Journal of Orthopaedic Trauma最新文献_第4页

Screw Configuration Does Not Significantly Alter Neck Shortening Following Valgus Impacted Femoral Neck Fracture (OTA Type 31B1.1) 股骨颈外翻撞击性骨折（OTA 31B1.1 型）后，螺钉配置不会显著改变股骨颈缩短程度

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma

Pub Date : 2024-07-11 DOI: 10.1097/bot.0000000000002850

Brittany DeClouette, Sehar Resad Ferati, Matthew T. Kingery, K. Egol

To compare three different cancellous screw configurations used for Garden 1 femoral neck fractures (FNF). Design: Retrospective review. A large urban academic medical center. All patients with OTA 31B1.1 FNF that underwent in situ fixation with cancellous screws between 2012 and 2021 were included. Patients were divided into three groups: two screws placed in a parallel fashion, three screws placed in an inverted triangle configuration, and three-screw fixation with placement of one “out of plane” (OOP) screw perpendicular to the long axis of the femur. Post operative femoral neck shortening (mm) was the primary outcome, which was compared amongst the three groups of different screw configurations. Sixty-one patients with a median follow-up of 1 year (IQR 0.6-1.8 years) and an average age of 72 years (IQR 65.0-83.0 years) were included. All fractures united. Overall, 68.9% of the cohort had ≤ 2 mm of femoral neck shortening. There was no difference between groups in the proportion of patients who experienced greater than 2 mm of shortening (p = 0.839) or in the amount (mm) of femoral neck shortening (Kruskal-Wallis χ2 = 0.517, p = 0.772). While most patients with valgus impacted femoral neck fractures treated with screw fixation do not experience further femoral neck shortening, some patients demonstrated continued radiographic shortening during the healing process. The development of further femoral neck shortening and the amount of shortening that occurs do not differ based on implant configuration. Multiple different screw configurations appear to be acceptable with regards to achieving healing and minimizing further femoral neck impaction. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

比较用于治疗 Garden 1 股骨颈骨折 (FNF) 的三种不同松质骨螺钉配置。设计：回顾性研究。一家大型城市学术医疗中心。纳入2012年至2021年间接受松质骨螺钉原位固定术的所有OTA 31B1.1 股骨颈骨折患者。患者被分为三组：平行放置两枚螺钉、倒三角形配置放置三枚螺钉，以及垂直于股骨长轴放置一枚 "平面外"（OOP）螺钉的三枚螺钉固定。术后股骨颈缩短（毫米）是三组不同螺钉配置之间的主要结果比较。 61名患者的中位随访时间为1年（IQR为0.6-1.8年），平均年龄为72岁（IQR为65.0-83.0岁）。所有骨折均为合并骨折。总体而言，68.9%的患者股骨颈缩短≤2毫米。在股骨颈缩短超过2毫米的患者比例（P = 0.839）或股骨颈缩短量（毫米）（Kruskal-Wallis χ2 = 0.517，P = 0.772）方面，组间没有差异。虽然大多数股骨颈外翻骨折患者在接受螺钉固定治疗后股骨颈不会进一步缩短，但有些患者在愈合过程中仍会出现影像学上的股骨颈缩短。股骨颈进一步缩短的情况和缩短的程度并不因植入物的配置而异。多种不同的螺钉结构在实现愈合和减少股骨颈进一步嵌顿方面似乎是可以接受的。预后三级。有关证据等级的完整描述，请参阅 "作者须知"。

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引用次数: 0

Recovery of Comfort and Capability after Upper Extremity Fracture is Predominantly Associated with Mindset: A Longitudinal Cohort from the United Kingdom 上肢骨折后舒适度和能力的恢复主要与心态有关：英国纵向队列研究

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma

Pub Date : 2024-07-08 DOI: 10.1097/bot.0000000000002868

Niels Brinkman, Jacob E. Thomas, T. Teunis, David Ring, Stephen Gwilym, Prakash Jayakumar

To determine the relative influence of mindset and fracture severity on 9-month recovery trajectories of pain and capability after upper extremity fractures. Design: Secondary use of longitudinal data. Single level-1 trauma center in Oxford, United Kingdom. English speaking adults with isolated proximal humerus, elbow or distal radius fracture managed operatively or non-operatively were included, and those with multiple fractures or cognitive deficit were excluded. Incapability (Quick-DASH) and pain intensity (11-point rating scale) were measured at baseline, 2-4 weeks, and 6-9 months after injury. Cluster analysis was used to identify statistical groupings of mindset (PROMIS Depression and Anxiety, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia) and fracture severity (low/moderate/high based on AO/OTA classification). The recovery trajectories of incapability and pain intensity for each mindset grouping were assessed, accounting for various fracture related aspects. Among 703 included patients (59 ± 21 years old, 66% women, 16% high energy injury), four statistical groupings with escalating levels of distress and unhelpful thoughts were identified (fracture severity was omitted considering it had no differentiating effect). Groups with less healthy mindset had a worse baseline incapability (group 2: β=4.1, 3: β=7.5, 4: β=17) and pain intensity (group 3: β=0.70, 4: β=1.4)(p<0.01). Higher fracture severity (β=4.5), high energy injury (β=4.0), and nerve palsy (β=8.1) were associated with worse baseline incapability (p<0.01), and high energy injury (β=0.62) and nerve palsy (β=0.76) with worse baseline pain intensity (p<0.01). Groups 3 and 4 had a prolonged rate of recovery of incapability (β=1.3, β=7.0) and pain intensity (β=0.19, β=1.1)(p<0.02). Patients with higher levels of unhelpful thinking and feelings of distress regarding symptoms experienced worse recovery of pain and incapability, with a higher effect size than fracture location, fracture severity, high energy injury, and nerve palsy. These findings underline the importance of anticipating and addressing mental health concerns during recovery from injury. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

目的：确定心态和骨折严重程度对上肢骨折后 9 个月疼痛和能力恢复轨迹的相对影响。设计：二次使用纵向数据。地点：英国牛津的一级创伤中心。纳入接受手术或非手术治疗的肱骨近端、肘部或桡骨远端孤立骨折的英语成人，排除多处骨折或认知障碍的成人。分别在基线、伤后2-4周和6-9个月测量了丧失能力（Quick-DASH）和疼痛强度（11点评分量表）。聚类分析用于确定心态（PROMIS 抑郁和焦虑量表、疼痛灾难化量表和坦帕运动恐惧症量表）和骨折严重程度（根据 AO/OTA 分类为低度/中度/高度）的统计分组。在考虑到与骨折相关的各种因素的情况下，对每种心态分组的能力和疼痛强度的恢复轨迹进行了评估。在纳入的 703 名患者（59 ± 21 岁，66% 为女性，16% 为高能量损伤）中，确定了四种统计分组，这些分组的痛苦和无益想法程度不断升级（考虑到骨折严重程度没有区分作用，因此省略了这一分组）。心态不那么健康的组别，其基准能力（第 2 组：β=4.1；第 3 组：β=7.5；第 4 组：β=17）和疼痛强度（第 3 组：β=0.70；第 4 组：β=1.4）均较差（P<0.01）。较高的骨折严重程度（β=4.5）、高能量损伤（β=4.0）和神经麻痹（β=8.1）与较差的基线能力相关（p<0.01），高能量损伤（β=0.62）和神经麻痹（β=0.76）与较差的基线疼痛强度相关（p<0.01）。第 3 组和第 4 组的能力恢复率（β=1.3，β=7.0）和疼痛强度恢复率（β=0.19，β=1.1）较长（P<0.02）。对症状有较多无益思维和痛苦感的患者，其疼痛和丧失能力的恢复情况较差，其影响大小高于骨折位置、骨折严重程度、高能量损伤和神经麻痹。这些发现强调了在伤后恢复期间预测和解决心理健康问题的重要性。预后三级。有关证据等级的完整描述，请参阅 "作者须知"。

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引用次数: 0

Tranexamic Acid Administered at Time of Hospital Admission Does Not Decrease Transfusion Rates or Blood Loss for Extracapsular Hip Fractures; A Double-Blinded Randomized Clinical Trial 入院时给予氨甲环酸不会降低髋关节囊外骨折的输血率或失血量；一项双盲随机临床试验

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma

Pub Date : 2024-07-08 DOI: 10.1097/bot.0000000000002870

Aaron R. Owen, Chelsea C. Boe, Nicolas P. Kuttner, Alexandra M. Cancio-Bello, Kristina M. Colbenson, Krystin A. Hidden, Jonathan D. Barlow, William W. Cross, S. Sems, Brandon J. Yuan

To evaluate TXA when administered immediately upon hospital presentation in patients with extracapsular peritrochanteric hip fractures to determine its effect on 1.) transfusion rates 2.) estimated blood loss, and 3.) complications. Design: Prospective, double-blinded, randomized clinical trial. Single Center, Level 1 Trauma Center All patients with isolated AO/OTA 31-A fracture patterns from 2018-2022 were eligible for inclusion. Study drug was administered in the emergency department at the time of presentation – 1-gram bolus over 10 minutes followed by a 1-gram infusion over 8 hours. The primary outcome was the rate of red blood cell (RBC) transfusion hospital day #1 – #4. Secondary outcomes included estimated blood loss and complications including venous thromboembolic events (VTE), stroke, myocardial infarction (MI), all-cause 90-day readmissions, and all-cause mortality. 128 patients were included – 64 patients were randomized to intravenous (IV) TXA and 64 patients to IV normal saline (i.e., placebo). There was no difference in the rate of RBC transfusion between treatment arms between hospital day #1 – #4 (27% in TXA arm vs. 31% in placebo arm, p=0.65). Patients randomized to placebo that required transfusion received a mean of 2.30 units compared to 1.94 units in the TXA cohort (p=0.55). There was no difference in the estimated blood loss between hospital day #1 – #4. There was no difference in the incidence of postoperative complications including VTE, stroke, MI, 90-day readmission, or death. The results of the current study do not support the use of preoperative TXA for reducing blood loss for geriatric patients with extracapsular hip fractures. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

目的：评估髋关节囊外转子周围骨折患者在入院后立即给予 TXA 的效果，以确定其对 1.) 输血率 2.) 估计失血量和 3.) 并发症的影响。设计：前瞻性、双盲、随机临床试验。单中心、1 级创伤中心 2018-2022 年间所有 AO/OTA 31-A 型孤立骨折患者均符合纳入条件。研究药物在急诊科就诊时给药--10 分钟内注射 1 克栓剂，然后在 8 小时内输注 1 克药物。主要结果是住院第1-4天的红细胞（RBC）输注率。次要结果包括估计失血量和并发症，包括静脉血栓栓塞事件（VTE）、中风、心肌梗塞（MI）、90 天内所有原因的再住院率和所有原因的死亡率。研究共纳入了 128 名患者，其中 64 名患者被随机分配静脉注射 TXA，64 名患者被随机分配静脉注射生理盐水（即安慰剂）。在住院第1天至第4天期间，治疗组之间的红细胞输注率没有差异（TXA治疗组为27%，安慰剂治疗组为31%，P=0.65）。随机接受安慰剂治疗的患者平均输血2.30个单位，而TXA治疗组患者平均输血1.94个单位（P=0.55）。住院第 1-4 天的估计失血量没有差异。术后并发症（包括 VTE、中风、心肌梗死、90 天再入院或死亡）的发生率没有差异。目前的研究结果不支持使用术前 TXA 减少髋关节囊外骨折老年患者的失血量。有关证据等级的完整描述，请参阅 "作者须知"。

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引用次数: 0

Surgeon Factors Rather than Patient Factors Account for Variation in Recommended Treatment Strategy for Patients with Multi-ligament Knee Injury 造成膝关节多韧带损伤患者推荐治疗策略差异的外科医生因素而非患者因素

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma

Pub Date : 2024-07-08 DOI: 10.1097/bot.0000000000002867

Niels Brinkman, Carl Nunziato, D. Laverty, David Ring, Austin Hill, T. Crijns

To seek the factors associated with timing, staging, and type of surgery in the management of multi-ligament knee injuries. Cross-sectional scenario-based experiment. 15 fictional patient scenarios with randomized elements. Fracture surgeons of the Science of Variation Group, an international collaborative of musculoskeletal surgeons that studies variation in care, were invited to participate. Surgeons with limited experience treating multi-ligament knee injuries were asked to self-exclude. Surgeon recommendations for operative treatment, timing of surgery, and use of open surgery in addition to arthroscopy were measured. Patient factors (age, time from injury, contralateral fracture, knee dislocation, combinations of ruptured ligaments, pre-existing osteoarthritis) and surgeon factors (gender, practice location, years of experience, supervision of trainees) associated with surgeon recommendations were assessed. Eighty-five surgeons participated, of which most were men (89%) and practiced in the United States (44%) or Europe (38%). Operative treatment was less likely among older patients (OR=0.051) and pre-existing osteoarthritis (OR=0.32), and more likely in knee dislocation (OR=1.9) and disruption of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and lateral collateral ligament (LCL) with or without medial collateral ligament (MCL; OR=5.1 and OR=3.1, respectively). Disruption of ACL, PCL, and MCL was associated with shorter time to surgery (β=-11). Longer time to surgery was associated with contralateral fracture (β=9.2), and surgeons supervising trainees (β=23) and practicing in Europe (β=13). Surgeon factors accounted for more variation in timing than patient and injury factors (5.1% vs 1.4%, respectively). Open surgery was more likely in patients with LCL injury (OR=2.9 to 3.3). The observation that surgeons were more likely to operate in younger patients with more severe injury has face validity, while the finding that surgeon factors accounted for more variation in timing of surgery than patient or injury factors suggests that treatment variation is based on opinion more so than evidence. Level III. See Instructions for Authors for a complete description of levels of evidence.

探究膝关节多韧带损伤治疗中手术时机、分期和类型的相关因素。基于情景的横断面实验。 15 个虚构的病人情景，并包含随机因素。邀请 "变异科学小组 "的骨折外科医生参与实验。"变异科学小组 "是一个由肌肉骨骼外科医生组成的国际合作组织，旨在研究护理中的变异。治疗多韧带膝关节损伤经验有限的外科医生被要求自行退出。对外科医生的手术治疗建议、手术时机以及开放手术和关节镜手术的使用情况进行了测量。评估了与外科医生建议相关的患者因素（年龄、受伤时间、对侧骨折、膝关节脱位、韧带断裂组合、原有骨关节炎）和外科医生因素（性别、执业地点、经验年限、实习生指导）。 85名外科医生参与了这项研究，其中大部分为男性（89%），在美国（44%）或欧洲（38%）执业。老年患者（OR=0.051）和原有骨关节炎患者（OR=0.32）接受手术治疗的几率较低，而膝关节脱位（OR=1.9）和前交叉韧带（ACL）、后交叉韧带（PCL）、外侧副韧带（LCL）断裂（伴有或不伴有内侧副韧带（MCL；OR=5.1，OR=3.1）患者接受手术治疗的几率较高。前交叉韧带、PCL和MCL断裂与手术时间缩短有关（β=-11）。手术时间较长与对侧骨折（β=9.2）、外科医生指导受训者（β=23）和在欧洲执业（β=13）有关。外科医生因素造成的手术时间差异大于患者和损伤因素（分别为 5.1% 和 1.4%）。LCL损伤患者更有可能接受开放手术（OR=2.9至3.3）。外科医生更倾向于为受伤更严重的年轻患者进行手术，这一观察结果具有表面有效性，而外科医生因素比患者或受伤因素在手术时机上造成的差异更大，这一发现表明治疗上的差异更多是基于观点而非证据。三级。有关证据等级的完整描述，请参阅 "作者须知"。

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引用次数: 0

Bicortical Compression and Construct Stability with Variable Pitch Locking Screws in Cadaveric Specimens 在尸体标本中使用可变螺距锁定螺钉实现皮质压缩和结构稳定性

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma

Pub Date : 2024-07-08 DOI: 10.1097/bot.0000000000002869

Zachary A. Koroneos, Shelby Alwine, Peter Tortora, Michael D. Pitcher, Christian Benedict, H. Wee, Allen Kunselman, Michael C. Aynardi, Gregory S. Lewis

A variable pitch locking screw is intended to provide interfragmentary compression combined with fixed angle stability of locking plate constructs. The objective of this study was to compare variable pitch locking screws (3.5 mm KreuLock Ti Locking Compression Screws, Arthrex Inc., Naples FL) with standard locking screws (from same manufacturer) in bicortical fixation scenarios in cadaver bone, by assessing: (1) interfragmentary compression and plate-bone compression; and (2) construct biomechanical stability. Nine matched pairs of fresh-frozen cadaveric specimens with an average age of 67.2 years (range, 37-83) were used. Interfragmentary compression and plate-bone compression associated with insertion of single bicortical screws were compared between the variable pitch and standard locking screws at increasing levels of torque. The specimens tested were distal tibiae having a simulated longitudinal fracture. Fibulae were osteotomized to create a stable longitudinal fracture pattern and were fixed with a five-screw plate construct with either all variable pitch or all standard locking screws. One of the five screws was placed across the osteotomy without lagging. Fibulae were tested cyclically with axial with torsional loading to compare, displacements, rotation and loads at failure, or tested in four-point bending to compare construct stiffness and maximum force to failure. Interfragmentary and plate-bone compression forces in the distal tibia model varied across specimens but were significantly higher with variable pitch locking screws compared to standard locking screws [512 N (SD = 324 N) vs. 79 N (SD = 64 N), p = 0.002 & 242 N (SD = 119 N) vs. 104 N (SD = 123 N), p = 0.028, respectively]. In cyclic loading of fibula constructs, no significant differences were detected in construct axial displacement or angular displacement (p > 0.05). In four-point bending, no differences were detected in maximum force or bending stiffness (p > 0.05). Variable pitch locking screws produced interfragmentary compression between cortices and plate-bone compression that were greater than standard locking screws. In a stable bicortical fibula fixation scenario under external loading, the stability of variable pitch locking screw constructs was similar to constructs with standard locking screws.

可变螺距锁定螺钉旨在为锁定钢板结构提供节间压缩和固定角度稳定性。本研究的目的是比较可变螺距锁定螺钉（3.5 毫米 KreuLock Ti 锁定加压螺钉，Arthrex 公司，佛罗里达州那不勒斯市）与标准锁定螺钉（来自同一制造商）在尸体骨中的双皮质固定情况，评估：(1) 椎节间加压和钢板-骨加压；(2) 结构的生物力学稳定性。九对匹配的新鲜冷冻尸体标本的平均年龄为 67.2 岁（37-83 岁）。比较了可变节距螺钉和标准锁定螺钉在扭矩不断增加的情况下插入单个双皮质螺钉时产生的节间压缩和板骨压缩。测试标本为模拟纵向骨折的胫骨远端。对腓骨进行截骨以形成稳定的纵向骨折形态，并用五螺钉钢板结构进行固定，钢板采用全可变螺距螺钉或全标准锁定螺钉。五根螺钉中的一根横穿截骨处，无滞后。在轴向和扭转负荷下对纤维进行周期性测试，以比较失效时的位移、旋转和负荷，或进行四点弯曲测试，以比较结构刚度和失效时的最大力。在胫骨远端模型中，不同标本的节间和板骨压缩力各不相同，但与标准锁定螺钉相比，可变螺距锁定螺钉的压缩力明显更高[分别为512 N (SD = 324 N) vs. 79 N (SD = 64 N)，p = 0.002和242 N (SD = 119 N) vs. 104 N (SD = 123 N)，p = 0.028]。在腓骨结构的循环加载中，未发现结构轴向位移或角位移有显著差异（p > 0.05）。在四点弯曲中，未发现最大力或弯曲刚度方面的差异（P > 0.05）。与标准锁定螺钉相比，变节距锁定螺钉在皮质间产生的节间压缩和板-骨压缩更大。在外部加载的稳定双皮质腓骨固定方案中，可变螺距锁定螺钉结构的稳定性与使用标准锁定螺钉的结构相似。

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引用次数: 0

Does Marijuana Smoking Increase the Odds of Surgical Site Infection after Orthopaedic Surgery? A Retrospective Cohort Study 吸食大麻会增加骨科手术后手术部位感染的几率吗？一项回顾性队列研究

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma

Pub Date : 2024-07-02 DOI: 10.1097/bot.0000000000002866

David E Ruckle, Alexander Chang, J. Jesurajan, Bradley Carlson, Matthew T. Gulbrandsen, R. Rice, M. D. Wongworawat

Does marijuana smoking increase the risk of surgical site infection (SSI) after open reduction and internal fixation of fractures? Retrospective Single academic level 1 trauma center in Southern California Adult patients who underwent open treatment for closed fractures between January 2009 and December 2021, had hardware placed, and had at least 6 months of postoperative follow up. Risk factors associated with the development of SSI were compared between current inhalational marijuana users and non-marijuana users. Complete data was available on 4,802 patients after exclusion of 82 who did not have a complete variable set. At the time of surgery 24% (1,133 patients) were current users of marijuana. At final follow up (minimum 6 months), there was a 1.6% infection rate (75 patients). The average age of the infection free group was 46.1 ± 23.1 and the average age of the SSI group was 47.0 ± 20.3 (p=0.73). 2,703 (57%) in the infection free group were male compared to 48 (64%) in the SSI group (p=0.49). On multivariate analysis, longer operative times (OR 1.002 [95% CI: 1.001-1.004]), diabetic status (OR 2.084 [95% CI: 1.225-3.547]), and current tobacco use (OR 2.493 [95% CI: 1.514-4.106]) (p<0.01 for all) were associated with an increased risk of SSI; however, current marijuana use was not (OR 0.678 [95% CI: 0.228-2.013], p=0.48). Tobacco use, diabetes, and longer operative times were associated with the development of SSI after open reduction and internal fixation of fractures; however, marijuana smoking was not shown to be associated with the development of SSI. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

吸食大麻是否会增加骨折切开复位内固定术后手术部位感染（SSI）的风险？回顾性研究南加州单个一级学术创伤中心 2009 年 1 月至 2021 年 12 月间接受闭合性骨折切开治疗、置入硬件并接受至少 6 个月术后随访的成人患者。比较了吸入大麻者和非吸入大麻者发生 SSI 的相关风险因素。在排除了 82 名没有完整变量集的患者后，我们获得了 4802 名患者的完整数据。手术时，24% 的患者（1,133 人）目前吸食大麻。在最终随访（至少 6 个月）中，感染率为 1.6%（75 名患者）。无感染组的平均年龄为 46.1 ± 23.1 岁，SSI 组的平均年龄为 47.0 ± 20.3 岁（P=0.73）。无感染组中有 2703 人（57%）为男性，而 SSI 组中有 48 人（64%）为男性（P=0.49）。在多变量分析中，手术时间较长（OR 1.002 [95% CI: 1.001-1.004]）、糖尿病状态（OR 2.084 [95% CI: 1.225-3.547]）和目前吸烟（OR 2.493[95%CI：1.514-4.106])（均为 p<0.01）与 SSI 风险增加有关；但目前吸食大麻与 SSI 风险增加无关（OR 0.678 [95% CI：0.228-2.013]，p=0.48）。吸烟、糖尿病和较长的手术时间与骨折切开复位内固定术后 SSI 的发生有关；但吸食大麻与 SSI 的发生无关。预后三级。有关证据等级的完整描述，请参阅 "作者须知"。

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引用次数: 0

Enhancing the Evaluation of Physical Function Following Orthopaedic Trauma Care: Comparison of PROMIS Computerized Adaptive Testing and Short Musculoskeletal Function Assessment. 加强骨科创伤护理后的身体功能评估：PROMIS 计算机适应性测试与简易肌肉骨骼功能评估的比较。

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-07-01 Epub Date: 2024-05-31 DOI: 10.1097/BOT.0000000000002814

Michiel A J Luijten, Lotte Haverman, Caroline B Terwee, Martijn Poeze, Diederik O Verbeek

Objectives: To compare measurement properties of Patient-Reported Outcomes Measurement Information System (PROMIS) (physical function [PF] and pain interference [PI]) computerized adaptive testing to traditional Short Musculoskeletal Function Assessment (SMFA) (dysfunction index [DI] and bother index [BI]). To explore factors associated with PROMIS scores.

Methods:

Design: Cross-sectional study.

Setting: Level I Trauma Center.

Patient selection criteria: Isolated upper/lower extremity fracture patients were recruited from the orthopaedic trauma outpatient clinic (October 1, 2021 to January 1, 2023).

Outcome measures: Correlations (Pearson), reliability (standard error [SE] [T score]), efficiency (amount of information per item [1 - SE2/Nitems]), and floor/ceiling effects were assessed. An r > 0.7 represented high correlation, and SE ≤ 2.2 represented sufficient reliability. Factors associated with worse PROMIS scores were also identified.

Results: In total, 202 patients completed PROMs at median 98 days follow-up. Correlations between PROMIS-PF and SMFA-DI, and PROMIS-PI and SMFA-BI were -0.84 and 0.65. Reliability was very high for both instruments (mean SE 2.0 [PROMIS-PF], SE 2.1 [PROMIS-PI], and SE 1.2 [SMFA-DI], SE 1.8 [SMFA-BI]). Relative efficiency for PROMIS-PF versus SMFA-DI, and PROMIS-PI versus SMFA-BI was 7.8 (SD 2.5) and 4.1 (SD 1.7), respectively. Neither PROMIS nor SMFA exhibited floor/ceiling effects. In the multivariable regression analyses, elevated levels of depression, among other factors, showed an (independent) association with worse PROMIS-PF and PROMIS-PI scores.

Conclusions: PROMIS-PF and PROMIS-PI CATs showed a (high and moderate) correlation with SMFA and hence measure a comparable construct of physical function and discomfort. As computerized adaptive tests are much more efficient to administer, they present a compelling alternative to SMFA for evaluating impact of fracture treatment. The relation between symptoms of depression and PROMIS scores emphasizes the importance of psychosocial aspects of health in orthopaedic trauma patients.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

目的比较患者报告结果测量信息系统（PROMIS）（身体功能[PF]和疼痛干扰[PI]）计算机自适应测试与传统的简易肌肉骨骼功能评估（SMFA）（功能障碍指数[DI]和困扰指数[BI]）的测量特性。探讨与 PROMIS 评分相关的因素：设计：横断面研究：设计：横断面研究：地点：一级创伤中心：从创伤骨科门诊招募孤立的上肢/下肢骨折患者（2021 年 10 月 1 日至 2023 年 1 月 1 日）：评估相关性（Pearson）、可靠性（标准误差 [SE] [T score]）、效率（每个项目的信息量 [1 - SE2/Nitems]）和地板/天花板效应。r>0.7代表高度相关，SE≤2.2代表足够可靠。此外，还确定了与 PROMIS 评分降低相关的因素：共有202名患者在中位随访98天时完成了PROMs。PROMIS-PF与SMFA-DI之间的相关性为-0.84，PROMIS-PI与SMFA-BI之间的相关性为0.65。两种工具的可靠性都非常高（平均SE为2.0[PROMIS-PF]、SE为2.1[PROMIS-PI]，SE为1.2[SMFA-DI]、SE为1.8[SMFA-BI]）。PROMIS-PF与SMFA-DI、PROMIS-PI与SMFA-BI的相对效率分别为7.8（SD 2.5）和4.1（SD 1.7）。PROMIS和SMFA均未表现出地板/天花板效应。在多变量回归分析中，除其他因素外，抑郁水平的升高与 PROMIS-PF 和 PROMIS-PI 评分的降低有（独立）关联：PROMIS-PF和PROMIS-PI CAT与SMFA显示出（高度和中度）相关性，因此测量的身体功能和不适具有可比性。由于计算机化自适应测试的实施效率更高，因此在评估骨折治疗的影响方面，计算机化自适应测试是SMFA的一个令人信服的替代方案。抑郁症状与PROMIS评分之间的关系强调了创伤骨科患者社会心理方面健康的重要性：预后III级。有关证据等级的完整描述，请参阅 "作者须知"。

{"title":"Enhancing the Evaluation of Physical Function Following Orthopaedic Trauma Care: Comparison of PROMIS Computerized Adaptive Testing and Short Musculoskeletal Function Assessment.","authors":"Michiel A J Luijten, Lotte Haverman, Caroline B Terwee, Martijn Poeze, Diederik O Verbeek","doi":"10.1097/BOT.0000000000002814","DOIUrl":"10.1097/BOT.0000000000002814","url":null,"abstract":"Objectives: To compare measurement properties of Patient-Reported Outcomes Measurement Information System (PROMIS) (physical function [PF] and pain interference [PI]) computerized adaptive testing to traditional Short Musculoskeletal Function Assessment (SMFA) (dysfunction index [DI] and bother index [BI]). To explore factors associated with PROMIS scores.Methods: Design: Cross-sectional study.Setting: Level I Trauma Center.Patient selection criteria: Isolated upper/lower extremity fracture patients were recruited from the orthopaedic trauma outpatient clinic (October 1, 2021 to January 1, 2023).Outcome measures: Correlations (Pearson), reliability (standard error [SE] [T score]), efficiency (amount of information per item [1 - SE2/Nitems]), and floor/ceiling effects were assessed. An r > 0.7 represented high correlation, and SE ≤ 2.2 represented sufficient reliability. Factors associated with worse PROMIS scores were also identified.Results: In total, 202 patients completed PROMs at median 98 days follow-up. Correlations between PROMIS-PF and SMFA-DI, and PROMIS-PI and SMFA-BI were -0.84 and 0.65. Reliability was very high for both instruments (mean SE 2.0 [PROMIS-PF], SE 2.1 [PROMIS-PI], and SE 1.2 [SMFA-DI], SE 1.8 [SMFA-BI]). Relative efficiency for PROMIS-PF versus SMFA-DI, and PROMIS-PI versus SMFA-BI was 7.8 (SD 2.5) and 4.1 (SD 1.7), respectively. Neither PROMIS nor SMFA exhibited floor/ceiling effects. In the multivariable regression analyses, elevated levels of depression, among other factors, showed an (independent) association with worse PROMIS-PF and PROMIS-PI scores.Conclusions: PROMIS-PF and PROMIS-PI CATs showed a (high and moderate) correlation with SMFA and hence measure a comparable construct of physical function and discomfort. As computerized adaptive tests are much more efficient to administer, they present a compelling alternative to SMFA for evaluating impact of fracture treatment. The relation between symptoms of depression and PROMIS scores emphasizes the importance of psychosocial aspects of health in orthopaedic trauma patients.Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11146170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does Scheduled Low-Dose Short-Term NSAID (Ketorolac) Modulate Cytokine Levels After Orthopaedic Polytrauma? A Secondary Analysis of a Randomized Clinical Trial. 计划性低剂量短期非甾体抗炎药（Ketorolac）能否调节骨科多发性创伤后的细胞因子水平？一项随机临床试验的二次分析。

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma

Pub Date : 2024-07-01 DOI: 10.1097/BOT.0000000000002807

Jeffrey A Foster, Gregory S Hawk, David C Landy, Jarod T Griffin, Andrew C Bernard, Douglas R Oyler, Wyatt G S Southall, Maaz Muhammad, Carlos R Sierra-Arce, Samuel D Mounce, Jacob S Borgida, Lusha Xiang, Arun Aneja

Objectives: To determine whether scheduled low-dose, short-term ketorolac modulates cytokine concentrations in orthopaedic polytrauma patients.

Methods:

Design: Secondary analysis of a double-blinded, randomized controlled trial.

Setting: Single Level I trauma center from August 2018 to October 2022.

Patient selection criteria: Orthopaedic polytrauma patients between 18 and 75 years with a New Injury Severity Score greater than 9 were enrolled. Participants were randomized to receive 15 mg of intravenous ketorolac every 6 hours for up to 5 inpatient days or 2 mL of intravenous saline similarly.

Outcome measures and comparisons: Daily concentrations of prostaglandin E2 and interleukin (IL)-1a, IL-1b, IL-6, and IL-10. Clinical outcomes included hospital and intensive care unit length of stay, pulmonary complications, and acute kidney injury.

Results: Seventy orthopaedic polytrauma patients were enrolled, with 35 participants randomized to the ketorolac group and 35 to the placebo group. The overall IL-10 trend over time was significantly different in the ketorolac group ( P = 0.043). IL-6 was 65.8% higher at enrollment compared to day 3 ( P < 0.001) when aggregated over both groups. There was no significant treatment effect for prostaglandin E2, IL-1a, or IL-1b ( P > 0.05). There were no significant differences in clinical outcomes between groups ( P > 0.05).

Conclusions: Scheduled low-dose, short-term, intravenous ketorolac was associated with significantly different mean trends in IL-10 concentration in orthopaedic polytrauma patients with no significant differences in prostaglandin E2, IL-1a, IL-1b, or IL-6 levels between groups. The treatment did not have an impact on clinical outcomes of hospital or intensive care unit length of stay, pulmonary complications, or acute kidney injury.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

目的确定计划中的低剂量、短期酮咯酸是否会调节骨科多发性创伤患者的细胞因子浓度：方法：设计：双盲随机对照试验的二次分析：2018年8月至2022年10月单个一级创伤中心.患者选择标准：年龄在 18-75 岁之间、新伤严重程度评分大于 9 分的骨科多发创伤患者入选。参与者被随机分配接受每 6 小时静脉注射 15 毫克酮咯酸，最多 5 个住院日，或同样接受 2 毫升静脉注射生理盐水：前列腺素 E2 (PGE2)、白细胞介素 (IL)-1a、IL-1b、IL-6 和 IL-10 的每日浓度。临床结果包括住院时间和重症监护室（ICU）时间、肺部并发症和急性肾损伤（AKI）：70名骨科多发性创伤患者参加了研究，其中35人被随机分配到酮咯酸组，35人被随机分配到安慰剂组。随着时间的推移，IL-10的总体趋势在酮咯酸组有显著差异（p = 0.043）。两组的总IL-6在入组时比第3天高65.8%（p < 0.001）。PGE2、IL-1a 或 IL-1b 的治疗效果不明显（p > 0.05）。两组的临床结果无明显差异（P > 0.05）：结论：在骨科多发性创伤患者中，计划的低剂量、短期静脉注射酮咯酸与IL-10浓度的平均趋势显著不同相关，而PGE2、IL-1a、IL-1b或IL-6水平在组间无显著差异。该疗法对住院或重症监护室生存期、肺部并发症或 AKI 等临床结果没有影响：有关证据等级的完整描述，请参阅 "作者须知"。

{"title":"Does Scheduled Low-Dose Short-Term NSAID (Ketorolac) Modulate Cytokine Levels After Orthopaedic Polytrauma? A Secondary Analysis of a Randomized Clinical Trial.","authors":"Jeffrey A Foster, Gregory S Hawk, David C Landy, Jarod T Griffin, Andrew C Bernard, Douglas R Oyler, Wyatt G S Southall, Maaz Muhammad, Carlos R Sierra-Arce, Samuel D Mounce, Jacob S Borgida, Lusha Xiang, Arun Aneja","doi":"10.1097/BOT.0000000000002807","DOIUrl":"10.1097/BOT.0000000000002807","url":null,"abstract":"Objectives: To determine whether scheduled low-dose, short-term ketorolac modulates cytokine concentrations in orthopaedic polytrauma patients.Methods: Design: Secondary analysis of a double-blinded, randomized controlled trial.Setting: Single Level I trauma center from August 2018 to October 2022.Patient selection criteria: Orthopaedic polytrauma patients between 18 and 75 years with a New Injury Severity Score greater than 9 were enrolled. Participants were randomized to receive 15 mg of intravenous ketorolac every 6 hours for up to 5 inpatient days or 2 mL of intravenous saline similarly.Outcome measures and comparisons: Daily concentrations of prostaglandin E2 and interleukin (IL)-1a, IL-1b, IL-6, and IL-10. Clinical outcomes included hospital and intensive care unit length of stay, pulmonary complications, and acute kidney injury.Results: Seventy orthopaedic polytrauma patients were enrolled, with 35 participants randomized to the ketorolac group and 35 to the placebo group. The overall IL-10 trend over time was significantly different in the ketorolac group ( P = 0.043). IL-6 was 65.8% higher at enrollment compared to day 3 ( P < 0.001) when aggregated over both groups. There was no significant treatment effect for prostaglandin E2, IL-1a, or IL-1b ( P > 0.05). There were no significant differences in clinical outcomes between groups ( P > 0.05).Conclusions: Scheduled low-dose, short-term, intravenous ketorolac was associated with significantly different mean trends in IL-10 concentration in orthopaedic polytrauma patients with no significant differences in prostaglandin E2, IL-1a, IL-1b, or IL-6 levels between groups. The treatment did not have an impact on clinical outcomes of hospital or intensive care unit length of stay, pulmonary complications, or acute kidney injury.Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does Anterior Plating of Pelvic Ring Fractures Increase Infection Risk in Patients With Bladder or Urethral Injuries? Erratum. 骨盆环骨折前路钢板置入术会增加膀胱或尿道损伤患者的感染风险吗？勘误。

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma

Pub Date : 2024-07-01 DOI: 10.1097/BOT.0000000000002811

引用次数: 0

Outcomes of Humerus Nonunion Surgery in Patients With Initial Operative Fracture Fixation: Erratum. 初次手术骨折固定患者的肱骨不愈合手术疗效勘误。

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma

Pub Date : 2024-07-01 DOI: 10.1097/BOT.0000000000002818

引用次数: 0