Orthopedics最新文献

{"title":"Comparative Outcomes of Lower Extremity Fractures in Patients With Type 1 and Type 2 Diabetes: A Retrospective Database Analysis.","authors":"Thomas E Olson, Christopher Hamad, Joshua Wiener, Trevor Lloyd, Jeannie Park, Autreen Golzar, Aliyah Walker, Rene Chun, John Adams, Nicholas Bernthal, Christopher Lee, William L Sheppard","doi":"10.3928/01477447-20260612-01","DOIUrl":"10.3928/01477447-20260612-01","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus (DM) is a major risk factor for adverse outcomes following orthopedic trauma. Although both type 1 (T1DM) and type 2 (T2DM) diabetes mellitus increase complication risk after lower extremity fracture fixation, their relative impacts remain poorly characterized.</p><p><strong>Materials and methods: </strong>We performed a retrospective cohort analysis to compare postoperative outcomes in patients with T1DM and T2DM who underwent surgical fixation of lower extremity fractures. Propensity score matching was performed within anatomical fracture subgroups based on age, sex, race, body mass index, hemoglobin A_1c, and nicotine dependence. Outcomes were compared using appropriate statistical tests and survival analysis.</p><p><strong>Results: </strong>A total of 10,464 patient-fracture encounters across 4 anatomic subgroups met inclusion criteria. After propensity score matching within each subgroup, 1,776 matched pairs (3,552 encounters) were analyzed. T1DM patients experienced higher rates of adverse outcomes compared to T2DM patients, with the greatest differences observed for infection (tibia: 7.3% vs 3.1%, <i>P</i> = .009; foot/ankle: 9.8% vs 1.8%, <i>P</i> < .001), amputation (femur: 2.9% vs 0.0%, <i>P</i> = .001; tibia: 2.6% vs 0.0%, <i>P</i> = .001), and mortality (hip: 21.8% vs 15.1%, <i>P</i> = .003; femur: 12.3% vs 4.4%, <i>P</i> < .001; tibia: 9.9% vs 2.5%, <i>P</i> < .001; foot/ankle: 7.5% vs 2.0%, <i>P</i> < .001). These risks appeared to increase distally, with the highest complication rates seen in the tibial and foot/ankle subgroups.</p><p><strong>Conclusions: </strong>T1DM confers a distinctly higher risk of infection, limb loss, and mortality following operative fixation of lower extremity fractures compared to T2DM, despite similar baseline characteristics after matching. These findings highlight the need for diabetes-subtype-specific perioperative management strategies to optimize outcomes in this high-risk population.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e317-e323"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397121","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":"Examining the Statistical Fragility of Randomized Trials on Operative Versus Nonoperative Treatment of Acromioclavicular Joint Separation Using the Reverse Continuous Fragility Index.","authors":"Alyssa D Althoff, Udit Dave, Jesus E Cervantes, Eric Y Hu, Katherine G Kessler, Thomas E Moran","doi":"10.3928/01477447-20260611-01","DOIUrl":"10.3928/01477447-20260611-01","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to analyze nonsignificant, continuous outcomes and establish the reverse continuous fragility index (rCFI) of randomized controlled trials (RCTs) comparing operative and nonoperative treatment of acromioclavicular (AC) joint separations.</p><p><strong>Materials and methods: </strong>Databases were searched from inception to February 2025 using \"('Acromioclavicular' OR 'AC joint') AND ('Randomized controlled trial' OR 'RCT')\". Included studies were RCTs published after 2004 comparing operative versus nonoperative treatment. rCFI was calculated for primary nonsignificant outcomes, and an rCFI quotient was derived by dividing each study's rCFI by its sample size.</p><p><strong>Results: </strong>Seven studies involving 362 patients (92.3% male; mean age, 39.2 ± 7.7 years) with an average 5.29-year follow-up were analyzed. All studies included Rockwood type III injuries; 2 included type IV and 4 included type V. Mean rCFI was 14.9 ± 6.5. Four studies favored operative treatment. A total of 80 patients were lost to follow-up (mean, 13.3 per study), exceeding the rCFI in 3 of 7 studies. The mean rCFI quotient was 0.21 ± 0.06.</p><p><strong>Conclusion: </strong>The rCFI of included RCTs highlights the fragility of the conclusion that nonoperative management of type III-V AC joint injuries provides noninferior clinical outcomes to operative management of these injuries.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e269-e274"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397205","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":"Alteon HA Femoral Stem vs Origin Stem in Total Hip Arthroplasty: A Retrospective Cohort Study.","authors":"Christian P Christensen, Craig B Hendricks, Amber M Muehlmann","doi":"10.3928/01477447-20260429-01","DOIUrl":"10.3928/01477447-20260429-01","url":null,"abstract":"<p><strong>Background and objective: </strong>Standard-length hydroxyapatite (HA)-coated femoral stems have demonstrated strong performance and survivorship in total hip arthroplasty. However, limited data exist comparing these outcomes to those of newer, shortened HA-coated stems.</p><p><strong>Materials and methods: </strong>This retrospective cohort study evaluated intraoperative and postoperative outcomes in patients who underwent total hip arthroplasty using either the standard-length Origin Stem or the shortened Alteon HA Femoral Stem.</p><p><strong>Results: </strong>A total of 479 patients were included (151 Origin, 328 Alteon HA). The Origin group showed higher rates of calcar fracture (3.3% vs 2.1%), distal femur reaming (2.0% vs 0.3%), and revision (1.3% vs 0.3%), though not statistically significant. Osseointegration was achieved in the majority of cases (Origin: 96.8%; Alteon HA: 95.0%). Both groups experienced significant improvements in Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and EQ-5D scores (<i>P</i> < .0001), as well as having comparable Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scores. Leg length discrepancy occurred significantly more frequently in the Origin group compared to the Alteon HA group (2.6% vs 0.3%). The Alteon HA group demonstrated a 2-year survivorship rate of 98.2%.</p><p><strong>Conclusion: </strong>Both the standard-length Origin and shortened Alteon HA stems showed excellent short-term results, with 96% of patients in each group experiencing meaningful functional improvement. Both implants showed high osseointegration with low complication and revision rates. The Origin stem required more distal reaming and had an increased leg length discrepancy risk, whereas the shorter Alteon HA stem provided greater intraoperative flexibility with equally strong early results.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"49 3","pages":"e235-e241"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043382","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":"A Modified Keshishyan Index Demonstrates Three-dimensional Assessment of Asymmetry in Pediatric Pelvic Fractures.","authors":"Kellen T Krajewski, Madeline Hornfeck, Julia S Sanders","doi":"10.3928/01477447-20260519-01","DOIUrl":"10.3928/01477447-20260519-01","url":null,"abstract":"<p><strong>Background: </strong>Orthopedic surgeons use a combination of plain radiographs and computed tomography (CT) to diagnose and manage pelvic ring injuries. Historically, pelvic ring asymmetry has been calculated using the Keshishyan index (KI) measured in 2 dimensions. Three-dimensional (3D) CT modeling may assess deformity more comprehensively, aiding in treatment decisions. This study aimed to evaluate the accuracy and reliability of a modified KI (MKI) derived from 3D models of pediatric patients with pelvic fractures.</p><p><strong>Materials and methods: </strong>Two separate raters identified landmarks 3 separate times on 29 generated models. Traditional KI (TKI) was calculated using the contralateral distance between the most anterior portion of the sacroiliac joint (SAAS) and the deepest point of the acetabulum. The MKI used the contralateral distance between the SAAS and pubic tubercle. KI was calculated on correlating radiographs (RxKI). Bland-Altman analyses and intra-/interclass correlation coefficients (ICC) were used to evaluate agreement between measurement methods and reliability.</p><p><strong>Results: </strong>RxKI and TKI measurements exhibited similar agreement with a mean bias (MB) of -0.0205. RxKI and MKI had a MB of 0.0012, and TKI and MKI had a MB of 0.0210. TKI reliability ranged from good to excellent (Intra = 0.923, 95% confidence interval [CI], 0.892-0.947; Inter = 0.897, 95% CI, 0.852-0.928), and MKI reliability was excellent (Intra = 0.938, 95% CI, 0.911-0.959; Inter = 0.912, 95% CI, 0.876-0.937).</p><p><strong>Conclusion: </strong>All methods exhibited excellent reliability, with MKI having the highest ICCs. MKI provided similar, reproducible values compared with RxKI, suggesting that clinicians can compare pelvic asymmetry values between CT and radiograph images.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"49 3","pages":"e242-e247"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043361","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":"Endobutton Combined With Medial Plate Fixation for the Treatment of Lisfranc Injuries.","authors":"Kai Xiao, Ruokun Huang, Xiong Qiu","doi":"10.3928/01477447-20260407-01","DOIUrl":"10.3928/01477447-20260407-01","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to demonstrate the clinical efficacy of the Endobutton in combination with medial plate fixation for the treatment of Lisfranc injuries.</p><p><strong>Materials and methods: </strong>We analyzed clinical data from 30 patients with Lisfranc injuries between February 2021 and October 2024 to assess foot function using Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale score, plantar pressure assessment, and weight-bearing imaging. We evaluated patients' postoperative pain and foot function, examined the appearance of the foot for any obvious deformities, assessed plantar pressure distribution, and conducted weight-bearing imaging to evaluate the gaps in patients' joints.</p><p><strong>Results: </strong>All 30 patients received effective follow-up for a duration of 12 to 14 months (mean ± standard deviation, 12.92 ± 1.129 months). At the final follow-up, no clinically significant foot deformities were observed, and weight-bearing radiographs demonstrated stable tarsometatarsal alignment without evidence of progressive joint subluxation or displacement. The differences in the first and second tarsometatarsal joints gap distances and VAS and AOFAS scores at 3 months postoperatively and at the final follow-up were statistically significant (<i>P</i> < .05) when compared to the preoperative period. The difference in the results of the plantar pressure test between the injured foot and the contralateral foot was not statistically significant (<i>P</i> > .05).</p><p><strong>Conclusion: </strong>For low-energy and crush Lisfranc injuries, Endobutton combined with medial plate fixation yielded favorable early clinical outcomes and reliable short-term surgical results in this single-center retrospective study. Although the clinical benefits of this combined technique are promising, its efficacy compared with conventional fixation methods requires further validation in well-designed prospective controlled trials.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e223-e228"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777851","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":"A Comparative Analysis of Suture-Button and InternalBrace Fixation for Purely Ligamentous Lisfranc Injuries.","authors":"Sanghoon Lee, Dong-Il Chun, Jaeho Cho, Sung Hun Won, Sung Hyun Lee, Young Yi","doi":"10.3928/01477447-20260304-01","DOIUrl":"10.3928/01477447-20260304-01","url":null,"abstract":"<p><strong>Background: </strong>Purely ligamentous Lisfranc injuries are challenging to manage. Traditional open reduction and internal fixation provides rigid stability but risks cartilage damage, hardware failure, and the need for removal. Flexible fixation methods such as the suture-button (SB) and InternalBrace (IB) systems aim to maintain reduction while allowing physiological motion. This study compared clinical and radiographic outcomes of SB and IB fixation for these injuries.</p><p><strong>Materials and methods: </strong>A retrospective comparative study included 64 patients (SB, n = 34; IB, n = 30) with acute, purely ligamentous Lisfranc injuries and ≥24-month follow-up. Primary outcomes were American Orthopaedic Foot & Ankle Society (AOFAS) midfoot and visual analog scale (VAS) pain scores; radiographic outcomes included maintenance of the first cuneiform to second metatarsal (C1-M2) interval. Secondary measures were time to full weight bearing, return to sport, and complications.</p><p><strong>Results: </strong>Both groups demonstrated significant improvements in AOFAS and VAS scores from preoperative to final follow-up (<i>P</i> < .001). There was no statistically significant difference between the SB and IB groups in mean final AOFAS scores (92.4 vs 91.5, respectively; <i>P</i> = .58) or VAS scores (1.5 vs 1.2, respectively; <i>P</i> = .21). Both techniques effectively maintained anatomic reduction, with no significant difference in the final C1-M2 diastasis (<i>P</i> = .75) and no clinically significant loss of reduction at final follow-up.</p><p><strong>Conclusion: </strong>SB and IB fixation provide excellent function, stable radiographic results, and low complication rates for purely ligamentous Lisfranc injuries, offering reliable alternatives to rigid fixation.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e197-e202"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777776","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":"Limb Salvage Versus Amputation for the Management of Primary Bone Tumors of the Upper Extremity: A Systematic Review.","authors":"Anas El Zouhbi, Thomas E Wanna, Jad M El Abiad, Adnan Fatfat, Ibrahim Yassine, Rachid Haidar","doi":"10.3928/01477447-20260422-01","DOIUrl":"10.3928/01477447-20260422-01","url":null,"abstract":"<p><p>Primary bone tumors are rare yet present a significant burden to patients, with surgery being the mainstay of treatment. We reviewed outcomes of limb salvage (LS) and amputation for management of upper extremity tumors. We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. A total of 2,886 studies were screened, and 5 studies were included (n = 187 patients; LS = 101, Amputation = 86). Commonly reported outcomes included local recurrence, metastasis at follow-up, and survival. Metastasis and local recurrence rates were in favor of LS surgery, with some studies reporting no differences. Survival was consistently reported to be statistically significantly in favor of LS.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"49 3","pages":"e248-e256"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043393","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":"Planned Versus Intraoperative Vascular Surgery Consultations in Orthopedic Oncology.","authors":"Dylan J Riley, Zachary R Butler, Samuel Alfonsi, Kayla Kupietzky, Michele Richard, Alan T Blank","doi":"10.3928/01477447-20260423-01","DOIUrl":"10.3928/01477447-20260423-01","url":null,"abstract":"<p><strong>Background and objective: </strong>Orthopedic oncology surgeries frequently involve complex resections where critical neurovascular structures are at risk, and vascular injury can result in severe complications, including functional loss and mortality. Although multidisciplinary vascular collaboration is increasingly recognized as beneficial in oncologic surgery, limited evidence exists regarding optimal timing of vascular surgery consultation in orthopedic oncology. This study evaluated whether preoperative planned consultations improve intraoperative and postoperative outcomes compared to intraoperative consultations.</p><p><strong>Materials and methods: </strong>A retrospective review identified 30 patients who underwent orthopedic oncology surgery requiring vascular surgery involvement between 2015 and 2025 at a single academic institution. Patients were categorized into planned vascular consultations (n = 18) and intraoperative consultations (n = 12). Data collection included demographics, operative details, estimated blood loss (EBL), complications, and type of vascular intervention.</p><p><strong>Results: </strong>The intra-operative consultation group experienced significantly higher median EBL (1,225 mL vs 325 mL, <i>P</i> = .015). Additionally, intraoperative consultations demonstrated trends toward longer operative times (307 vs 185.5 minutes) and higher postoperative complication rates. Infections occurred in 42% of intraoperative cases compared to 17% of planned cases. One intraoperative patient also experienced cardiac arrest, and another developed deep vein thrombosis.</p><p><strong>Conclusion: </strong>Planned vascular surgery consultations are associated with significantly reduced intraoperative blood loss and trend toward improved operative efficiency and fewer postoperative complications. This is the first study directly comparing outcomes between planned and intraoperative vascular consultations in orthopedic oncology. Early vascular involvement enables better anticipation of vascular challenges and supports proactive multidisciplinary collaboration to enhance patient safety and optimize resource use.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"49 3","pages":"e190-e196"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043335","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":"Effect of Socioeconomic Disadvantage on Patient-reported Outcomes After Orthopedic Trauma: A Study Using the Area Deprivation Index.","authors":"Haley D Puckett, Jacob S Borgida, Rebekah M Kleinsmith, Stephen A Doxey, Riley Swenson, Rachael L Rivard, Sandy Vang, Lauren M Shapiro, Mai P Nguyen, Brian P Cunningham","doi":"10.3928/01477447-20260326-01","DOIUrl":"10.3928/01477447-20260326-01","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic status (SES) is increasingly recognized as a key factor influencing outcomes after orthopedic procedures. The objective of this study was to determine the effect of socioeconomic disadvantage on patient-reported outcomes (PROs) after orthopedic trauma.</p><p><strong>Materials and methods: </strong>A retrospective review of PROs was performed for orthopedic trauma patients from 2018 to 2023. The Area Deprivation Index (ADI) was used as a surrogate for socioeconomic disadvantage. Outcomes included Patient-Reported Outcomes Measurement Information System Global Physical Health and Global Mental Health 10-item short forms (PROMIS 10 GPH and GMH) at 6 weeks, 3 months, 6 months, and 1 year postoperatively. A mixed-model analysis was performed to compare outcomes among ADI cohorts.</p><p><strong>Results: </strong>In total, 844 patients were included. Of these, 313 (37.1%) were in the least socioeconomically disadvantaged group. There was a significant difference in the distributions of age, marital status, smoking status, and self-reported race among the five ADI cohorts (<i>P</i> < .002). Patients with an ADI of 1 or 2 (low disadvantage) had significantly higher PROMIS 10 GPH scores compared with their counterparts in ADI Groups 3/4, 5/6, and 9/10, although all groups saw a similar significant improvement from the 6-week to 1-year follow-up.</p><p><strong>Conclusion: </strong>Socioeconomic disadvantage has a significant effect on PROMIS 10 GPH and GMH scores following orthopedic trauma procedures. However, patients in all ADI cohorts saw improvements in PROMIS 10 GPH up to 1 year postoperatively. It is important to identify patients in socioeconomically disadvantaged areas and create care pathways to better optimize their improvements postoperatively.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e213-e222"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777779","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":"Impact of Varied Severity of Chronic Kidney Disease Stage on Surgical Outcomes Following Distal Radius Fracture Operative Fixation.","authors":"Joshua G Sanchez, Katie M Zehner, Andrew Salib, Claire A Donnelly, Fortunay H Diatta, F Perry Wilson, Jonathan N Grauer","doi":"10.3928/01477447-20260323-02","DOIUrl":"10.3928/01477447-20260323-02","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) alters bone metabolism, immune function, and vascular health, potentially increasing postoperative risk following distal radius fracture (DRF) operative fixation (ie, open reduction and internal fixation, percutaneous pinning). However, data stratifying risk by CKD severity remain limited. This study evaluated the association between CKD stage and 90-day complications and 1-year orthopedic-related events following DRF operative fixation.</p><p><strong>Materials and methods: </strong>Adults aged 18 to 65 undergoing isolated DRF operative fixation were identified in the PearlDiver M170 database. Patients were stratified by CKD status: none, stage 1 to 2, stage 3 to 4, and stage 5 or end-stage renal disease (ESRD). Ninety-day medical complications and 1-year orthopedic-related events were assessed using univariable and multivariable logistic regression controlling for age and sex, with and without adjustment for Elixhauser Comorbidity Index (ECI). Bonferroni correction was significant at <i>P</i> ≤ .001.</p><p><strong>Results: </strong>Among 29,009 patients, 28,411 (97.9%) had no CKD history, 101 (0.3%) had stage 1 to 2 CKD, 336 (1.2%) had stage 3 to 4, and 161 (0.6%) had stage 5/ESRD. Complication risk increased stepwise with CKD severity. Adjusting for age and sex, odds ratios (OR) for any 90-day complication were 5.62, 15.07, and 30.63 for stages 1 to 2, 3 to 4, and 5/ESRD, respectively (all <i>P</i> < .001). After ECI adjustment, associations remained significant, although attenuated (OR = 2.23, 5.93, and 11.04, respectively). No differences were observed in 1-year orthopedic-related events, including hardware removal or malunion/nonunion.</p><p><strong>Conclusion: </strong>CKD independently and incrementally increased short-term complication risk following DRF operative fixation, even after accounting for comorbidity burden. These findings support stage-based perioperative counseling and multidisciplinary optimization in patients with CKD.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e203-e212"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628202","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}