Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews最新文献

{"title":"Revision Olecranon Fixation: Is Tension Band Wiring the Solution? A Case Series and Review of the Literature.","authors":"Marcus C Appleton, Sohan K Jakkaraju, Paul C Appleton, Anil K Dutta","doi":"10.5435/JAAOSGlobal-D-25-00049","DOIUrl":"10.5435/JAAOSGlobal-D-25-00049","url":null,"abstract":"<p><strong>Background: </strong>The optimal revision construct for failed olecranon fracture fixation is controversial. Here, we aim to review existing revision techniques and describe tension band wiring as a surgical option for these challenging scenarios and to evaluate its clinical and radiographic outcomes.</p><p><strong>Methods: </strong>This retrospective case series was performed at an urban, university-based, level-1 trauma center. Patients aged 18 to 65 years who underwent revision fixation of their olecranon fracture using tension band wiring were included. The study data were collected through a retrospective chart review and review of the existing radiographic studies. Primary outcome measure was mechanical failure. Secondary outcome measures included nonunion, malunion, medical, and surgical complications. Functional outcome was determined by range of motion and restoration of extensor mechanism strength.</p><p><strong>Results: </strong>A total of five patients were included in this study. Causes for revision were acute implant failure (n = 2), aseptic nonunion (n = 1), and infected nonunion (n = 2). All patients eventually achieved bony union after revision. Two patients required an additional surgery because of Kirschner wire migration (n = 1) and symptomatic implant (n = 1). Average flexion was 126° (range 110 to 135) and average extension was 18° (range 5 to 30). All patients experienced restoration of extensor mechanism with full strength and returned to their previous working status. No other mechanical failures, surgical complications, or medical complications occurred.</p><p><strong>Conclusions: </strong>Early results of revision open reduction and internal fixation for failed olecranon fracture fixation using tension band wiring demonstrated favorable outcomes and low complication rates. This technique may be used for revision of failed olecranon fixation.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academic Orthopaedic Surgeon Financial Compensation in the United States: Trends and Distribution.","authors":"Rahul H Jayaram, Dheeman Futela, Wesley Day, Ajay Malhotra, Jonathan N Grauer","doi":"10.5435/JAAOSGlobal-D-25-00112","DOIUrl":"10.5435/JAAOSGlobal-D-25-00112","url":null,"abstract":"<p><strong>Introduction: </strong>The overall trends in academic orthopaedic surgery compensation are not well studied. The aim of this study was to assess trends and distribution of academic orthopaedic surgery financial compensation and consider in relation to academic rank, sex, and race/ethnicity.</p><p><strong>Methods: </strong>The 2017 to 2023 American Association of Medical Colleges Faculty Salary Surveys were used, which collect information for full-time faculty at US medical schools. Financial compensation data for orthopaedic faculty, across subspecialities, were stratified by year, academic rank, sex, race/ethnicity, and geographic region. Trends in median, 25th, and 75th percentile compensation were assessed.</p><p><strong>Results: </strong>Responses for 2,601 faculty members across orthopaedic departments were available, including 82 instructors, 1,176 assistant professors, 668 associate professors, 487 full professors, 104 chiefs (lead a division within the larger department), and 84 chairs (head an entire academic department). Median faculty compensation increased on an average of 1.80% to 6.93%, with the greatest increase at the chief and chair levels and smaller increases for instructors and professors of varying rank. From 2017 to 2013, women were consistently compensated less than men at all ranks except chairs. In 2023, women in academic orthopaedic surgery made less cents-on-the-dollar relative to men of equal rank across all ranks. Asian assistant professors made 0.90 cents-on-the-dollar, and Hispanic/Latino and Black/African American assistant professors made 0.87 cents-on-the-dollar compared with White faculty of equal rank. However, among professors, these groups had higher median compensation (1.06 to 1.1 cents-on-the-dollar) compared with White professors. The geographic variations of compensation were within the range of 15k for assistant professors, 32k for associate professors, 196k for chiefs, 95k for professors, and 83k for chairs.</p><p><strong>Conclusion: </strong>This study summarizes trends of academic orthopaedic faculty compensation and shows salaries barely keeping pace with inflation and persistent compensation inequities, which highlights the need for fair, transparent compensation models and additional studies of factors impacting physician compensation.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Dimensional Printed Anterior Cervical Standalone Combined Cage-Plate-300 Consecutive Medical Implants.","authors":"Mosope Soda, Bradley Moatz, Paul Asdourian, Daina Brooks, Bryan Cunningham, Paul C McAfee","doi":"10.5435/JAAOSGlobal-D-24-00245","DOIUrl":"10.5435/JAAOSGlobal-D-24-00245","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The primary objective was to investigate the perioperative parameters and clinical outcomes of a novel three-dimensional (3D) printed titanium interbody spacer and integral screws. The secondary objective was to compare the survivorship rate of the 3D-printed titanium integrated spacer (3D-printed spacer group) with that of a polyether-ether-ketone (PEEK) integrated spacer (PEEK group) and traditional allograft spacer combined with an anterior cervical plate (control group).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This is a retrospective study comprising 157 consecutive patients (representing 300 surgical levels) investigating the perioperative and clinical outcomes of a novel 3D-printed titanium integrated spacer for anterior cervical diskectomy and fusion (ACDF).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A consecutive series of 157 patients (N = 300 surgical levels) presenting with cervical radiculopathy, myelopathy, or spondylosis underwent ACDF with the 3D-printed titanium spacer. Perioperative outcomes including surgical time, estimated blood loss, length of hospital stay, and number of surgical levels were collected. Clinical outcomes including the American Spinal Injury Association neurologic impairment score and Neck Disability Index (NDI) were measured preoperatively and postoperatively. Survivorship was defined as no failures, no anterior revision surgeries, no instrumentation removals, and no subsidence requiring surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean surgical time for the 3D-printed spacer group was 126.3 ± 34.0 minutes, the estimated blood loss was 85.9 ± 30.5 cc, and the length of hospital stay was 1.5 ± 1.4 days. Surgical levels were distributed as follows: 33.8% single-level, 42.7% two-level, 21.6% three-level, and 1.9% four-level ACDF procedures. 98.7% of patients in the 3D-printed spacer group reported improved American Spinal Injury Association scores. The mean NDI preoperatively was 37.2 ± 18.7, and the mean NDI postoperatively was 21.2 ± 18.3, with 58.6% of patients reporting NDI improvement of 15% or greater. Survivorship was observed in 97.4% of patients in the 3D-printed spacer group, 98.0% in the PEEK group, and 93.3% in the control group (chi-square analysis: X2 [1, N = 1529] = 16.9, P = 0.0002).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A novel 3D-printed titanium spacer with integral screws for ACDF demonstrated improved survivorship rates compared with the traditional allograft spacer and anterior plate. Among 157 patients, only two required supplemental posterior fixation, one required removal for excessive kyphosis and were successfully revised with a 3D-printed corpectomy spacer, and one had notable subsidence at 6 weeks postoperatively (4 total failures based on the survivorship criteria; 97.4% survivorship success rate (153/157 patients)). Not a single case of neurologic progression was observed in the 3D-printed spacer group-no iatrogenic progressive radiculopathy nor myelopathy, unlike the","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Functional Outcomes and Pain Intensity Variations After Total Knee Arthroplasty: A Comparative Analysis of Pain Block Techniques.","authors":"Mor Kliger-Tendler, Michal Elboim-Gabyzon, Einal Bathish, Haim Shtarker","doi":"10.5435/JAAOSGlobal-D-24-00323","DOIUrl":"10.5435/JAAOSGlobal-D-24-00323","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare post-total knee arthroplasty (TKA) outcomes (function, pain, and quadriceps strength) between femoral nerve block (FNB), intra-articular block, and a control group. In addition, it sought to identify predictors of postoperative functional capacity.</p><p><strong>Methods: </strong>Fifty-four TKA patients were evaluated. Preoperative assessments included quadriceps strength and the Oxford knee score. Postoperative assessments on days 1 and 3/4 included the timed up and go (TUG), Elderly Mobility Scale, and Five Times Sit-to-Stand tests. Pain levels, hospitalization duration, surgical time, complications, and falls were also recorded.</p><p><strong>Results: </strong>No significant differences in functional outcomes, pain levels, or quadriceps strength were found between the FNB, intra-articular block, and control groups, except for the TUG test on day 3/4, which favored FNB (P < 0.01). Preoperative quadriceps strength was a valuable predictor of early functional outcomes, with FNB improving TUG scores on day 3/4.</p><p><strong>Discussion: </strong>The choice of pain block technique had limited effect on short-term functional outcomes post-TKA, except for early mobility as measured by the TUG test on day 3/4. Preoperative quadriceps strength markedly predicted initial functional performance. Additional research is needed to enhance postoperative pain management and early rehabilitation strategies.</p><p><strong>Clinical trial registration number: </strong>NCT05478005.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral Neck Fractures: Incidence, Reasons, and Risk Factors of Conversion From Hemiarthroplasty to Total Hip Arthroplasty.","authors":"Michael J Gouzoulis, Rajiv S Vasudevan, Stephanie V Kaszuba, Anthony E Seddio, Lee E Rubin, Jonathan N Grauer, Mengnai Li","doi":"10.5435/JAAOSGlobal-D-24-00312","DOIUrl":"10.5435/JAAOSGlobal-D-24-00312","url":null,"abstract":"<p><strong>Background: </strong>There is controversy over the choice of hemiarthroplasty (HA) versus total hip arthroplasty for treatment of femoral neck fractures in geriatric patients, especially those who are relatively healthy and active. A concern for selection of HA is that the patients may later require conversion to THA.</p><p><strong>Methods: </strong>All geriatric patients with femoral neck fractures who underwent HA were identified in the national PearlDiver data set. Patients were required to have 5 years of follow-up, and incidence of conversion was determined. Univariable and multivariable analyses were conducted to determine factors associated with conversion. The timing of conversion and reasons for conversions were determined.</p><p><strong>Results: </strong>A total of 7,501 patients were identified with femoral neck fractures who underwent initial treatment with HA. Of those, 173 (2.3%) underwent conversion to THA within 5 years. On multivariable analysis, conversion was associated with patients being younger than 75 years (odds ratio: 1.64, P = 0.002) and having a higher Elixhauser Comorbidity Index (odds ratio: 1.04 per point, P = 0.018). Of the conversions performed over a five year period, 109 patients (63.0%) were within the 1st year. The most common reason for conversion to THA was degenerative causes (67.6%).</p><p><strong>Conclusions: </strong>Overall, there was a low rate (2.3%) of conversion from HA to THA for those who were tracked for 5 years after HA for femoral neck fracture. This low conversion rate is supportive that HA offers a durable answer for most patients for whom this treatment choice is pursued.</p><p><strong>Levels of evidence: </strong>III.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imposter Phenomenon, Burnout, and Suicidal Ideation Among Orthopaedic Surgery Residents.","authors":"Andrew J Gaetano, Eisa Razzak, Jason Howard, Shreya M Saraf, Mary K Mulcahey","doi":"10.5435/JAAOSGlobal-D-25-00092","DOIUrl":"10.5435/JAAOSGlobal-D-25-00092","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of imposter phenomenon (IP) and its risk factors among orthopaedic surgery residents remains poorly understood. The purpose of this study was to determine the prevalence of IP, burnout, and suicidal ideation among orthopaedic surgery residents. Secondarily, we aimed to identify risk factors associated with higher levels of IP.</p><p><strong>Methods: </strong>An anonymous survey including the Clance Imposter Phenomenon Survey (CIPS) was distributed to orthopaedic surgery residents. CIPS scores were compared using t-tests and one-way analyses of variance, and multivariable logistic regression was used to identify risk factors.</p><p><strong>Results: </strong>Forty-two orthopaedic surgery residents were surveyed. Significant or intense IP was reported by 23 respondents (54.8%), with women (P < 0.001), those who experienced burnout within the past 5 years (P = 0.002), those who experienced suicidal ideation (P = 0.003), and those with a research year during medical school (P = 0.018) reporting higher levels of IP. Residents with a gap year before medical school were 4.85 times more likely to experience significant or intense IP (95% confidence interval, 1.063 to 22.107, P = 0.041). Among respondents, 15 (35.7%) were experiencing burnout, 26 (61.9%) experienced burnout over the past 5 years, 3 (7.1%) experienced suicidal ideation during their lifetime, and one (2.4%) experienced suicidal ideation during residency.</p><p><strong>Conclusion: </strong>Significant or intense IP was reported by 54.8% of orthopaedic surgery residents, with higher levels reported by women, those with a research year during medical school, those who experienced burnout within the past 5 years, and those with a history of suicidal ideation.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopaedic Authorship: Sex-Based Resident Publication Trends.","authors":"Chloe K Herczeg, Santiago Aragon, Mia V Rumps, Mary K Mulcahey","doi":"10.5435/JAAOSGlobal-D-24-00261","DOIUrl":"10.5435/JAAOSGlobal-D-24-00261","url":null,"abstract":"<p><strong>Introduction: </strong>Orthopaedic surgery is a historically male-dominated specialty. The purpose of this study was to analyze sex-specific, educational, geographic, and publication trends of orthopaedic surgery residents to quantify female representation in training and academia.</p><p><strong>Methods: </strong>Demographic information was collected from accredited orthopaedic surgery residency websites. Schools and programs were ranked by the Doximity Residency Navigator and US News & World Report evaluations. Publications metrics were searched in PubMed and Scopus.</p><p><strong>Results: </strong>Three thousand three hundred forty-five orthopaedic surgery residents were identified on residency websites, and 2,736 (81.8%) male and 609 (18.2%) female residents. Female residents more often attended top 20 residency programs (28.6% vs. 19.2%, P = 0.00000026), top 50 research medical schools (45.7% vs. 34.8%, P = 0.0000036), and residencies affiliated with top 20 research schools (19.0% vs. 14.1%, P = 0.0026). Female residents authored 1,740 publications (16.4%), whereas male residents authored 8,801 (82.9%). No difference was observed in H-indices, median interquartile range by training year, authorship position, publications in top journals, or research output.</p><p><strong>Conclusion: </strong>Although female orthopaedic surgery residents were more likely to be affiliated with higher-ranking educational institutions, this had no clear influence on research productivity, as suggested by comparable median interquartile ranges and H-indices. Future studies should explore whether research productivity has evolved over time and, if so, how.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of the Design of Polyethylene Inserts in Total Knee Arthroplasty on Patient Reported Outcomes.","authors":"Bhavana Gunda, Leah Goldberg, Angie Alban, Sara Strecker, Caitlin McCracken, Robert James Carangelo, Dan Witmer","doi":"10.5435/JAAOSGlobal-D-25-00075","DOIUrl":"10.5435/JAAOSGlobal-D-25-00075","url":null,"abstract":"<p><strong>Introduction: </strong>Several types of polyethylene liners have been developed to address the specific needs of patients' anatomy within total knee arthroplasty (TKA). In modern TKA, the posterior-stabilized (PS) and the cruciate-retaining (CR) designs are the most common, with the medial congruent (MC) design becoming more popular. The MC total knee arthroplasty has a posterior dwell point allowing for more flexion. The purpose of this study was to determine differences in patient-reported outcomes (PROMs) or postoperative outcomes between these three TKAs.</p><p><strong>Methods: </strong>Patients who underwent a primary, elective, unilateral TKA between June 2021 and July 2023 were identified. Demographics and perioperative and postoperative outcomes were extracted from the medical record. PROMs from 624 patients were obtained through a digital engagement platform. A P value ≤0.05 was considered statistically significant.</p><p><strong>Results: </strong>Patients were subdivided into three groups; 111 PS-TKA, 278 CR-TKA, and 235 MC-TKAs. Most implants were Zimmer (71.5%) and were cemented (92.9%). Patients in the CR group were predominantly male (P = 0.003) and had a lower body mass index (P < 0.001). No differences were seen in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores at any time point (preoperative: P = 0.073; 12 weeks: P = 0.144; 6 months: P = 0.666; 1 year: P = 0.622). A similar percentage of patients met the minimal clinically important difference (P = 0.480), and Forgotten Joint Scores were equivalent (P = 0.930). Patient physical therapy parameters (Timed Up and Go test [P = 0.779] and ambulation distance [P = 0.103]), inpatient pain levels (at rest: P = 0.101, with activity: P = 0.052), or morphine milligram equivalents dosed (P = 0.608) were comparable. No differences were seen in 30-day complications.</p><p><strong>Conclusion: </strong>This study fails to demonstrate a difference in PROMs, functional parameters, or complications between the PS-TKAs, CR-TKAs, and MC-TKAs. All three constructs perform similarly in the immediate postoperative period. Because equivalent outcomes occur with each polyethylene, implant choice should be left to physician preference.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management of Facet Fracture Dislocations of the Subaxial Spine: A Retrospective Cohort Study.","authors":"Josh Callaway, Hania Shahzad, Shannon Tse, Ashley Frei, Yashar Javidan, Rolando Roberto, Hai Le","doi":"10.5435/JAAOSGlobal-D-25-00083","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-25-00083","url":null,"abstract":"<p><strong>Introduction: </strong>Facet fracture dislocations of the subaxial spine pose notable risks of neurologic injury and spinal instability. The optimal surgical approach-whether anterior-alone, posterior-alone, or combined anterior-posterior-remains debated. The aim of this study was to evaluate the effectiveness, safety, and long-term outcomes of these surgical approaches.</p><p><strong>Methods: </strong>A retrospective analysis of patients presenting with cervical facet fractures at a single level I trauma center was conducted. They were divided into anterior-alone, posterior-alone, and combined AP surgical groups. Primary outcomes including preoperative neurologic status (American Spinal Injury Association [ASIA] classification), intensive care unit stay, long-term neurologic recovery, and revision surgery rates were compared between patients undergoing each of these approaches.</p><p><strong>Results: </strong>A total of 33 patients were included in the analysis. Bilateral dislocations were more common in the posterior group (87.5%) compared with the anterior group (50%). Anterior surgery was performed more frequently for C4-5 and C5-6 dislocations (57.1%). Patients with ASIA E were more likely to undergo anterior surgery while those with ASIA A-D tended to have combined or posterior approaches. The average intensive care unit stay was 8.9 days (median 3), 6.6 days (median 4), and 6.3 days (median 4) for anterior, posterior, and combined groups, respectively. Long-term neurologic recovery was observed in 28.6% of anterior patients, 12.5% of posterior patients, and 36.4% of combined patients. The anterior group had a higher revision surgery rate (14.3%; P = 0.284). Patients in the anterior group were most likely to be discharged home with minimal care requirements.</p><p><strong>Conclusion: </strong>Anterior surgery is a particularly viable option for C4-5 and C5-6 dislocations in patients with minimal neurologic impairment. Combined AP surgery is more beneficial for bilateral C4-5 and C5-6 dislocations when severe neurologic deficits or other complex injuries necessitate greater stabilization. Posterior approaches may be preferable for complex bilateral dislocations, particularly at C6-7 and C7-T1, where anterior visualization is limited.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Pain Management With Ketorolac, Acetaminophen, and Gabapentin in Femoral Shaft Fractures: A Prospective Cohort Study.","authors":"Hans Hess Arcelay, José I Acosta Julbe, Alexandra M Claudio-Marcano, Francis X Cedeño Rodriguez, Edgardo Martinez, Ruben Tresgallo, Norman Ramirez Lluch, Luis Lojo-Sojo","doi":"10.5435/JAAOSGlobal-D-25-00027","DOIUrl":"10.5435/JAAOSGlobal-D-25-00027","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain management in orthopaedic trauma surgery is critical. Amid the opioid crisis, nonopioid analgesia offers a promising alternative. We aim to evaluate the feasibility of a multimodal regimen, including intravenous ketorolac, oral acetaminophen, and oral gabapentin, in managing postoperative pain after femur shaft fractures treated with intramedullary nailing.</p><p><strong>Methods: </strong>We conducted a prospective cohort study to evaluate the postoperative pain of patients with isolated femur shaft fractures treated with intramedullary nailing. The experimental group consisted of 29 patients, while the control group consisted of 42 patients who received standard opioid-based pain management. The outcomes measured were the Visual Analog Scale (VAS) scores and the morphine milligram equivalents every 12 hours until 48 hours postoperatively.</p><p><strong>Results: </strong>Patient demographics were comparable between the experimental and control groups, with a significant age difference (31 vs. 40; P = 0.002) but not in sex, body mass index, smoking status, or diabetes prevalence. We observed no significant differences in VAS scores at 12, 24, 36, and 48 hours after surgery. In addition, there was a marked reduction in opioid usage in the experimental group, with P-values < 0.001 at each time point.</p><p><strong>Conclusion: </strong>The study concludes that the coadministration of ketorolac, acetaminophen, and gabapentin is an effective opioid-sparing alternative for postoperative pain in isolated femur shaft fractures. Future research could benefit from a more diverse patient population in orthopaedic trauma to further validate our results and explore long-term outcomes.</p><p><strong>Level of evidence: </strong>Prospective Cohort Study; Level 2.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}