Patient-Reported Outcomes After Lateral Process Talus Fracture
Conclusions:
Most patients with lateral process talus fracture achieve excellent outcome as measured by the PROMIS PF and FAAM at medium-term follow-up. Displaced fractures are likely best managed with early surgical treatment. Patients treated with early surgery have significantly fewer subtalar fusions as compared to patients with nonoperative treatment.
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 - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Mapping of Posterior Talar Dome Access Through Posteromedial Versus Posterolateral Approaches
Objective:
To evaluate the accessible area of the talar dome through 2 standard posterior approaches [posteromedial (PM) and posterolateral (PL)] with and without distraction.
Methods:
A standard PM or PL approach was performed with and without external fixator distraction on 12 through-knee cadaveric legs (6 matched pairs). The accessible area of the talar dome was outlined and imaged in a microcomputed tomography scanner to achieve 3D reconstructions of the accessible surface area. The study outcomes were accessible surface area of the talar dome in (1) total surface area and (2) sagittal plane distance of the...
Source: Journal of Orthopaedic Trauma - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Are Orthopaedic Trauma Surgeons Adequately Compensated for Longer Procedures? An Analysis of Relative Value Units and Operative Times From the American College of Surgeons National Surgical Quality Improvement Program Database
Background:
The physician work relative value unit (wRVU) scale is the primary determinant of compensation. Operative time, technical skill, effort, and surgical complexity contribute to wRVU allocation. The aim of this study was to identify the relationship between these factors and reimbursement for trauma procedures.
Methods:
The National Surgical Quality Improvement Program database was queried for orthopaedic trauma procedures from 2016 to 2018. Physician wRVU data were obtained from the 2020 Centers for Medicare & Medicaid Services fee schedule. The primary outcome measured was mean wRVU per minute of oper...
Source: Journal of Orthopaedic Trauma - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Admission Hyperglycemia Is a Risk Factor for Deep Surgical-Site Infection in Orthopaedic Trauma Patients
Conclusions:
Admission glucose ≥200 mg/dL was a significant independent risk factor for 90-day deep surgical site infections in orthopaedic trauma patients and may serve as an important marker for infection 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 - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Mapping of Vertical Femoral Neck Fractures in Young Patients Using Advanced 2 and 3-Dimensional Computed Tomography
Conclusions:
We investigated and reported on the pathoanatomy of high-energy femoral neck fractures in young adults with the goal of increasing understanding of the injury and improving surgeons' ability to provide for improved treatment decisions and quality fracture repair.
Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Commentary on: “'Damage Control' Fixation of Displaced Femoral Neck Fractures in High-Risk Elderly Patients: A Feasibility Case Series”
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - November 25, 2021 Category: Orthopaedics Tags: Invited Commentary Source Type: research
“Damage Control” Fixation of Displaced Femoral Neck Fractures in High-Risk Elderly Patients: A Feasibility Case Series
Conclusion:
In the acutely ill patients with DFNFs, “damage control” fixation with CRPP can be safely performed in lieu of HA to stabilize the fracture in those unable to tolerate anesthesia or the sequelae of major surgery. Patients should be followed closely to evaluate the need for secondary surgery.
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 - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Surgical Versus Nonsurgical Treatment of Lateral Clavicle Fractures: A Short-Term Follow-Up of Treatment and Complications in 122 Patients
Conclusions:
Half of the surgically treated patients underwent implant removal, whereas delayed surgeries in nonsurgically treated patients were very rare. Nonsurgical treatment should be considered more often as an alternative to surgery even for the usually surgically treated Neer type II and V lateral clavicle 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 - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Operative Versus Nonoperative Treatment of Acute Displaced Distal Clavicle Fractures: A Multicenter Randomized Controlled Trial
Conclusion:
Although this study failed to demonstrate a difference in functional outcomes between operative and nonoperative treatment of Neer type II distal clavicle fractures, nonoperative management led to more complications including a moderate rate of nonunion, which often required secondary surgery to correct, a higher rate of early dissatisfaction with shoulder appearance, and a delayed return to activities in the first 6 months. Operative management provided a safe and reliable treatment option with few complications, but often required secondary implant removal, especially with hook plate fixation.
Level of...
Source: Journal of Orthopaedic Trauma - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Can We Predict the Need for Unplanned Reoperation After Nonunion Repair?
Conclusions:
Initial injury characteristics such as nerve or vascular injury at initial injury and positive infection status at the index nonunion surgery were associated with the need for a secondary surgery after nonunion repair. Appropriate care of these patients should be aimed at adjusting expectations of unplanned reoperation in the future and potentially enhanced treatment strategies.
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 - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Sacral Fracture Completeness in Lateral Compression Type 1 Pelvic Ring Injuries Has Weak Interobserver Reliability
Conclusions:
Completeness of sacral fractures had weak interobserver reliability among fellowship-trained orthopaedic trauma surgeons. Sacral fractures that were considered incomplete by all surgeons did have occult instability. These results highlight the large potential for error created by using sacral fracture completeness as a criterion to rule out occult instability.
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 - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Acute Compartment Syndrome in Type IIIB Open Tibial Shaft Fractures Using a 2-Stage Orthoplastic Approach
Objective:
To determine the rate of acute compartment syndrome (ACS) in a series of patients with Gustilo–Anderson type IIIB open tibial shaft fractures that were treated using a specific 2-stage orthoplastic protocol.
Design:
Consecutive cohort study.
Patients/Participants:
Ninety-three (n = 93) consecutive patients with a type IIIB open tibial shaft fracture (OTA/AO-42) treated using a 2-stage orthoplastic approach, between August 2015 and January 2018. After exclusions, 83 (n = 83) were eligible for analysis.
Intervention:
Colloid resuscitation and 2-stage orthoplastic reconstruction of type I...
Source: Journal of Orthopaedic Trauma - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Ninety-Day Readmission Rates in a Geriatric Hip Fracture Population, From a Bundled Care Payment Initiative Perspective
Conclusions:
This study identified a 90-day readmission rate of nearly 20% in patients with geriatric fragility fractures. Application of the BCPI definitions currently used in the Care for Joint Replacement payment model will result in more readmissions being attributed to the index surgical event than classically considered. If bundled payment models remain the future, further investigation of this population's risk factors for readmission is needed in light of these findings.
Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal...
Source: Journal of Orthopaedic Trauma - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Impact of Intraoperative Hypothermia on Transfusion Requirements in Patients With Pelvic and Acetabular Trauma
Conclusions:
For patients with pelvic trauma who present with an admission acidosis, intraoperative hypothermia is an independent risk factor for postoperative blood transfusion. This information is clinically important given the modifiable nature of intraoperative patient temperature and the known complications and sequelae associated with increased transfusion rates.
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 - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
Assessing Soft Tissue Perfusion Using Laser-Assisted Angiography in Tibial Plateau and Pilon Fractures: A Pilot Study
Objectives:
To determine whether skin perfusion surrounding tibial plateau and pilon fractures is associated with the Tscherne classification for severity of soft tissue injury. The secondary aim was to determine if soft tissue perfusion improves from the time of injury to the time of definitive fracture fixation in fractures treated using a staged protocol.
Design:
Prospective cohort study.
Setting:
Academic trauma center.
Patients:
Eight pilon fracture patients and 19 tibial plateau fracture patients who underwent open reduction internal fixation.
Main Outcome Measures:
Skin perfusion (flu...
Source: Journal of Orthopaedic Trauma - November 25, 2021 Category: Orthopaedics Tags: Original Article Source Type: research
