Modern Results of Functional Bracing of Humeral Shaft Fractures: A Multicenter Retrospective Analysis: Erratum
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 26, 2020 Category: Orthopaedics Tags: Erratum Source Type: research

Erratum
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Erratum Source Type: research

Quantitative Lesser Trochanter Profile Versus Cortical Step Sign in Assessing Femoral Malrotation After Femoral Nailing
We describe the novel quantitative lesser trochanter profile (QLTP) technique to determine the magnitude and direction of femoral malrotation and to compare its performance with the cortical step sign technique. For this assessment, 9 orthopaedic surgeons estimated the magnitude and direction of femoral malrotation with each technique in 198 anteroposterior view images of the proximal cadaveric femur and osteotomy sites. Based on the results, the main benefit of the QLTP technique over the cortical step sign technique is the ability to determine the direction of femoral malrotation. The QLTP technique was also more accurat...
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Technical Trick Source Type: research

Smoking Is Associated With Longer Intensive Care Unit Stays in Spine Trauma Patients
Conclusions: A history of smoking, older age, obesity, and increasing American Spinal Injury Association Impairment Scale was independently associated with increased ICU length of stay in patients with surgical spine trauma. This study highlights the health care burden of smoking in the trauma population and may help physicians triage scarce ICU resources. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Can We Estimate the Amount of Malrotation in Supracondylar Humerus Fractures After CRPP?
Conclusions: Estimation of axis of malrotation and degrees of malrotation within 5 degrees in SCHFx can be predicted in 75% of our 3D printed models. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Tension Band Wiring Provides Excellent Patient-Reported Long-Term Results for Both Comminuted and Simple Displaced Olecranon Fractures
Conclusions: We found no relevant differences in either subjective or objective functionality between patients with simple or comminuted olecranon fractures after fixation with TBW. Therefore, TBW seems to be an adequate and justifiable treatment modality for both simple and comminuted olecranon fractures. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

A Biomechanical Study of Tuberosity-Based Locked Plate Fixation Compared with Standard Proximal Humeral Locking Plate Fixation for 3-Part Proximal Humeral Fractures
Conclusions: The TBP had a significantly higher load to failure and significantly lower mean fracture displacement compared with the PHLP. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Dual Mini-Fragment Plating Is Comparable With Precontoured Small Fragment Plating for Operative Diaphyseal Clavicle Fractures: A Retrospective Cohort Study
Conclusions: This retrospective comparative study found no difference in union or maintenance of reduction for diaphyseal clavicle fractures fixed with DmF compared with Pc plating. Patients treated with DmF plates may have lower rates of symptomatic implant removal. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Cost-Effectiveness of Operative Versus Nonoperative Management of Patients With Intra-articular Calcaneal Fractures
Conclusion: From both US societal and health care payer perspectives, operative treatment of displaced intra-articular calcaneal fractures utilizing an extensile lateral approach is cost-effective at commonly accepted willingness-to-pay thresholds compared with nonoperative treatment over a 5-year time horizon. Patient variability may impact cost-effectiveness and should be explored in future research. Level of Evidence: Economic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Early Definitive Care Is as Effective as Staged Treatment Protocols for Open Ankle Fractures Caused by Rotational Mechanisms: A Retrospective Case–Control Study
Conclusion: Our study showed that early definitive treatment compared with a staged protocol for Gustilo–Anderson type I, II, and IIIa open ankle fractures has similar rates of infection, shorter hospital stay, fewer surgical interventions, and similar clinical outcomes. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

The Learning Curve of Suprapatellar Nailing: Adoption Over Time Can Decrease Operative Time and Radiation Exposure
Objective: To determine whether suprapatellar nailing (SPN) over time can decrease operative time and radiation exposure when compared with infrapatellar nailing (IPN) of tibial shaft fractures. Design: Retrospective. Setting: Single, Level 1 trauma center. Patients: Extra-articular adult tibial shaft fractures treated with intramedullary nailing alone within a 7-year period. Intervention: Patients were treated with SPN or IPN techniques based on the discretion of the operating surgeon. Main Outcome Measurements: Operative time and radiation exposure. Results: Three hundred forty-one fractures (SPN: 177...
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Plate-Assisted Intramedullary Nailing of Gustilo Type IIIB Open Tibial Diaphyseal Fractures: Does Adjunctive Plate Retention Affect Complication Rate?
Conclusions: In the context of an orthoplastic approach, the use of a RAP with definitive intramedullary nailing does not seem to significantly increase the rate of deep infection or nonunion in patients with type IIIB open tibial shaft fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Iatrogenic Peroneal Nerve Palsy Rates Secondary to Open Reduction Internal Fixation for Tibial Plateau Fractures Using an Intraoperative Distractor
Conclusions: Peroneal nerve palsy is a common sequela of ORIF for TPFs involving the lateral compartment using an intraoperative distractor. Staged external fixation followed by definitive ORIF using intraoperative distraction was associated with significant risk for developing nerve palsy (9/10). Many patients (40%) who develop peroneal nerve palsies do not recover, leading to permanent loss of motor and/or sensory function for 7% of patients studied. None of the epidemiologic variables evaluated yielded predictive value for development of peroneal nerve palsy or subsequent resolution. Caution should be exercised in avo...
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Variables Associated With Lag Screw Sliding After Single-Screw Cephalomedullary Nail Fixation of Intertrochanteric Fractures
Conclusions: Unstable fracture patterns are unavoidable; however, careful attention to calcar reduction and selection of dual-screw CMN implants may minimize lag screw sliding and its detrimental effects on outcomes. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in the Elderly: A Cost-Effectiveness Analysis
Conclusions: Hemiarthroplasty is a cost-effective option compared with screw fixation for the treatment of nondisplaced femoral neck fractures in the low-demand elderly. Medical comorbidities and other factors that impact perioperative mortality should also be considered in the treatment decision. Level of Evidence: Economic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Intravenous Ibuprofen Reduces Opioid Consumption During the Initial 48 Hours After Injury in Orthopedic Trauma Patients
Conclusions: IV ibuprofen provided adequate analgesia, prolonged time to first narcotic administration, and was opioid-sparing for the treatment of pain in orthopedic trauma patients, which makes Caldolor a recommended candidate for managing acute pain in the diverse orthopaedic trauma population. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

The Orthopaedic Trauma Service and COVID-19: Practice Considerations to Optimize Outcomes and Limit Exposure
This article summarizes and provides relevant information (orthopaedic trauma service, outpatient fracture clinic, inpatient surgery) to the practicing orthopaedic traumatologist on maximizing outcomes while limiting exposure during the pandemic. Level of Evidence: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 19, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

In response
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Fracture Reduction Quality Is More Important Than Implant Choice for Stability Reconstruction in Two-Part Intertrochanteric Femur Fractures
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

The “Flexor Carpi Radialis” Approach to the Knee for the Management of Posterior Tibial Plateau Fractures
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Invited Commentary Source Type: research

The “FCR” Approach to the Knee for the Management of Posterior Tibial Plateau Fractures
We present a simple method of conceptualizing a direct posterior approach through a single longitudinal incision, by likening it to a commonly performed orthopedic approach, the flexor carpi radialis approach to the wrist. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Technical Trick Source Type: research

Predicting Functional Outcomes Following Fracture Nonunion Repair—Development and Validation of a Risk Profiling Tool
Objectives: To develop a tool that can be used preoperatively to identify patients at risk of poor functional outcome following operative repair of fracture nonunion. Design: Retrospective analysis of prospectively collected data. Setting: Academic medical center. Patients/Participants: Three hundred twenty-eight patients who underwent operative repair of a fracture nonunion were prospectively followed for a minimum of 12 months post-operatively. Intervention: After randomization, 223 (68%) patients comprised an experimental cohort and 105 (32%) patients comprised a separate validation cohort. Within the expe...
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Comparison of Clinical Outcomes After Intramedullary Fixation of Tibia Fractures Caused by Blunt Trauma and Civilian Gunshot Wounds: A Retrospective Review
Conclusions: This study suggests that tibia fractures from civilian GSWs are heterogeneous injuries, and outcomes are dependent on the extent of soft-tissue injury, bone exposure, and bone loss. There are comparable infection rates in all fractures due to civilian GSWs and closed fractures, which are lower than high-grade open fractures. Tibia GSW fractures with exposed bone and comminution have higher complication rates and should be treated accordingly. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Rates and Risk Factors for Failure of Surgical Repair of the Knee Extensor Mechanism
Conclusions: Overall, patients with fractures were more likely experience repair failure than patients with tendon injuries, but all patients underwent similar rates of reoperation. Inflammatory arthritis in patients with QTRs and older patient age in FRs are risk factors for repair failure. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Early Radiographic Union Score for Hip Is Predictive of Femoral Neck Fracture Complications Within 2 Years
Objectives: To determine if the Radiographic Union Score for Hip (RUSH) measured at 3 and 6 months after femoral neck fracture were predictive of reoperation for infection, nonunion, delayed union, avascular necrosis, or implant failure within 24 months of initial surgery. Design: Secondary analysis of a randomized controlled trial. Logistic regression was performed to investigate associations between lower RUSH and reoperation. Results were reported as odds ratios (OR), 95% confidence intervals (CIs), and associated P values. All tests were 2 tailed with alpha = 0.05. Setting: Eighty-one clinical sites across 8 co...
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

What are the Risk Factors for Deep Infection in OTA/AO 43C Pilon Fractures?
Conclusions: High-grade open pilon fractures are at risk of deep infection, and medial/anterior open fracture wounds are particularly vulnerable to developing deep infection. The anteromedial/anterolateral surgical approaches should be selected based on a complete understanding of the fracture pattern and soft tissue injury; however, the posterolateral approach to the tibia should be used with some caution. Ultimately injury factors (segmental bone loss and need for soft tissue coverage) seem to be the most important variables in driving deep infection, and a complete understanding of the bone and soft tissue injury is n...
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Immediate Improvement in Physical Function After Symptomatic Syndesmotic Screw Removal
Objective: To investigate the immediate impact of removing symptomatic syndesmotic screws on PROMIS outcomes and ankle range of motion (ROM) in patients who had previously undergone ankle fracture open reduction and internal fixation (ORIF) and syndesmotic fixation and later experienced functional limitations. Design: Prospective cohort study. Setting: Level 1—trauma center. Patients/Participants: Fifty-eight patients with ankle fractures with syndesmotic instability that required ORIF with syndesmotic fixation who underwent syndesmotic screw removal (SSR) and 71 patients who underwent ankle ORIF with synd...
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Plate-Assisted Intramedullary Nailing of Proximal Third Tibia Fractures
Conclusions: Plate-assisted IMN of proximal third tibia fractures can safely be performed even in open tibia fractures with similar rates of nonunion, infection, and implant removal rates to patients treated with IMN only. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Clinical Results of Acetabular Fracture Fixation Using a Focal Kocher–Langenbeck Approach Without a Specialty Traction Table
Conclusion: Overall, we report on the largest cohort in the literature undergoing a prone Kocher–Langenbeck without a specialty table for acetabular fracture fixation. We found that limited extremity prepping and draping for a prone Kocher–Langenbeck on a flat, radiolucent table did not result in an increased rate of postoperative neurological complications or malreductions of acetabular fractures. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Time to Surgery and Patient Mortality in Geriatric Acetabular Fractures
Objectives: To determine whether surgical intervention within 48 hours of injury results in decreased mortality in geriatric patients who have sustained acetabular fractures. Design: Retrospective case series. Setting: University Level 1 Trauma Center. Patients/Participants: One hundred eighty-three patients 65 years of age and older who were operatively treated for acetabular fractures between 2002 and 2017. The average age was 76 years. Intervention: Operative fixation of acetabular fracture. Main Outcome Measurements: Chi square tests were used to compare 30-day, 6-month, and 1-year mortality after oper...
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Does Implant Removal Across the Sacroiliac Joint Improve Pain and Outcomes?
Conclusion: A select group of patients who have symptomatic screws across the sacroiliac joint may benefit from elective screw removal. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Comparing the Efficiency, Radiation Exposure, and Accuracy Using C-Arm versus O-Arm With 3D Navigation in Placement of Transiliac–Transsacral and Iliosacral Screws: A Cadaveric Study Evaluating an Early Career Surgeon
Objectives: To compare the efficiency, radiation exposure to surgeon and patient, and accuracy of C-arm versus O-arm with navigation in the placement of transiliac–transsacral and iliosacral screws by an orthopaedic trauma fellow, for a surgeon early in practice. Methods: Twelve fresh frozen cadavers were obtained. Preoperative computed tomography scans were reviewed to assess for safe corridors in the S1 and S2 segments. Iliosacral screws were assigned to the S1 segment in dysmorphic pelvises. Screws were randomized to modality and laterality. An orthopaedic trauma fellow placed all screws. Time of procedure an...
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Open Reduction Is Associated With Greater Hazard of Early Reoperation After Internal Fixation of Displaced Femoral Neck Fractures in Adults 18–65 Years
Conclusions: Open reduction of displaced femoral neck fractures in nonelderly adults is associated with a greater hazard of reoperation without significantly improving reduction. Prospective randomized trials are indicated to confirm a causative effect of open versus closed reduction on outcomes after femoral neck fracture. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Perfusion Pressure Lacks Diagnostic Specificity for the Diagnosis of Acute Compartment Syndrome
Objective: To evaluate the diagnostic performance of perfusion pressure (PP) thresholds for fasciotomy. Design: Prospective observational study. Setting: Seven Level-1 trauma centers. Patients/Participants: One hundred fifty adults with severe leg injuries and ≥2 hours of continuous PP data who had been enrolled in a multicenter observational trial designed to develop a clinical prediction rule for acute compartment syndrome (ACS). Main Outcome Measurements: For each patient, a given PP criterion was positive if it was below the specified threshold for at least 2 consecutive hours. The diagnostic performan...
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Ability of Thromboelastography to Detect Hypercoagulability: A Systematic Review and Meta-Analysis
Conclusions: Only 1 parameter, MA, was consistently used to both define hypercoagulability and be predictive of VTE after traumatic injury and surgical intervention; however, there remains a broad variability in the definition of hypercoagulability as determined by MA and thus limits its predictive ability. In addition, when hypercoagulability was measured throughout the perioperative period, TEG consistently demonstrated hypercoagulability starting on post-op day 1 (POD1). Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: Review Article Source Type: research

In Memoriam: William G. DeLong Jr, MD (1948-2020)
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 22, 2020 Category: Orthopaedics Tags: In Memoriam Source Type: research

In response
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Re: Improved Reduction of the Tibiofibular Syndesmosis With TightRope Compared With Screw Fixation: .
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Advances in the Preoperative Planning of Revision Trauma Surgery Using 3D Printing Technology
Summary: The management of complex fractures at the time of revision surgery remains one of the most challenging tasks for orthopaedic trauma surgeons. As the major principle of treatment remains to achieve an anatomic reduction and a stable fixation, precise preoperative diagnostics and treatment planning are of utmost importance. Thus, knowledge of the 3-dimensional anatomy of the fracture site and its surrounding tissue is indispensable. However, radiographic tools have thus far mostly been unable to recapitulate the complexity of the fracture site in toto. In recent years, the development of 3-dimensional (3D) printe...
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Technical Trick Source Type: research

Treatment of Ipsilateral Femoral Neck and Shaft Fractures With Cannulated Screws and Antegrade Reconstruction Nail
Summary: Ipsilateral femoral neck and shaft fractures are challenging injuries, and there are different fixation options but no consensus on a superior construct. Our preferred method is cannulated screw fixation of the femoral neck and antegrade reconstruction nailing of the shaft. Compressive fixation of the femoral neck fracture with cancellous lag screws followed by reconstruction nail placement provides compressive fixation and fixed angle support of the neck fracture while allowing for more optimal treatment of femoral shaft fractures at or above the isthmus. The purpose of this submission is to describe the surgic...
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Technical Trick Source Type: research

Impact of Resident Training Level on Radiation Exposure During Fixation of Proximal Femur Fractures
Conclusion: Orthopaedic surgery residents and attendings must remain aware of radiation exposure secondary to intraoperative fluoroscopy. Appropriate personal protective equipment should be worn, and more experienced surgeons should take a more active role in the complex cases to decrease exposure risk. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Transcutaneous Hemoglobin Screening in an Adult Orthopaedic Trauma Population
Objectives: To evaluate a noninvasive hemoglobin measurement device in an orthopaedic trauma population. Design: Prospective. Setting: Level 1 trauma center. Patients/Participants: One hundred five patients consecutively admitted to the orthopaedic trauma service after surgical treatment of fracture. Intervention: Transcutaneous hemoglobin (TcHgb) monitoring using the Masimo Pronto Pulse CO-Oximeter model with Rainbow SET Technology for spot TcHgb measurement. Main Outcome Measurements: TcHgb measurements and standard venipuncture hemoglobin (vHgb) were obtained. Patient preferences for each were recorded....
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Fracture Patterns and Comminution Zones in OTA/AO 34C Type Patellar Fractures
Conclusions: The patterns of fracture lines and comminution zones OTA/AO 34C type fractures were repeatable on the constructed maps. A transverse fracture line on the inferior pole which was observed in the C2 and C3 type fractures may be used for the modification of current classification systems to direct treatment. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

The Incidence and Risk Factors Associated With the Need for Fasciotomy in Tibia and Forearm Fractures: An Analysis of the National Trauma Data Bank
Objective: The aims of this study were to analyze a large national trauma database to determine the incidence of, risk factors for, and outcomes after a fasciotomy of the lower leg or forearm after fracture. Methods: Data from the National Trauma Data Bank for the years 2004–2016 were analyzed, and we identified 301,351 patients with forearm fractures and 369,237 patients with tibial fractures. Risk factors, length of stay (LOS), and mortality were assessed to determine associations with an injury that required a fasciotomy. Results: A total of 1.22% of the forearm fractures and 3.79% of the tibial fractures ...
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

True Cost of Operating Room Time: Implications for an Orthopaedic Trauma Service
Conclusions: This is the first published study to document the true per minute cost of an orthopaedic trauma operating room. Such information is valuable when defining the value of a dedicated operating room, negotiating employment contracts, defining call stipends, and brokering capital purchases for the orthopaedic trauma service. Level of Evidence: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Do Hospital or Surgeon Volume Affect Outcomes After Surgical Management of Tibial Shaft Fractures?
Objectives: To determine whether hospital and surgeon volume are associated with outcomes after operative fixation of tibial shaft fractures. Methods: Adults (≥18 year old) who underwent operative fixation of diaphyseal tibial fractures were identified in the New York Statewide Planning and Research Cooperative System data set from 2001 to 2015. Reoperation, nonunion, and other adverse event rates were compared across surgeon and hospital volume using multivariable Cox proportional hazards regression, adjusting for clinical and demographic factors. Low-volume providers (lowest 20%) were compared with high-volume pr...
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Surgical Site Infection After Open Upper Extremity Fracture and the Effect of Urgent Operative Intervention
Objectives: To identify which factors are predictive of surgical site infection in upper extremity fractures, and to assess whether the timing of operative debridement influences infection risk. Design: Retrospective database review. Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients: Patients in the NSQIP database with fractures involving the upper extremity. Intervention: Surgical management of upper extremity fracture, including operative debridement for open injuries. Main Outcome Measurements: Surgical site infe...
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Reamed Versus Unreamed Intertrochanteric Femur Fractures, Is It Time?
This study compares the intraoperative and postoperative outcomes of the traditional technique of femoral canal reaming to placement of an unreamed 10-mm nail. Design: Retrospective cohort study. Setting: Academic Level I Trauma Center, Southeastern US. Patients/Participants: Intertrochanteric femur fractures treated with a CMN (January 2016–December 2018) were retrospectively identified. Inclusion criteria were as follows: low-energy mechanism, at least 60 years of age, and long CMN. Exclusion criteria were as follows: short CMN, polytrauma, and subtrochanteric fractures. Outcome Measurements: Records we...
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

A Reimbursement System Based on a 48-Hour Target Time for Surgery Shortens the Waiting Time for Hip Fracture Fixation in Elderly Patients
Objectives: To evaluate whether a pay-for-performance reimbursement system, aimed at expediting surgical fixation of hip fractures in elderly patients, has, in fact, succeeded in shortening the waiting time for surgery. Design: Retrospective analysis of prospectively collected data. Setting: Academic Level II trauma center. Patients/Participants: One hundred fifty patients older than 70 years with femoral neck fractures (OTA/AO 31 A1–A3). Intervention: Implementation of a reimbursement system which incentivizes meeting a 48-hour target time for surgical fixation of hip fractures in elderly patients. Me...
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Original Article Source Type: research

Early Operative Treatment of Acetabular Fractures Does Not Increase Blood Loss: A Retrospective Review
Conclusions: Fixation of acetabular fractures within 48 hours of admission did not increase blood loss or intraoperative transfusions. CS was successful in returning an average of one unit of blood to a majority of patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 24, 2020 Category: Orthopaedics Tags: Original Article Source Type: research