Objectives: To determine which in-hospital complications following the operative treatment of hip fractures are associated with increased inpatient, 30-day and 1 year mortality.
Methods: Design: Retrospective study.
Setting: A single academic medical center and a Level 1 Trauma Center.
Patient selection criteria: All patients who were operatively treated for hip fractures (OTA/AO 31A, 31B and Vancouver A,B, and C periprosthetic fractures) at a single center between October, 2014 and June, 2023.
Outcome measures and comparisons: Occurrence of an in-hospital complication was recorded. Cohorts were based upon mortality time points (during admission, 30-days and 1-year) and compared to patients who were alive at those time points to determine which in- hospital complications were most associated with mortality. Correlation analysis was performed between patients who died and those who were alive at each time point.
Results: A total of 3,134 patients (average age of 79.6 years, range 18-104 years and 66.6% female) met inclusion for this study. The overall mortality rate during admission, 30 days and 1 year were found to be 1.6%, 3.9% and 11.1%, respectively. Sepsis was the complication most associated with increased in-hospital mortality (OR: 7.79, 95% CI 3.22 - 18.82, p<0.001) compared to other in-hospital complications. Compared to other in-hospital complications, stroke was the complication most associated with 30-day mortality (OR: 7.95, 95% CI 1.82 - 34.68, p<0.001). Myocardial infarction was the complication most associated with 1-year mortality (OR: 2.86, 95% CI 1.21 - 6.77, p=0.017) compared to other in-hospital complications.
Conclusions: Post-operative sepsis, stroke and myocardial infraction were the three complications most associated with mortality during admission, 30-day mortality and 1-year mortality, respectively, during the operative treatment of hip fractures.
Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Objectives: To investigate and compare the predictive ability of the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) and the Gustilo-Anderson classification systems for fracture-related infections (FRI) in patients with open tibia fractures.
Methods: Design: Retrospective cohort study.
Setting: Academic trauma center.
Patient selection criteria: Patients aged 16 years or older with an operatively treated open tibia fracture (OTA-OTA 41, 42, and 43) between 2010 and 2021.
Outcome measures and comparisons: The primary outcome was FRI. The OTA-OFC and the Gustilo-Anderson classifications were compared in their ability to predict FRI.
Results: 890 patients (mean age, 43 years [range, 17 to 96]; 75% male) with 912 open tibia fractures were included. 142 (16%) had an infection. The OTA-OFC was not significantly better at predicting FRI than the Gustilo-Anderson classification (area under the curve, 0.66 vs. 0.66; P = 0.89). The Gustilo-Anderson classification was a stronger predictor of FRI than any single OTA-OFC domain, explaining 72% of FRI variance. Only the addition of the OTA-OFC wound contamination domain to Gustilo-Anderson significantly increased the variance explained (72% vs. 84%, P = 0.04). Embedded contamination increased the risk of FRI by approximately 10% as the risk of FRI with embedded contamination was 16% for Type I or IIs, 26% for Type IIIAs, 45% for Type IIIBs, and 46% for Type IIICs.
Conclusions: The more complex OTA-OFC system was not better than the Gustilo-Anderson classification system in predicting FRIs in patients with open tibia fractures. Adding embedded wound contamination to the Gustilo-Anderson classification system significantly improved its prognostic ability.
Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Objectives: To evaluate the outcomes of staged management with external fixation (ex-fix) prior to definitive fixation of distal femur fractures.
Methods: Design: Retrospective cohort.
Setting: Single Level I Trauma Center.
Patient selection criteria: Adults treated operatively between 2004 and 2019 for distal femur fractures (OTA/AO 33A/33C) were identified using Current Procedural Terminology codes. Excluded cases were those with screw only fixation, acute distal femur replacement, 33B fracture pattern, no radiographs available, or did not have 6-months of follow-up.
Outcome measures and comparisons: Postoperative complication rates including surgical site infection [SSI], reoperation to promote bone healing, final knee arc of motion <90 degrees, heterotopic ossification formation, and reoperation for stiffness were compared between patients treated with ex-fix prior to definitive fixation and those not requiring ex-fix.
Results: A total of 407 patients were included with a mean follow-up of 27 months (median [IQR] of 12 [7,33] months), (range 6-192 months). Most patients were male (52%) with an average age of 48 [Range: 18-92] years. Ex-fix was utilized in 150 (37%) cases and 257 (63%) cases underwent primary definitive fixation. There was no difference in SSI rates (p=0.12), final knee arc of motion <90 degrees (p=0.51), and reoperation for stiffness (p=0.41) between the ex-fix and no ex-fix groups. The 150 patients requiring ex-fix spent an average of 4.2 days (SD 3.3) in the ex-fix before definitive fixation. These patients were further analyzed by comparing the duration of time spent in ex-fix, <4 days (n=82) and ≥4 days (n=68). Despite longer time spent in ex-fix prior to definitive fixation, there was again no significant difference in any of the complication and reoperation rates when comparing the two groups, including final knee arc of motion <90 degrees (p=0.63), reoperation for stiffness (p=1.00), and SSI (p=0.79).
Conclusion: Ex-fix of distal femur fractures as a means of temporary stabilization prior to definitive ORIF does not increase the risk of complications such as SSI, final knee arc of motion <90 degrees, or reoperations for bone healing or stiffness when compared to single stage ORIF of distal femur fractures.
Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Objectives: The objective of this study was to report outcomes of the Retrograde Femoral Nail-Advanced with Lateral Attachment Washer (RFNA-LAW) (Synthes; Paoli, PA) compared to laterally locked plates (LLP) when treating AO/OTA type 33 distal femoral fractures.
Methods: Design: Retrospective chart review.
Setting: Single, academic, Level-1 Trauma Center.
Patient selection criteria: All adult patients who had fixation of an AO/OTA type 33 distal femoral fracture with the RFNA-LAW combination or LLP from 2018-2023 with follow-up to union or a minimum of one year. immediately post-operatively and at final follow-up.
Outcome measures and comparisons: The main outcome measure was union. Secondary outcomes included implant failure, infection, and alignment immediately post-operatively and at final follow-up. Patients were followed for a minimum of 1-year or to skeletal healing.
Results: Forty-eight patients (19 female) with a mean age of 56 years (range 19-94 years) were in the RFNA-LAW group. Fifty-three patients (29 female) with a mean age of 66 years (24-91 years) were in the LLP group. There were no significant differences when comparing Body Mass Index, diabetes, smoking status, mechanism of injury, or fracture classification between groups (p>0.05). There was no difference in immediate, post-operative alignment (p = 0.49). When comparing aLDFA measurements at final follow-up, there was significantly more malalignment in the LLP group (p = 0.005). There were 8 implant failures (15%) in the LLP group compared to 1 in the RFNA-LAW group (2%) (p = 0.02). There were 14 reoperations (26%) in the LLP group compared to 4 (8%) in the RFNA-LAW group (p = 0.02).
Conclusions: The Retrograde Nail Advanced - Lateral Attachment Washer combination demonstrated a high union rate when treating complex fractures of the distal femur. When compared to lateral locked plating, this implant combination demonstrated significantly lower rates of nonunion and reoperation.
Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Objectives: To determine the difference in mortality and reoperation rate between femoral neck fractures (FNFx) treated with cannulated screw fixation (CS) or hemiarthroplasty (HA).
Methods: Design: Retrospective study.
Setting: Institutional registry data from a single Level I trauma center.
Patient selection criteria: Inclusion criteria were patients ≥60 years old with a FNFx (AO/OTA 31-B) who underwent primary operative treatment with a HA or CS.
Outcome measures and comparisons: Mortality and reoperation rates following primary operative treatment between patients treated with either hemiarthroplasty or cannulated screws. Kaplan-Meier survival curves were generated. Comparisons in the primary outcomes were made between the hemiarthroplasty or cannulated screw cohorts using univariate and multivariate analysis where appropriate.
Results: A total of 2,211 patients were included in the study (1,721 HA and 490 CS) and followed for an average of 34.5 months. The average age was 82.3 years (60-106 years) and predominantly female (66.3%). 1-year mortality was higher for the HA group compared to CS with a HR of 1.37 (p=0.03), however over the lifetime of patient or to final follow up, survival was not statistically significant with a RR of 0.95 95% CI, 0.83-1.1, p=0.97) The rate of reoperation at one year was lower for HA (5.0%) than for CS (10.1%), (HR 3.0, 95% CI, 2.1-4.34, p<0.0001).
Conclusions: Patients with FNFx treated with hemiarthroplasty had the same risk of mortality as those patients treated with cannulated screws across lifetime of patients or until final follow up. There is no difference in mortality at the 30- and 90-day timepoint, but a significant difference in mortality at 1 year. Hemiarthroplasty treatment was associated with a significantly lower reoperation risk when compared to cannulated screws across the lifetime of the patient or until final follow up.
Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.
Objectives: To describe subperiosteal elevation of the ulnar nerve and compare to anterior transposition and in situ decompression techniques.
Methods: Design: Retrospective comparative study.
Setting: Urban Level 1 trauma center.
Patient selection criteria: Distal humerus fractures (OTA/AO 13) treated with open reduction internal fixation between 2014-2022.
Outcome measures and comparisons: Rate of pre- and post-operative neuritis grouped by management of the ulnar nerve. During subperiosteal elevation, the ulnar nerve was identified and raised off the ulna subperiosteally and mobilized submuscularly anterior to the medial epicondyle to protect the nerve. The nerve was released only laterally off the triceps and the medial soft tissue attachment is maintained. The main outcomes measurements was rate of neuritis documented within physical exam.
Results: Within the 125 patients, 35 underwent subperiosteal elevation (mean age of 56 ± 21 years, 57% female), 63 in situ decompression (mean age of 60 ± 18 years, 46% female), and 27 anterior transposition (mean age of 55 ± 20 years, 59% female). Pre-operative ulnar neuritis was present in 34%, 21%, and 33% of patients treated with subperiosteal elevation, in situ decompression, and anterior transposition, respectively (p=0.26). At post-operative evaluation symptom resolution occurred in 100%, 69%, and 33% of patients treated with subperiosteal elevation, in situ decompression, and anterior transposition, respectively (p=0.003). New cases of post-operative ulnar neuritis occurred in 6%, 8%, and 26% of patients treated with subperiosteal elevation, in situ decompression, and anterior transposition, respectively (p=0.054). Subperiosteal elevation outperformed anterior transposition regarding post-operative ulnar neuritis (p=0.019) and symptom resolution (p=0.002) and performed similarly to in situ decompression (p>0.05). On multiple regression analysis, anterior transposition was an independent risk factor for post-operative neuritis (OR=5.2, p=0.023).
Conclusions: Subperiosteal elevation is an effective way to minimize post-operative neuritis and similar to an in-situ decompression during distal humerus fracture fixation. Based on the results of this cohort, authors recommended that anterior transposition of the ulnar nerve be used with caution due to association with post-operative ulnar neuritis.
Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：