Journal of Orthopaedic Trauma

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OBJECTIVE: 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). METHODS: Data Sources: A systematic review of the literature using PRISMA guidelines of MEDLINE, EMBASE, and Cochrane Library was screened from 2010-2023. STUDY SELECTION: Inclusion criteria were evidence level I or II studies comparing nonoperative and/or operative repair techniques including open reduction internal fixation plate osteosynthesis (ORIF-Plate), minimally invasive percutaneous plating (MIPO), and intramedullary nail fixation (IMN) for the management of HSF (AO OTA 12A,B,C)...

OBJECTIVES: To compare radiographic and clinical outcomes in non-operative management of humeral shaft fractures treated initially with coaptation splinting (CS) followed by delayed functional bracing (FB) versus treatment with immediate FB. METHODS: Design: Retrospective cohort study. SETTING: Academic Level 1 Trauma Center. PATIENT SELECTION CRITERIA: Patients with closed humeral shaft fractures managed non-operatively with initial CS followed by delayed FB or with immediate FB from 2016 to 2022...

OBJECTIVES: To evaluate radiographic and clinical patient reported clinical outcomes following dorsal hook plating of displaced patella fractures with permittance of immediate post-operative active closed chain range of motion. DESIGN: Retrospective review of prospectively collected data. SETTING: Urban Academic Level 1 Trauma Center. PATIENT SELECTION CRITERIA: Adult patients with displaced patella fractures (OTA/AO 34C1-3) who underwent dorsal plating with immediate range of motion between 2018-2023...

OBJECTIVES: To determine whether scheduled low-dose, short-term ketorolac modulates cytokine concentrations in orthopaedic polytrauma patients. DESIGN: Secondary analysis of a double-blinded, randomized controlled trial. SETTING: Single Level I trauma center from August 2018 to October 2022. PATIENT SELECTION CRITERIA: Orthopaedic polytrauma patients between 18-75 years with a New Injury Severity Score greater than 9 were enrolled...

OBJECTIVES: To examine the impact of fascia iliaca (FI) blocks performed in the emergency department on femoral shaft and distal femur fracture patients on opioid consumption, length of stay, and readmission rate. DESIGN: Prospective cohort study. SETTING: Community-based level 1 trauma center. PATIENT SELECTION CRITERIA: Patients with isolated low energy femoral shaft or distal femur fractures (OTA/AO 32 and 33) presenting from January 1, 2020 to May 31, 2022 were included...

OBJECTIVES: To analyze the relationship between patient resilience and patient reported outcomes after orthopaedic trauma. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Single Level 1 Trauma Center. PATIENT SELECTION CRITERIA: Patients were selected based on completion of the Patient Reported Outcomes Measurement Information System (PROMIS) and Brief Resilience Scale (BRS) surveys 6-months after undergoing operative fracture fixation following orthopaedic trauma...

OBJECTIVES: To determine if a multi-disciplinary institutional protocol can optimize the time to antibiotic (Abx) administration for open fractures (openFx) and improve compliance with the administration of Abx prophylaxis during trauma activation. METHODS: Design: Retrospective pre-post study design. SETTING: Single Level II Trauma Center. PATIENT SELECTION CRITERIA: All patients that triggered a trauma activation with suspected openFx and were treated according to the institutional single antibiotic regimen were eligible for inclusion...

OBJECTIVES: To determine the early implant failure rate of a novel retrograde intramedullary femoral nail. METHODS: Design: Retrospective matched case control. SETTING: Academic level 1 trauma center. PATIENTS SELECTION CRITERIA: Patients 18 years and older with an acute AO/OTA 32-A, 32-B, 32-C, and 33-A fracture or periprosthetic distal femur fracture from April 2018 to April 2022 were included in the study. The two interventions compared were the Synthes Expert Retrograde/antegrade femoral nail (RAFN or control implant) versus the next generation RFN-Advanced retrograde femoral nail (RFNA or experimental implant) (Synthes, West Chester, PA)...

OBJECTIVES: Prior studies have demonstrated elevated inflammatory cytokine concentrations in the synovial fluid of articular fracture patients post-injury. Similarly, CT-based fracture energy measurements have been correlated to PTOA risk after pilon fracture. The purpose of this study was to determine the associations between synovial fluid cytokine levels, fracture energy, and overall trauma to the body in articular fracture patients. METHODS: Acute tibial plateau, tibial plafond, and rotational ankle fracture patients were prospectively enrolled from December 2011 through January 1, 2019...

OBJECTIVE: To assess trends in PROMIS Physical Function (PF) and Pain Interference (PI) in surgically treated tibial shaft fracture patients progressing to union versus nonunion. DESIGN: Retrospective cohort study. SETTING: Level 1 trauma center. PATIENT SELECTION CRITERIA: Patients with operatively treated tibial shaft fractures (AO/OTA 42-A,B,C) using an intramedullary nail. OUTCOME MEASURES AND COMPARISONS: PROMIS physical function and pain interference were compared between patients progressing to union and patients requiring nonunion repair...

OBJECTIVES: To estimate the prevalence of suboptimal fluoroscopy of sacral outlet images due to anatomic and equipment dimensions. Pelvic retroversion is hypothesized to mitigate this issue. DESIGN: In silico simulations using retrospectively collected computed tomography (CT) data from human patients. SETTING: Level I trauma center. PATIENT SELECTION CRITERIA: Adults with AO/OTA 61 pelvic ring disruptions treated with posterior pelvic fixation between July and December 2021...

OBJECTIVES: To assess the correlation between the amount of proximal screw lateralization and clinical symptoms in patients treated with a cephalomedullary nail after a pertrochanteric fracture. DESIGN: Retrospective study. SETTING: Level 1 trauma center. PATIENT SELECTION CRITERIA: Patients operated for a pertrochanteric fracture (OTA/AO A1, A2, A3) between 2019 and 2022 and treated with a cephalomedullary nail were included...

OBJECTIVES: Intramedullary nailing (IMN) is the treatment of choice for most tibial shaft fractures (TSF). However, an iatrogenic pitfall may be rotational malalignment. The aim of this retrospective analysis was to determine predictors of rotational malalignment following IMN of TSF. DESIGN: Retrospective study. SETTING: Single level one trauma centre. PATIENT SELECTION CRITERIA: Patients that had a unilateral IMN for TSF with a low-dose bilateral post-operative CT to assess rotational malalignment...

OBJECTIVES: To evaluate the timing of definitive fixation of tibial plateau fractures relative to fasciotomy closure with regards to alignment and articular reduction. METHODS: Design: Retrospective Case Series. SETTING: Four Level I trauma centers. PATIENT SELECTION CRITERIA: Patients with tibial plateau fractures with ipsilateral compartment syndrome treated with fasciotomy between 2006-2018 met inclusion criteria...

OBJECTIVE: The objective of this study was to assess the incidence of infection in patients with cut-out after PFF osteosynthesis. METHODS: Design: Retrospective cohort study. SETTING: Third-level trauma center. PATIENT SELECTION CRITERIA: Patients presenting with a cut-out following proximal femur fracture (PFF) (OTA/AO 31A) osteosynthesis, between January 2007 to December 2020. OUTCOME MEASUREMENTS: The primary outcome was infection according to EBJIS criteria...

OBJECTIVES: To test the hypothesis that primary osteosynthesis of humeral shaft fractures may lead to more favorable clinical, functional, and patient-reported outcomes than fixation following a trial of nonoperative management. DESIGN: Retrospective Cohort Review. SETTING: Academic Level I Trauma Center. PATIENT SELECTION CRITERIA: Adult patients who presented with humeral shaft fractures, and ultimately underwent open reduction and internal fixation (ORIF) from 05/2011 to 05/2021...

OBJECTIVES: To determine if talar neck fractures with concomitant ipsilateral foot and/or ankle fractures (TNIFAFs) are associated with higher rates of avascular necrosis (AVN) compared to isolated talar neck fractures (ITNs). DESIGN: Retrospective Cohort. SETTING: Single Level I Trauma Center. PATIENT SELECTION CRITERIA: Skeletally mature patients who sustained talar neck fractures from January 2008 to January 2017 with at least six months follow-up...

OBJECTIVE: To quantify how patients with LC1 pelvis fracture value attributes of operative versus nonoperative treatment. METHODS: Design: Discrete choice experiment. SETTING: 3 US Level 1 trauma centers. PATIENT SELECTION CRITERIA: Adult survivors of an LC1 pelvis treated between June 2016 through March 2023 were identified from institutional registries. The choice experiment was administered as a survey from March through August 2023...

OBJECTIVES: Randomized controlled trials (RCTs) in the femoral neck fracture literature frequently report p-values for outcomes which have substantial implications in guiding surgical management. This study utilized the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to assess the statistical stability of outcomes reported in RCTs evaluating the management and treatment of femoral neck fractures. METHODS: Data Sources: Pubmed, Emabse, and MEDLINE were queried for RCTs (January 1, 2010 to February 28th, 2023) that evaluated surgical management/treatment of femoral neck fractures...