Journal of Orthopaedic Trauma最新文献_第6页

Patient Preferences for Operative Versus Nonoperative Treatment of LC1 Pelvis Fracture: A Discrete Choice Experiment. 患者对 LC1 骨盆骨折手术治疗与非手术治疗的偏好：离散选择实验。

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-06-01 DOI: 10.1097/BOT.0000000000002794

Joseph T Patterson, Joshua A Parry, Zachary M Working, Natasha A McKibben, Joseph Baca, Andrew Duong, Joshua Senior, Annabel Kim, Lucas S Marchand, Nathan O'Hara

Objectives: To quantify how patients with lateral compression type 1 (LC1) pelvis fracture value attributes of operative versus nonoperative treatment.

Methods:

Design: Discrete choice experiment.

Setting: Three US Level 1 trauma centers.

Patient selection criteria: Adult survivors of an LC1 pelvis treated between June 2016 and March 2023 were identified from institutional registries. The choice experiment was administered as a survey from March through August 2023.

Outcome measures and comparisons: Participants chose between 12 hypothetical comparisons of treatment attributes including operative or nonoperative care, risk of death, severity of pain, risk of secondary surgery, shorter hospital stay, discharge destination, and independence in ambulation within 1 month of injury. The marginal utility of each treatment attribute, for example, the strength of participants' aggregate preference for an attribute as indicated by their survey choices, was estimated by multinomial logit modeling with and without stratification by treatment received.

Results: Four hundred forty-nine eligible patients were identified. The survey was distributed to 182 patients and collected from 72 patients (39%) at a median 2.3 years after injury. Respondents were 66% female with a median age of 59 years (IQR, 34-69 years). Before injury, 94% ambulated independently and 75% were working; 41% received operative treatment. Independence with ambulation provided the highest relative marginal utility (21%, P < 0.001), followed by discharge to home versus skilled nursing (20%, P < 0.001), moderate versus severe postdischarge pain (17%, P < 0.001), shorter hospital stay (16%, P < 0.001), secondary surgery (15%, P < 0.001), and mortality (10%, P = 0.02). Overall, no relative utility for operative versus nonoperative treatment was observed (2%, P = 0.54). However, respondents strongly preferred the treatment they received: operative patients valued operative treatment (utility, 0.37 vs. -0.37, P < 0.001); nonoperative patients valued nonoperative treatment (utility, 0.19 vs. -0.19, P < 0.001).

Conclusions: LC1 pelvis fracture patients valued independence with ambulation, shorter hospital stay, and avoiding secondary surgery and mortality in the month after their injury. Patients preferred the treatment they received rather than operative versus nonoperative care.

目的：量化 LC1 骨盆骨折患者对手术治疗和非手术治疗属性的评价：量化 LC1 骨盆骨折患者对手术治疗与非手术治疗属性的评价：设计：离散选择实验：设计：离散选择实验：3 个美国 1 级创伤中心.患者选择标准：患者选择标准：2016 年 6 月至 2023 年 3 月期间接受过 LC1 骨盆治疗的成年幸存者均从机构登记册中确认。选择实验从 2023 年 3 月到 8 月以调查的形式进行：参与者在 12 项治疗属性的假设比较中进行选择，包括手术或非手术治疗、死亡风险、疼痛严重程度、二次手术风险、住院时间缩短、出院目的地以及受伤后一个月内的独立行走能力。每个治疗属性的边际效用，即调查选择所显示的参与者对某一属性的总体偏好程度，通过多项式对数模型进行估算，包括按接受的治疗分层和不按接受的治疗分层：确定了 449 名符合条件的患者。向 182 名患者发放了调查问卷，并从 72 名患者（39%）中收集了问卷，中位数为伤后 2.3 年。受访者中 66% 为女性，中位年龄为 59 岁（IQR 34-69）。受伤前，94% 的人可以独立行走，75% 的人有工作。41%的人接受了手术治疗。独立行走提供了最高的相对边际效用（21%，p 结论：LC1 骨盆骨折患者重视受伤后一个月内的独立行走、缩短住院时间、避免二次手术和死亡率。患者更喜欢他们所接受的治疗，而不是手术与非手术治疗：证据级别：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

Extra-articular Osteotomy for the Management of Intra-articular Tibial Plateau Valgus Malunion 关节外截骨术治疗胫骨平台关节内翻转畸形

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-05-20 DOI: 10.1097/bot.0000000000002845

B. J. Page, Michael D. Greenstein, Gerard A Sheridan, A. Fragomen, S. Rozbruch

To report a case series of extra-articular osteotomies for the management of intra-articular tibial plateau malunions and to assess the ability to correct deformity and improve knee range of motion (ROM). Retrospective case series Academic, tertiary, referral center. Adult patients with tibial plateau fracture malunion treated with extra-articular osteotomy of the femur and/or tibia between 2014-2023. Outcome Measures and Comparison: Mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), lateral distal femoral angle (LDFA), and posterior proximal tibia angle (PPTA) correction; knee ROM, and time to weight bearing. There were 7 patients included, 6 (85.7%) were female and 1 (14.3%) were male. The median age was 43.5 years (IQR 38.5-51, range 32-62). Four (57.1%) patients were treated with a high tibial osteotomy (HTO) and 3 (42.9%) patients were treated with an HTO and distal femoral osteotomy (DFO). One patient had concomitant supramalleolar osteotomy with HTO to address distal tibia procurvatum and valgus. Four were treated with hexapod frames and 3 were treated with plates and screws. Median follow-up was 22.5 months (IQR 10.5-107 months, range 7-148 months). Surgical intervention corrected median radiographic measures of valgus malalignment pre-operatively relative to post-operative values. This included MAD (42.5mm to 0mm), valgus angle (12.5° to 1.5°), MPTA (95° to 88.0°), and LDFA 86.0° to 87.3°). Surgical intervention increased maximal knee range of motion pre- to post-operatively. Median time to full weight bearing was 81.5 days (IQR 46-57 days, range 41-184 days Two patients were converted to total knee arthroplasty after 5 and 10 years following HTO with hexapod frame. Extra-articular osteotomy is an effective treatment for addressing intra-articular malunion after tibia plateau fractures. It is effective in correcting the MAD, valgus deformity, MPTA, LDFA, PPTA, and improving knee ROM (measured through knee extension and flexion). Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

报告一系列关节外截骨术治疗关节内胫骨平台发育不良的病例，并评估其矫正畸形和改善膝关节活动范围（ROM）的能力。回顾性病例系列学术性三级转诊中心。 2014-2023年间接受股骨和/或胫骨关节外截骨治疗的胫骨平台骨折畸形成人患者。结果测量和比较：机械轴偏差（MAD）、胫骨内侧近端角（MPTA）、股骨外侧远端角（LDFA）和胫骨后侧近端角（PPTA）矫正；膝关节ROM和负重时间。共纳入了 7 名患者，其中 6 名（85.7%）为女性，1 名（14.3%）为男性。中位年龄为 43.5 岁（IQR 38.5-51，范围 32-62）。4名患者（57.1%）接受了胫骨高位截骨术（HTO），3名患者（42.9%）接受了胫骨高位截骨术和股骨远端截骨术（DFO）。一名患者在接受高胫骨截骨术的同时进行了股骨上截骨术，以解决胫骨远端前凸和外翻问题。四名患者接受了六脚支架治疗，三名患者接受了钢板和螺钉治疗。中位随访时间为22.5个月（IQR为10.5-107个月，范围为7-148个月）。相对于术后值，手术干预纠正了术前外翻错位的中位影像学测量值。这包括MAD（42.5毫米至0毫米）、外翻角度（12.5°至1.5°）、MPTA（95°至88.0°）和LDFA（86.0°至87.3°）。从术前到术后，手术干预增加了膝关节的最大活动范围。完全负重的中位时间为 81.5 天（IQR 为 46-57 天，范围为 41-184 天），其中两名患者在使用六足骨架进行 HTO 治疗 5 年和 10 年后转为全膝关节置换术。关节外截骨是治疗胫骨平台骨折后关节内骨缝愈合不良的有效方法。它能有效矫正 MAD、外翻畸形、MPTA、LDFA、PPTA，并改善膝关节 ROM（通过膝关节伸屈测量）。治疗等级 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

Factors Associated with Infection in Patients with Combined Pelvic Ring and Bladder Injuries 骨盆环和膀胱联合损伤患者感染的相关因素

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-05-20 DOI: 10.1097/bot.0000000000002846

Nathan P. Olszewski, Joseph M Sliepka, Joseph J. Bigham, Reza Firoozabadi, Michael J. Githens, Milton “Chip” Routt, Conor P Kleweno

To identify the infection rate in patients with combined pelvic ring and bladder injuries. Secondary aims included identifying treatment and injury factors associated with infection. Design: Retrospective Review Single Level I Tertiary Academic Center All patients over a 12-year period with combined pelvic ring and bladder injuries were evaluated. Exclusion criteria were non-operative management of the pelvic ring, isolated posterior fixation, and follow-up less than 90 days. Outcome Measure and Comparisons: Primary outcome measured was deep infection of the anterior pelvis requiring surgical irrigation and debridement. 106 patients with anterior stabilization of the pelvis in the setting of a bladder injury were included. 7 (6.6%) patients developed a deep infection and required surgical debridement within 90 days. Patients undergoing open reduction and internal fixation (ORIF) with plating of the anterior pelvis and acute concomitant bladder repair had an infection rate of 2.2% (1/43). Patients undergoing closed reduction and anterior fixation with either external fixation or percutaneous rami screw post bladder repair had an infection rate of 17.6% (3/17). There was a higher infection rate among patients with combined intraperitoneal (IP) and extraperitoneal (EP) bladder injuries (23%) when compared to those with isolated EP (3.8%) or IP (9.1%) bladder injuries (p=0.029). Acute ORIF of the anterior pelvis in patients with combined pelvic ring and bladder injuries has a low infection rate. Patients with combined IP and EP bladder injuries are at increased risk of infection compared to those with isolated IP and EP injuries. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

确定合并骨盆环和膀胱损伤患者的感染率。次要目的包括确定与感染相关的治疗和损伤因素。设计：回顾性研究单个一级三级学术中心对 12 年内所有合并骨盆环和膀胱损伤的患者进行了评估。排除标准为骨盆环未进行手术治疗、孤立的后固定术以及随访少于 90 天。结果测量和比较：主要测量结果是需要手术冲洗和清创的骨盆前部深度感染。共纳入 106 名在膀胱损伤的情况下接受骨盆前路稳定术的患者。7例（6.6%）患者出现深度感染，需要在90天内进行手术清创。接受开放复位内固定术（ORIF）和骨盆前部钢板固定术并同时接受急性膀胱修复术的患者感染率为2.2%（1/43）。在膀胱修复术后接受闭合复位和前路固定术（外固定或经皮髂骨螺钉）的患者感染率为17.6%（3/17）。合并腹膜内（IP）和腹膜外（EP）膀胱损伤的患者感染率（23%）高于单独腹膜外（EP）（3.8%）或腹膜内（IP）膀胱损伤（9.1%）的患者（P=0.029）。合并骨盆环和膀胱损伤患者的急性骨盆前部手术切除术感染率较低。与孤立的 IP 和 EP 损伤相比，合并 IP 和 EP 膀胱损伤的患者感染风险更高。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

Safety of Magnetic Resonance Imaging in Orthopaedic Trauma Patients with External Fixation: A Two Center Case Series. 外固定骨科创伤患者磁共振成像的安全性：两中心病例系列

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-05-14 DOI: 10.1097/bot.0000000000002843

Jacob S. Borgida, Robert Kaspar Wagner, Alice W. Wong, Seonghwan Yee, Jad S. Husseini, Arun Aneja, Mitchel B. Harris, Thuan V. Ly

To report on adverse events during magnetic resonance imaging (MRI) on patients with external fixators. Design: Retrospective case series. Two Level 1 Trauma Centers. Patients with external fixators on the appendicular skeleton or pelvis undergoing MRI between January 2005 and September 2023. Outcome Measures and Comparisons: Adverse events, defined as any undesirable event associated with the external fixator being inside or outside the MRI bore during imaging, including: (subjective) heating, displacement or pullout of external fixator, or early MRI termination for any reason. Ninety-seven patients with 110 external fixators had at least one MRI with an external fixator inside or outside of the MRI bore. The median age was 51 years (IQR: 39 – 63) and 56 (58%) were male. The most common external fixator locations were the ankle (24%), knee (21%), femur (21%), and pelvis (19%). The median duration of an MRI was 40 minutes (IQR: 26 – 58), 86% were performed using 1.5 Tesla MRI, and 14% were performed using 3.0 Tesla MRI. Ninety-five percent of MRI were performed for the cervical spine/head. Two MRI scans (1.6%), one of the shoulder and one of the head and cervical spine, with the external fixator outside of the bore were terminated early due to patient discomfort. There were no documented events of displacement or pullout of the external fixator. These findings suggest that MRI of the (cervical) spine and head can be safely obtained in patients with external fixators on the appendicular skeleton or pelvis. Given the low numbers of MRIs performed with the external fixator inside the bore, further studies are necessitated to determine the safety of this procedure. The results from this study can aid orthopaedic surgeons, radiologists, and other stakeholders in developing local institutional guidelines on MRI scanning with external fixators in situ. Prognostic Level lV. See Instructions for Authors for a complete description of levels of evidence.

报告使用外固定器的患者在磁共振成像（MRI）期间发生的不良事件。设计：回顾性病例系列。两家一级创伤中心。 2005 年 1 月至 2023 年 9 月期间接受核磁共振成像检查的阑尾骨骼或骨盆外固定器患者。结果测量和比较：不良事件，定义为成像过程中与外固定器位于 MRI 孔内或孔外相关的任何不良事件，包括：（主观）加热、外固定器移位或拔出，或因任何原因提前终止 MRI。 97名患者共使用了110个外固定器，至少有一次核磁共振成像时外固定器在核磁共振成像孔内或孔外。中位年龄为 51 岁（IQR：39 - 63），男性 56 人（58%）。最常见的外固定器位置是踝关节（24%）、膝关节（21%）、股骨（21%）和骨盆（19%）。核磁共振成像的中位持续时间为 40 分钟（IQR：26 - 58），86% 使用 1.5 特斯拉核磁共振成像，14% 使用 3.0 特斯拉核磁共振成像。95%的磁共振成像是针对颈椎/头部进行的。有两次核磁共振成像扫描（1.6%），一次是肩部扫描，一次是头部和颈椎扫描，外固定器在孔外，由于患者不适而提前终止。没有外固定器移位或脱出的记录。这些研究结果表明，在阑尾骨骼或骨盆上使用外固定器的患者可以安全地进行（颈椎）脊柱和头部的核磁共振成像检查。鉴于外固定器在孔内进行核磁共振成像的数量较少，有必要进行进一步研究以确定该手术的安全性。这项研究的结果可帮助矫形外科医生、放射科医生和其他利益相关者制定有关在原位使用外固定器进行核磁共振成像扫描的地方性机构指南。预后等级lV。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

Validation of Patient-Reported Outcome Measurement Information System (PROMIS) for Detection of Posttraumatic Stress in Children and Adolescents Following Procedures for Acute Orthopaedic Trauma 验证 "患者报告结果测量信息系统"（PROMIS）以检测急性骨科创伤手术后儿童和青少年的创伤后应激反应

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-05-14 DOI: 10.1097/bot.0000000000002842

Collin May, Hillary Brenda Nguyen, Patricia Miller, Justyna Klajn, Emily S. Rademacher, Michaela O’Connor, Daniel Hedequist, Benjamin Shore

The efficiency and validity of PROMIS surveys were determined for pediatric orthopaedic trauma patients with posttraumatic stress disorder (PTSD) symptoms in a clinic setting. Design: Prospective cohort study. Single-institution, Level I Trauma Center. All consecutive children aged 8-18 years undergoing procedures or surgery for orthopaedic trauma. Outcome Measures and Comparisons: The convergent, divergent, and discriminant validity of the PROMIS Anger and Anxiety computerized adaptive tests (CATs) were evaluated and compared to the previously validated Child PTSD Symptom Scale (CPSS). The efficiency in time to completion of the outcome measures was compared between the CPSS and PROMIS surveys. Cutoffs for increased likelihood of PTSD were established for the PROMIS questionnaires. A total of 233 subjects were included in this study (mean age 13.1 years with SD 2.8 years, 71% male). The majority (51%) of injuries were sports-related and most (60%) involved the upper extremity. Of those included, 41 patients had high levels of PTSD symptoms on the CPSS (18%; 95% CI=13.1-23.2%). The CPSS took 182 (IQR 141-228) seconds versus 52 (IQR 36-84) and 52 (IQR 36-70) seconds for PROMIS Anger and Anxiety CATs, respectively. Convergent validity showed patient scores on both PROMIS instruments significantly correlated with CPSS scores (Anger: p<0.001, r=0.51; Anxiety: p<0.001, r=0.41). Neither PROMIS score correlated with UCLA Activity Score (Anger: r=-0.26; Anxiety: r=-0.22), a functional outcome measure, demonstrating divergent validity. Both PROMIS instruments sufficiently discriminated across PTSD risk groups (Anger p<0.001; Anxiety p<0.001). A score of at least 53 on PROMIS Anger or at least 48 on PROMIS Anxiety indicated an increased likelihood of PTSD risk. PROMIS Anger and Anxiety CATs are efficient and valid for evaluating posttraumatic stress in children following orthopaedic trauma procedures. Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

针对诊所环境中出现创伤后应激障碍（PTSD）症状的小儿骨科创伤患者，确定 PROMIS 调查的效率和有效性。设计：前瞻性队列研究。单一机构、一级创伤中心。所有连续接受矫形创伤手术或外科手术的 8-18 岁儿童。结果测量和比较：评估 PROMIS 愤怒和焦虑电脑适应性测试 (CAT) 的收敛性、发散性和判别性，并与之前验证过的儿童创伤后应激障碍症状量表 (CPSS) 进行比较。比较了 CPSS 和 PROMIS 调查完成结果测量的时间效率。为 PROMIS 问卷确定了创伤后应激障碍可能性增加的临界值。本研究共纳入 233 名受试者（平均年龄 13.1 岁，标准差 2.8 岁，71% 为男性）。大部分（51%）受伤与运动有关，大部分（60%）涉及上肢。在纳入的患者中，有 41 名患者在 CPSS（18%；95% CI=13.1-23.2%）中出现了严重的创伤后应激障碍症状。CPSS 用时 182（IQR 141-228）秒，而 PROMIS 愤怒和焦虑 CAT 用时分别为 52（IQR 36-84）秒和 52（IQR 36-70）秒。聚合效度显示，患者在 PROMIS 和 CPSS 两项工具上的得分均与 CPSS 分数显著相关（愤怒：p<0.001，r=0.51；焦虑：p<0.001，r=0.41）。PROMIS 评分与功能性结果测量指标 UCLA 活动评分均无相关性（愤怒：r=-0.26；焦虑：r=-0.22），这表明两者之间存在差异。两种 PROMIS 工具都能充分区分创伤后应激障碍风险群体（愤怒 p<0.001；焦虑 p<0.001）。PROMIS 愤怒指数得分至少达到 53 分，或 PROMIS 焦虑指数得分至少达到 48 分，表明患创伤后应激障碍风险的可能性增加。 PROMIS愤怒和焦虑CAT对于评估矫形创伤手术后儿童的创伤后应激反应既有效又有效。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

Frailty is More Predictive of Mortality than Age in Patients with Hip Fractures 虚弱比年龄更能预测髋部骨折患者的死亡率

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-05-08 DOI: 10.1097/bot.0000000000002844

Abigail Sagona, Carlos A. Ortega, Liqin Wang, Devon T Brameier, Faith Selzer, Li Zhou, Arvind G. von Keudell

To investigate the association between the Comprehensive Geriatric Assessment-based Frailty Index (FI) and adverse outcomes in older adult patients undergoing hip fracture surgery. Retrospective cohort study Academic Level 1 Trauma Center. All patients aged 65 or older who underwent surgical repair of a hip fracture between May 2018 and August 2020 were identified through institutional database review. Outcome Measures and Comparisons: Data including demographics, FI, injury presentation, and hospital course were collected. Patients were grouped by FI as non-frail (FI < 0.21), frail (0.21≤FI<0.45), and severely frail (FI >0.45). Adverse outcomes of these groups were compared using Kaplan Meier survival analysis. Risk factors for one-year re-hospitalization and two-year mortality were evaluated using Cox hazard regression. 316 patients were included, with 62 non-frail, 185 frail, and 69 severely frail patients. The total population was on average 83.8 years old, predominantly white (88.0%), and majority female (69.9%) with an average FI of 0.33 (SD: 0.14). The non-frail cohort was on average 78.8 years old, 93.6% white, and 80.7% female; the frail cohort was on average 84.5 years old, 92.4% white, and 71.9% female, and the severely frail cohort was on average 86.4 years old, 71.0% white, and 55.1% female. Rate of one-year readmission increased with frailty level, with a rate of 38% in non-frail patients, 55.6% in frail patients, and 74.2% in severely frail patients (p=0.001). The same pattern was seen in two-year mortality rates, with a rate of 2.8% in non-frail patients, 36.7% in frail patients, and 77.5% in severely frail patients (p<0.0001). Being classified as frail or severely frail exhibited greater association with mortality within 2 years than age, with hazard ratio of 17.81 for frail patients and 56.81 for severely frail patients compared to 1.19 per 5 years of age. Increased frailty as measured by the Frailty Index is significantly associated with increased two-year mortality and one-year hospital readmission rates following hip fracture surgery. Degree of frailty predicts mortality more strongly than age alone. Assessing frailty with the Frailty Index can identify higher-risk surgical candidates, facilitate clinical decision-making, and guide discussions about goals of care with family members, surgeons, and geriatricians. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

研究基于老年综合评估的虚弱指数（FI）与接受髋部骨折手术的老年患者不良预后之间的关系。回顾性队列研究学术一级创伤中心。通过机构数据库审查，确定所有在 2018 年 5 月至 2020 年 8 月期间接受髋部骨折手术修复的 65 岁或以上患者。结果测量和比较：收集的数据包括人口统计学、FI、受伤表现和住院过程。根据 FI 将患者分为非虚弱组（FI < 0.21）和虚弱组（0.21≤FI0.45）。采用卡普兰-梅耶尔生存分析法比较这两组患者的不良预后。采用 Cox 危险回归法评估了一年内再次住院和两年内死亡率的危险因素。研究共纳入了 316 名患者，其中包括 62 名非体弱患者、185 名体弱患者和 69 名严重体弱患者。总人口的平均年龄为 83.8 岁，以白人为主（88.0%），女性占多数（69.9%），平均 FI 为 0.33（标清：0.14）。非虚弱人群的平均年龄为 78.8 岁，白人占 93.6%，女性占 80.7%；虚弱人群的平均年龄为 84.5 岁，白人占 92.4%，女性占 71.9%；严重虚弱人群的平均年龄为 86.4 岁，白人占 71.0%，女性占 55.1%。一年再入院率随虚弱程度的增加而增加，非虚弱患者为 38%，虚弱患者为 55.6%，严重虚弱患者为 74.2%（P=0.001）。两年死亡率也呈现出同样的模式，非体弱患者的死亡率为 2.8%，体弱患者为 36.7%，而严重体弱患者为 77.5%（P<0.0001）。与年龄相比，被归类为虚弱或严重虚弱与两年内死亡率的关系更大，虚弱患者的危险比为 17.81，严重虚弱患者的危险比为 56.81，而每 5 岁患者的危险比为 1.19。以虚弱指数衡量的虚弱程度的增加与髋部骨折术后两年死亡率和一年再入院率的增加有显著关联。虚弱程度比单纯的年龄更能预测死亡率。用虚弱指数评估虚弱程度可以确定风险较高的手术候选者，促进临床决策，并指导与家庭成员、外科医生和老年病学家讨论护理目标。预后等级 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

Mid to Long-term Outcomes of Grade III-B Open Tibial Fractures Definitively Managed with a Circular Frame: A 13-Year Prospective Database Study at a Major Trauma Centre. 使用圆形框架明确处理的 III-B 级开放性胫骨骨折的中长期疗效：一家大型创伤中心为期13年的前瞻性数据库研究。

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-05-08 DOI: 10.1097/bot.0000000000002841

Kiran R Madhvani, A. Fong, Tom Clark, Khemerin Eng, Codrin Condurche, J. McGregor-Riley, D. Shields

The aim of this study was to report experience of a major trauma centre utilising circular frames as definitive fixation in patients sustaining Gustilo-Anderson (GA) 3B open tibial fractures. Design: A prospectively maintained database was retrospectively interrogated. Single major trauma centre in the United Kingdom. All patients over the age of 16 sustaining an open tibial fracture with initial debridement performed at the study centre. All patients also received orthoplastic care for a soft tissue defect (via skeletal deformation or a soft tissue cover procedure) and subsequent definitive management using an Ilizarov ring fixator. Patients who received primary debridement at another centre, had pre-existing infection, sustained a periarticular fracture or those who did not afford a minimum of 12-months follow-up were excluded. Case notes and radiographs were reviewed to collate patient demographics and injury factors. The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventions. 225 patients met inclusion criteria. Mean age was 43.2 years old, with 72% males, 34% smokers and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). 8 (3.5%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. 79 (35.1%) patients had a secondary intervention of which; 8 comprised debridement of deep infection, 29 bony procedures, 8 soft tissue operations, 30 frame adjustments and 4 patients requiring a combination of soft tissue and bony procedures. Bony union was achieved in 221 cases (98.2%), 195 (86.7%) achieved union in a single frame without the need for secondary intervention, 26 required frame adjustments to achieve union. Autologous bone grafts were used in 10 cases. Orthoplastic care including circular frame fixation for GA-3B fractures of the tibia resulted in a low rate of deep infection (3.5%) and achieved excellent union rates (98.2%). Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

本研究旨在报告一家大型创伤中心在对古斯蒂洛-安德森（GA）3B开放性胫骨骨折患者进行最终固定时使用圆形框架的经验。设计：对前瞻性维护的数据库进行回顾性查询。英国的一家大型创伤中心。所有年满16岁的开放性胫骨骨折患者均在研究中心进行了初步清创。所有患者还接受了软组织缺损矫形治疗（通过骨骼变形或软组织覆盖手术），随后使用伊利扎洛夫环形固定器进行最终治疗。在其他中心接受过初次清创术、原有感染、关节周围骨折或未接受至少 12 个月随访的患者均被排除在外。研究人员对病例记录和X光片进行了审查，以整理患者的人口统计学特征和损伤因素。主要结果是深度感染率，次要结果包括骨折愈合时间和二次干预。 225名患者符合纳入标准。平均年龄为43.2岁，男性占72%，吸烟者占34%，糖尿病患者占3%。接受框架治疗的总时间平均为 6.4 个月（标准差为 7.7）。8名（3.5%）患者出现了深部感染，41名（20%）患者出现了针眼部位感染的迹象。79例（35.1%）患者进行了二次干预，其中8例包括深度感染清创、29例骨性手术、8例软组织手术、30例骨架调整，4例患者需要软组织和骨性手术相结合。221例患者（98.2%）实现了骨性结合，195例（86.7%）无需二次干预即可在单个骨架上实现骨性结合，26例患者需要调整骨架才能实现骨性结合。10例使用了自体骨移植。胫骨GA-3B骨折的整形治疗包括环形骨架固定，深部感染率较低（3.5%），愈合率极高（98.2%）。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

The Effects of Unitizing Nail-Plate Constructs in Distal Femur Fractures: A Biomechanical Study 股骨远端骨折中单元化钉板结构的效果：生物力学研究

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-05-06 DOI: 10.1097/bot.0000000000002839

Erik N Mayer, Matin Lendhey, Ben Kelley, Brendan Shi, Alexander Upfill-Brown, Sai K. Devana, D. Brodke, Akash A Shah, Troy Sekimura, Varun Gudapati, Brian Zukotynski, Jeannie Park, Amber R. Witt, Mara Marciante, Jonathan M. Mahoney, Brandon S Bucklen, Christopher Lee

To assess the biomechanical differences between linked and unlinked constructs in young and osteoporotic cadavers in addition to osteoporotic sawbones. Intraarticular distal femur fractures with comminuted metaphyseal regions were created in three young matched pair cadavers, three osteoporotic matched pair cadavers, and six osteoporotic sawbones. Precontoured distal femur locking plates were placed in addition to a standardized retrograde nail, with unitized constructs having one 4.5 mm locking screw placed distally through the nail. Nonunitized constructs had seven 4.5 mm locking screws placed through the plate around the nail, with one 5 mm distal interlock placed through the nail alone. Cadaveric specimens were subjected to axial fatigue loads between 150 and 1500 N (R Ratio = 10) with 1 Hx frequency for 10,000 cycles. Sawbones were axially loaded at 50% of the ultimate load for fatigue testing to achieve runout, with testing performed with 30 and 300 N (R Ratio = 10) loads with 1 Hz frequency for 10,000 cycles. In young cadavers, there was no difference in the mean cyclic displacement of the unitized constructs (1.51 ± 0.62mm) compared to the non-unitized constructs (1.34 ± 0.47mm) (Figure 4A), (p = 0.722). In osteoporotic cadavers, there was no difference in the mean cyclic displacement of the unitized constructs (2.46 ± 0.47mm) compared to the non-unitized constructs (2.91 ± 1.49mm) (p=0.639). There was statistically no significant difference in cyclic displacement between the unitized and non-unitized groups in osteoporotic sawbones(p = 0.181) Linked constructs did not demonstrate increased axial stiffness or decreased cyclical displacement in comparison to unlinked constructs in young cadaveric specimens, osteoporotic cadaveric specimens, or osteoporotic sawbones.

评估年轻和骨质疏松尸体以及骨质疏松锯骨中连接和非连接结构的生物力学差异。在三具年轻的配对尸体、三具骨质疏松的配对尸体和六块骨质疏松的锯骨中创建了粉碎性骨骺区的股骨远端关节内骨折。除了标准化的逆行钉外，还放置了预弯股骨远端锁定钢板，单位化结构的远端通过钢钉放置了一颗 4.5 毫米锁定螺钉。非单元化结构则在钢板上围绕钢钉放置了七颗 4.5 毫米的锁定螺钉，仅在钢钉上放置了一颗 5 毫米的远端锁定螺钉。尸体标本承受的轴向疲劳载荷在 150 到 1500 N 之间（R Ratio = 10），频率为 1 Hx，循环次数为 10,000 次。在疲劳测试中，锯骨的轴向载荷为极限载荷的 50%，以实现跳动，测试以 30 和 300 N（R 比 = 10）的载荷和 1 Hz 的频率进行，循环 10,000 次。在年轻尸体中，单元化结构的平均循环位移（1.51 ± 0.62 毫米）与非单元化结构的平均循环位移（1.34 ± 0.47 毫米）相比没有差异（图 4A），（p = 0.722）。在骨质疏松尸体中，单元化结构的平均周期位移（2.46 ± 0.47mm）与非单元化结构的平均周期位移（2.91 ± 1.49mm）相比没有差异（p=0.639）。在骨质疏松的锯骨中，单元化组和非单元化组的周期位移在统计学上没有明显差异（p=0.181）。在年轻的尸体标本、骨质疏松的尸体标本或骨质疏松的锯骨中，与非链接结构相比，链接结构没有显示出轴向刚度的增加或周期位移的减少。

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引用次数: 0

Increased 1-year revision rates among left-sided intertrochanteric femur fractures 左侧股骨转子间骨折 1 年翻修率增加

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-05-06 DOI: 10.1097/bot.0000000000002829

Alex Gu, Keli Doe, Lauren Bracey, A. Agarwal, Taylor Raffa, Benjamin Farley, Thomas Fraychinaud, Brock Knapp, Sean A. Tabaie, James Debritz, Robert Sterling

To compare 1-year revision rates among left and right-sided intertrochanteric femur fractures. Retrospective 120+ contributing centers to Multicentered database Patients who sustained an intertrochanteric femur fracture (ITFFs) and had a cephalomedullary nail (CMN) from 2015-2022 were identified. Patients were then stratified based on left- or right-sided fracture. Patients were excluded if <18 years old, less than 1-year follow up. The intervention investigated was CMN on left or right side. Outcome Measures and Comparisons: 1-year revision surgery, comparing CMN performed on left or right side for ITFFs In total, 113,626 patients met inclusion criteria, with 55,295 in the right-sided cohort and 58,331 in the left-sided cohort. There was no difference between cohorts with respect to age, gender, diabetes, osteoporosis, chronic kidney disease, or congestive heart failure (p>0.05 for all). Patients who sustained a left intertrochanteric femur fracture (ITFFs) and treated with a CMN were more likely to have revision surgery at 1 year (Left: 1.24%, Right: 0.90%; OR: 1.24; 95% CI: 1.15-1.1.33) or develop a nonunion or malunion (Left: 1.30%, Right: 0.98%; OR: 1.31; 95% CI: 1.14-1.52). The most common revision surgery conducted for both cohorts was conversion total hip arthroplasty (Left: 70.4% and Right: 70.0%). Patients who sustained a left intertrochanteric femur fracture and were treated with a CMN were more likely to undergo revision 1-year due to nonunion. There were no differences in demographics and comorbidities between cohorts. Though left versus right-sided confounding variables may exist, the difference in nonunion rate may be explained by clockwise torque of the lag screw used in most implants. Increased awareness, implant design, and improved technique during fracture reduction and fixation may help lower this disproportionate nonunion rate and its associated morbidity and financial impact. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

比较左侧和右侧股骨转子间骨折的 1 年翻修率。回顾性研究 120 多个中心加入多中心数据库对 2015-2022 年期间发生股骨转子间骨折（ITFF）并使用头髓内钉（CMN）的患者进行鉴定。然后根据左侧或右侧骨折对患者进行分层。如果所有条件均为 0.05，则排除患者。）左侧股骨转子间骨折（ITFFs）并接受CMN治疗的患者更有可能在1年后接受翻修手术（左侧：1.24%，右侧：0.90%；OR：1.24；95% CI：1.15-1.1.33）或出现不愈合或错位（左侧：1.30%，右侧：0.98%；OR：1.31；95% CI：1.14-1.52）。两个队列中最常见的翻修手术都是转换全髋关节置换术（左侧：70.4%，右侧：70.0%）。左侧股骨转子间骨折并接受CMN治疗的患者更有可能在1年后因不愈合而接受翻修手术。两组患者在人口统计学和合并症方面没有差异。虽然左侧和右侧可能存在混杂变量，但大多数植入物使用的滞后螺钉的顺时针扭矩可能是造成不愈合率差异的原因。在骨折复位和固定过程中提高意识、改进植入物设计和技术可能有助于降低这种不成比例的不愈合率及其相关的发病率和经济影响。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

A Cadaveric Study: Does Ankle Positioning Impact the Quality of Anatomic Syndesmosis Reduction? 尸体研究：踝关节定位是否会影响解剖楔缝缩窄的质量？

IF 2.3 3区医学 Q1 Medicine

Journal of Orthopaedic Trauma

Pub Date : 2024-05-06 DOI: 10.1097/bot.0000000000002827

Arun Aneja, M. Nazal, Jarod T. Griffin, Jeffrey A. Foster, Maaz Muhammad, Carlos R Sierra-Arce, Wyatt G S Southall, R. K. Wagner, Thuan V. Ly, Arjun Srinath

To compare the quality of syndesmotic reduction with the ankle in maximal dorsiflexion versus neutral plantarflexion (normal resting position). Baseline computed tomography (CT) imaging of 10 cadaveric ankle specimens from 5 donors was obtained with the ankles placed in normal resting position. Two fellowship-trained orthopaedic surgeons disrupted the syndesmosis of each ankle specimen. All ankles were then placed in neutral plantarflexion and were subsequently reduced with thumb pressure under direct visualization via an anterolateral approach and stabilized with one 0.062-inch K-wire placed from lateral to medial in a quadricortical fashion across the syndesmosis. Post-reduction CT scans were then obtained with the ankle in normal resting position. This process was repeated with the ankles placed in maximal dorsiflexion during reduction and stabilization. Post-reduction CT scans were then obtained with the ankles placed in normal resting position. All post-reduction CT scans were compared to baseline CT imaging using mixed-effects linear regression with significance set at p<0.05. Syndesmotic reduction and stabilization in maximal dorsiflexion led to increased external rotation of the fibula compared to baseline scans [13.0 degrees ± 5.4 degrees (mean ± SD) vs. 7.5 degrees ± 2.4 degrees, p=0.002]. There was a tendency towards lateral translation of the fibula with the ankle reduced in maximal dorsiflexion (3.3 mm ± 1.0 mm vs. 2.7 mm ± 0.7 mm, p=0.096). No other statistically significant differences between measurements of reduction with the ankle placed in neutral plantarflexion or maximal dorsiflexion compared to baseline were present (p> 0.05). Reducing the syndesmosis with the ankle in maximal dorsiflexion may lead to malreduction with external rotation of the fibula. There was no statistically significant difference in reduction quality with the ankle placed in neutral plantarflexion compared to baseline. Future studies should assess the clinical implications of ankle positioning during syndesmotic fixation.

比较踝关节处于最大背屈位和中立跖屈位（正常静止位）时腓肠肌联合缩窄的质量。对来自 5 位捐献者的 10 个尸体踝关节标本进行基线计算机断层扫描（CT）成像，并将踝关节置于正常静止位置。两名受过研究培训的骨科医生破坏了每个踝关节标本的腓骨联合。然后将所有踝关节置于中性跖屈位，随后在直视下通过前外侧入路用拇指压迫缩小踝关节，并用一根 0.062 英寸的 K 型钢丝从外侧到内侧以四角形方式穿过踝关节联合进行稳定。然后在踝关节处于正常静止位置的情况下进行还原后 CT 扫描。在还原和稳定过程中，将踝关节置于最大外展位置，重复上述过程。然后在踝关节处于正常静止位置时进行还原后 CT 扫描。使用混合效应线性回归法将所有还原后 CT 扫描与基线 CT 成像进行比较，显著性设定为 p 0.05）。在踝关节处于最大背屈状态下减小腓骨联合可能会导致腓骨外旋时减小不良。与基线相比，踝关节处于中立跖屈位时的缩窄质量没有明显的统计学差异。未来的研究应评估巩膜固定过程中踝关节定位的临床意义。

{"title":"A Cadaveric Study: Does Ankle Positioning Impact the Quality of Anatomic Syndesmosis Reduction?","authors":"Arun Aneja, M. Nazal, Jarod T. Griffin, Jeffrey A. Foster, Maaz Muhammad, Carlos R Sierra-Arce, Wyatt G S Southall, R. K. Wagner, Thuan V. Ly, Arjun Srinath","doi":"10.1097/bot.0000000000002827","DOIUrl":"https://doi.org/10.1097/bot.0000000000002827","url":null,"abstract":"\u0000 \u0000 To compare the quality of syndesmotic reduction with the ankle in maximal dorsiflexion versus neutral plantarflexion (normal resting position).\u0000 \u0000 \u0000 \u0000 Baseline computed tomography (CT) imaging of 10 cadaveric ankle specimens from 5 donors was obtained with the ankles placed in normal resting position. Two fellowship-trained orthopaedic surgeons disrupted the syndesmosis of each ankle specimen. All ankles were then placed in neutral plantarflexion and were subsequently reduced with thumb pressure under direct visualization via an anterolateral approach and stabilized with one 0.062-inch K-wire placed from lateral to medial in a quadricortical fashion across the syndesmosis. Post-reduction CT scans were then obtained with the ankle in normal resting position. This process was repeated with the ankles placed in maximal dorsiflexion during reduction and stabilization. Post-reduction CT scans were then obtained with the ankles placed in normal resting position. All post-reduction CT scans were compared to baseline CT imaging using mixed-effects linear regression with significance set at p<0.05.\u0000 \u0000 \u0000 \u0000 Syndesmotic reduction and stabilization in maximal dorsiflexion led to increased external rotation of the fibula compared to baseline scans [13.0 degrees ± 5.4 degrees (mean ± SD) vs. 7.5 degrees ± 2.4 degrees, p=0.002]. There was a tendency towards lateral translation of the fibula with the ankle reduced in maximal dorsiflexion (3.3 mm ± 1.0 mm vs. 2.7 mm ± 0.7 mm, p=0.096). No other statistically significant differences between measurements of reduction with the ankle placed in neutral plantarflexion or maximal dorsiflexion compared to baseline were present (p> 0.05).\u0000 \u0000 \u0000 \u0000 Reducing the syndesmosis with the ankle in maximal dorsiflexion may lead to malreduction with external rotation of the fibula. There was no statistically significant difference in reduction quality with the ankle placed in neutral plantarflexion compared to baseline. Future studies should assess the clinical implications of ankle positioning during syndesmotic fixation.\u0000","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141010267","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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