Pub Date : 2024-12-01DOI: 10.1097/BOT.0000000000002894
Augustine M Saiz
{"title":"Displaced Femoral Neck Fracture in a Young Patient: Should I Perform an Open Reduction?","authors":"Augustine M Saiz","doi":"10.1097/BOT.0000000000002894","DOIUrl":"10.1097/BOT.0000000000002894","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 12","pages":"668-670"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915171","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}
Objectives: The midline lateral parapatellar (LP) approach has been shown in a cadaveric study to provide superior articular exposure compared to the anterolateral approach (AL). The purpose of this study was to report on outcomes and complications with the LP approach.
Methods: Design: Retrospective comparative cohort study and prospective cohort.
Setting: Academic Level-I trauma center.
Patient selection criteria: Adult patients with minimum 3 months follow up who underwent open reduction internal fixation (ORIF) of an acute, isolated lateral tibial plateau fracture (OTA/AO 41-B1, 41-B2, 41-B3) via a LP arthrotomy or AL submeniscal arthrotomy between 2010-2019.Outcome Measures and Comparisons: Retrospective cohort evaluated using postoperative complications including infection, delayed wound healing, and reoperation rate. Prospective cohort evaluated using Short Musculoskeletal Function Assessment (SMFA), knee range of motion (ROM), and complications.
Results: The mean age for the LP cohort was 41.5 years (19-79) and 18/32 (56.3%) were male. The mean age for the AL cohort was 42.8 years (18-71) and 29/49 (59.2%) were male. The mean age for patients in the prospective study was 31.4 years (19-59) and 9/14 (64.3%) were male. Mean follow-up was 9.3 months and 20.3 months for the retrospective and prospective cohorts respectively. There was no significant difference in complication or reoperation rate (p>0.39). For the prospective cohort mean ROM was 130 degrees. Mean SMFA dysfunction index (DI) was 9.0 and mean bother index (BI) was 11.1.
Conclusions: The lateral parapatellar approach resulted in comparable clinical and functional outcomes to those seen historically with the anterolateral approach. It is a safe alternative and may be of most benefit when treating comminuted lateral tibial plateau fractures.
{"title":"The Midline Lateral Parapatellar Arthrotomy: A Safe Alternative Approach for Lateral Tibial Plateau Fractures.","authors":"Nathan Heineman, Alexander Turner, Mingyuan Cheng, Ishvinder Grewal, Drew Sanders, Ashoke Sathy","doi":"10.1097/BOT.0000000000002938","DOIUrl":"10.1097/BOT.0000000000002938","url":null,"abstract":"<p><strong>Objectives: </strong>The midline lateral parapatellar (LP) approach has been shown in a cadaveric study to provide superior articular exposure compared to the anterolateral approach (AL). The purpose of this study was to report on outcomes and complications with the LP approach.</p><p><strong>Methods: </strong>Design: Retrospective comparative cohort study and prospective cohort.</p><p><strong>Setting: </strong>Academic Level-I trauma center.</p><p><strong>Patient selection criteria: </strong>Adult patients with minimum 3 months follow up who underwent open reduction internal fixation (ORIF) of an acute, isolated lateral tibial plateau fracture (OTA/AO 41-B1, 41-B2, 41-B3) via a LP arthrotomy or AL submeniscal arthrotomy between 2010-2019.Outcome Measures and Comparisons: Retrospective cohort evaluated using postoperative complications including infection, delayed wound healing, and reoperation rate. Prospective cohort evaluated using Short Musculoskeletal Function Assessment (SMFA), knee range of motion (ROM), and complications.</p><p><strong>Results: </strong>The mean age for the LP cohort was 41.5 years (19-79) and 18/32 (56.3%) were male. The mean age for the AL cohort was 42.8 years (18-71) and 29/49 (59.2%) were male. The mean age for patients in the prospective study was 31.4 years (19-59) and 9/14 (64.3%) were male. Mean follow-up was 9.3 months and 20.3 months for the retrospective and prospective cohorts respectively. There was no significant difference in complication or reoperation rate (p>0.39). For the prospective cohort mean ROM was 130 degrees. Mean SMFA dysfunction index (DI) was 9.0 and mean bother index (BI) was 11.1.</p><p><strong>Conclusions: </strong>The lateral parapatellar approach resulted in comparable clinical and functional outcomes to those seen historically with the anterolateral approach. It is a safe alternative and may be of most benefit when treating comminuted lateral tibial plateau fractures.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729715","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}
Pub Date : 2024-10-01DOI: 10.1097/BOT.0000000000002874
Julianna E Winter, Jacob S Budin, Bela P Delvadia, Arjun Verma, William F Sherman, K Chandra Vemulapalli, Olivia C Lee
<p><strong>Objectives: </strong>To evaluate the risk of developing a new mental disorder diagnosis within 2 years of lower extremity fracture.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>National insurance claims database.</p><p><strong>Patient selection criteria: </strong>Patients between 18 and 65 years with lower extremity, pelvis, and acetabular fractures without prior mental disorders as defined using International Classification of Diseases, 9th and 10th revision diagnosis codes were included. Mental disorders evaluated included alcohol use disorder, generalized anxiety disorder, bipolar disorder, major depressive disorder, drug use disorder, panic disorder, posttraumatic stress disorder, and suicide attempt.</p><p><strong>Outcome measures and comparisons: </strong>The individual lower extremity fracture cohorts were matched 1:4 with nonfracture controls. The specific groups of interest were pelvis fractures, acetabulum fractures, proximal femur fractures, femoral shaft fractures, distal femur fractures, patella fractures, tibia plateau fractures, tibia shaft fractures, ankle fractures, pilon fractures, calcaneus fractures, and Lisfranc fractures. Rates of mental disorders after primary lower extremity fractures within 2 years were compared using multivariable logistic regression.</p><p><strong>Results: </strong>Overall, the 263,988 patient-fracture group was 57.2% female with an average age of 46.6 years. Compared with controls with no fracture, patients who sustained pelvis, acetabulum, proximal femur, femoral shaft, distal femur, patella, tibia plateau, tibia shaft, pilon, calcaneus, or Lisfranc fracture had a statistically significantly increased risk of being diagnosed with a queried mental disorder within 2 years of fracture. When comparing all fracture patients by location, those suffering from fractures proximal to the knee joint, including pelvis fractures [OR: 1.51, 95% confidence interval (CI): 1.39-1.64] and proximal femur fractures [odds ratio (OR): 1.36, 95% CI: 1.26-1.47], demonstrated greater risk of developing any of the queried mental disorders compared with fractures distal to the knee, including ankle fractures (OR: 0.99, 95% CI: 0.95-1.03) and pilon fractures (OR: 1.05, 95% CI: 0.81-1.36). When comparing specific fracture patients with patients without fracture by mental disorder, patients demonstrated an increased risk of suicide attempt following fracture of the pelvis, acetabulum, femoral shaft, distal femur, and calcaneus, as well as patients sustaining a Lisfranc fracture.</p><p><strong>Conclusions: </strong>There is an increased risk of being diagnosed with a new mental disorder following lower extremity trauma in patients without prior mental disorder diagnosis compared with matched individuals without a lower extremity fracture. Among the fractures studied, those that were more proximal, such as pelvis and proximal femur fractures, c
{"title":"Lower Extremity Trauma is Associated With an Increased Rate of New Mental Disorder Diagnosis and Suicide Attempt.","authors":"Julianna E Winter, Jacob S Budin, Bela P Delvadia, Arjun Verma, William F Sherman, K Chandra Vemulapalli, Olivia C Lee","doi":"10.1097/BOT.0000000000002874","DOIUrl":"10.1097/BOT.0000000000002874","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the risk of developing a new mental disorder diagnosis within 2 years of lower extremity fracture.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>National insurance claims database.</p><p><strong>Patient selection criteria: </strong>Patients between 18 and 65 years with lower extremity, pelvis, and acetabular fractures without prior mental disorders as defined using International Classification of Diseases, 9th and 10th revision diagnosis codes were included. Mental disorders evaluated included alcohol use disorder, generalized anxiety disorder, bipolar disorder, major depressive disorder, drug use disorder, panic disorder, posttraumatic stress disorder, and suicide attempt.</p><p><strong>Outcome measures and comparisons: </strong>The individual lower extremity fracture cohorts were matched 1:4 with nonfracture controls. The specific groups of interest were pelvis fractures, acetabulum fractures, proximal femur fractures, femoral shaft fractures, distal femur fractures, patella fractures, tibia plateau fractures, tibia shaft fractures, ankle fractures, pilon fractures, calcaneus fractures, and Lisfranc fractures. Rates of mental disorders after primary lower extremity fractures within 2 years were compared using multivariable logistic regression.</p><p><strong>Results: </strong>Overall, the 263,988 patient-fracture group was 57.2% female with an average age of 46.6 years. Compared with controls with no fracture, patients who sustained pelvis, acetabulum, proximal femur, femoral shaft, distal femur, patella, tibia plateau, tibia shaft, pilon, calcaneus, or Lisfranc fracture had a statistically significantly increased risk of being diagnosed with a queried mental disorder within 2 years of fracture. When comparing all fracture patients by location, those suffering from fractures proximal to the knee joint, including pelvis fractures [OR: 1.51, 95% confidence interval (CI): 1.39-1.64] and proximal femur fractures [odds ratio (OR): 1.36, 95% CI: 1.26-1.47], demonstrated greater risk of developing any of the queried mental disorders compared with fractures distal to the knee, including ankle fractures (OR: 0.99, 95% CI: 0.95-1.03) and pilon fractures (OR: 1.05, 95% CI: 0.81-1.36). When comparing specific fracture patients with patients without fracture by mental disorder, patients demonstrated an increased risk of suicide attempt following fracture of the pelvis, acetabulum, femoral shaft, distal femur, and calcaneus, as well as patients sustaining a Lisfranc fracture.</p><p><strong>Conclusions: </strong>There is an increased risk of being diagnosed with a new mental disorder following lower extremity trauma in patients without prior mental disorder diagnosis compared with matched individuals without a lower extremity fracture. Among the fractures studied, those that were more proximal, such as pelvis and proximal femur fractures, c","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"547-556"},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759339","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}
Pub Date : 2024-10-01DOI: 10.1097/BOT.0000000000002865
Nihar S Shah, Sarah N Pierrie, Julie Agel, Reza Firoozabadi, H Claude Sagi
Objectives: Individuals with pelvic and acetabular fractures are at high risk of venous thromboembolism (VTE). The purpose of this study was to determine whether serum markers for thrombophilia and rapid thromboelastography (r-TEG) values correlate with increased VTE risk among patients with pelvic and acetabular fractures.
Methods: .
Design: Prospective observational study.
Setting: Two urban academic level 1 trauma centers.
Patient selection criteria: Adult patients with isolated pelvis and/or acetabulum fractures (OTA/AO 61 and 62) treated surgically placed on a standardized VTE chemoprophylaxis regimen with enoxaparin over a 5-year period were included.
Outcome measures and comparisons: Serum r-TEG, coagulation laboratory values, and markers for heritable thrombophilia were drawn postoperatively and after completion of a 6-week course of enoxaparin. The primary outcome was VTE event (either deep venous thrombosis or pulmonary embolism) diagnosed using a Duplex ultrasound, chest computed tomography angiogram, or lung ventilation-perfusion ordered based on clinical suspicion of a VTE event. Laboratory markers and values were then compared between patients who went on to have a VTE event and those who did not and patients with and without markers of thrombophilia.
Results: One hundred thirty-three adult patients with isolated operative pelvic and/or acetabular fractures were enrolled in this study. The average age of patients at time of injury was 48.3 years (range 18-91). Sixty-seven percent of patients in the study were (n = 90) males. Sixty-three percent of patients (n = 84) completed both clinical and laboratory follow-up. Forty-one percent of patients (n = 54) had 1 or more markers of heritable thrombophilia. Twelve percent (n = 10) of patients who completed follow-up were diagnosed with VTE. Age, sex, and smoking status were not associated with VTE. Patients who developed VTE had a higher body mass index (P = 0.04). Having more than 1 marker of heritable thrombophilia (P = 0.004) and an r-TEG mean amplitude greater than 72 mm postoperatively was positively associated with VTE (P = 0.02).
Conclusions: Among patients treated surgically for isolated pelvic and acetabular fractures who received enoxaparin prophylaxis, the presence of more than 1 marker of heritable thrombophilia or r-TEG mean amplitude value greater than 72 mm postoperatively was associated with an increased risk of VTE.
Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Heritable Thrombophilia and Increased Risk for Venous Thromboembolism Despite Thromboprophylaxis After Pelvis or Acetabulum Fracture.","authors":"Nihar S Shah, Sarah N Pierrie, Julie Agel, Reza Firoozabadi, H Claude Sagi","doi":"10.1097/BOT.0000000000002865","DOIUrl":"10.1097/BOT.0000000000002865","url":null,"abstract":"<p><strong>Objectives: </strong>Individuals with pelvic and acetabular fractures are at high risk of venous thromboembolism (VTE). The purpose of this study was to determine whether serum markers for thrombophilia and rapid thromboelastography (r-TEG) values correlate with increased VTE risk among patients with pelvic and acetabular fractures.</p><p><strong>Methods: </strong>.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Two urban academic level 1 trauma centers.</p><p><strong>Patient selection criteria: </strong>Adult patients with isolated pelvis and/or acetabulum fractures (OTA/AO 61 and 62) treated surgically placed on a standardized VTE chemoprophylaxis regimen with enoxaparin over a 5-year period were included.</p><p><strong>Outcome measures and comparisons: </strong>Serum r-TEG, coagulation laboratory values, and markers for heritable thrombophilia were drawn postoperatively and after completion of a 6-week course of enoxaparin. The primary outcome was VTE event (either deep venous thrombosis or pulmonary embolism) diagnosed using a Duplex ultrasound, chest computed tomography angiogram, or lung ventilation-perfusion ordered based on clinical suspicion of a VTE event. Laboratory markers and values were then compared between patients who went on to have a VTE event and those who did not and patients with and without markers of thrombophilia.</p><p><strong>Results: </strong>One hundred thirty-three adult patients with isolated operative pelvic and/or acetabular fractures were enrolled in this study. The average age of patients at time of injury was 48.3 years (range 18-91). Sixty-seven percent of patients in the study were (n = 90) males. Sixty-three percent of patients (n = 84) completed both clinical and laboratory follow-up. Forty-one percent of patients (n = 54) had 1 or more markers of heritable thrombophilia. Twelve percent (n = 10) of patients who completed follow-up were diagnosed with VTE. Age, sex, and smoking status were not associated with VTE. Patients who developed VTE had a higher body mass index (P = 0.04). Having more than 1 marker of heritable thrombophilia (P = 0.004) and an r-TEG mean amplitude greater than 72 mm postoperatively was positively associated with VTE (P = 0.02).</p><p><strong>Conclusions: </strong>Among patients treated surgically for isolated pelvic and acetabular fractures who received enoxaparin prophylaxis, the presence of more than 1 marker of heritable thrombophilia or r-TEG mean amplitude value greater than 72 mm postoperatively was associated with an increased risk of VTE.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"38 10","pages":"521-526"},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348671","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}
Pub Date : 2024-10-01DOI: 10.1097/BOT.0000000000002875
Objective: To determine how fracture clinic patients perceive the dangers of distracted driving.
Methods:
Design: Analysis of patient perception subset data from the original DRIVSAFE study; a large, multicenter cross-sectional study, surveying fracture clinic patients about distracted driving.
Setting: Four Level 1 Canadian trauma center fracture clinics.
Patient selection criteria: English-speaking patients with a valid Canadian driver's license and a traumatic musculoskeletal injury sustained in the past 6 months.
Outcome measures and comparisons: Primary outcome was patients' safety ratings of driving distractions. As per the original DRIVSAFE study, patients were categorized as distraction-prone or distraction-averse using their questionnaire responses and published crash-risk odds ratios (ORs). A regression analysis was performed to identify associations with unsafe driving perceptions.
Results: The study included 1378 patients, 749 (54.3%) male and 614 (44.6%) female. The average age was 45.8 ± 17.0 years (range 16-87). Sending electronic messages was perceived as unsafe by 92.9% (1242/1337) of patients, while reading them was seen as unsafe by 81.2% (1086/1337). Approximately three-quarters of patients viewed making (78.9%, 1061/1344) and accepting (74.8%, 998/1335) calls on handheld mobile phones as unsafe. However, 31.0% (421/1356) of patients believed that they had no differences in their driving ability when talking on the phone while 13.1% (175/1340) reported no driving differences when texting. Younger age (OR, 0.93 [95% confidence interval (CI) 0.90-0.96], P < 0.001), driving experience (OR, 1.06 [95% CI 1.02-1.09], P < 0.001), and distraction-prone drivers (OR, 3.79 [95% CI 2.91-4.94], P < 0.001) were associated with unsafe driving perceptions.
Conclusions: There is a clear association between being prone to distractions and unsafe driving perceptions, with distraction-prone drivers being 3.8 times more likely to perceive driving distractions as safe. This information could potentially influence the appropriate delivery and content of future educational efforts to change the perception of driving distractions and thereby reduce distracted driving.
Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
{"title":"The Dangers of Distracted Driving: A Substudy of Patient Perception Data From the DRIVSAFE Observational Study.","authors":"","doi":"10.1097/BOT.0000000000002875","DOIUrl":"10.1097/BOT.0000000000002875","url":null,"abstract":"<p><strong>Objective: </strong>To determine how fracture clinic patients perceive the dangers of distracted driving.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Analysis of patient perception subset data from the original DRIVSAFE study; a large, multicenter cross-sectional study, surveying fracture clinic patients about distracted driving.</p><p><strong>Setting: </strong>Four Level 1 Canadian trauma center fracture clinics.</p><p><strong>Patient selection criteria: </strong>English-speaking patients with a valid Canadian driver's license and a traumatic musculoskeletal injury sustained in the past 6 months.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcome was patients' safety ratings of driving distractions. As per the original DRIVSAFE study, patients were categorized as distraction-prone or distraction-averse using their questionnaire responses and published crash-risk odds ratios (ORs). A regression analysis was performed to identify associations with unsafe driving perceptions.</p><p><strong>Results: </strong>The study included 1378 patients, 749 (54.3%) male and 614 (44.6%) female. The average age was 45.8 ± 17.0 years (range 16-87). Sending electronic messages was perceived as unsafe by 92.9% (1242/1337) of patients, while reading them was seen as unsafe by 81.2% (1086/1337). Approximately three-quarters of patients viewed making (78.9%, 1061/1344) and accepting (74.8%, 998/1335) calls on handheld mobile phones as unsafe. However, 31.0% (421/1356) of patients believed that they had no differences in their driving ability when talking on the phone while 13.1% (175/1340) reported no driving differences when texting. Younger age (OR, 0.93 [95% confidence interval (CI) 0.90-0.96], P < 0.001), driving experience (OR, 1.06 [95% CI 1.02-1.09], P < 0.001), and distraction-prone drivers (OR, 3.79 [95% CI 2.91-4.94], P < 0.001) were associated with unsafe driving perceptions.</p><p><strong>Conclusions: </strong>There is a clear association between being prone to distractions and unsafe driving perceptions, with distraction-prone drivers being 3.8 times more likely to perceive driving distractions as safe. This information could potentially influence the appropriate delivery and content of future educational efforts to change the perception of driving distractions and thereby reduce distracted driving.</p><p><strong>Level of evidence: </strong>Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"e347-e354"},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759375","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}
Pub Date : 2024-09-18DOI: 10.1097/bot.0000000000002911
Abrianna S Robles,Zachary A Rockov,Melissa M Gross,Brett A Ewing,Charles M Lieder,Brian M Weatherford,Ashley E Levack,John M Garlich,Justin M Haller,Jeffrey S Earhart,Geoffrey S Marecek
OBJECTIVESTo evaluate the incidence of anterolateral tibial plafond involvement in pronation-abduction (PAB) ankle fractures and analyze the accuracy of radiographs in detecting anterolateral tibial plafond involvement, impaction, and predicting the need for direct visualization and an articular reduction.METHODSDesign: A multi-institutional retrospective chart review.SETTINGFive level 1 trauma centers in the United States.PATIENT SELECTION CRITERIAAdult patients with PAB ankle fractures (OTA/AO 44B2.3, 44C2.2, 44C2.3) from 2020-2022 were reviewed by 7 fellowship-trained orthopedic trauma surgeons. They were queried about the presence of anterolateral tibial plafond involvement and impaction, and whether they would need direct visualization and an articular reduction using both radiographs and CT.OUTCOME MEASUREMENTS AND COMPARISONSThe presence of anterolateral tibial plafond impaction was tabulated separately using radiographs and CT scans. The accuracy of radiographs and changes in surgical plan after CT review were calculated using CT as the gold standard.RESULTS61 fractures in 61 patients were evaluated with CT and/or plain radiographs. Using plain radiographs, anterolateral tibial plafond involvement and impaction were identified in 61% and 36% of cases, respectively. In the 38 fractures with both plain radiographs and CT scans, anterolateral tibial plafond involvement was identified in 66% of radiographs and 74% of CT scans (p = 0.4). Plafond impaction was identified in 42% of plain radiographs and 37% of CT scans (p = 0.62). There was no difference in the rate of involvement between radiographs and CT scan. The diagnosis of anterolateral tibial plafond impaction using plain radiographs was correct in 74% of fractures when compared to CT imaging, resulting in a sensitivity of 71%, a specificity of 75%, a positive predictive value (PPV) of 62%, and a negative predictive value (NPV) of 82%. Plain radiographs correctly predicted the need for direct visualization and an articular reduction in 74% of cases and had a PPV of 59% and a NPV of 86%.CONCLUSIONSAnterolateral tibial plafond involvement and impaction was present on CT in 74% and 37% of pronation-abduction (PAB) ankle fractures, respectively. Plain radiographs had higher NPV for identifying impaction and the need for articular reduction than they did sensitivity, specificity or PPV. CT is an important tool for preoperative planning that should be considered when planning for operative fixation of PAB ankle fractures.LEVEL OF EVIDENCEPrognostic level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Radiographic Accuracy of Identifying Anterolateral Tibial Plafond Involvement in Pronation Abduction Ankle Fractures.","authors":"Abrianna S Robles,Zachary A Rockov,Melissa M Gross,Brett A Ewing,Charles M Lieder,Brian M Weatherford,Ashley E Levack,John M Garlich,Justin M Haller,Jeffrey S Earhart,Geoffrey S Marecek","doi":"10.1097/bot.0000000000002911","DOIUrl":"https://doi.org/10.1097/bot.0000000000002911","url":null,"abstract":"OBJECTIVESTo evaluate the incidence of anterolateral tibial plafond involvement in pronation-abduction (PAB) ankle fractures and analyze the accuracy of radiographs in detecting anterolateral tibial plafond involvement, impaction, and predicting the need for direct visualization and an articular reduction.METHODSDesign: A multi-institutional retrospective chart review.SETTINGFive level 1 trauma centers in the United States.PATIENT SELECTION CRITERIAAdult patients with PAB ankle fractures (OTA/AO 44B2.3, 44C2.2, 44C2.3) from 2020-2022 were reviewed by 7 fellowship-trained orthopedic trauma surgeons. They were queried about the presence of anterolateral tibial plafond involvement and impaction, and whether they would need direct visualization and an articular reduction using both radiographs and CT.OUTCOME MEASUREMENTS AND COMPARISONSThe presence of anterolateral tibial plafond impaction was tabulated separately using radiographs and CT scans. The accuracy of radiographs and changes in surgical plan after CT review were calculated using CT as the gold standard.RESULTS61 fractures in 61 patients were evaluated with CT and/or plain radiographs. Using plain radiographs, anterolateral tibial plafond involvement and impaction were identified in 61% and 36% of cases, respectively. In the 38 fractures with both plain radiographs and CT scans, anterolateral tibial plafond involvement was identified in 66% of radiographs and 74% of CT scans (p = 0.4). Plafond impaction was identified in 42% of plain radiographs and 37% of CT scans (p = 0.62). There was no difference in the rate of involvement between radiographs and CT scan. The diagnosis of anterolateral tibial plafond impaction using plain radiographs was correct in 74% of fractures when compared to CT imaging, resulting in a sensitivity of 71%, a specificity of 75%, a positive predictive value (PPV) of 62%, and a negative predictive value (NPV) of 82%. Plain radiographs correctly predicted the need for direct visualization and an articular reduction in 74% of cases and had a PPV of 59% and a NPV of 86%.CONCLUSIONSAnterolateral tibial plafond involvement and impaction was present on CT in 74% and 37% of pronation-abduction (PAB) ankle fractures, respectively. Plain radiographs had higher NPV for identifying impaction and the need for articular reduction than they did sensitivity, specificity or PPV. CT is an important tool for preoperative planning that should be considered when planning for operative fixation of PAB ankle fractures.LEVEL OF EVIDENCEPrognostic level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"43 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258368","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}
Pub Date : 2024-09-05DOI: 10.1097/bot.0000000000002908
Cassandra Ricketts,Mir Ibrahim Sajid,Meghan McCaskey,Reed Andrews,Hassan R Mir
OBJECTIVESTo describe and report outcomes of a minimally invasive open intramedullary (IM) fibular nailing technique for fixation of ankle fractures.METHODSDesign: Case Series.SETTINGUrban Level 1 trauma center.PATIENT SELECTION CRITERIAAdult patients with ankle fractures (OTA 44A-C) treated with locked fibular IM nailing via a minimally invasive open technique for fracture and syndesmotic reduction between 2021 and 2024.Outcome Measures and Comparisons: Quality of reduction, complications, and patient-reported outcomes (PRO).RESULTSA total of 150 consecutive patients operated by a single surgeon were included. Mean age was 53.3 (17-97) years, and mean BMI was 30.6 ± 7.4 kg/m2. 93(62%) patients were female, and 78 (52%) patients were Caucasian. 72 (48%) patients were obese, 40 (27.7%) patients were current/former smokers, 39 (26%) patients were diabetic, and 23 (15.3%) patients had open fractures. 37 (24.7%) patients had isolated lateral malleolus fractures, 48 (32%) had bimalleolar fractures, and 65(43.3%) had trimalleolar fractures. 123 (82%) patients had 2 syndesmotic screws placed, 26 (17.3%) had 1 screw, and 1 (0.7%) had none.Quality of reduction was good for 98%, fair for 2%, and poor for none per McLennan's criteria. 113 patients (75.3%) were followed until clinical and radiographic union for a mean of 7.6 months (range 3-22) months). 110 patients (97.3%) went on to successful clinical and radiographic union following the index procedure. No patient had a superficial surgical-site infection, and 3 (2.6%) had deep surgical-site infections. 3 patients had a loss of reduction, and 6 patients had implant failure (5 broken syndesmotic screws, and 1 medial malleolus screw). 9 (8%) patients had unplanned reoperations (3 for debridement, 2 for loss of reduction, and 4 for removal of symptomatic implants).Mean ankle range of motion at final follow-up visit was 12.9° (0-40) of dorsiflexion, 39.6° (10-70) of plantarflexion, 23.5° (5-40) of inversion, and 18.2° (5-50) of eversion. Mean PROs at final follow-up visit were: Global Physical Health: 42.4 (23.5-67.6), Global Mental Health: 47.5 (21-67.6), Physical Function: 37.5 (14.7-57.8), Pain: 54.9 (22-72) and Mobility: 36.9 (16-65.3).CONCLUSIONSMinimally invasive open fibular IM nailing allowed for excellent reduction and results in union with low rates of complications and good patient reported outcomes.LEVEL OF EVIDENCETherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Ankle Fractures Treated with Locked Fibular Intramedullary Nailing: Description and Outcomes of a Minimally Invasive Open Technique.","authors":"Cassandra Ricketts,Mir Ibrahim Sajid,Meghan McCaskey,Reed Andrews,Hassan R Mir","doi":"10.1097/bot.0000000000002908","DOIUrl":"https://doi.org/10.1097/bot.0000000000002908","url":null,"abstract":"OBJECTIVESTo describe and report outcomes of a minimally invasive open intramedullary (IM) fibular nailing technique for fixation of ankle fractures.METHODSDesign: Case Series.SETTINGUrban Level 1 trauma center.PATIENT SELECTION CRITERIAAdult patients with ankle fractures (OTA 44A-C) treated with locked fibular IM nailing via a minimally invasive open technique for fracture and syndesmotic reduction between 2021 and 2024.Outcome Measures and Comparisons: Quality of reduction, complications, and patient-reported outcomes (PRO).RESULTSA total of 150 consecutive patients operated by a single surgeon were included. Mean age was 53.3 (17-97) years, and mean BMI was 30.6 ± 7.4 kg/m2. 93(62%) patients were female, and 78 (52%) patients were Caucasian. 72 (48%) patients were obese, 40 (27.7%) patients were current/former smokers, 39 (26%) patients were diabetic, and 23 (15.3%) patients had open fractures. 37 (24.7%) patients had isolated lateral malleolus fractures, 48 (32%) had bimalleolar fractures, and 65(43.3%) had trimalleolar fractures. 123 (82%) patients had 2 syndesmotic screws placed, 26 (17.3%) had 1 screw, and 1 (0.7%) had none.Quality of reduction was good for 98%, fair for 2%, and poor for none per McLennan's criteria. 113 patients (75.3%) were followed until clinical and radiographic union for a mean of 7.6 months (range 3-22) months). 110 patients (97.3%) went on to successful clinical and radiographic union following the index procedure. No patient had a superficial surgical-site infection, and 3 (2.6%) had deep surgical-site infections. 3 patients had a loss of reduction, and 6 patients had implant failure (5 broken syndesmotic screws, and 1 medial malleolus screw). 9 (8%) patients had unplanned reoperations (3 for debridement, 2 for loss of reduction, and 4 for removal of symptomatic implants).Mean ankle range of motion at final follow-up visit was 12.9° (0-40) of dorsiflexion, 39.6° (10-70) of plantarflexion, 23.5° (5-40) of inversion, and 18.2° (5-50) of eversion. Mean PROs at final follow-up visit were: Global Physical Health: 42.4 (23.5-67.6), Global Mental Health: 47.5 (21-67.6), Physical Function: 37.5 (14.7-57.8), Pain: 54.9 (22-72) and Mobility: 36.9 (16-65.3).CONCLUSIONSMinimally invasive open fibular IM nailing allowed for excellent reduction and results in union with low rates of complications and good patient reported outcomes.LEVEL OF EVIDENCETherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"41 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185934","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}
Pub Date : 2024-09-05DOI: 10.1097/bot.0000000000002910
Christian Michelitsch,Benedikt Jochum,Andrin Baer,Samuel Haupt,Philipp F Stillhard,Jonathan Copp,Christoph Sommer
OBJECTIVESTo evaluate the surgical outcomes of femoral neck fractures (FNF) in young adults treated with a closed reduction technique as it pertains to reduction quality, rates of union and risk factors for complication.METHODSDesign: Retrospective cohort study with radiograph and electronic medical record review.SETTINGLevel 1 Swiss Trauma center.PATIENT SELECTION CRITERIABetween 2012 and 2021, young adults with isolated FNF (AO/OTA 31-B1) treated with percutaneous screw fixation were selected. Exclusion criteria were open reduction technique, age over 65 or under 16, pathologic fractures, associated femoral head or shaft fractures.OUTCOME MEASURES AND COMPARISONSPrimary outcome was quality of reduction, as assessed by three experienced trauma surgeons' evaluation of, intraoperative and/or first postoperative radiographs using the overall impression, the Garden's alignment index, and Lowell`s criteria. Additionally, clinical outcomes, conversion to arthroplasty and complications following closed reduction and fixation of femoral neck fractures was reviewed.RESULTSA total of 54 patients with a median (IQR) age of 57.5 (48-60) years were included. Among them, 22 (41%) were female and 32 (59%) were male. The closed reduction technique demonstrated satisfactory reduction results in up to 87% of cases. Major complications occurred in 19%, with 17% requiring conversion to total hip arthroplasty. Unacceptable or borderline acceptable reduction quality correlated significantly with the need for later conversion (p=0.03).CONCLUSIONSThe study supported the use of the closed reduction technique for acute FNF in patients under 65, achieving satisfactory reduction results in up to 87% of cases with comparable complication rates to treatment of young femoral neck fractures with open reduction. Furthermore, it underscored the significance of the surgeon's overall impression of reduction quality, alongside the established reduction criteria, the Garden alignment index and Lowell's criteria, in evaluating the quality of the reduction. Additionally, risk of conversion to total hip arthroplasty was associated with worse closed reduction quality.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Closed reduction followed by percutaneous fixation of acute femoral neck fractures in young adults: a retrospective cohort study.","authors":"Christian Michelitsch,Benedikt Jochum,Andrin Baer,Samuel Haupt,Philipp F Stillhard,Jonathan Copp,Christoph Sommer","doi":"10.1097/bot.0000000000002910","DOIUrl":"https://doi.org/10.1097/bot.0000000000002910","url":null,"abstract":"OBJECTIVESTo evaluate the surgical outcomes of femoral neck fractures (FNF) in young adults treated with a closed reduction technique as it pertains to reduction quality, rates of union and risk factors for complication.METHODSDesign: Retrospective cohort study with radiograph and electronic medical record review.SETTINGLevel 1 Swiss Trauma center.PATIENT SELECTION CRITERIABetween 2012 and 2021, young adults with isolated FNF (AO/OTA 31-B1) treated with percutaneous screw fixation were selected. Exclusion criteria were open reduction technique, age over 65 or under 16, pathologic fractures, associated femoral head or shaft fractures.OUTCOME MEASURES AND COMPARISONSPrimary outcome was quality of reduction, as assessed by three experienced trauma surgeons' evaluation of, intraoperative and/or first postoperative radiographs using the overall impression, the Garden's alignment index, and Lowell`s criteria. Additionally, clinical outcomes, conversion to arthroplasty and complications following closed reduction and fixation of femoral neck fractures was reviewed.RESULTSA total of 54 patients with a median (IQR) age of 57.5 (48-60) years were included. Among them, 22 (41%) were female and 32 (59%) were male. The closed reduction technique demonstrated satisfactory reduction results in up to 87% of cases. Major complications occurred in 19%, with 17% requiring conversion to total hip arthroplasty. Unacceptable or borderline acceptable reduction quality correlated significantly with the need for later conversion (p=0.03).CONCLUSIONSThe study supported the use of the closed reduction technique for acute FNF in patients under 65, achieving satisfactory reduction results in up to 87% of cases with comparable complication rates to treatment of young femoral neck fractures with open reduction. Furthermore, it underscored the significance of the surgeon's overall impression of reduction quality, alongside the established reduction criteria, the Garden alignment index and Lowell's criteria, in evaluating the quality of the reduction. Additionally, risk of conversion to total hip arthroplasty was associated with worse closed reduction quality.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"57 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185947","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}
Pub Date : 2024-09-05DOI: 10.1097/bot.0000000000002914
Muhamed M Farhan-Alanie,Alastair Stephens,Hamza Umar,Ali Ridha,Mateen Arastu,Michael Blankstein
OBJECTIVESThis study aimed to compare 30-day post-operative mortality, and revision for aseptic femoral component loosening and all-causes following hip hemiarthroplasty performed with or without pressurisation of the bone cement in neck of femur fracture patients.METHODSDesign: Retrospective cohort study.SETTINGLevel I trauma center.PATIENT SELECTION CRITERIAPatients ≥60 years with OTA/AO 31B who underwent a cemented hip hemiarthroplasty from 10th December 2007 (database inception) to 15th November 2023 (search date) were reviewed.Outcome Measures and Comparisons: Comparisons were made between patients who underwent hip hemiarthroplasty with versus without pressurisation of the bone cement for outcomes 30-day post-operative mortality, revision for aseptic femoral component loosening, and revision for all-causes.RESULTS406 procedures among 402 patients, and 722 procedures among 713 patients were performed with and without pressurisation of the bone cement respectively. Mean ages were 83.1 and 84.3 years (p=0.018), with 72.2% and 68.6% (p=0.205) females in the pressurised and non-pressurised cement patient groups respectively. There were no differences in 30-day post-operative mortality (7.2% versus 8.2%; HR 0.89, 95%CI 0.46-1.73, p=0.727). There were no differences in all-cause revision (HR 1.04, 95%CI 0.27-4.04, p=0.953). No revisions were performed for aseptic loosening. Survival at 10 years post-operatively was 15.3% (95%CI 11.46-19.64) and 12.6% (95%CI 7.67-18.82) among patients who underwent hemiarthroplasty with and without bone cement pressurisation respectively.CONCLUSIONSThere were no differences in 30-day post-operative mortality among patients who underwent hemiarthroplasty with, compared to, without bone cement pressurisation. Bone cement pressurisation did not confer any advantages for revision outcomes which may be attributed in part to patients' high mortality rate and low survival beyond 10 years post-operatively.LEVEL OF EVIDENCELevel III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Shall We Not Pressurise It? Effects of Bone Cement Pressurisation on Mortality and Revision Following Hip Hemiarthroplasty for Neck of Femur Fracture Patients: A Comparative Cohort Study.","authors":"Muhamed M Farhan-Alanie,Alastair Stephens,Hamza Umar,Ali Ridha,Mateen Arastu,Michael Blankstein","doi":"10.1097/bot.0000000000002914","DOIUrl":"https://doi.org/10.1097/bot.0000000000002914","url":null,"abstract":"OBJECTIVESThis study aimed to compare 30-day post-operative mortality, and revision for aseptic femoral component loosening and all-causes following hip hemiarthroplasty performed with or without pressurisation of the bone cement in neck of femur fracture patients.METHODSDesign: Retrospective cohort study.SETTINGLevel I trauma center.PATIENT SELECTION CRITERIAPatients ≥60 years with OTA/AO 31B who underwent a cemented hip hemiarthroplasty from 10th December 2007 (database inception) to 15th November 2023 (search date) were reviewed.Outcome Measures and Comparisons: Comparisons were made between patients who underwent hip hemiarthroplasty with versus without pressurisation of the bone cement for outcomes 30-day post-operative mortality, revision for aseptic femoral component loosening, and revision for all-causes.RESULTS406 procedures among 402 patients, and 722 procedures among 713 patients were performed with and without pressurisation of the bone cement respectively. Mean ages were 83.1 and 84.3 years (p=0.018), with 72.2% and 68.6% (p=0.205) females in the pressurised and non-pressurised cement patient groups respectively. There were no differences in 30-day post-operative mortality (7.2% versus 8.2%; HR 0.89, 95%CI 0.46-1.73, p=0.727). There were no differences in all-cause revision (HR 1.04, 95%CI 0.27-4.04, p=0.953). No revisions were performed for aseptic loosening. Survival at 10 years post-operatively was 15.3% (95%CI 11.46-19.64) and 12.6% (95%CI 7.67-18.82) among patients who underwent hemiarthroplasty with and without bone cement pressurisation respectively.CONCLUSIONSThere were no differences in 30-day post-operative mortality among patients who underwent hemiarthroplasty with, compared to, without bone cement pressurisation. Bone cement pressurisation did not confer any advantages for revision outcomes which may be attributed in part to patients' high mortality rate and low survival beyond 10 years post-operatively.LEVEL OF EVIDENCELevel III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"42 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185949","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}
Pub Date : 2024-09-05DOI: 10.1097/bot.0000000000002913
Andrew B Rees,Alexander R Dombrowsky,Samuel L Posey,Meghan K Wally,Laurence B Kempton,Joseph R Hsu,Kevin D Phelps
{"title":"Why Make the Cut? The Anconeus Triceps Hemipeel Approach for Distal Humerus Exposure Without Olecranon Osteotomy.","authors":"Andrew B Rees,Alexander R Dombrowsky,Samuel L Posey,Meghan K Wally,Laurence B Kempton,Joseph R Hsu,Kevin D Phelps","doi":"10.1097/bot.0000000000002913","DOIUrl":"https://doi.org/10.1097/bot.0000000000002913","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":"25 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185935","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}
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