Pub Date : 2024-04-22DOI: 10.1097/bot.0000000000002823
J. Brodell, Brittany Haws, Jeffrey B. Shroff, Steven Karnyski, Samantha Hoffman, Sandeep P. Soin, Catherine A. Humphrey, J. Gorczyca, John P. Ketz
To determine if rates of pin site infection and surgical site infection amongst patients managed with primary closure after external fixator removal were similar to those allowed to heal secondarily. Design: Retrospective cohort Urban/Suburban Academic Level I Trauma Center Patients who had received a lower extremity external fixator for provisional management prior to definitive fixation of lower extremity fractures were included with pin site wounds closed primarily or allowed to heal by secondary intention. The rate of pin tract infection and surgical site infection following primary closure of external fixator pin sites relative to patients whose pin sites were allowed to heal via secondary intention. . 256 patients were evaluated, 143 patients (406 pin sites) in the primary closure group and 113 patients (340 in sites) in the secondary closure group. The average age was 49 ± 16 years. Sixty-five percent of included patients were male. There was no difference in pin tract infections between cohorts (Primary=0.5%, Secondary=1.5%, p=0.26). External fixator duration in the primary closure group was 11.5 ± 8.4 days, and 13.0 ± 8.1 days in the secondary closure group (p=0.15). There was a greater rate of surgical site infections in the secondary intention cohort (15.9% vs 7.7%, p=0.047). There was no difference in pin site infection rate after primary pin site closure relative to patients who were allowed to heal via secondary intention. Furthermore, there was a lower rate of surgical site infection after primary closure. These results challenge the dogma of secondary closure for ex fix pin sites, suggesting that debridement and primary closure is a safe option for management of external fixator pin sites, and may impart benefit in decreasing infection risk. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Primary Closure of External Fixator Pin Sites is Safe After Orthopaedic Trauma Surgery","authors":"J. Brodell, Brittany Haws, Jeffrey B. Shroff, Steven Karnyski, Samantha Hoffman, Sandeep P. Soin, Catherine A. Humphrey, J. Gorczyca, John P. Ketz","doi":"10.1097/bot.0000000000002823","DOIUrl":"https://doi.org/10.1097/bot.0000000000002823","url":null,"abstract":"\u0000 \u0000 To determine if rates of pin site infection and surgical site infection amongst patients managed with primary closure after external fixator removal were similar to those allowed to heal secondarily.\u0000 \u0000 \u0000 \u0000 \u0000 Design: Retrospective cohort\u0000 \u0000 \u0000 \u0000 Urban/Suburban Academic Level I Trauma Center\u0000 \u0000 \u0000 \u0000 Patients who had received a lower extremity external fixator for provisional management prior to definitive fixation of lower extremity fractures were included with pin site wounds closed primarily or allowed to heal by secondary intention.\u0000 \u0000 \u0000 \u0000 The rate of pin tract infection and surgical site infection following primary closure of external fixator pin sites relative to patients whose pin sites were allowed to heal via secondary intention. .\u0000 \u0000 \u0000 \u0000 256 patients were evaluated, 143 patients (406 pin sites) in the primary closure group and 113 patients (340 in sites) in the secondary closure group. The average age was 49 ± 16 years. Sixty-five percent of included patients were male. There was no difference in pin tract infections between cohorts (Primary=0.5%, Secondary=1.5%, p=0.26). External fixator duration in the primary closure group was 11.5 ± 8.4 days, and 13.0 ± 8.1 days in the secondary closure group (p=0.15). There was a greater rate of surgical site infections in the secondary intention cohort (15.9% vs 7.7%, p=0.047).\u0000 \u0000 \u0000 \u0000 There was no difference in pin site infection rate after primary pin site closure relative to patients who were allowed to heal via secondary intention. Furthermore, there was a lower rate of surgical site infection after primary closure. These results challenge the dogma of secondary closure for ex fix pin sites, suggesting that debridement and primary closure is a safe option for management of external fixator pin sites, and may impart benefit in decreasing infection risk.\u0000 \u0000 \u0000 \u0000 Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.\u0000","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675342","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 : 2024-04-22DOI: 10.1097/bot.0000000000002821
C. Sabatini, E. Edmonds, J. Nepple, Elizabeth S. Liotta, Katelyn Hergott, C. Perkins, P. Wilson, Ying Li, H. Ellis, Nirav K. Pandya, A. Pennock, David D. Spence, S. Willimon, D. Bae, M. Kocher, Michael T. Busch, David N. Williams, B. Heyworth
To compare the clinical, radiographic, and patient-reported outcomes of non-operative and operative treatment of adolescents with comminuted ‘Z-type’ mid-shaft clavicle fractures. Design: Prospective observational cohort Eight tertiary-care pediatric centers Patients 10 to 18 years-old who were treated either operatively or non-operatively for a diaphyseal clavicle fracture between 2013 and 2017 were screened/enrolled at the time of injury. The current sub-cohort analysis was derived from a larger adolescent clavicle study population of 907 patients. Complications and validated patient-reported outcome measures (PROs):(ASES, QuickDASH, Marx Shoulder Activity Score, EQ-5D, EQ-VAS, and patient satisfaction score) were compared between operative and non-operative cohorts. Eighty-one patients (69 male (85.2%), 12 female; average age 15 years (11.1-18.7); 78 with sports participation (96.2%)), were followed through bony healing and return to sports, while 59 patients (73%) completed two-year follow-up with patient-reported outcomes (PROs), 26 of whom were treated non-operatively and 33 treated operatively. All demographic and fracture characteristics were similar (p>0.05) between the two-year follow-up cohorts except for fracture shortening, which was greater in the operative cohort (23 mm vs 29 mm, p=0.01). After controlling for this potential confounder through both regression and propensity matched sub-group analysis, non-operative versus operative cohorts showed no difference in rates of nonunion (0%), delayed union (0% vs. 2.3%, p=1.0), symptomatic malunion (2.7% vs 0%, p=0.4), refracture (2.7% vs 2.2%, p=1.0), unexpected subsequent surgery (5.4% vs. 11.4%, p=0.45), or clinically significant complications (5.4% vs. 16%, p=0.17). There were no differences in any PROs between cohorts, both before and after controlling for the difference in fracture shortening (all p-values >0.05). In this prospective comparison of complications and two-year PROs in adolescents with comminuted Z-type clavicle fractures, non-operative and operative treatment yielded similar outcomes. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
目的：比较青少年锁骨中轴粉碎性 "Z型 "骨折非手术治疗和手术治疗的临床、影像学和患者报告结果。 设计：前瞻性观察队列 八家三级医疗儿科中心 2013年至2017年期间因锁骨骨骺骨折接受手术或非手术治疗的10至18岁患者在受伤时接受筛查/登记。目前的子队列分析来自于一个由 907 名患者组成的更大的青少年锁骨研究群体。 比较了手术组群和非手术组群的并发症和有效的患者报告结局指标（PROs）：（ASES、QuickDASH、马克思肩部活动评分、EQ-5D、EQ-VAS和患者满意度评分）。 81名患者（69名男性（85.2%），12名女性；平均年龄15岁（11.1-18.7）；78名参加过运动（96.2%））接受了骨愈合和恢复运动的随访，59名患者（73%）完成了为期两年的患者报告结果（PROs）随访，其中26名患者接受了非手术治疗，33名患者接受了手术治疗。两年随访期间，两组患者的所有人口统计学特征和骨折特征均相似（P>0.05），但骨折缩短率除外，手术治疗组的骨折缩短率更高（23 毫米对 29 毫米，P=0.01）。通过回归分析和倾向匹配亚组分析对这一潜在混杂因素进行控制后，非手术队列与手术队列在骨折不愈合率（0%）、延迟愈合率（0% vs. 2.3%，p=1.0）方面没有差异。2.3%，P=1.0）、症状性骨折（2.7% vs 0%，P=0.4）、再骨折（2.7% vs 2.2%，P=1.0）、意外后续手术（5.4% vs 11.4%，P=0.45）或临床重大并发症（5.4% vs 16%，P=0.17）的发生率均无差异。在控制骨折缩短差异之前和之后，两组患者的任何PRO指标均无差异（所有P值均大于0.05）。 在这项前瞻性的Z型锁骨粉碎性骨折青少年并发症和两年PROs比较中，非手术治疗和手术治疗的结果相似。 治疗等级为二级。有关证据等级的完整描述，请参阅 "作者须知"。
{"title":"Non-Operative Versus Operative Treatment of Z-Type Comminuted Clavicle Fractures in Adolescents: A Prospective Sub-Stratified Cohort Analysis","authors":"C. Sabatini, E. Edmonds, J. Nepple, Elizabeth S. Liotta, Katelyn Hergott, C. Perkins, P. Wilson, Ying Li, H. Ellis, Nirav K. Pandya, A. Pennock, David D. Spence, S. Willimon, D. Bae, M. Kocher, Michael T. Busch, David N. Williams, B. Heyworth","doi":"10.1097/bot.0000000000002821","DOIUrl":"https://doi.org/10.1097/bot.0000000000002821","url":null,"abstract":"\u0000 \u0000 To compare the clinical, radiographic, and patient-reported outcomes of non-operative and operative treatment of adolescents with comminuted ‘Z-type’ mid-shaft clavicle fractures.\u0000 \u0000 \u0000 \u0000 Design: Prospective observational cohort\u0000 \u0000 \u0000 \u0000 Eight tertiary-care pediatric centers\u0000 \u0000 \u0000 \u0000 Patients 10 to 18 years-old who were treated either operatively or non-operatively for a diaphyseal clavicle fracture between 2013 and 2017 were screened/enrolled at the time of injury. The current sub-cohort analysis was derived from a larger adolescent clavicle study population of 907 patients.\u0000 \u0000 \u0000 \u0000 Complications and validated patient-reported outcome measures (PROs):(ASES, QuickDASH, Marx Shoulder Activity Score, EQ-5D, EQ-VAS, and patient satisfaction score) were compared between operative and non-operative cohorts.\u0000 \u0000 \u0000 \u0000 Eighty-one patients (69 male (85.2%), 12 female; average age 15 years (11.1-18.7); 78 with sports participation (96.2%)), were followed through bony healing and return to sports, while 59 patients (73%) completed two-year follow-up with patient-reported outcomes (PROs), 26 of whom were treated non-operatively and 33 treated operatively. All demographic and fracture characteristics were similar (p>0.05) between the two-year follow-up cohorts except for fracture shortening, which was greater in the operative cohort (23 mm vs 29 mm, p=0.01). After controlling for this potential confounder through both regression and propensity matched sub-group analysis, non-operative versus operative cohorts showed no difference in rates of nonunion (0%), delayed union (0% vs. 2.3%, p=1.0), symptomatic malunion (2.7% vs 0%, p=0.4), refracture (2.7% vs 2.2%, p=1.0), unexpected subsequent surgery (5.4% vs. 11.4%, p=0.45), or clinically significant complications (5.4% vs. 16%, p=0.17). There were no differences in any PROs between cohorts, both before and after controlling for the difference in fracture shortening (all p-values >0.05).\u0000 \u0000 \u0000 \u0000 In this prospective comparison of complications and two-year PROs in adolescents with comminuted Z-type clavicle fractures, non-operative and operative treatment yielded similar outcomes.\u0000 \u0000 \u0000 \u0000 Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.\u0000","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676132","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 : 2024-04-22DOI: 10.1097/bot.0000000000002822
Robert Kaspar Wagner, M. P. Emmelot, C. van Trikt, Caroline E. Visser, Edgar J. G. Peters, Stein J. Janssen, Peter Kloen
To determine (1) the rate of positive cultures in presumed aseptic nonunions, (2) the rate and microbial spectrum of positive cultures that represented occult infection, and (3) rates of nonunion healing. Retrospective cohort study. Tertiary referral center. Adult patients with a presumed aseptic nonunion treated with single-stage revision between 2002 and 2022. The rate of positive cultures compared for two protocols: old: 1 – 2 samples cultured 7 days vs. new: 5 samples cultured 14 days. The rate of positive cultures meeting occult infection criteria with the new protocol (≥ 2 samples with phenotypically indistinguishable microorganisms, or ≥1 sample with a high virulent microorganism). Nonunion healing rates between protocols and between groups based on culture results with the new protocol. 179 patients were included. The rate of positive cultures was 14% (n = 15/105) with the old protocol, and 51% (n = 38/74) with the new protocol (p < 0.001). With the new protocol, the rate of positive cultures meeting occult infection criteria was 19% (n = 14/74), and Coagulase-negative staphylococci (48%) and Cutibacterium acnes (38%) were the most common microorganisms. Nonunion healing rates after the primary revision did not differ between protocols (old: 82% vs. new: 86%, p = 0.41) and groups based on culture result (sterile: 86% vs. occultly infected: 93%, p = 0.66). The final overall nonunion healing rate was 97%. Occult infections were identified in 1 in 5 presumed aseptic nonunions using a standardized protocol with 5 intraoperative samples cultured 14 days, and were predominantly caused by slow growing, gram-positive microorganisms. The local spectrum and antimicrobial sensitivity of occult infections should be considered when developing empiric antimicrobial protocols. Patients with presumed aseptic nonunions can expect high healing rates regardless of the culture result. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Characteristics and Outcomes of Occult Infections in Presumed Aseptic Nonunions: A Retrospective Cohort Study","authors":"Robert Kaspar Wagner, M. P. Emmelot, C. van Trikt, Caroline E. Visser, Edgar J. G. Peters, Stein J. Janssen, Peter Kloen","doi":"10.1097/bot.0000000000002822","DOIUrl":"https://doi.org/10.1097/bot.0000000000002822","url":null,"abstract":"\u0000 \u0000 To determine (1) the rate of positive cultures in presumed aseptic nonunions, (2) the rate and microbial spectrum of positive cultures that represented occult infection, and (3) rates of nonunion healing.\u0000 \u0000 \u0000 \u0000 Retrospective cohort study.\u0000 \u0000 \u0000 \u0000 Tertiary referral center.\u0000 \u0000 \u0000 \u0000 Adult patients with a presumed aseptic nonunion treated with single-stage revision between 2002 and 2022.\u0000 \u0000 \u0000 \u0000 The rate of positive cultures compared for two protocols: old: 1 – 2 samples cultured 7 days vs. new: 5 samples cultured 14 days. The rate of positive cultures meeting occult infection criteria with the new protocol (≥ 2 samples with phenotypically indistinguishable microorganisms, or ≥1 sample with a high virulent microorganism). Nonunion healing rates between protocols and between groups based on culture results with the new protocol.\u0000 \u0000 \u0000 \u0000 179 patients were included. The rate of positive cultures was 14% (n = 15/105) with the old protocol, and 51% (n = 38/74) with the new protocol (p < 0.001). With the new protocol, the rate of positive cultures meeting occult infection criteria was 19% (n = 14/74), and Coagulase-negative staphylococci (48%) and Cutibacterium acnes (38%) were the most common microorganisms. Nonunion healing rates after the primary revision did not differ between protocols (old: 82% vs. new: 86%, p = 0.41) and groups based on culture result (sterile: 86% vs. occultly infected: 93%, p = 0.66). The final overall nonunion healing rate was 97%.\u0000 \u0000 \u0000 \u0000 Occult infections were identified in 1 in 5 presumed aseptic nonunions using a standardized protocol with 5 intraoperative samples cultured 14 days, and were predominantly caused by slow growing, gram-positive microorganisms. The local spectrum and antimicrobial sensitivity of occult infections should be considered when developing empiric antimicrobial protocols. Patients with presumed aseptic nonunions can expect high healing rates regardless of the culture result.\u0000 \u0000 \u0000 \u0000 Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.\u0000","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677724","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 : 2024-04-10DOI: 10.1097/bot.0000000000002815
Indraneel S. Brahme, Peter A Cole
{"title":"The Scapular Skiver Screw: A Useful Fixation Technique for Inferior Glenoid and Scapular Neck Fractures","authors":"Indraneel S. Brahme, Peter A Cole","doi":"10.1097/bot.0000000000002815","DOIUrl":"https://doi.org/10.1097/bot.0000000000002815","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140718545","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 : 2024-04-09DOI: 10.1097/bot.0000000000002816
Tyler Thorne, Joseph Featherall, Dillon C. O’Neill, L. Lisitano, Justin Haller
This study compared the maximal compression force prior to thread stripping of the novel bone-screw-fastener (BSF) compared to the traditional-buttress-screw (TBS) in synthetic osteoporotic and cadaveric bone models. Maximum compression force of the plate-bone interface prior to loss of screw purchase during screw tightening was measured between self-tapping 3.5mm BSF and 3.5mm TBS using calibrated load cells. Three synthetic biomechanical models were used: a synthetic osteoporotic diaphysis (model 1); a 3-layer biomechanical polyurethane foam with 50-10-50 pounds-per-cubic-foot (PCF) layering (model 2), and a 3-layer polyurethane foam with 50-15-50 PCF layering (model 3). For the cadaveric metaphyseal model, three sets of cadaveric tibial plafonds and three sets of cadaveric tibial plateaus were used. A plate with sensors between the bone-plate interface was used to measure compression force during screw tightening in the synthetic bone models, while an annular load cell that measured screw compression as it slid through a guide was used to measure compression in the cadaver models. Across all synthetic osteoporotic bone models, the BSF demonstrated greater maximal compression force prior to stripping compared to the TBS (model 1, 155.51N(SD=7.77N) vs 138.78N(SD=12.74N), p=0.036; model 2, 218.14N (SD=14.15N) vs 110.23N(SD=8.00N), p<0.001; model 3, 382.72N(SD=20.15) vs 341.09N(SD=15.57N), p=0.003. The BSF had greater maximal compression force for the overall cadaver trials, the tibial plafond trials, and the tibial plateau trials (overall, 111.27N vs 97.54N(SD 32.32N), p=0.002; plafond, 149.6N vs 132.92N(SD 31.32N), p=0.006; plateau 81.33N vs 69.89N(SD 33.38N), p=0.03. The novel bone-screw-fastener generated 11-65% greater maximal compression force than the traditional-buttress-screw in synthetic osteoporotic and cadaveric metaphyseal bone models. A greater compression force may increase construct stability, facilitate early weight bearing, and reduce construct failure.
本研究比较了新型骨螺钉紧固件（BSF）与传统压紧螺钉（TBS）在合成骨质疏松和尸体骨模型中螺纹剥离前的最大压紧力。 使用校准的称重传感器测量了自攻式 3.5 毫米 BSF 和 3.5 毫米 TBS 在螺钉拧紧过程中失去螺钉附着力之前板骨界面的最大压缩力。使用了三种合成生物力学模型：合成骨质疏松干骺端（模型 1）、50-10-50 磅/立方英尺（PCF）分层的三层生物力学聚氨酯泡沫（模型 2）和 50-15-50 PCF 分层的三层聚氨酯泡沫（模型 3）。在尸体骺模型中，使用了三组尸体胫骨板和三组尸体胫骨平台。在合成骨模型中，使用在骨-板界面之间装有传感器的钢板来测量螺钉拧紧时的压缩力，而在尸体模型中，使用测量螺钉滑过导板时压缩力的环形负荷传感器来测量压缩力。 在所有合成骨质疏松症骨模型中，与 TBS 相比，BSF 在剥离前显示出更大的最大压缩力（模型 1，155.5N（SD=7.77））。51N(SD=7.77N) vs 138.78N(SD=12.74N), p=0.036；模型 2, 218.14N(SD=14.15N) vs 110.23N(SD=8.00N), p<0.001；模型 3, 382.72N(SD=20.15) vs 341.09N(SD=15.57N), p=0.003。在整体尸体试验、胫骨平台试验和胫骨高原试验中，BSF 的最大压缩力更大（整体，111.27N vs 97.54N（SD 32.32N），p=0.002；平台，149.6N vs 132.92N（SD 31.32N），p=0.006；高原，81.33N vs 69.89N（SD 33.38N），p=0.03）。 在合成骨质疏松模型和尸体骺骨模型中，新型骨螺钉紧固器产生的最大压缩力比传统压紧螺钉大 11-65%。更大的压缩力可以增加结构的稳定性，促进早期负重，减少结构失败。
{"title":"A Novel Bone-Screw-Fastener Demonstrates Greater Maximum Compression Force Prior to Failure Compared to a Traditional Buttress Screw.","authors":"Tyler Thorne, Joseph Featherall, Dillon C. O’Neill, L. Lisitano, Justin Haller","doi":"10.1097/bot.0000000000002816","DOIUrl":"https://doi.org/10.1097/bot.0000000000002816","url":null,"abstract":"\u0000 \u0000 This study compared the maximal compression force prior to thread stripping of the novel bone-screw-fastener (BSF) compared to the traditional-buttress-screw (TBS) in synthetic osteoporotic and cadaveric bone models.\u0000 \u0000 \u0000 \u0000 Maximum compression force of the plate-bone interface prior to loss of screw purchase during screw tightening was measured between self-tapping 3.5mm BSF and 3.5mm TBS using calibrated load cells. Three synthetic biomechanical models were used: a synthetic osteoporotic diaphysis (model 1); a 3-layer biomechanical polyurethane foam with 50-10-50 pounds-per-cubic-foot (PCF) layering (model 2), and a 3-layer polyurethane foam with 50-15-50 PCF layering (model 3). For the cadaveric metaphyseal model, three sets of cadaveric tibial plafonds and three sets of cadaveric tibial plateaus were used. A plate with sensors between the bone-plate interface was used to measure compression force during screw tightening in the synthetic bone models, while an annular load cell that measured screw compression as it slid through a guide was used to measure compression in the cadaver models.\u0000 \u0000 \u0000 \u0000 Across all synthetic osteoporotic bone models, the BSF demonstrated greater maximal compression force prior to stripping compared to the TBS (model 1, 155.51N(SD=7.77N) vs 138.78N(SD=12.74N), p=0.036; model 2, 218.14N (SD=14.15N) vs 110.23N(SD=8.00N), p<0.001; model 3, 382.72N(SD=20.15) vs 341.09N(SD=15.57N), p=0.003. The BSF had greater maximal compression force for the overall cadaver trials, the tibial plafond trials, and the tibial plateau trials (overall, 111.27N vs 97.54N(SD 32.32N), p=0.002; plafond, 149.6N vs 132.92N(SD 31.32N), p=0.006; plateau 81.33N vs 69.89N(SD 33.38N), p=0.03.\u0000 \u0000 \u0000 \u0000 The novel bone-screw-fastener generated 11-65% greater maximal compression force than the traditional-buttress-screw in synthetic osteoporotic and cadaveric metaphyseal bone models. A greater compression force may increase construct stability, facilitate early weight bearing, and reduce construct failure.\u0000","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140725622","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 : 2024-04-09DOI: 10.1097/bot.0000000000002813
Lauren A. Merrell, Kester Gibbons, Abhishek Ganta, S. Konda, K. Egol
To evaluate the association between obesity and treatment approaches, perioperative factors, and clinical and radiographic outcomes following subtrochanteric fracture fixation. METHODS: Design: Retrospective Cohort Academic Medical Center Patients operatively treated for an AO/OTA 32Axa, 32Bxa, or 32Cxa subtrochanteric femur fracture. Outcome Measures and Comparisons: Injury characteristics, perioperative parameters, fixation information, postoperative complications, clinical and radiographic outcomes. Univariable analyses were conducted between the obese (BMI > 30 kg/m2) and the non-obese (BMI < 30 kg/m2) cohorts. Regression analyses were performed to assess BMI as a continuous variable Of 230 operatively treated subtrochanteric fracture patients identified, 49 (21%) were obese and 181 (79%) were non-obese. The average age of the obese cohort was 69.6 ± 17.2 years, with 16 (33%) males and 33 (77%) females. The average age of the non-obese cohort was 71.8 ± 19.2 years, with 60 (33%) males and 121 (77%) females. Aside from BMI, there were no significant differences in demographics between the obese and non-obese (age [p=0.465], gender [p=0.948], ASA Score [p=0.739]). Both cohorts demonstrated similar injury characteristics including mechanism of injury, atypical fracture type, and AO/OTA fracture pattern (32A, 32B, 32C). Obese patients underwent more open reduction procedures (59% open obese, 11% open non-obese, p<0.001), a finding further quantified by a 24% increased likelihood of open reduction for every 1 unit increase in BMI (OR: 1.2, 95% CI: 1.2-1.3, p<0.001). There was no difference in average nail diameter, 1 vs 2-screw nail design, or number of locking screws placed. The obese cohort was operated on more frequently on a fracture table (p<0.001) when compared to the non-obese cohort which was operated on more frequently on a flat table (p<0.001). There were no significant differences (p>0.050) in postoperative complications, mortality/readmission rates, hospital quality measures, fixation failure or time to bone healing. The treatment of subtrochanteric fractures in obese patients is associated with a higher likelihood of surgeons opting for open fracture reduction and the use of different operating room table types, but no difference was observed in postoperative complications, mortality or readmission rates, or healing timeline when compared to non-obese patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Subtrochanteric Femur Fractures: The Association Between Obesity and Perioperative, Clinical, and Radiographic Outcomes","authors":"Lauren A. Merrell, Kester Gibbons, Abhishek Ganta, S. Konda, K. Egol","doi":"10.1097/bot.0000000000002813","DOIUrl":"https://doi.org/10.1097/bot.0000000000002813","url":null,"abstract":"\u0000 \u0000 To evaluate the association between obesity and treatment approaches, perioperative factors, and clinical and radiographic outcomes following subtrochanteric fracture fixation.\u0000 METHODS: Design: Retrospective Cohort\u0000 \u0000 \u0000 \u0000 Academic Medical Center\u0000 \u0000 \u0000 \u0000 Patients operatively treated for an AO/OTA 32Axa, 32Bxa, or 32Cxa subtrochanteric femur fracture.\u0000 \u0000 Outcome Measures and Comparisons: Injury characteristics, perioperative parameters, fixation information, postoperative complications, clinical and radiographic outcomes. Univariable analyses were conducted between the obese (BMI > 30 kg/m2) and the non-obese (BMI < 30 kg/m2) cohorts. Regression analyses were performed to assess BMI as a continuous variable\u0000 \u0000 \u0000 \u0000 Of 230 operatively treated subtrochanteric fracture patients identified, 49 (21%) were obese and 181 (79%) were non-obese. The average age of the obese cohort was 69.6 ± 17.2 years, with 16 (33%) males and 33 (77%) females. The average age of the non-obese cohort was 71.8 ± 19.2 years, with 60 (33%) males and 121 (77%) females. Aside from BMI, there were no significant differences in demographics between the obese and non-obese (age [p=0.465], gender [p=0.948], ASA Score [p=0.739]). Both cohorts demonstrated similar injury characteristics including mechanism of injury, atypical fracture type, and AO/OTA fracture pattern (32A, 32B, 32C). Obese patients underwent more open reduction procedures (59% open obese, 11% open non-obese, p<0.001), a finding further quantified by a 24% increased likelihood of open reduction for every 1 unit increase in BMI (OR: 1.2, 95% CI: 1.2-1.3, p<0.001). There was no difference in average nail diameter, 1 vs 2-screw nail design, or number of locking screws placed. The obese cohort was operated on more frequently on a fracture table (p<0.001) when compared to the non-obese cohort which was operated on more frequently on a flat table (p<0.001). There were no significant differences (p>0.050) in postoperative complications, mortality/readmission rates, hospital quality measures, fixation failure or time to bone healing.\u0000 \u0000 \u0000 \u0000 The treatment of subtrochanteric fractures in obese patients is associated with a higher likelihood of surgeons opting for open fracture reduction and the use of different operating room table types, but no difference was observed in postoperative complications, mortality or readmission rates, or healing timeline when compared to non-obese patients.\u0000 \u0000 \u0000 \u0000 Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.\u0000","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140727781","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 : 2024-04-08DOI: 10.1097/bot.0000000000002819
Michael S. Roberts, Jordan P. Conroy, Michael DeSarno, M. Blankstein, Jesse C. Hahn, Craig S. Bartlett, P. Schottel
To determine the accuracy of the intermalleolar method, an intraoperative fluoroscopic method for assessing tibial rotation in patients undergoing intramedullary nail fixation for tibial shaft fractures, by comparing it to the gold standard, computed tomography (CT). Design: Prospective cohort study Academic Level 1 trauma center Consecutive patients, age 18 years and older, with unilateral tibial shaft fractures who underwent intramedullary fixation from September, 2021 to January, 2023. Intraoperatively, tibial rotation measurements were performed using the intermalleolar method on both the uninjured and injured limbs. Postoperatively, patients underwent bilateral low-dose lower extremity rotational CT scans. CT measurements were made by four blinded observers. Mean absolute rotational differences and standard errors were calculated to compare the injured and uninjured limbs. Subgroup analysis was performed assessing accuracy relating to injured versus uninjured limbs, BMI, AO/OTA fracture pattern, tibial and fibular fracture location, and distal articular fracture extension requiring fixation. Of the 20 tibia fractures, the mean patient age was 43.4 years. The intermalleolar method had a mean absolute rotational difference of 5.1 degrees (SE 0.6, range 0 – 13.7) compared to CT. Sixty percent (24/40) of the measurements were within 5 degrees, 90% (36/40) of the measurements were within 10 degrees, and 100% (40/40) were within 15 degrees of the CT. No patients were revised for malrotation postoperatively. The intermalleolar method is accurate and consistently provides intraoperative tibial rotation measurements within 10 degrees of the mean CT measurement for adult aged patients undergoing intramedullary nail fixation for unilateral tibial shaft fractures. This method may be employed in the operating room to accurately quantify tibial rotation and assist with intraoperative rotational corrections. Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
{"title":"The Intermalleolar Method for Intraoperative Rotational Assessment of the Tibia – A Prospective Clinical Validation Study","authors":"Michael S. Roberts, Jordan P. Conroy, Michael DeSarno, M. Blankstein, Jesse C. Hahn, Craig S. Bartlett, P. Schottel","doi":"10.1097/bot.0000000000002819","DOIUrl":"https://doi.org/10.1097/bot.0000000000002819","url":null,"abstract":"\u0000 \u0000 To determine the accuracy of the intermalleolar method, an intraoperative fluoroscopic method for assessing tibial rotation in patients undergoing intramedullary nail fixation for tibial shaft fractures, by comparing it to the gold standard, computed tomography (CT).\u0000 \u0000 \u0000 \u0000 \u0000 Design: Prospective cohort study\u0000 \u0000 \u0000 \u0000 Academic Level 1 trauma center\u0000 \u0000 \u0000 \u0000 Consecutive patients, age 18 years and older, with unilateral tibial shaft fractures who underwent intramedullary fixation from September, 2021 to January, 2023.\u0000 \u0000 \u0000 \u0000 Intraoperatively, tibial rotation measurements were performed using the intermalleolar method on both the uninjured and injured limbs. Postoperatively, patients underwent bilateral low-dose lower extremity rotational CT scans. CT measurements were made by four blinded observers. Mean absolute rotational differences and standard errors were calculated to compare the injured and uninjured limbs. Subgroup analysis was performed assessing accuracy relating to injured versus uninjured limbs, BMI, AO/OTA fracture pattern, tibial and fibular fracture location, and distal articular fracture extension requiring fixation.\u0000 \u0000 \u0000 \u0000 Of the 20 tibia fractures, the mean patient age was 43.4 years. The intermalleolar method had a mean absolute rotational difference of 5.1 degrees (SE 0.6, range 0 – 13.7) compared to CT. Sixty percent (24/40) of the measurements were within 5 degrees, 90% (36/40) of the measurements were within 10 degrees, and 100% (40/40) were within 15 degrees of the CT. No patients were revised for malrotation postoperatively.\u0000 \u0000 \u0000 \u0000 The intermalleolar method is accurate and consistently provides intraoperative tibial rotation measurements within 10 degrees of the mean CT measurement for adult aged patients undergoing intramedullary nail fixation for unilateral tibial shaft fractures. This method may be employed in the operating room to accurately quantify tibial rotation and assist with intraoperative rotational corrections.\u0000 \u0000 \u0000 \u0000 Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.\u0000","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140730933","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 : 2024-04-02DOI: 10.1097/bot.0000000000002808
Christopher A Colasanti, Utkarsh Anil, Michele N Cerasani, Zachary I Li, Allison M Morgan, Ryan W Simovitch, Philipp Leucht, Joseph D Zuckerman
The purpose of this study was to perform a network meta-analysis (NMA) of level I and II evidence comparing different management techniques to define the optimum treatment method for humeral shaft fractures (HSF).
{"title":"Management of Humeral Shaft Fracture: A Network Metanalysis of Individual Treatment Modalities.","authors":"Christopher A Colasanti, Utkarsh Anil, Michele N Cerasani, Zachary I Li, Allison M Morgan, Ryan W Simovitch, Philipp Leucht, Joseph D Zuckerman","doi":"10.1097/bot.0000000000002808","DOIUrl":"https://doi.org/10.1097/bot.0000000000002808","url":null,"abstract":"The purpose of this study was to perform a network meta-analysis (NMA) of level I and II evidence comparing different management techniques to define the optimum treatment method for humeral shaft fractures (HSF).","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140600480","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 : 2024-04-02DOI: 10.1097/BOT.0000000000002812
Sean T Campbell, Jeffrey Earhart, Lucas S Marchand, Robert E Bilodeau, Kathryn A Barth, William M. Ricci, Michael F. Githens
{"title":"Intraosseous Shelf Plate Fixation for Depressed Articular Fragments in Tibial Plateau Fractures: A Technical Trick and Case Series.","authors":"Sean T Campbell, Jeffrey Earhart, Lucas S Marchand, Robert E Bilodeau, Kathryn A Barth, William M. Ricci, Michael F. Githens","doi":"10.1097/BOT.0000000000002812","DOIUrl":"https://doi.org/10.1097/BOT.0000000000002812","url":null,"abstract":"","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140754175","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 : 2024-04-01DOI: 10.1097/BOT.0000000000002763
Matthew Brown, Gerard Cush, Samuel B Adams
Summary: Treatment of traumatic critical-sized bone defects remains a challenge for orthopaedic surgeons. Autograft remains the gold standard to address bone loss, but for larger defects, different strategies must be used. The use of 3D-printed implants to address lower extremity trauma and bone loss is discussed with current techniques including bone transport, Masquelet, osteomyocutaneous flaps, and massive allografts. Considerations and future directions of implant design, augmentation, and optimization of the peri-implant environment to maximize patient outcome are reviewed.
{"title":"Use of 3D-Printed Implants in Complex Foot and Ankle Reconstruction.","authors":"Matthew Brown, Gerard Cush, Samuel B Adams","doi":"10.1097/BOT.0000000000002763","DOIUrl":"10.1097/BOT.0000000000002763","url":null,"abstract":"<p><strong>Summary: </strong>Treatment of traumatic critical-sized bone defects remains a challenge for orthopaedic surgeons. Autograft remains the gold standard to address bone loss, but for larger defects, different strategies must be used. The use of 3D-printed implants to address lower extremity trauma and bone loss is discussed with current techniques including bone transport, Masquelet, osteomyocutaneous flaps, and massive allografts. Considerations and future directions of implant design, augmentation, and optimization of the peri-implant environment to maximize patient outcome are reviewed.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175104","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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