 to 2022. Single- and multilevel CDA procedures were identified using Current Procedural Terminology and Medicare Severity Diagnosis Related Group codes. Inflation-adjusted payments and procedure counts were analyzed using descriptive statistics, linear regression, analysis of variance, and <i>t</i> tests. Subgroup comparisons included region, provider type, and core-based statistical area classification. Statistical significance was set at the <i>P</i> < .05 level.</p><p><strong>Results: </strong>Outpatient single-level CDA volume increased by 1,016.0% from 2016 to 2022, whereas inpatient CDA volume decreased by 90.3%. Outpatient reimbursement rose from $1,459 to $3,143 (<i>P</i> = .011), whereas inpatient reimbursement increased from $24,956 to $32,679 (<i>P</i> = .025). Reimbursement was significantly higher in ambulatory surgical centers than for surgeon-only claims ($11,869 vs $1,219; <i>P</i> < .001), and in inpatient settings compared to surgeons (<i>P</i> < .001). Regional and rural-urban variation was observed, with the West consistently demonstrating higher reimbursement and volume for both outpatient and inpatient CDA.</p><p><strong>Conclusion: </strong>CDA procedures have shifted dramatically toward outpatient care, with marked differences in Medicare reimbursement across provider types and regions.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e310-e316"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Drivers of Implant Cost Variation in Distal Radius Fracture Open Reduction and Internal Fixation.","authors":"Christy Zheng, Leah Demetri, Philip Blazar, Brandon E Earp, Dafang Zhang","doi":"10.3928/01477447-20260723-01","DOIUrl":"https://doi.org/10.3928/01477447-20260723-01","url":null,"abstract":"<p><strong>Background: </strong>Volar locking plates are widely used for open reduction and internal fixation (ORIF) of distal radius fractures; however, variation exists in implant selection, construct complexity, and overall cost.</p><p><strong>Materials and methods: </strong>Patients who underwent ORIF with a volar locking plate for distal radius fractures between January 2023 and December 2024 were identified using current procedural terminology codes 25607, 25608, and 25609. Demographic and clinical variables were extracted from the electronic health record. Implant, supply, and total material costs were obtained from cost reports, and screw counts were verified on radiographs. Bivariate analyses of costs and explanatory variables were performed using Student's <i>t</i> test, Mann-Whitney U test, or chi-squared tests.</p><p><strong>Results: </strong>In a cohort of 496 patients, median age was 63 years and 81.9% were women. The median implant cost was $1,641 (interquartile range: $1,417 to $1,944), and the median total material cost was $1,830 (interquartile range: $1,633 to $2,264). A mean of 8.7 ± 1.4 screws were used per case. Both implant costs and total costs were significantly associated with implant manufacturer, total screw count, bone allograft use, fracture type, and operating time (all <i>P</i> < .05). Costs were not associated with age, sex, body mass index, race, diabetes, smoking status, dominant hand fracture, open fracture, surgeon subspeciality, or surgical assistant type (<i>P</i> > .05).</p><p><strong>Conclusion: </strong>Implant costs for distal radius ORIF are largely influenced by variables related to fracture complexity, such as screw count, bone allograft use (and usage), and operation time, as well as system-level variables, such as implant manufacturer.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"49 4","pages":"e343-e350"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}