Hip Fracture With Elevated Troponin: Harbinger of Mortality or Need for Accelerated Surgery?
Objective:
To determine the association of elevated troponin levels with time to surgery and the risk of mortality and other key clinical outcomes among elderly patients with hip fracture who had measured troponin levels at hospital admission.
Design:
Retrospective cohort study.
Setting:
Single academic trauma center.
Patients:
We included 299 consecutive patients 60 years of age or older with a hip fracture and cardiac troponin levels measured at the time of hospital admission.
Intervention:
Patients with elevated cardiac troponin levels at hospital admission (n = 43) compared with patients...
Source: Journal of Orthopaedic Trauma - November 26, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
Predicting the Subsequent Contralateral Hip Fracture: Is FRAX the Answer?
Conclusions:
This study demonstrates the strong ability of the FRAX score to triage patients at risk of subsequent contralateral hip fracture within 2 years. In this high-risk FRAX group, patients age older than 80 years and who have decreasing BMI after their index fracture have a 12.5% increased risk of fracture within 2 years which is 4× higher than the current World Health Organization 10-year 3% hip fracture risk standard used to initiate pharmacologic treatment. Therefore, high-risk patients identified using this methodology should be targeted more aggressively with preventative measures including social, medica...
Source: Journal of Orthopaedic Trauma - November 26, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
Preoperative and Intraoperative Considerations Using Intramedullary Nails for the Treatment of Tibial Shaft Fractures Below Total Knee Arthroplasty
Summary:
Periprosthetic tibial shaft fractures below total knee arthroplasty (TKA) are relatively rare, with an incidence of approximately 1%. However, as the rates of arthroplasty increase, orthopaedic surgeons are likely to see a corresponding increase in these types of fractures. Native tibial shaft fractures are routinely treated with either nails or plates, and the success of intramedullary nailing of tibial shaft fractures has been well described in the literature. In this article, we seek to describe a case series of tibial shaft fractures in patients with ipsilateral TKA treated with infrapatellar intramedullar...
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Technical Trick Source Type: research
Results of a Nationwide Practice Survey of Orthopaedic Traumatologists
Conclusions:
The results of this nationwide survey provide insight into the current clinical status of orthopaedic traumatology. Providers may find this information useful in job searches and contract negotiations. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Current Opinions and Surveys Source Type: research
Role of Fibular Allograft in Proximal Humerus Fractures: A Systematic Review
Conclusions:
FA improved the clinical and radiological results, thereby reducing complications. The optimal indication for this procedure may be a 4-part fracture with medial column disruption in younger adults.
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 - October 20, 2022 Category: Orthopaedics Tags: Review Article Source Type: research
Do Intrawound Antibiotics Reduce the Incidence of Surgical Site Infections in Pelvic and Lower-Limb Trauma Surgery? A Systematic Review and Meta-analysis
Conclusions:
Seven studies were included in the systematic review. Results of the meta-analysis suggested a potential 23% reduction in the odds of developing a deep surgical site infection in patients treated with intraoperative antibiotic powder compared with those managed with intravenous antibiotics alone (odds ratio 0.77, 95% confidence interval 0.52–1.13), although the results did not reach statistical significance. Further powered studies including randomized controlled trials would be of great value to validate the results suggested in this study and inform best practice intraoperative antibiotic prophylaxis i...
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Review Article Source Type: research
Technique and Early Outcomes for High-Energy Calcaneus Fractures Treated With Staged External Fixation to Combined Open Reduction Internal Fixation and Subtalar Arthrodesis
Objective:
(1) To present an effective surgical technique for the treatment of open and high-energy calcaneal fractures with significant soft tissue injuries. (2) To present complications with this technique and to evaluate patient-reported outcomes of staged external fixation followed by delayed reconstruction with open reduction internal fixation (ORIF) and subtalar arthrodesis.
Design:
Retrospective case series.
Setting:
Level I trauma center.
Patients/Participants:
Twelve patients with 13 calcaneus fractures associated with open traumatic wounds (10 patients) or other severe soft tissue injury ...
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
Relative Sagittal Alignment of the Medial and Lateral Articular Surfaces of the Tibial Plateau Using Radiographic Parameters: A Radiographic Cadaveric Study
Objectives:
To characterize anatomic slope (sagittal alignment) of medial and lateral articular surfaces of the tibial plateau using x-ray and computed tomography (CT).
Methods:
Fluoroscopy was used to acquire “perfect” anteroposterior (AP) images of 8 cadaveric knees by tilting a C-arm through a 30-degree cranial/caudal arc in 0.5-degree increments. Five surgeons independently selected perfect AP images that most accurately profiled medial and lateral articular surfaces. Corresponding angles were used to define tangent subchondral structures on sagittal CT that were considered as dominant bony landmarks in ...
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
Additional Imaging is of Limited Value in Traumatic Hip Fractures With a History of Distant Malignancy and No Suspicious Lesion on Plain Radiographs
Conclusions:
In the absence of a suspicious metastatic lesion on initial plain radiographs, further preoperative imaging is unlikely to identify a lesion that will affect management and confers significant delays to surgery. Sending intraoperative histological samples may help guide postoperative oncological management, but further work is needed to prove its utility.
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 - October 20, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
Mortality Prediction in Hip Fracture Patients: Physician Assessment Versus Prognostic Models
Conclusions:
In this study, prognostic models and physicians demonstrated similar discriminating abilities when predicting mortality in hip fracture patients. Although physicians overestimated mortality, they were better at identifying high-risk patients and at predicting long-term mortality.
Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
Implementation of a Dedicated Orthopaedic Trauma Room in Hip and Femur Fracture Care: A 17-Year Analysis
Objective:
To examine the effects of implementing a dedicated orthopaedic trauma room (DOTR) on hip and femur fracture care.
Design:
A retrospective cohort study. Setting: Level 1 trauma center. Patients: 2928 patients with femoral neck, pertrochanteric, and femoral shaft and distal femur (FSDF) fractures.
Intervention:
Implementation of a DOTR.
Main Outcome Measures:
Hospital length of stay (LOS), emergency department (ED) LOS, intensive care unit (ICU) LOS, and time to operating room (TTOR).
Results:
Implementation of a DOTR resulted in significant improvement in TTOR for all patient group...
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
Risk Factors for Deep Infection and Conversion Total Hip Arthroplasty After Operative Combined Pelvic Ring and Acetabular Fractures
Objectives:
To determine risk factors for deep infection and conversion total hip arthroplasty (THA) after operative management of combined pelvic ring and acetabular injuries.
Design:
Retrospective case control study.
Setting:
Level 1 trauma center.
Patients and Intervention:
We reviewed 150 operative combined pelvic ring and acetabular injuries at our institution from 2010 to 2019, with an average follow-up of 690 (90–3282) days.
Main Outcome Measurements:
Deep infection and conversion THA.
Results:
Patients who developed deep infection (N = 17, 11.3%) had higher rates of hip disl...
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
Posterior Exposure in Kocher–Langenbeck With Gluteus Minimus Debridement vs. the Gibson Approach: A Cadaveric Study
Conclusions:
Debridement of the gluteus minimus caudal to the level of the superior gluteal neurovascular bundle can significantly increase anterior and cranial exposure in the Kocher–Langenbeck approach and provide similar areas of access when compared with that in the Gibson approach. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
Reformatting of Computed Tomography Scans Parallel to the S1 End Plate Increases Visualization of Trans Sacral Pathway in the First Sacral Segment, Especially With Dysmorphism
Objective:
To determine whether reformatted computed tomography (CT) scans would increase surgeons' confidence in placing a trans sacral (TS) screw in the first sacral segment.
Setting:
Level 1 trauma center.
Design:
A retrospective cohort study.
Patients/Participants:
There were 50 patients with uninjured pelvises who were reviewed by 9 orthopaedic trauma fellowship-trained surgeons and 5 orthopaedic residents.
Main Outcome Measurements:
The overall percentage of surgeons who believe it was safe to place a TS screw in the first sacral segment with standard (axial cuts perpendicular to the s...
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
Prospective Characterization of Pain and Function in Patients With Unstable Pelvic Fractures Treated With Posterior Screw Fixation
Objectives:
Describe patient-reported pain and function within 24 months of a pelvic fracture treated with posterior screw fixation and identify factors associated with increased pain.
Design:
Prospective case series.
Setting:
Academic trauma center.
Patients/Intervention:
Eighty-eight patients with adult pelvic fracture treated with sacroiliac or transiliac screws.
Main Outcome Measures:
Average pain measured with the Brief Pain Inventory (BPI); function measured with the Majeed Pelvic Outcome Score from 6 to 24 months postinjury.
Results:
The mean pain from 6 to 24 months postinjury...
Source: Journal of Orthopaedic Trauma - October 20, 2022 Category: Orthopaedics Tags: Original Article Source Type: research
