Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Mortality among elderly hip fracture patients following surgical intervention- an institutional review of a tertiary care centre of North India","authors":"Kumar Keshav ,&nbsp;Siddhartha Singh ,&nbsp;Pulak Sharma ,&nbsp;Anurag Baghel ,&nbsp;Amit Kumar ,&nbsp;Prabhaker Mishra","doi":"10.1016/j.jcot.2025.103058","DOIUrl":"10.1016/j.jcot.2025.103058","url":null,"abstract":"<div><h3>Background</h3><div>We conducted a retrospective study of prospectively collected data to find the thirty-day and one-year mortality rate among geriatric patients with surgically operated hip fractures, and to evaluate the possible association with various non-modifiable and modifiable factors amongst deceased and survivors.</div></div><div><h3>Methods</h3><div>All elderly patients (above 60 years) with hip fractures (trochanteric or/and femoral neck) admitted and operated between July 2018 to February 2024 and having a minimum follow-up of 4.5 months (18 weeks) if alive, were included. Patients that were managed non-operatively, age &lt;60 years, having associated lower limb injuries or polytrauma, those not falling within the time duration mentioned above and previously operated cases of hip fractures were excluded from the study. Telephonic enquiries were done to patients or their relatives to know whether the patients were alive or had expired. The data, so collected, was used to find the mortality rate. Relevant statistical analyses were applied to look for any association between the mortality and various data-demographic, injury-related, comorbidities and hematological.</div></div><div><h3>Results</h3><div>A total of 168 patients were included based on inclusion-exclusion criteria. Out of these, there were 136 patients having a follow-up of one year or more. 30-day mortality in our series was 4.76 % (8 out of 168) and 1-year mortality was 19.85 % (27 out of 136). Presence of “any comorbidity” and “the total number of comorbidities” at admission had a significant association with deceased individuals in comparison to non-deceased ones (p-value&lt;0.001 in both). There was also a statistically significant negative association of the survival time (number of days) with the number of comorbidities.</div></div><div><h3>Conclusion</h3><div>Mortality rate following hip fractures in geriatric patients remains as high as one-fifth at one year. Comorbidities have a significant effect on one-year mortality and the postoperative survival duration is negatively associated with number of comorbidities.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103058"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative prediction of four stranded hamstring graft size in anterior cruciate ligament Reconstruction: Is magnetic resonance imaging evaluation of semitendinosus and gracillis tendon better than anthropometric data?","authors":"Bishnu Prasad ,&nbsp;Sudhanshu Sekhar Das ,&nbsp;Sudarsan Behera ,&nbsp;Saroj Kumar Patra ,&nbsp;Paulson Verghese ,&nbsp;Ashish Kumar Satapathy","doi":"10.1016/j.jcot.2025.103057","DOIUrl":"10.1016/j.jcot.2025.103057","url":null,"abstract":"<div><h3>Background</h3><div>To determine the correlation between intraoperative measurements of four-stranded hamstring grafts, preoperative MRI measurements, and anthropometric measurements. The study aimed to provide insights into graft diameter assessment and assist in the selection of hamstrings for graft preparation in the Indian population.</div></div><div><h3>Material and methods</h3><div>In this prospective study, 50 patients with complete anterior cruciate ligament (ACL) injuries, with or without meniscal injuries, were included. Prior to surgery, anthropometric data and the largest axial diameter of the semitendinous and gracilis tendon at the medial femoral epicondyle were measured. The study aimed to establish correlations between Final diameter of the graft, preoperative hamstring graft diameter and anthropometric measurements.</div></div><div><h3>Results</h3><div>Radiological data was found to predict graft diameter better than anthropometric data. Gracilis diameter was more specific for graft diameters ≥8 mm.</div></div><div><h3>Conclusion</h3><div>Preoperative hamstring tendon diameter in the MRI is better predictor as compared to anthropometric data to predict of four strandend size of the graft.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103057"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total hip arthroplasty in sickle cell disease: A systematic review and meta-analysis of functional outcomes and complications","authors":"Ankush Mohabey ,&nbsp;Jomon De Joseph ,&nbsp;Felista Karen Joseph ,&nbsp;Kalyani Deshmukh ,&nbsp;Prajakta Warjukar ,&nbsp;Aravind P. Gandhi","doi":"10.1016/j.jcot.2025.103060","DOIUrl":"10.1016/j.jcot.2025.103060","url":null,"abstract":"<div><h3>Background</h3><div>Sickle cell disease (SCD) is a significant risk factor for avascular necrosis (AVN) of the femoral head, often necessitating total hip arthroplasty (THA) at a younger age than patients with primary osteoarthritis. This systematic review and meta-analysis aimed to evaluate the functional outcomes, surgical complications, and intraoperative blood loss in SCD patients undergoing THA.</div></div><div><h3>Materials and methods</h3><div>A systematic search of databases, including Cochrane, Web of Science, Scopus, EMBASE, and PubMed, was conducted on November 5, 2024. Studies involving sickle cell patients who underwent THA were included. Functional outcomes were assessed using scoring systems such as the Oxford Hip Score (OHS) and Harris Hip Score (HHS). Postoperative complications, revision rates, and intraoperative blood loss were also analyzed. Statistical analyses were conducted to derive pooled estimates and confidence intervals. PROSPERO ID: CRD42024609360.</div></div><div><h3>Results</h3><div>A total of 25 studies met the inclusion criteria, comprising both retrospective and prospective studies. The pooled analysis revealed a significant improvement in functional outcomes, with a mean HHS increase of 6.96 (95 % CI: 5.56–8.35). Mean age of patients ranged from 20 to 35 years. Pooled estimate of complications included aseptic loosening (12 %), dislocation (1 %), heterotopic ossification (8 %), iatrogenic fracture (8 %), infection (8 %), osteolysis (8 %), periprosthetic fractures (8 %), revision surgery (11 %), sickle cell crisis (5 %), and thromboembolism (2 %). The mean blood loss was 1059.24 ml.</div></div><div><h3>Conclusion</h3><div>THA in sickle cell patients presents considerable challenges with a high risk of complications. Despite these challenges, THA can lead to functional improvement. Given the heightened risk profile, multidisciplinary perioperative care strategies are essential to optimize outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103060"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between haemoglobin A1c level and hip fracture risk in type 2 diabetes patients: A systematic review and meta-analysis","authors":"Mohammad Arshad Ikram ,&nbsp;Justin Vijay Gnanou ,&nbsp;Chin Chai Chong ,&nbsp;Nisar Ahmed ,&nbsp;Shobna Sai Letchumenan ,&nbsp;Zairul-Nizam Zainol Fithri","doi":"10.1016/j.jcot.2025.103040","DOIUrl":"10.1016/j.jcot.2025.103040","url":null,"abstract":"<div><h3>Background</h3><div>Hip fractures are prevalent in the elderly. Diabetes complication includes osteoporosis, which raises the possibility of hip fractures in an elderly population with type 2 diabetes mellitus. The purpose of this Meta-analysis is to determine whether long-term glycaemic management, as measured by HbA1c in patients with diabetes mellitus, is associated with a lower incidence of hip fractures.</div></div><div><h3>Methods</h3><div>The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA) guidelines. We searched PubMed, Ovid, and ScienceDirect, and did a manual search of the reference lists of identified studies for published data on the association between hip fractures and glycaemic control. This systematic review was registered with PROSPERO with a Registration number: CRD42021260328. All eligible articles were included, and a meta-analysis on the comparison between HbA1c values above 6.5 and below 6.5 and between HbA1c values above 6.0 and below 6.0 in patients above 65 years with diabetes mellitus will be done by using a Forest plot. Odds Ratio (OR) and 95 % confidence intervals (CIs) will be calculated as summary statistics for dichotomous outcomes.</div></div><div><h3>Results</h3><div>Thirty-seven relevant articles were identified in the initial search, and four of these studies met the inclusion criteria for this systematic review and meta-analysis.</div></div><div><h3>Conclusion</h3><div>Our study suggests that hip fractures are more common in the elderly diabetic population when haemoglobin A1c levels exceed 6.5 %.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103040"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of a curved internal fixation device in adult pelvic Fractures: Short-Term clinical outcomes in high and low energy fractures","authors":"Anthony Sleiman ,&nbsp;Christopher Bejcek ,&nbsp;Jeffrey Baker ,&nbsp;Jeffrey D. Voigt ,&nbsp;Kristin Delfino ,&nbsp;Matthew Gardner","doi":"10.1016/j.jcot.2025.103035","DOIUrl":"10.1016/j.jcot.2025.103035","url":null,"abstract":"<div><h3>Background</h3><div>Current methods of percutaneous fixation for pelvic and acetabular fractures are limited due to the curvature of the pelvic anatomy. The goals of fixation are to reduce pain, improve mobility and decrease length of stay. An implant specifically designed for use in the curved osseous fixation pathways of the pelvis may allow for more stable fixation.</div></div><div><h3>Objective</h3><div>The objective of this review was to examine the results of a new method of fixation (CurvaFix<strong>®</strong>) for pelvic and acetabular fractures.</div></div><div><h3>Methods</h3><div>A retrospective chart review of CurvaFix was employed and evaluated for implant fixation, complications, hospital length of stay (LOS), and inpatient mobility and then compared to current standards of care from the literature for percutaneous fixation.</div></div><div><h3>Results</h3><div>A curved intramedullary device was used to treat 31 low energy and 21 high energy fractures over a median 3.4 months. The median LOS was 7 [1 to 27] days for low and 11 [0 to 68] days for high energy fractures. Median time to first inpatient ambulation was 37 h in high energy fractures and 25 h in low energy injuries. Aggregated complications occurred in 21.3 % (10/46) of patients. Peri-implant failure occurred in 2 patients, with no incidences of hardware failure.</div></div><div><h3>Conclusions</h3><div>This case series demonstrates curved internal fixation is a viable option to consider among other treatment modalities for pelvic ring and acetabular fractures and may allow for early inpatient ambulation and a shorter LOS. Comparative studies are needed to confirm this.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103035"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are the diagnoses attributed to persistent hip pain after hip arthroplasty? A systematic review","authors":"Kael Hulin ,&nbsp;Angie Fearon ,&nbsp;Phil Newman","doi":"10.1016/j.jcot.2025.103036","DOIUrl":"10.1016/j.jcot.2025.103036","url":null,"abstract":"<div><h3>Background</h3><div>Persistent hip pain after total hip arthroplasty has been reported in up to 23 % of cases. Despite routine clinical tests, the source of pain often remains unclear, and diagnosis requires extensive investigation with imaging or surgical exploration.</div></div><div><h3>Aims</h3><div>This systematic review aimed to identify the diagnoses attributable to the painful hip arthroplasty. The second aim was to identify diagnostic techniques used to identify them.</div></div><div><h3>Method</h3><div>Three databases (Medline, Scopus and CINAHL) were searched from 2012 to 2024 using keywords and medical subject headings (MeSH) including ‘persistent pain AND hip arthroplasty AND diagnoses’. Quality assessment was undertaken with the Joanna Briggs Institute checklist for case-series. Data extraction was performed by one author using Covidence software and crosschecked by another for accuracy. Data included age, sex, arthroplasty type, diagnostic method, and confirmed diagnosis. Data was synthesised to provide a quantitative overview of diagnoses and diagnostic methods. PROSPERO number CRD42022340158.</div></div><div><h3>Results</h3><div>The search and reference screening returned 285 papers of which seven high quality and two unclear quality case-series met the inclusion criteria. There was a total of 388 painful hip arthroplasties included. Prostheses loosening or infection was present in 28.6 % of cases. Iliopsoas impingement was present in 21 % of cases. Causes outside the hip accounted for 16.4 % of cases with referred pain from the lumbar spine (14.6 %) most common. Greater trochanteric pain syndrome (GTPS) was present in 13 %. The painful etiology remained unknown in 9.2 % of participants. The most common diagnostic imaging technique was x-ray (100 %) followed by magnetic resonance imaging (22 %).</div></div><div><h3>Conclusion</h3><div>Prosthesis loosening and infection remain a significant cause of pain despite preliminary screening to exclude them. Iliopsoas impingement and causes outside the hip require significant consideration due to high prevalence. Less common differential diagnoses have been identified. X-ray is an important front-line imaging tool while other advanced imaging is used selectively to identify a diagnosis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103036"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BioFire in osteoarticular Infections: Rapid syndromic testing for early and accurate diagnosis – A narrative review","authors":"Vibhu Krishnan Viswanathan ,&nbsp;Vijay Kumar Jain ,&nbsp;Karthikeyan P. Iyengar ,&nbsp;Raju Vaishya","doi":"10.1016/j.jcot.2025.103038","DOIUrl":"10.1016/j.jcot.2025.103038","url":null,"abstract":"<div><h3>Introduction</h3><div>In the increasing peril due to multidrug-resistant (MDR) pathogens, importance of novel molecular technologies for rapid pathogen identification has been acknowledged. In this context, the role of multiplex molecular technique, BioFire® Arthritis panel (BFAP) in the evaluation of osteoarticular infections (OI) has been recognized. The current review was performed to comprehensively evaluate the status of BFAP in OI.</div></div><div><h3>Methods</h3><div>A literature search was performed in June 2024 using five databases. Clinical studies (prospective and retrospective series) evaluating the role of BFAP in OI were considered. Experimental studies, editorials, and reviews were excluded. A narrative approach was used for the synthesis of results.</div></div><div><h3>Results</h3><div>Ten manuscripts were finally selected for the review. This test uses cartridge methodology, and the panel includes 31 microorganisms and eight resistance markers. The panel consists of nucleic acid extraction, reverse transcription, amplification of nucleic acid, and analysis of results in an automated manner (approximated duration of 1 h/run). It has been acknowledged for providing rapid results with relatively good diagnostic precision (90.9 % sensitivity, 98.5 % specificity). However, when off-panel pathogens (like <em>Staphylococcus epidermidis/Cutibacterium acnes</em>) are considered, sensitivity drops to 56 %. It significantly impacts its accuracy and false negative results.</div></div><div><h3>Conclusion</h3><div>The benefits of the BioFire® panel include rapid turn-around time, excellent sensitivity and specificity for on-panel pathogens, and ability to identify antimicrobial resistance. The benefits of BFAP are demonstrated in native septic arthritis and OI in pediatric population. In view of exclusion of specific organisms, its sensitivity and accuracy in diagnosing PJI (early acute PJI) and chronic infections are low.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103038"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystic bone Lesions: Diagnostic pitfalls and therapeutic considerations","authors":"Ashwin Prajapati ,&nbsp;Ashish Gulia ,&nbsp;Kaival Gundavda ,&nbsp;Rajesh Botchu ,&nbsp;Amit Janu","doi":"10.1016/j.jcot.2025.103046","DOIUrl":"10.1016/j.jcot.2025.103046","url":null,"abstract":"<div><div>Bone tumors are rare lesions that often pose diagnostic and therapeutic challenges for an orthopedic surgeon. Malignant bone lesions comprise &lt;0.2 % of all cancers and the precise incidence of benign bone lesions is not documented. Many of these lesions appear cystic on imaging with varying number of overlapping features between benign lesions like Unicameral bone cyst, locally aggressive like Aneurysmal bone cyst, infections like hydatid cyst of bone to malignant like telangiectatic osteosarcoma. To aid the diagnosis, cystic bone lesions are classified into primary and secondary bone cysts. Primary bone cysts include simple bone cysts (SBC), aneurysmal bone cysts (ABC), epidermal inclusion cysts, intraosseous ganglion, intraosseous lipoma, and hydatid cysts of bone. Secondary bone cysts arise within a primary bone condition leading to cyst formation and include pathologies like fibrous dysplasia (FD), telangiectatic osteosarcoma, eosinophilic granuloma, Giant cell tumor (GCT) of bone and brown tumors. Each of these has peculiar diagnostic hallmarks, requires different treatment, and carries different prognosis. Due to their rarity and overlapping clinico-radiological features, cystic lesions often pose diagnostic and therapeutic dilemmas for clinicians and radiologists, often leading to errors in diagnosis and inadequate treatment which can endanger a patient's limb or life. Through this article, we aim to describe specific diagnostic hallmarks and treatment plans for these cystic bone lesions which can aid radiologists and treating orthopedic surgeons in diagnosing and manage these lesions optimally.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103046"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and radiological outcomes of percutaneous wiring for two and three part fractures of the proximal humerus","authors":"Sanjay Sanatkumar Desai ,&nbsp;Rachit Vipul Shah ,&nbsp;Vishwesh Devendrasinh Chudasama","doi":"10.1016/j.jcot.2025.103044","DOIUrl":"10.1016/j.jcot.2025.103044","url":null,"abstract":"<div><h3>Background</h3><div>Proximal humerus fractures are common, with minimally displaced types often managed non-surgically. However, displaced fractures present a challenge due to complex patterns and numerous treatment options. While there is a general agreement on managing displaced four-part fractures in the elderly, two- and three-part fractures can be treated using various surgical methods, including open reduction and internal fixation (ORIF) with plate, ORIF with intramedullary nail, external fixation, screw fixation, arthroplasty, and percutaneous wiring. This study aims to evaluate the functional and radiological outcomes of treating two- and three-part proximal humerus fractures using closed percutaneous wire fixation.</div></div><div><h3>Methods</h3><div>39 patients, with a mean age of 67 years, treated with percutaneous wiring for displaced two and three-part proximal humerus fractures were prospectively evaluated. Radiological evaluation comprised of anteroposterior and axillary radiographs to look for union while functional evaluation was done using the Constant-Murley (CM) and American Shoulder and Elbow Society (ASES) scoring systems.</div></div><div><h3>Results</h3><div>Union was seen in all the cases and 92.3 % patients had satisfactory result with a mean CM score of 72.7 and mean ASES score of 74.2, at an average follow up of 14 months (12–32 months). Three patients (7.69 %) had unsatisfactory results. One patient had malunion secondary to infection. Two patients had low functional scores secondary to systemic illnesses. None of the patients underwent revision surgery.</div></div><div><h3>Conclusion</h3><div>Percutaneous wiring for displaced two- and three-part fractures of proximal humerus is a reliable, minimally invasive method of fixation. The procedure has predictable outcomes with low complication rate and can be performed under regional block.</div></div><div><h3>Level of Evidence</h3><div>Level IV; Case series; Treatment Study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103044"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The additional value of radiology reports in the follow-up of extremity fractures: a retrospective study in an academic hospital","authors":"Mare M.H. Walraven ,&nbsp;Pieta Krijnen ,&nbsp;David A. Vuijk ,&nbsp;Monique Reijnierse ,&nbsp;Inger B. Schipper ,&nbsp;Marco F. Termaat","doi":"10.1016/j.jcot.2025.103043","DOIUrl":"10.1016/j.jcot.2025.103043","url":null,"abstract":"<div><h3>Background</h3><div>Radiology reports on radiographic findings during follow-up (FU) after extremity fractures are generally not yet available when the patient is seen by the treating orthopedic trauma surgeon and may therefore be redundant. The aim of this study was to explore the inter-observer agreement on the reported findings of the FU radiograph between orthopedic trauma surgeons and radiologists.</div></div><div><h3>Method</h3><div>This retrospective cohort study included all FU radiographs of adult patients with an extremity fracture, treated in a Dutch university hospital between January 2022 and July 2023. The radiologist's and orthopedic trauma surgeon's assessments of unacceptable alignment, delayed/non-union and abnormalities associated with osteosynthesis material (OSM) on the FU radiographs were collected from the medical files. Fracture healing was considered normal in the absence of these findings. The interobserver agreement of the radiographic parameters between surgeon and radiologist was determined using Cohens' Kappa (κ). Additionally, incidental findings and their clinical relevance were explored.</div></div><div><h3>Results</h3><div>953 FU radiographs of 569 patients were included. The interobserver agreement was close to perfect for normal fracture healing (κ = 0.82, 95 % CI 0.77–0.88) and delayed/non-union (κ = 0.94, 95 % CI 0.89–0.99). The inter-observer agreement was substantial for unacceptable alignment of the fracture (κ = 0.80, 95 % CI 0.72–0.88) and abnormalities associated with the OSM (κ = 0.77, 95 % CI 0.65–0.89). Twenty-one incidental findings were diagnosed in the FU by the radiologist of which two were also independently described by the surgeon. Three of the findings that were missed or not described by the surgeon could have clinical significance, however the missing of these findings did not lead complications or additional hospital visits. These included two missed rib fractures and one osteochondral defect, which led to prolonged immobilization due to pain.</div></div><div><h3>Conclusion</h3><div>Radiographic reports in the FU of extremity fractures have limited additional value for clinical care and probably lacks cost-effectiveness or efficiency.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103043"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}