Journal of Orthopaedic Trauma最新文献_第5页

Comparison of Operative and Non-Operative Management of Elderly Fragility Pelvic Ring Fractures 老年脆性骨盆环骨折的手术和非手术疗法比较

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-06-13 DOI: 10.1097/bot.0000000000002863

Riley A. Swenson, T. Paull, Rob A. Yates, Jeffrey A. Foster, Jarod T. Griffin, Wyatt G. S. Southall, Arun Aneja, Mai P. Nguyen

To compare outcomes of nonoperative and percutaneous fixation of geriatric fragility lateral compression I (LC1) pelvic ring fractures. Design: Retrospective Two level one trauma centers Included were patients 60 years of age or older with an isolated LC1 pelvic ring fracture managed nonoperatively or those who failed mobilization and were managed operatively with percutaneous sacral fixation after failing to mobilize. Patients with high energy mechanisms of injury or polytrauma were excluded. Outcome Measures and Comparisons: The primary outcome was pain as measured by Visual Analog Scale (VAS) after treatment. Secondary outcomes included length of stay (LOS), discharge disposition, mortality, readmission rates, and complications. In total, 231 patients were included with a mean age of 79.5 years (range 60-100). One hundred eighty-five(80.0%) patients were female. Sixty-two (26.8%) patients received percutaneous sacral fixation after failed mobilization, and 169 (73.2%) were managed nonoperatively. In the operative group, the median time to surgery was hospital day four. Nonoperative patients were older (81.5 ± 10.0 years vs. 74.2 ± 9.4 years, p<0.01), and had a shorter hospital LOS (4.8 ± 6.2 days) than the operative group (10.6 ± 9.5 days, p<0.01). Patients in the operative group had more pain (VAS 7.9 ± 3.0) than the nonoperative group (VAS 6.6 ± 3.0) (p=0.01) on admission, but had similar pain control post-operatively (VAS 4.4 ± 3.0) compared to the nonoperative group (VAS 4.5 ± 3.6) on the equivalent hospital day (p=0.91). Thus, patients in the operative group experienced more improvement in pain (VAS 3.3 ± 2.7) compared to the nonoperative group (VAS 1.9 ± 3.9) after treatment (p=0.02). Ninety-day mortality (p=0.21) and readmission rates (p=0.27) were similar for both groups. Two patients in the operative cohort sustained nerve injuries, while one patient in the nonoperative group had a nonunion and underwent surgery. Patients who undergo percutaneous surgical fixation for low energy LC1 injuries have similar discharge disposition, mortality, complication rates, and readmission rates compared to patients treated nonoperatively. Percutaneous surgical fixation may provide significant pain relief for patients who failed conservative management. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

比较老年脆性侧方压缩 I 型（LC1）骨盆环骨折的非手术治疗和经皮固定治疗的效果。设计：回顾性研究两家一级创伤中心纳入了 60 岁或以上的孤立性 LC1 骨盆环骨折患者，这些患者接受了非手术治疗，或在活动失败后接受了经皮骶骨固定手术治疗。高能量损伤或多发性创伤患者除外。结果测量和比较：主要结果是治疗后的疼痛，以视觉模拟量表（VAS）进行测量。次要结果包括住院时间（LOS）、出院处置、死亡率、再入院率和并发症。共纳入 231 名患者，平均年龄为 79.5 岁（60-100 岁不等）。185名（80.0%）患者为女性。62名（26.8%）患者在活动失败后接受了经皮骶骨固定术，169名（73.2%）患者接受了非手术治疗。手术组的中位手术时间为住院第四天。非手术组患者年龄较大（81.5 ± 10.0 岁 vs. 74.2 ± 9.4 岁，P<0.01），住院时间（4.8 ± 6.2 天）短于手术组（10.6 ± 9.5 天，P<0.01）。手术组患者入院时的疼痛程度（VAS 7.9 ± 3.0）高于非手术组（VAS 6.6 ± 3.0）（P=0.01），但术后疼痛控制情况（VAS 4.4 ± 3.0）与同等住院日的非手术组（VAS 4.5 ± 3.6）相似（P=0.91）。因此，手术组患者在治疗后的疼痛改善程度（VAS 3.3 ± 2.7）高于非手术组（VAS 1.9 ± 3.9）（P=0.02）。两组患者的九十天死亡率（P=0.21）和再入院率（P=0.27）相似。手术组中有两名患者出现神经损伤，而非手术组中有一名患者出现骨不连并接受了手术。与非手术治疗的患者相比，接受经皮手术固定治疗低能量 LC1 损伤的患者的出院处置、死亡率、并发症发生率和再入院率相似。对于保守治疗失败的患者，经皮手术固定可显著缓解疼痛。治疗级别 III。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

Utility of CT scans for detecting operative malleolar fractures associated with tibial shaft fractures CT 扫描在检测与胫骨轴骨折相关的手术踝骨骨折方面的实用性

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-06-11 DOI: 10.1097/bot.0000000000002862

Victoria J. Nedder, Ty Moon, Anna M. Swetz, George Ochenjele, Robert J. Wetzel, J. Sontich, Joshua K. Napora

The purpose of this study was to define the utility of CT scans for detecting articular extension in tibial shaft fractures and determine if radiographic parameters can predict the presence of operative distal tibia articular fractures (DTAFs). Design: Retrospective cohort study Single Level I Trauma Center Patients ages 18 years and older who were treated operatively for tibial shaft fractures occurring at or below the tibial isthmus were included. Patients were excluded for extension of the main tibial shaft fracture into the tibial plafond (OTA/AO 43B/C), ballistic injuries, and absence of a pre-operative CT scan. Primary outcome was CT utility, defined as the presence of a DTAF or DTAF displacement on CT that was not recognized on plain radiographs on secondary analysis at the time of the study by a senior level resident. Secondary outcome was the association between radiographic parameters and operative DTAFs. Variables with p ≤ 0.2 on univariate testing were included in multiple binary logistic regression model to determine independent predictors of operative DTAFs. 144 patients were included with a mean age of 52 years. 76 patients (53%) were male. CT utility was 41% for identification of unrecognized DTAFs. CT utility was 79% for isolated pDTAF, 57% for medial DTAF, 83% for isolated anterolateral DTAF, and 100% for multiple DTAFs. Operative DTAFs were independently associated with spiral tibial shaft fracture type (p < 0.001) and low fibular fracture (p = 0.04). In patients who had both spiral tibial shaft fracture type and low fibula fracture, the rate of operative DTAF was 46% (22/48). CT scans identified distal tibia articular fractures (DTAFs) that were unrecognized on plain radiographs in 41% of cases. CT scans were most useful in identifying non-posterior DTAFs. CT scans may be considered for all distal third tibia fractures, but especially those with spiral tibial shaft patterns and low fibular fractures, to avoid missing operative articular injury. Level III

本研究旨在确定 CT 扫描在检测胫骨轴骨折关节伸展方面的作用，并确定放射学参数是否能预测手术胫骨远端关节骨折 (DTAF) 的存在。设计：回顾性队列研究单个一级创伤中心纳入因发生在胫骨峡部或以下的胫骨轴骨折而接受手术治疗的 18 岁及以上患者。排除了胫骨主轴骨折延伸至胫骨韧带（OTA/AO 43B/C）、弹道伤和术前未进行 CT 扫描的患者。主要结果是 CT 实用性，即 CT 上出现 DTAF 或 DTAF 移位，且高级住院医师在研究时进行的二次分析中未在平片上发现。次要结果是放射学参数与手术 DTAF 之间的关联。单变量检验 p≤ 0.2 的变量被纳入多元二元逻辑回归模型，以确定手术 DTAF 的独立预测因素。共纳入 144 名患者，平均年龄为 52 岁。76名患者（53%）为男性。CT 在识别未识别的 DTAF 方面的效用为 41%。对于孤立的 pDTAF，CT 的实用率为 79%；对于内侧 DTAF，CT 的实用率为 57%；对于孤立的前外侧 DTAF，CT 的实用率为 83%；对于多发性 DTAF，CT 的实用率为 100%。手术 DTAF 与螺旋胫骨轴骨折类型（p < 0.001）和低位腓骨骨折（p = 0.04）独立相关。在同时具有螺旋胫骨轴骨折类型和低位腓骨骨折的患者中，手术 DTAF 的比例为 46%（22/48）。在 41% 的病例中，CT 扫描发现了平片无法识别的胫骨远端关节骨折 (DTAF)。CT 扫描对识别非后方的 DTAF 最有帮助。所有胫骨第三远端骨折，尤其是具有螺旋状胫骨轴型和低位腓骨骨折的病例，均可考虑进行 CT 扫描，以避免错过手术关节损伤。三级

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引用次数: 0

Success of Resident Research Grants in Orthopaedic Trauma from 2000 – 2022: A Retrospective Review 2000 - 2022 年创伤骨科住院医师研究补助金的成功情况：回顾性评述

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-06-11 DOI: 10.1097/bot.0000000000002851

Mackinzie A Stanley, Joyee Tseng, Mackenzie Bird, Geoffrey S. Marecek

To determine the publication rate for orthopaedic trauma resident research projects that receive grant funding as well as the long-term academic involvement of the grant recipients. All awardees of resident research grants from Orthopaedic Trauma Association (OTA), AO North America (AONA), and Orthopaedic Research and Education Foundation (OREF) from 2000 – 2022 were identified. Three public databases were queried for subsequent related publications. Academic position, total number of publications, and h-index of grant recipients in 2024 were analyzed as indicators of sustained academic involvement. 397 orthopaedic trauma grants (OTA 117, AONA 225, OREF 55) were identified. 38% (151) of grants resulted in a publication with no significant difference between agencies (p = 0.94). The average amount awarded was $9,843, with no correlation to publication (p = 0.63). The mean time to publication was 3.57 ± 2.33 years. The time to publication for AONA was significantly longer than for OTA (4.14 vs 2.83 years, p= 0.004). There was no difference in total publications, h-index, or NIH grants between grant recipients from different agencies. More OTA grant recipients held an academic position compared to AONA grant recipients (63% vs 43%, p = 0.003). Grant awardees with initial publication success were 1.7 times as likely to have a future academic appointment (p = 0.014) and had 1.9 times the number of publications than those without (p = 0.001). Awardees with an h-index in the top quartile were significantly more likely to have published than those with an h-index in the bottom quartile (p = 0.007). In conclusion, fewer than half of orthopaedic trauma-related resident research grants resulted in a publication with comparable rates across agencies. Grant size did not predict publication success. Publication success was a positive predictor of continued academic involvement. Most publications occurred within five years, suggesting these grants may be most helpful in career development if awarded during the first 1-2 years of a 5-year orthopaedic residency program. Level III. See Instructions for Authors for a complete description of levels of evidence.

确定获得基金资助的创伤骨科住院医师研究项目的发表率以及基金获得者的长期学术参与情况。确定 2000 年至 2022 年期间获得创伤骨科协会 (OTA)、AO 北美 (AONA) 和骨科研究与教育基金会 (OREF) 驻院研究基金的所有人员。在三个公共数据库中查询了后续相关出版物。作为持续学术参与的指标，对 2024 年获得资助者的学术职位、发表论文总数和 h 指数进行了分析。共确定了 397 项创伤骨科基金（OTA 117 项、AONA 225 项、OREF 55 项）。38%（151 项）的基金发表了论文，不同机构之间差异不大（p = 0.94）。平均资助金额为 9843 美元，与发表论文无相关性（p = 0.63）。发表论文的平均时间为 3.57 ± 2.33 年。AONA的发表时间明显长于OTA（4.14年 vs 2.83年，p= 0.004）。来自不同机构的基金获得者在发表论文总数、h指数或美国国立卫生研究院（NIH）基金方面没有差异。与 AONA 基金获得者相比，更多的 OTA 基金获得者担任学术职务（63% vs 43%，p= 0.003）。初次成功发表论文的受资助者未来获得学术职位的可能性是未成功发表论文者的1.7倍（p = 0.014），发表论文的数量是未成功发表论文者的1.9倍（p = 0.001）。h指数在前四分之一的获奖者发表论文的可能性明显高于h指数在后四分之一的获奖者（p = 0.007）。总之，只有不到一半的骨科创伤相关住院医师研究基金最终发表了论文，各机构之间的比例相当。研究基金的规模并不能预测发表论文的成功率。成功发表论文是继续参与学术活动的积极预测因素。大多数论文都是在五年内发表的，这表明如果在五年制骨科住院医师培训计划的前 1-2 年期间获得这些资助，可能对职业发展最有帮助。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

Lower Extremity Amputation in Fracture Related Infection 骨折相关感染的下肢截肢手术

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-06-11 DOI: 10.1097/bot.0000000000002853

Karen J. Carter, Matthew T. Yeager, Robert W. Rutz, E. M. Benson, Evan G. Gross, Collier Campbell, Joey P. Johnson, C. Spitler

To analyze patient demographics, comorbidities, fracture characteristics, presenting characteristics, microbiology, and treatment course of patients with fracture related infections (FRIs) to determine risk factors leading to amputation. Retrospective cohort. Single Level I Trauma Center (2013-2020). Adults with lower extremity (femur and tibia) fracture related infections were identified via review of an institutional database. Inclusion criteria were operatively managed fracture of the femur or tibia with an FRI and adequate documentation present in the electronic medical record (EMR). This included patients whose primary injury was managed at this institution as well as referred to this institution after the onset of FRI as long as all characteristics and risk factors assessed in the analysis were documented. Exclusion criteria were infected chronic osteomyelitis from a non-fracture related pathology and follow-up less than 6 months. Risk factors (demographics, comorbidities, and surgical, injury, and perioperative characteristics) leading to amputation in patients with fracture related infections were evaluated. A total of 196 patients were included in this study. The average age of the study group was 44 +/- 16 years. Most patients were male (63%) and white (71%). The overall amputation rate was 9.2%. There were significantly higher rates of chronic kidney disease (CKD) (p=0.039), open fractures (p=0.034), transfusion required during open reduction internal fixation (p=0.033), gram negative infections (p=0.048), and FRI related operations (p=0.001) in the amputation cohort. On multivariate, patients with CKD were 28.8 times more likely to undergo amputation (aOR=28.8 [2.27 to 366, p=0.010). A subanalysis of 79 patients with either a methicillin-sensitive Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA) infection showed patients with MRSA were significantly more likely to undergo amputation compared to patients with MSSA (p=0.031). MRSA was present in all cases of amputation in the Staphylococcal subanalysis. Findings from this study highlight chronic kidney disease as a risk factor for amputation in the tibia and femur with fracture-related infection. Additionally, MRSA was present in all cases of Staphylococcal amputation. Identifying patients and infection patterns that carry a higher risk of amputation can assist surgeons in minimizing the burden on these individuals. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

分析骨折相关感染（FRI）患者的人口统计学特征、合并症、骨折特征、发病特征、微生物学和治疗过程，以确定导致截肢的风险因素。回顾性队列。单个一级创伤中心（2013-2020 年）。通过审查机构数据库，确定下肢（股骨和胫骨）骨折相关感染的成人患者。纳入标准为股骨或胫骨骨折经手术治疗后出现 FRI，且电子病历（EMR）中有充分的记录。这包括原发伤在本机构接受治疗的患者，以及在发生 FRI 后转诊到本机构的患者，只要记录了分析中评估的所有特征和风险因素即可。排除标准是非骨折相关病理引起的感染性慢性骨髓炎，且随访时间少于 6 个月。对导致骨折相关感染患者截肢的风险因素（人口统计学、合并症以及手术、损伤和围手术期特征）进行了评估。本研究共纳入了 196 名患者。研究组的平均年龄为 44 +/- 16 岁。大多数患者为男性（63%）和白人（71%）。总体截肢率为 9.2%。截肢队列中，慢性肾病（CKD）（P=0.039）、开放性骨折（P=0.034）、切开复位内固定术中需要输血（P=0.033）、革兰氏阴性感染（P=0.048）和 FRI 相关手术（P=0.001）的比例明显更高。在多变量分析中，患有慢性肾脏病的患者接受截肢手术的几率要高出28.8倍（aOR=28.8 [2.27-366, p=0.010）。对79名感染甲氧西林敏感金黄色葡萄球菌（MSSA）或耐甲氧西林金黄色葡萄球菌（MRSA）的患者进行的一项子分析表明，与MSSA患者相比，MRSA患者截肢的几率明显更高（P=0.031）。在葡萄球菌亚分析中，所有截肢病例中都存在 MRSA。这项研究的结果突出表明，慢性肾病是胫骨和股骨骨折相关感染截肢的风险因素。此外，所有葡萄球菌截肢病例中都存在 MRSA。识别截肢风险较高的患者和感染模式有助于外科医生最大限度地减轻这些患者的负担。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

Effects of Obesity on Systemic Complications after Operative Pelvic Ring Fractures 肥胖对骨盆环骨折术后全身并发症的影响

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-06-11 DOI: 10.1097/bot.0000000000002852

Mihir Patel, Stevan Fairburn, G. McGwin, C. Spitler

To determine the effect of obesity on systemic complications after operative pelvic ring injuries. Design: Retrospective cohort study Single level 1 trauma center All patients at a level 1 trauma center who underwent operative fixation of a pelvic ring injury from 2015-2022 were included. Patients were grouped based on body mass index (BMI) into four categories (normal = BMI <25, overweight = BMI 25-30, obese = BMI 30-40, and morbidly obese BMI >40). Systemic complications including acute respiratory distress syndrome, pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism, ileus, acute kidney injury (AKI), myocardial infarction, and mortality were recorded. Patients who developed a complication were compared to those who did not in regard to demographic and clinical parameters to determine risk factors for each complication. A total of 1056 patients underwent pelvic ring fixation including 388 normal BMI, 267 overweight, 289 obese, and 112 morbidly obese patients. The average age of all patients was 36.9 years, with a range from 16 to 85 years. Overall, 631 patients (59.8%) were male. The overall complication and mortality rates were 23.2% and 1.4%, respectively. BMI was a significant independent risk factor for all-cause complication with an odds ratio (OR) of 1.67 for overweight, 2.30 for obese, and 2.45 for morbidly obese patients. The risk of DVT and AKI were also significantly increased with every weight class above normal with ORs of 5.06 and 3.02, respectively, for morbidly obese patients (BMI >40). This study demonstrated that among patients undergoing pelvic ring fixation, higher BMI was associated with increased risks of overall complication and specifically DVT and AKI. As the prevalence of obesity continues to increase in the population, surgeons should be cognizant that these patients may be at higher risk of certain post-operative complications during the initial trauma admission. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

目的：确定肥胖对骨盆环损伤手术后全身并发症的影响。设计：回顾性队列研究单1级创伤中心纳入2015-2022年期间在1级创伤中心接受骨盆环损伤手术固定的所有患者。根据体重指数（BMI）将患者分为四类（正常 = BMI 40）。记录了全身并发症，包括急性呼吸窘迫综合征、肺炎、败血症、深静脉血栓形成（DVT）、肺栓塞、回肠梗阻、急性肾损伤（AKI）、心肌梗死和死亡率。将出现并发症的患者与未出现并发症的患者在人口统计学和临床参数方面进行比较，以确定每种并发症的风险因素。共有 1056 名患者接受了骨盆环固定术，其中包括 388 名体重指数正常、267 名超重、289 名肥胖和 112 名病态肥胖患者。所有患者的平均年龄为 36.9 岁，从 16 岁到 85 岁不等。总体而言，631 名患者（59.8%）为男性。总体并发症发生率和死亡率分别为 23.2% 和 1.4%。体重指数是全因并发症的重要独立风险因素，超重患者的几率比（OR）为 1.67，肥胖患者为 2.30，病态肥胖患者为 2.45。体重每超过正常值一个等级，发生深静脉血栓和急性肾损伤的风险也会显著增加，病态肥胖患者（体重指数大于 40）的比值比分别为 5.06 和 3.02。这项研究表明，在接受骨盆环固定术的患者中，体重指数越高，总体并发症风险越高，尤其是深静脉血栓和 AKI。由于肥胖症在人群中的发病率持续上升，外科医生应该认识到，这些患者在最初的创伤入院过程中可能会面临更高的术后并发症风险。预后 III 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

Iatrogenic Sciatic Nerve Injury in Posterior Acetabular Surgery: Surgeon More Predictive Than Position 后髋臼手术中的先天性坐骨神经损伤：外科医生比体位更有预测性

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-06-10 DOI: 10.1097/bot.0000000000002860

Nathaniel E. Schaffer, Lauren Luther, R. B. Ponce, Sean P. Wrenn, Joseph R. Cave, A. F. Moreno-Diaz, Cade A. Morris, Lauren M. Tatman, P. Mitchell

Identify factors that contribute to iatrogenic sciatic nerve palsy during acetabular surgery through a Kocher-Langenbeck (KL) approach, and to evaluate if variation among individual surgeons exists. Design: Retrospective cohort Level I trauma center Adults undergoing fixation of acetabular fractures (AO/OTA 62) through a posterior approach by 9 orthopaedic traumatologists between November 2010 and November 2022. Outcome Measures and Comparisons: Prevalence of iatrogenic sciatic nerve palsy and comparison of the prevalence and risk of palsy between prone and lateral positions before and after adjusting for individual surgeon and presence of transverse fracture patterns in logistic regression. Comparison of the prevalence of palsy between high- (>1 case/month) and low-volume surgeons. A total of 644 acetabular fractures repaired through a posterior approach were included (median age 39, 72% male). Twenty of 644 surgeries (3.1%) resulted in iatrogenic sciatic nerve palsy with no significant difference between the prone (3.1%, 95% CI: 1.9% – 4.9%) and lateral (3.3%, 95% CI: 1.3% – 8.1%) positions (p = 0.64). Logistic regression adjusting for surgeon and transverse fracture pattern demonstrated no significant effect for position (OR 1.0, 95% CI: 0.3 – 3.9). Transverse fracture pattern was associated with increased palsy risk (OR 3.0, 95% CI: 1.1 – 7.9). Individual surgeon was significantly associated with iatrogenic palsy (p < 0.02). Surgeon and presence of a transverse fracture line predicted iatrogenic nerve palsy after posterior approach to the acetabulum in this single-center cohort. Surgeons should perform the KL approach for acetabular fixation in the position they deem most appropriate, as position was not associated rate of iatrogenic palsy in this series. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

确定在通过 Kocher-Langenbeck (KL) 方法进行髋臼手术时导致坐骨神经麻痹的因素，并评估不同外科医生之间是否存在差异。设计：回顾性队列 I 级创伤中心 2010 年 11 月至 2022 年 11 月期间，9 位创伤骨科医师通过后路对髋臼骨折（AO/OTA 62）进行固定的成人。结果测量和比较：先天性坐骨神经麻痹的发生率，以及俯卧位和侧卧位发生率和风险的比较，在逻辑回归中调整个体外科医生和横向骨折模式前后的比较。比较工作量大（>1 例/月）和工作量小的外科医生的神经麻痹发生率。共纳入了 644 例通过后路修复的髋臼骨折（中位年龄 39 岁，72% 为男性）。644 例手术中有 20 例（3.1%）导致先天性坐骨神经麻痹，俯卧位（3.1%，95% CI：1.9% - 4.9%）和侧卧位（3.3%，95% CI：1.3% - 8.1%）之间无显著差异（P = 0.64）。调整外科医生和横向骨折模式的逻辑回归结果表明，体位对骨折无明显影响（OR 1.0，95% CI：0.3 - 3.9）。横向骨折模式与瘫痪风险增加有关（OR 3.0，95% CI：1.1 - 7.9）。外科医生的个体差异与先天性麻痹密切相关（P < 0.02）。在这个单中心队列中，外科医生和横向骨折线的存在预示着髋臼后入路后的先天性神经麻痹。外科医生应在他们认为最合适的位置进行 KL 入路髋臼固定，因为在该系列研究中，位置与先天性神经麻痹的发生率无关。治疗级别 IV。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

Effect of obesity on short and long-term complications after ankle fracture fixation 肥胖对踝关节骨折固定术后短期和长期并发症的影响

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-06-04 DOI: 10.1097/bot.0000000000002849

Abhinav Janghala, K. Niknam, Ryan D. Freshman, C. Cogan, Alan L. Zhang, D. Lansdown

This study evaluated the relationship between obesity and postoperative complications in patients undergoing ankle open reduction internal fixation (ORIF). Design: Retrospective cohort study PearlDiver-Mariner All-Payor Database. Patients who underwent ankle ORIF from 2010-2021 and had a minimum 2 year follow-up were identified using CPT, ICD-9, and ICD-10 codes. Patients were stratified by Body Mass Index (BMI) into non-obese, obese, morbidly obese, and super-obese groups. Complication rates, including 90-day readmissions, infection, and post-traumatic osteoarthritis, were compared between obesity groups. Patients were additionally compared with a 1:1 matched analysis that controlled for demographics and comorbidities. A total of 160,415 patients undergoing ankle ORIF from 2010 to 2021 were identified. The cohort consisted mostly of females (64.8%) and the average age was 52.5 (SD 18.4). There were higher rates of 90-day readmissions, UTIs, DVT/PE, pneumonia, superficial infections, and acute kidney injuries in patients with increasing levels of obesity (p<0.001). There were increased odds of nonunion and post-traumatic arthritis in the matched analysis at 2 years in the obesity group (OR: 2.36, 95%CI: 1.68 – 3.31, p<0.001; OR: 2.18 95%CI: 1.77 – 2.68, p<0.001, respectively). Postoperative medical complication rates in patients undergoing ankle ORIF, including infection, are higher in obese patients, even in the 1:1 matched analysis that controlled for demographic and comorbidity factors. Rates of nonunion and post-traumatic arthritis were higher in obese patients, as well. As such, it is important for surgeons to provide appropriate education regarding the risks after ankle ORIF in patients with obesity. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

本研究评估了踝关节开放复位内固定术（ORIF）患者肥胖与术后并发症之间的关系。设计：回顾性队列研究PearlDiver-Mariner全付费数据库。使用 CPT、ICD-9 和 ICD-10 编码识别 2010-2021 年间接受踝关节开放复位内固定术且随访至少 2 年的患者。患者按体重指数（BMI）分为非肥胖组、肥胖组、病态肥胖组和超肥胖组。比较了不同肥胖组的并发症发生率，包括 90 天再入院、感染和创伤后骨关节炎。此外，还对患者进行了1:1匹配分析比较，对人口统计学和合并症进行了控制。 2010年至2021年期间，共有160,415名患者接受了踝关节ORIF手术。队列中女性居多（64.8%），平均年龄为 52.5 岁（SD 18.4）。肥胖程度越高的患者90天再入院率、UTI、DVT/PE、肺炎、表皮感染和急性肾损伤的发生率越高（P<0.001）。在 2 年的匹配分析中，肥胖组患者发生骨不连和创伤后关节炎的几率增加（OR：2.36，95%CI：1.68 - 3.31，p<0.001；OR：2.18，95%CI：1.77 - 2.68，p<0.001）。即使在控制了人口统计学和合并症因素的1:1匹配分析中，肥胖患者接受踝关节ORIF术后医疗并发症（包括感染）的发生率也更高。肥胖患者的非愈合率和创伤后关节炎发生率也更高。因此，外科医生必须就肥胖患者踝关节 ORIF 术后的风险提供适当的教育。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

Perceptions in Orthopedic Surgery on the use of cannabis In Treating pain: A survey of musculoskeletal trauma patients - Results from the Canadian POSIT Study 矫形外科对使用大麻治疗疼痛的看法：对肌肉骨骼创伤患者的调查 - 加拿大 POSIT 研究的结果

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-06-03 DOI: 10.1097/bot.0000000000002848

M. Gjorgjievski, Kim Madden, Conner Bullen, Frank Koziarz, Alex Koziarz, A. Cenic, Silvia Li, Mohit Bhandari, H. Johal

To evaluate the patient-reported expectations regarding cannabis for pain following musculoskeletal (MSK) trauma and patients’ perceptions and attitudes regarding its use. Design: A cross-sectional retrospective survey-based study. Three orthopaedic clinics in Ontario (Level-1 trauma center, Level-2 trauma center, rehabilitation clinic). Adult patients presenting to the clinics from January 24, 2018, to March 7, 2018, with traumatic MSK injuries (fractures/dislocations and muscle/tendon/ligament injury) were administered an anonymous questionnaire on cannabis for MSK pain. Outcome Measures and Comparisons: Primary outcome measure was the patients’ perceived effect of cannabis on MSK pain, reported on a continuous pain scale (0-100%, 0 being no pain and 100 unbearable pain). Secondary outcomes included preferences, such as administration route, distribution method, timing, and barriers (lack of knowledge, concerns for side-effects/addiction, moral/religious opposition, etc.) regarding cannabis use. In total, 440 patients were included in this study, 217 (49.3%) of whom were female and 222 (50.5%) were male, with a mean age of 45.6 years old (range 18-92, SD 15.6). Patients estimated cannabis could treat 56.5% (95% CI 54.0-59.0%) of their pain and replace 46.2% (95% CI 42.8-49.6%) of their current analgesics. Nearly one-third (131/430, 30.5%) reported they had used medical cannabis and more than a quarter (123/430, 28.6%) used it in the previous year. Most felt cannabis may be beneficial to treat pain (304/334, 91.0%), and reduce opioid use (293/331, 88.5%). Not considering using cannabis for their injury (132/350, 37.7%) was the most common reason for not discussing cannabis with physicians. Higher reported pain severity (β=0.2/point, 95% CI 0.1-0.3, p=0.005) and previous medical cannabis use were associated with higher perceived pain reduction (β=11.1, 95% CI 5.4-16.8, p<0.001). One in three orthopaedic trauma patients used medical cannabis. Patients considered cannabis could potentially be an effective option for managing traumatic MSK pain and believed cannabis could reduce opioid usage following acute musculoskeletal trauma. This data will help inform clinicians discussing medical cannabis usage with orthopaedic trauma patients moving forward. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

目的：评估患者报告的对肌肉骨骼（MSK）创伤后使用大麻止痛的期望，以及患者对使用大麻的看法和态度。设计：横断面回顾性调查研究。对象：安大略省的三家骨科诊所（一级创伤中心、二级创伤中心、康复诊所）。对 2018 年 1 月 24 日至 2018 年 3 月 7 日期间因创伤性 MSK 损伤（骨折/脱位和肌肉/肌腱/韧带损伤）到诊所就诊的成年患者进行了关于大麻治疗 MSK 疼痛的匿名问卷调查。结果测量和比较：主要结果测量是患者对大麻对 MSK 疼痛的感知效果，采用连续疼痛量表（0-100%，0 为无痛，100 为疼痛难忍）进行报告。次要结果包括使用途径、分配方法、时间等偏好，以及使用大麻的障碍（缺乏知识、担心副作用/成瘾、道德/宗教反对等）。本研究共纳入了 440 名患者，其中女性 217 人（占 49.3%），男性 222 人（占 50.5%），平均年龄 45.6 岁（18-92 岁不等，SD 15.6）。据患者估计，大麻可以治疗其 56.5%（95% CI 54.0-59.0%）的疼痛，并可替代 46.2%（95% CI 42.8-49.6%）的现有镇痛药。近三分之一（131/430，30.5%）的人称他们曾使用过医用大麻，超过四分之一（123/430，28.6%）的人在过去一年中使用过医用大麻。大多数人认为大麻可能有益于治疗疼痛（304/334，91.0%）和减少阿片类药物的使用（293/331，88.5%）。不考虑使用大麻治疗伤痛（132/350，37.7%）是不与医生讨论大麻的最常见原因。报告的疼痛严重程度越高（β=0.2/点，95% CI 0.1-0.3，p=0.005），以前使用过医用大麻的患者感觉疼痛减轻的程度越高（β=11.1，95% CI 5.4-16.8，p<0.001）。每三名骨科创伤患者中就有一名使用医用大麻。患者认为大麻可能是治疗创伤性 MSK 疼痛的有效选择，并认为大麻可以减少急性肌肉骨骼创伤后阿片类药物的使用。这些数据将有助于临床医生在与创伤骨科患者讨论医用大麻使用问题时获得更多信息。治疗级别 III。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

Skeletal Traction for Isolated Femur Fractures Does Not Reduce Opioid Consumption. 骨骼牵引治疗孤立性股骨骨折不会减少阿片类药物的用量。

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-06-01 DOI: 10.1097/BOT.0000000000002791

Brian Mullis, Jesse Caballero, Abhijit Seetharam, Lauren Ingrid Pitz, Greg E Gaski

Objectives: Isolated femoral shaft fractures can be treated preoperatively with skeletal traction (TXN) or maintenance of a position of comfort (COMF). The goal of this retrospective review was to determine whether preoperative opioid consumption differs significantly between these forms of treatment.

Methods:

Design: Case-control retrospective study.

Setting: Two academic Level 1 trauma centers.

Patient selection criteria: Patients presenting to the emergency department with isolated OTA/AO 32A-C femoral shaft fractures from 2017 to 2020.

Outcome measures and comparisons: The primary outcome was preoperative opioid consumption (morphine milligram equivalents) comparing patients treated with application of TXN or placed in a position of COMF.

Results: Two hundred and twenty patients were studied (COMF n = 167, TXN n = 53). Multivariate regression analysis revealed significantly greater preoperative opioid consumption in the emergency department for the TXN group compared with COMF (2.6 more morphine milligram equivalents [confidence interval, 0.23-4.96], P = 0.031). There was no difference in preoperative opioid consumption between groups on the hospital floor ( P = 0.811) nor during the entire preoperative course ( P = 0.486). The total preoperative rate of opioid consumption (morphine milligram equivalents/hour) did not differ ( P = 0.825).

Conclusions: Patients with isolated femoral shaft fractures treated preoperatively with skeletal traction consumed more opioids in the emergency department compared with patients treated in a position of comfort, but no difference in opioid consumption was observed between groups for the entire preoperative course. A position of comfort may be considered as an acceptable alternative to skeletal traction for patients with isolated femur fractures.

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

目标：股骨干孤立性骨折可在术前采用骨骼牵引（TXN）或维持舒适体位（COMF）治疗。本回顾性研究旨在确定这两种治疗方式的术前阿片类药物用量是否存在显著差异：方法：设计：方法：设计：病例对照回顾性研究：患者选择标准：2017-2020年因孤立性OTA/AO 32A-C股骨干骨折到急诊科就诊的患者.结果测量和比较：主要结果为术前阿片类药物消耗量（吗啡毫克当量（MME）），比较采用骨骼牵引（TXN）或舒适体位（COMF）治疗的患者：研究了 220 名患者（COMF 167 人，TXN 53 人）。多变量回归分析显示，TXN组与COMF组相比，在急诊科（ED）的术前阿片类药物消耗量明显更大（多出2.6 MME [CI 0.23,4.96]，P=0.031））。在医院楼层（P=0.811）和整个术前过程（P=0.486）中，各组间的术前阿片类药物消耗量没有差异。术前阿片类药物总用量（MME/小时）没有差异（P=0.825）：结论：与采用舒适体位治疗的患者相比，术前采用骨骼牵引治疗的孤立性股骨柄骨折患者在急诊室消耗的阿片类药物更多，但在整个术前治疗过程中，观察到不同组别之间的阿片类药物消耗量没有差异。对于孤立性股骨骨折患者来说，舒适体位可被视为骨骼牵引的一种可接受的替代方法：证据等级：治疗三级。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

Early Complications of a Novel Retrograde Intramedullary Femoral Nail in the Treatment of Femur Fractures. 治疗股骨骨折的新型逆行股骨髓内钉的早期并发症。

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma

Pub Date : 2024-06-01 DOI: 10.1097/BOT.0000000000002804

David J Cinats, Azhar Bashir, Clarence B Toney, Jibanananda Satpathy, Stephen L Kates, Paul W Perdue

Objectives: To determine the early implant failure rate of a novel retrograde intramedullary femoral nail.

Methods:

Design: Retrospective cohort study.

Setting: Academic level 1 trauma center.

Patients selection criteria: Patients aged 18 years and older with an acute OTA/AO 32-A, 32-B, 32-C, and 33-A fractures or periprosthetic distal femur fracture from April 2018 to April 2022 were included in the study. The 2 interventions compared were the Synthes Expert retrograde/antegrade femoral nail (or control implant) versus the next-generation retrograde femoral nail (RFN)-advanced retrograde femoral nail (RFNA or experimental implant) (Synthes, West Chester, PA).

Outcome measures and comparisons: Early implant-related complications between the experimental and control implants were assessed including locking screw back out, screw breakage, intramedullary nail failure, need for secondary surgery, and loss of fracture reduction.

Results: Three hundred fourteen patients were identified with a mean age of 31.0 years, and 62.4% of the patients being male. Open fractures occurred in 32.5% of patients with 3.8% of injuries being distal femur periprosthetic fractures. Fifty-six patients were in the experimental group and 258 patients in the control group. Mean follow-up was 46.8 weeks for the control cohort and 21.0 weeks for the experimental cohort. Distal interlocking screw back out occurred in 23.2% (13 of 56) of the experimental group patients and 1.9% (5 of 258) of the control group patients ( P < 0.0001). Initial diagnosis of interlocking screw back out occurred at an average of 3.2 weeks postoperatively (range, 2-12 weeks). Fifty-four percent of patients who sustained screw back out underwent a secondary operation to remove the symptomatic screws (12.5% of all patients treated with the experimental implant required an unplanned secondary operation due to screw back out). A logistic regression model was used to predict screw back out and found the experimental implant group was 4.3 times as likely to experience distal locking screw back out compared with the control group ( P = 0.01).

Conclusions: The retrograde femoral nail-advanced implant was associated with a significantly higher rate of screw back out with a substantial number of unplanned secondary surgeries compared with the previous generation of this implant.

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

目的：确定新型逆行股骨髓内钉的早期植入失败率：确定新型逆行股骨髓内钉的早期植入失败率：设计设计：回顾性匹配病例对照：学术一级创伤中心。患者选择标准：研究纳入2018年4月至2022年4月期间18岁及以上急性AO/OTA 32-A、32-B、32-C和33-A骨折或股骨远端假体周围骨折患者。比较的两种干预措施是 Synthes 专家逆行/逆行股骨钉（RAFN 或对照组植入物）与新一代 RFN-Advanced 逆行股骨钉（RFNA 或实验组植入物）（Synthes，宾夕法尼亚州西切斯特）：对实验植入物和对照植入物的早期植入相关并发症进行评估，包括锁定螺钉后脱、螺钉断裂、髓内钉失效、二次手术需求和骨折复位损失：314名患者的平均年龄为31.0岁，其中62.4%为男性。32.5%的患者发生开放性骨折，3.8%为股骨远端假体周围骨折。实验组有56名患者，对照组有258名患者。对照组的平均随访时间为46.8周，实验组为21.0周。23.2%的实验组患者（56例中的13例）和1.9%的对照组患者（258例中的5例）发生了远端联锁螺钉反脱（p结论：与上一代RFNA植入物相比，RFNA植入物的螺钉反锁率明显更高，并导致大量意外二次手术：证据等级：治疗III级。有关证据等级的完整描述，请参阅 "作者须知"。

{"title":"Early Complications of a Novel Retrograde Intramedullary Femoral Nail in the Treatment of Femur Fractures.","authors":"David J Cinats, Azhar Bashir, Clarence B Toney, Jibanananda Satpathy, Stephen L Kates, Paul W Perdue","doi":"10.1097/BOT.0000000000002804","DOIUrl":"10.1097/BOT.0000000000002804","url":null,"abstract":"Objectives: To determine the early implant failure rate of a novel retrograde intramedullary femoral nail.Methods: Design: Retrospective cohort study.Setting: Academic level 1 trauma center.Patients selection criteria: Patients aged 18 years and older with an acute OTA/AO 32-A, 32-B, 32-C, and 33-A fractures or periprosthetic distal femur fracture from April 2018 to April 2022 were included in the study. The 2 interventions compared were the Synthes Expert retrograde/antegrade femoral nail (or control implant) versus the next-generation retrograde femoral nail (RFN)-advanced retrograde femoral nail (RFNA or experimental implant) (Synthes, West Chester, PA).Outcome measures and comparisons: Early implant-related complications between the experimental and control implants were assessed including locking screw back out, screw breakage, intramedullary nail failure, need for secondary surgery, and loss of fracture reduction.Results: Three hundred fourteen patients were identified with a mean age of 31.0 years, and 62.4% of the patients being male. Open fractures occurred in 32.5% of patients with 3.8% of injuries being distal femur periprosthetic fractures. Fifty-six patients were in the experimental group and 258 patients in the control group. Mean follow-up was 46.8 weeks for the control cohort and 21.0 weeks for the experimental cohort. Distal interlocking screw back out occurred in 23.2% (13 of 56) of the experimental group patients and 1.9% (5 of 258) of the control group patients ( P < 0.0001). Initial diagnosis of interlocking screw back out occurred at an average of 3.2 weeks postoperatively (range, 2-12 weeks). Fifty-four percent of patients who sustained screw back out underwent a secondary operation to remove the symptomatic screws (12.5% of all patients treated with the experimental implant required an unplanned secondary operation due to screw back out). A logistic regression model was used to predict screw back out and found the experimental implant group was 4.3 times as likely to experience distal locking screw back out compared with the control group ( P = 0.01).Conclusions: The retrograde femoral nail-advanced implant was associated with a significantly higher rate of screw back out with a substantial number of unplanned secondary surgeries compared with the previous generation of this implant.Level of evidence: Therapeutic 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":1.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140119780","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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